Australian Indigenous Communities Research Articles

Rheumatic heart disease: an ongoing public health concern in vulnerable communities

Abstract Background Acute rheumatic fever (ARF) results from an autoimmune response triggered by group A streptococcus (GAS) infection (1). Severe or recurrent ARF episodes can cause permanent heart valve damage, leading to complications including heart failure, stroke, arrhythmias, carditis, and decompensation during pregnancy (2). Purpose Rheumatic fever (RF) remains a public health concern in Australia, particularly among Indigenous, migrant populations and socioeconomically disadvantaged communities. Europe and various regions worldwide have experienced significant migration from areas with a high prevalence of RHD (3). Amongst the more than 1 million asylum seekers who arrived in Europe in 2015, an estimated 1% could potentially be affected by RHD (3). This migration influx underscores the pressing need for the implementation of strategies in health policy and practice. We aimed to outline the attributes of our RF-RHD cohort to aid in the formulation of a Model of Care (MoC). Methods Cases were identified on a quarterly basis either through the NSW Public Health Rapid, Emergency, Disease, and Syndromic Surveillance (PHREDSS) system or via clinical diagnoses reported to the Public Health Unit (PHU) from January 2015 to June 2023. Demographic profiles, clinical particulars, and patient outcomes were collected from patients in the South Western Sydney Local Health District (SWSLHD), NSW, Australia. Results A total of 45 cases were reported (Table 1). This consisted predominantly of females with an average age at diagnosis of 14 years. A majority were obese (69%). Most were in the Maori and Pacific Islander populations (62%), while a smaller portion of patients were of Aboriginal or Torres Strait Islander descent (9%) (Australian Indigenous community). Notably, 84% of patients diagnosed with ARF subsequently progressed to RHD. Among the reported cases, 16 patients underwent valvular surgery, 2 patients progressed to end-stage heart failure, and there was 1 mortality. 39% (11) of female patients were pregnant during the study period, with 6 (55%) of these patients decompensating during their pregnancy (Table 2). Conclusion Rheumatic fever persists as a public health concern on a global scale. Our findings emphasize the need for a high index of clinical awareness in considering RF/RHD in socioeconomically disadvantaged communities. In our setting, there is a disproportionate burden of disease among the Pacific Islander population. The high occurrence of cardiac decompensation during pregnancy, underscores the need for close monitoring in this demographic. Despite the prevalence of rheumatic fever predominantly affecting young patients in vulnerable groups, we found a significant proportion of individuals lost to follow-up or not connected with Cardiology services. Addressing rheumatic fever requires a comprehensive approach that encompasses improved healthcare accessibility, targeted health education initiatives, and socioeconomic interventions.

Mediation in Matters Involving Sorcery in PNG Villages and Remote Australian Indigenous Communities

The article discusses the application of mediation to conflict involving sorcery and sorcery-related violence in Papua New Guinea (PNG) villages and remote Australian Indigenous communities. The article proposes that a Hybrid Mediation Approach to managing this form of conflict can be effective. This approach re-imagines the stages of mediation not as fixed or rigid steps but as design parameters that empower the parties through incorporating local values and traditions into the dispute management process. The hybrid element of the approach refers to the incorporation of local values and traditions into the mediation design. The article makes reference to specific examples of sorcery-related conflict at the remote Australian community of Aurukun and a village in PNG to provide a background to this discussion of effective mediation techniques.

Oral microbiome research - working in partnership with Indigenous Australian communities.

Microbiome research is currently biased towards populations of European descent, with such populations providing a weak basis upon which to understand microbiome-health relationships in under-studied populations, many of whom carry the highest burdens of disease. Most oral microbiome studies to date have been undertaken in industrialized countries. Research involving marginalised populations should be shaped by a number of guiding principles. In the Indigenous Australian context, one useful framework is the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement. This paper describes how the microbiome research field is having impacts in the Indigenous Australian health space, and describes a particular project involving Indigenous Australians in which the CONSIDER statement is used as the underlying framework.

Melding language and image: Kaytetye Indigemoji as a language learning project

ABSTRACT Purpose In recent years, digital projects have created tools for learning languages, such as mobile applications (apps). In contexts where the language has low prestige, innovative digital learning tools can support language revitalisation. This article takes the Australian Kaytetye Indigemoji app as a case study in community resource development. It aims to do two things: (1) show how resource development can be a vital forum for language teaching and learning; and (2) assess the affordances of digital images—fundamental to the Indigemoji app—for Indigenous language learning. Methodology Taking an ethnographic approach encompassing informal conversation and participant observation embedded in relevant literature, we analyse the community workshop where the Kaytetye Indigemoji app was developed. Findings We find that the development process can provide an essential language-learning activity. We also find that visual opportunities presented by the app harness existing multimodal practices in central Australian Indigenous communities, including symbolic art and a highly developed alternate sign language. We show that effective digital learning resources can be built through community development processes which engage with local learning methods. Value This research identifies how digital resource development can be harnessed to be maximally useful for Indigenous language learning in a small and relatively disadvantaged area in Australia.

Genomic characterization of a unique Panton-Valentine leucocidin-positive community-associated methicillin-resistant Staphylococcus aureus lineage increasingly impacting on Australian indigenous communities.

In 2010 a single isolate of a trimethoprim-resistant multilocus sequence type 5, Panton-Valentine leucocidin-positive, community-associated methicillin-resistant Staphylococcus aureus (PVL-positive ST5 CA-MRSA), colloquially named WA121, was identified in northern Western Australia (WA). WA121 now accounts for ~14 % of all WA MRSA infections. To gain an understanding of the genetic composition and phylogenomic structure of WA121 isolates we sequenced the genomes of 155 WA121 isolates collected 2010-2021 and present a detailed genomic description. WA121 was revealed to be a single clonally expanding lineage clearly distinct from sequenced ST5 strains reported outside Australia. WA121 strains were typified by the presence of the distinct PVL phage φSa2wa-st5, the recently described methicillin resistance element SCCmecIVo carrying the trimethoprim resistance (dfrG) transposon Tn4791, the novel β-lactamase transposon Tn7702 and the epidermal cell differentiation inhibitor (EDIN-A) plasmid p2010-15611-2. We present evidence that SCCmecIVo together with Tn4791 has horizontally transferred to Staphylococcus argenteus and evidence of intragenomic movement of both Tn4791 and Tn7702. We experimentally demonstrate that p2010-15611-2 is capable of horizontal transfer by conjugative mobilization from one of several WA121 isolates also harbouring a pWBG749-like conjugative plasmid. In summary, WA121 is a distinct and clonally expanding Australian PVL-positive CA-MRSA lineage that is increasingly responsible for infections in indigenous communities in northern and western Australia. WA121 harbours a unique complement of mobile genetic elements and is capable of transferring antimicrobial resistance and virulence determinants to other staphylococci.

Feasibility and acceptability of the use of flash glucose monitoring encountered by Indigenous Australians with type 2 diabetes mellitus: initial experiences from a pilot study

BackgroundType 2 diabetes mellitus (T2DM) is highly prevalent within the Indigenous Australian community. Novel glucose monitoring technology offers an accurate approach to glycaemic management, providing real-time information on glucose levels and trends. The acceptability and feasibilility of this technology in Indigenous Australians with T2DM has not been investigated.ObjectiveThis feasibility phenomenological study aims to understand the experiences of Indigenous Australians with T2DM using flash glucose monitoring (FGM).MethodsIndigenous Australians with T2DM receiving injectable therapy (n = 8) who used FGM (Abbott Freestyle Libre) for 6-months, as part of a clinical trial, participated in semi-structured interviews. Thematic analysis of the interviews was performed using NVivo12 Plus qualitative data analysis software (QSR International).ResultsSix major themes emerged: 1) FGM was highly acceptable to the individual; 2) FGM’s convenience was its biggest benefit; 3) data from FGM was a tool to modify lifestyle choices; 4) FGM needed to be complemented with health professional support; 5) FGM can be a tool to engage communities in diabetes management; and 6) cost of the device is a barrier to future use.ConclusionsIndigenous Australians with T2DM had positive experiences with FGM. This study highlights future steps to ensure likelihood of FGM is acceptable and effective within the wider Indigenous Australian community.

Cultural, sociopolitical, environmental and built assets supporting health and well-being in Torres Strait Island communities: protocol for a scoping review

IntroductionRisks to an individual’s health should be considered alongside the environmental, sociocultural and sociopolitical context(s) in which they live. Environmental mapping is an approach to identifying enablers and barriers to...

Geogenic particles induce bronchial susceptibility to non-typeable Haemophilus influenzae

Exposure to geogenic (earth-derived) particulate matter (PM) is linked to an increased prevalence of bronchiectasis and other respiratory infections in Australian Indigenous communities. Experimental studies have shown that the concentration of iron in geogenic PM is associated with the magnitude of respiratory health effects, however, the mechanism is unclear. We investigated the effect of geogenic PM and iron oxide on the invasiveness of non-typeable Haemophilus influenzae (NTHi). Peripheral blood mononuclear cell-derived macrophages or epithelial cell lines (A549 & BEAS-2B) were exposed to whole geogenic PM, their primary constituents (haematite, magnetite or silica) or diesel exhaust particles (DEP). The uptake of bacteria was quantified by flow cytometry and whole genome sequencing (WGS) was performed on NTHi strains. Geogenic PM increased the invasiveness of NTHi in bronchial epithelial cells. Of the primary constituents, haematite also increased NTHi invasion with magnetite and silica having significantly less impact. Furthermore, we observed varying levels of invasiveness amongst NTHi isolates. WGS analysis suggested isolates with more genes associated with heme acquisition were more virulent in BEAS-2B cells. The present study suggests that geogenic particles can increase the susceptibility of bronchial epithelial cells to select bacterial pathogens in vitro, a response primarily driven by haematite content in the dust. This demonstrates a potential mechanism linking exposure to iron-laden geogenic PM and high rates of chronic respiratory infections in remote communities in arid environments.

Working with Indigenous Australian communities designing a nutritional mHealth tool during the Covid-19 pandemic

Enacting a research project that is beneficial and meaningful for Indigenous communities and agencies in Australia remains a challenge in both the research and nutrition fields. This article describes how the Mums and Bubs Deadly Diets project is embedding Indigenous ways of knowing and doing and partnering with Indigenous communities to co-design mobile health technology. Each step in the process of developing and implementing this project has been actively conscious of the intentions of the Australian Institute of Aboriginal and Torres Strait Islander Studies Code of Ethics and the National Ethics Standards for working with Indigenous Australians. Describing the project’s approach, methods of negotiation and responses to challenges, administering institutions and Indigenous communities, including coronavirus disease-19, provides the opportunity to reflect and forward plan for future projects.

Disease profiles in the Indigenous Australian population are suggestive of a common complement control haplotype.

Aboriginal and Torres Strait Islander People (respectfully referred to as Indigenous Australians herein) are disparately burdened by many infectious and chronic diseases relative to Australians with European genetic ancestry. Some of these diseases are described in other populations to be influenced by the inherited profile of complement genes. These include complement factor B, H, I and complement factor H-related (CFHR) genes that can contribute to a polygenic complotype. Here the focus is on the combined deletion of CFHR1 and 3 to form a common haplotype (CFHR3-1Δ). The prevalence of CFHR3-1Δ is high in people with Nigerian and African American genetic ancestry and correlates to a higher frequency and severity of systemic lupus erythematosus (SLE) but a lower prevalence of age-related macular degeneration (AMD) and IgA-nephropathy (IgAN). This pattern of disease is similarly observed among Indigenous Australian communities. Additionally, the CFHR3-1Δ complotype is also associated with increased susceptibility to infection with pathogens, such as Neisseria meningitidis and Streptococcus pyogenes, which also have high incidences in Indigenous Australian communities. The prevalence of these diseases, while likely influenced by social, political, environmental and biological factors, including variants in other components of the complement system, may also be suggestive of the CFHR3-1Δ haplotype in Indigenous Australians. These data highlight a need to define the Indigenous Australian complotypes, which may lead to the discovery of new risk factors for common diseases and progress towards precision medicines for treating complement-associated diseases in Indigenous and non-Indigenous populations. Herein, the disease profiles suggestive of a common complement CFHR3-1Δ control haplotype are examined.

The temporality of community sentiment on the Australian continent: mineral extraction, waste storage and Indigenous protest writing

ABSTRACT The Australian federal government has recently recommenced a previously paused process to select a site for a national nuclear waste storage facility despite significant opposition from Australian Indigenous communities and others. This article considers what some might understand as a contemporary issue by examining its relationship to previous events. It emphasizes how Western linear temporality facilitates disregard for negative community sentiment and the consigning of previous wrongs to the past. In contrast, Indigenous temporalities – where time is understood as immanent and space and time intermingled – emphasize positive relationships and require the remediation of past wrongs to support just futures. Thus, historical nuclear weapons testing in Australia, current plans for waste storage, and historical and ongoing ecological and social consequences of resource extraction are all related, reflecting the violence of British colonization and contemporary settler colonial governance. Using a literary studies approach, this article examines historically significant moments of Indigenous Australian protest writing regarding extractive industries, nuclear waste storage, and settler colonial governance, to show that some Indigenous communities in Australia have clearly communicated their negative sentiments. It argues for equitable relationships as a first step towards the restitution of past wrongs and the creation of just futures.

Community-based water demand management: socio-technical strategies for improving water security in Australian Indigenous communities

Sustainable water management in remote Australian communities is a delicate balance between sufficient and acceptable supply options and appropriate and effective demand approaches. This paper focus on the evaluation of community-based water demand management strategies piloted in four remote Aboriginal and Torres Strait Island communities in Australia. Findings of the pilot demonstrate that from a systems perspective, community-based demand management centred around education and encouragement of residents to conserve and use water efficiently, provide greater opportunities for long-term sustainable water management outcomes that support building of social capital. To ensure truly transformative management outcomes, a toolbox of socio-technological strategies should be used including, where possible, smart metering of water consumption and use of water-efficient devices. A key element of this approach to demand management calls for a shift away from business-as-usual policy towards a flexible learning approach that involves genuine collaboration between water managers and Indigenous communities.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Soundings on a Relational Epistemology: Encountering Indigenous Knowledge through Interwoven Experience

ABSTRACT Engagement with concepts of Indigenous knowledge can generate valuable conversation on what knowledge is within diverse cultures and their interactions, enriching the intellectual frameworks guiding collaborative research with Indigenous Australian communities. However, significant limitations of this term can be shown by looking to specific traditions of thought and performance within Indigenous Australia. In this article, I argue that use of the term Indigenous knowledge often carries tacit epistemological assumptions that obscure various relational and participatory dynamics of knowledge. This can be seen in tendencies to utilise the term as a marker of cultural separation rather than looking to the ways distinct traditions allow relational growth across cultural differences. I develop this critique with reference to Yolŋu manikay (public ceremonial song) as it foregrounds interactivity between different peoples and places as integral to meaningful engagement with ancestral traditions. These observations echo recent methodological work within Australian ethnomusicology, in which collaborative research activities prioritise ceremonial revitalisation and archival repatriation over ethnographic documentation. I suggest this focus might be further consolidated by emphasising characteristics such as respect, attentiveness and friendship, which can motivate collaborative research and constitute knowledge within unique localities of people and place.

Methodologies to reveal young Australian Indigenous students’ mathematical proficiency

A 7-month mathematics proficiency program was conducted in a primary Australian Indigenous community school. This paper focuses on outlining the specific methodologies employed to explore how students’ mathematical proficiency changed throughout the implementation of the program in Years 2 to 4 (~ 7 to 9 years old). A mixed methods research design was utilised, and findings will be presented to evidence how the combination of standardised tests, diagnostic tests, and Newman interviews were useful in capturing and making visible young Indigenous student’s mathematical proficiency. Whilst standardised tests provided a useful and comparable measure of student achievement, diagnostic tests and Newman interviews gave space for Indigenous student voice and demonstrated their strengths and areas for improvement in relation to their conceptual understanding, procedural fluency, and strategic competence. From these findings, recommendations concerning the adjustment of data collection procedures for young students in this setting are presented. The findings question the accuracy of standardised tests in revealing young students’ proficiency, and this has implications for the extent to which standardised tests are relied upon to inform educational reform particularly for Indigenous students. Striving for equitable educational outcomes is an important endeavour in Australia, and such undertakings must be driven by meaningful and accurate evidence of students’ proficiency in mathematics.

Communities Setting the Direction for Their Right to Nutritious, Affordable Food: Co-Design of the Remote Food Security Project in Australian Indigenous Communities

Despite long histories of traditional food security, Indigenous peoples globally are disproportionately exposed to food insecurity. Addressing this imbalance must be a partnership led by Indigenous peoples in accordance with the UN Declaration of the Rights of Indigenous Peoples. We report the co-design process and resulting design of a food security research project in remote Australia and examine how the co-design process considered Indigenous peoples' ways of knowing, being, and doing using the CREATE Tool. Informed by the Research for Impact Tool, together Aboriginal Community Controlled Health Organisation staff, Indigenous and non-Indigenous public health researchers designed the project from 2018-2019, over a series of workshops and through the establishment of research advisory groups. The resulting Remote Food Security Project includes two phases. Phase 1 determines the impact of a healthy food price discount strategy on the diet quality of women and children, and the experience of food (in)security in remote communities in Australia. In Phase 2, community members propose solutions to improve food security and develop a translation plan. Examination with the CREATE Tool showed that employing a co-design process guided by a best practice tool has resulted in a research design that responds to calls for food security in remote Indigenous communities in Australia. The design takes a strengths-based approach consistent with a human rights, social justice, and broader empowerment agenda. Trial registration: The trial included in Phase 1 of this project has been registered with Australian New Zealand Clinical Trials Registry: ACTRN12621000640808.

Language is sacred, language is life - Australian Northern Territory language education policy and indigenous community sustainability

Language is sacred, language is life - Australian Northern Territory language education policy and indigenous community sustainability

Language is sacred, language is life - Australian Northern Territory language education policy and indigenous community sustainability

Language is sacred, language is life - Australian Northern Territory language education policy and indigenous community sustainability

Indigenous and Settler Understandings for Addressing Gender-Based Violence in Australia: The Significance of a Decolonial Approach

Addressing the gendered dimensions of family violence remains a key focus in the primary prevention of violence against women (PVAW) in Indigenous and non-Indigenous Australian communities. What is seen as more important for Indigenous communities in PVAW is addressing the legacies and ongoing impacts of colonisation on Indigenous people, families, and communities. This focus on decolonisation deviates from settler PVAW programs where the emphasis is on challenging hegemonic masculinity and patriarchy. In this paper, I consider the importance of critiquing the western logic of colonisation within both Indigenous and non-Indigenous PVAW programs through examining the links between hegemonic masculinity, colonisation and neoliberal capitalism. I draw attention to the inherent violence and corrosion within processes of colonisation that adversely affect the social and emotional wellbeing and relationships of Indigenous and non-Indigenous men (albeit in very different ways) and argue the importance of a decolonising approach for addressing gender-based violence within Indigenous and non-Indigenous programs.

A systematic review and meta-analysis of human and zoonotic dog soil-transmitted helminth infections in Australian Indigenous communities.

Soil-transmitted helminths (STH) infect 1.5 billion people and countless animals worldwide. In Australian Indigenous communities, STH infections have largely remained endemic despite control efforts, suggesting reservoirs of infection may exist. Dogs fulfil various important cultural, social and occupational roles in Australian Indigenous communities and are populous in these settings. Dogs may also harbour zoonotic STHs capable of producing morbidity and mortality in dogs and humans. This review provides an overview of human and zoonotic STH infections, identifies the Australian Indigenous locations affected and the parasite species and hosts involved. The meta-analysis provides estimates of individual study and pooled true prevalence of STH infections in Australian Indigenous communities and identifies knowledge gaps for further research on zoonotic or anthroponotic potential. A systematic literature search identified 45 eligible studies documenting the presence of Strongyloides stercoralis, Trichuris trichiura, Ancylostoma caninum, Ancylostoma duodenale, Ancylostoma ceylanicum, undifferentiated hookworm, and Ascaris lumbricoides. Of these studies, 26 were also eligible for inclusion in meta-analysis to establish true prevalence in the light of imperfect diagnostic test sensitivity and specificity by Rogan-Gladen and Bayesian methods. These studies revealed pooled true prevalence estimates of 18.9% (95% CI 15.8-22.1) for human and canine S. stercoralis infections and 77.3% (95% CI 63.7-91.0) for canine A. caninum infections indicating continued endemicity, but considerably more heterogenous pooled estimates for canine A. ceylanicum infections, and A. duodenale, undifferentiated hookworm and T. trichiura in humans. This review suggests that the prevalence of STHs in Australian Indigenous communities has likely been underestimated, principally based on imperfect diagnostic tests. Potential misclassification of hookworm species in humans and dogs due to outdated methodology, also obscures this picture. High-quality contemporary studies are required to establish current true prevalence of parasite species in all relevant hosts to guide future policy development and control decisions under a culturally sound One Health framework.