Children In Remote Communities Research Articles

Housing conditions and respiratory morbidity in Indigenous children in remote communities in Northwestern Ontario, Canada.

Background:Rates of lower respiratory tract infection (LRTI) among First Nations (FN) children living in Canada are elevated. We aimed to quantify indoor environmental quality (IEQ) in the homes of FN children in isolated communities and evaluate any associations with respiratory morbidity.Methods:We performed a cross-sectional evaluation of 98 FN children (81 with complete data) aged 3 years or younger, living in 4 FN communities in the Sioux Lookout region of Northern Ontario. We performed medical chart reviews and administered questionnaires. We performed a housing inspection, including quantifying the interior surface area of mould (SAM). We monitored air quality for 5 days in each home and quantified the contaminant loading of settled floor dust, including endotoxin. We analyzed associations between IEQ variables and respiratory conditions using univariable and multivariable analyses.Results:Participants had a mean age of 1.6 years and 21% had been admitted to hospital for respiratory infections before age 2 years. Houses were generally crowded (mean occupancy 6.6 [standard deviation 2.6, range 3–17] people per house). Serious housing concerns were frequent, including a lack of functioning controlled ventilation. The mean SAM in the occupied space was 0.2 m2. In multivariable modelling, there was evidence of an association of LRTI with log endotoxin (p = 0.07) and age (p = 0.02), and for upper respiratory tract infections, with SAM (p = 0.07) and age (p = 0.03). Wheeze with colds was associated with log endotoxin (p = 0.03) and age (p = 0.04).Interpretation:We observed poor housing conditions and an association between endotoxin and wheezing in young FN children living in Northern Ontario.

Scabies in remote Aboriginal and Torres Strait Islander populations in Australia: A narrative review.

Scabies has recently gained international attention, with the World Health Organization (WHO) recognizing it as a neglected tropical disease. The International Alliance for the Control of Scabies recently formed as a partnership of more than 15 different countries, with an aim to lead a consistent and collaborative approach to preventing and controlling scabies globally. Scabies is most prevalent in low-resource and low socioeconomic areas that experience overcrowding and has a particularly high prevalence in children, with an estimated 5% to 10% in endemic countries. Scabies is widespread in remote Aboriginal and Torres Strait Islander communities in Australia with the prevalence of scabies in Aboriginal and Torres Strait Islander children in remote communities estimated to be as high as 33%, making it the region with the third highest prevalence in the world. This population group also have very high rates of secondary complications of scabies such as impetigo, poststreptococcal glomerulonephritis (PSGN), and rheumatic heart disease (RHD). This article is a narrative review of scabies in remote Aboriginal and Torres Strait Islander populations in Australia, including clinical manifestations of disease and current treatment options and guidelines. We discuss traditional approaches to prevention and control as well as suggestions for future interventions including revising Australian treatment guidelines to widen the use of oral ivermectin in high-risk groups or as a first-line treatment.

A community-based service enhancement model of training and employing Ear Health Facilitators to address the crisis in ear and hearing health of Aboriginal children in the Northern Territory, the Hearing for Learning Initiative (the HfLI): study protocol for a stepped-wedge cluster randomised trial

BackgroundAlmost all Aboriginal children in remote communities have persistent bilateral otitis media affecting hearing and learning throughout early childhood and school years, with consequences for social and educational outcomes, and later employment opportunities. Current primary health care and specialist services do not have the resources to meet the complex needs of these children.Method/designThis stepped-wedge cluster randomised trial will allocate 18 communities to one of five 6-monthly intervention start dates. Stratification will be by region and population size. The intervention (Hearing for Learning Initiative, HfLI) consists of six 20-h weeks of training (delivered over 3 months) that includes Certificate II in Aboriginal Primary Health Care (3 modules) and competencies in ear and hearing data collection (otoscopy, tympanometry and hearScreen), plus 3 weeks of assisted integration into the health service, then part-time employment as Ear Health Facilitators to the end of the trial. Unblinding will occur 6 months prior to each allocated start date, to allow Community Reference Groups to be involved in co-design of the HfLI implementation in their community. Relevant health service data will be extracted 6-monthly from all 18 communities. The primary outcome is the difference in proportion of children (0 to 16 years of age) who have at least one ear assessment (diagnosis) documented in their medical record within each 6-month period, compared to control periods (no HfLI). Secondary outcomes include data on sustainability, adherence to evidence-based clinical guidelines for otitis media, including follow-up and specialist referrals, and school attendance. Structured interviews with staff working in health and education services, Ear Health Trainees, Ear Health Facilitators and families will assess process outcomes and the HfLI broader impact.DiscussionThe impact of training and employment of Ear Health Facilitators on service enhancement will inform the health, education and employment sectors about effectiveness of skills and job creation that empowers community members to contribute to addressing issues of local importance, in this instance ear and hearing health of children.Trial registrationClinicalTrials.gov NCT03916029. Registered on 16 April 2019.

Moving away from the deficit perspective: Aboriginal child development in partnership with families

ABSTRACT A “diversity as fundamental heterogeneity” approach is required to contest the widely held perspective that Aboriginal children in remote communities in central Australia are growing up in deficit and disadvantage. This article discusses the current language perpetuating the deficit model of Aboriginal child development that is failing to recognise strengths of Aboriginal children growing up in remote communities in central Australia. Through stories about daily life in Papunya, this article argues that to understand and measure Aboriginal child development, it is necessary to also understand the child’s cultural context in which they are living and learning. Participant selection was conducted using key participants who became community researchers in the research project. The main findings were Aboriginal children in Papunya must grow up with a “two-ways” approach to education that prioritises their own culture and language.

Demonstration of high value care to improve oral health of a remote Indigenous community in Australia

BackgroundThe oral health of Indigenous children in remote communities is much worse than other population groups in Australia. Providing and maintaining an oral health service is challenging due to the remoteness of communities, the associated high cost, and the low retention of clinical staff. An annual preventive intervention delivered by fly-in clinicians may be a more cost-effective way to manage this problem. In this analysis we estimate the cost-effectiveness of an annual professional intervention for the prevention of dental caries in children of a remote Indigenous community in Far North Queensland.MethodsA cost-effectiveness analysis was conducted based on an annual preventive intervention protocol. This included treating all dental decay in those with disease, applying fissure sealants, a disinfectant swab, fluoride varnish and providing oral hygiene instructions and dietary advice to all participating school children. This study included an intervention group and a natural comparison group and both groups were followed-up for 2 years after the initial preventive intervention. A Markov model was built to assess the cost-effectiveness of the intervention compared with the usual care. Costs of treatment from the Queensland Department of Health were used and effectiveness was measured as quality-adjusted life years (QALYs) with the CHU-9D. One-way and probabilistic sensitivity analyses were conducted to identify key drivers and quantify uncertainty.ResultsThe preventive intervention was found to be highly cost-effective. The incremental cost per QALY gained was AU$3747. Probability of new caries and seeking treatment were identified as the main drivers of the model. In probabilistic sensitivity analysis intervention was cost effective in 100% of simulations.ConclusionAn annual preventive intervention for remote Indigenous communities in Australia is a highly cost-effective strategy to prevent dental caries and improve the quality of life of children.

Childhood, Play and School: A Literature Review in Australia

Around age three, First Nations children in remote communities in Australia undertake a major transition from the home to formal schooling. This very important period of child development is typically monitored by non-First Nations educators. Yet these educators typically know little about First Nations child development of children aged birth to seven. The purpose of this review is to demonstrate the importance of describing the process of acquiring social and cultural practices that enable a child to become a dynamic, knowledgeable participant in a First Nations context from a strengths perspective.

An Abecedarian Approach with Aboriginal Families and Their Young Children in Australia: Playgroup Participation and Developmental Outcomes

New approaches to support the early learning for young Indigenous children are important to government policies across Australia. This study explores whether the Abecedarian Approach Australia (3a) intervention, with strong cultural adaptations, can boost young Aboriginal children’s early language and learning skills, prior to preschool. Participants in this study were Aboriginal children attending playgroups, Families as First Teachers, in school settings in two remote communities in the Northern Territory. Implementation data on two components (Conversational Reading and LearningGames) of the Abecedarian Approach Australia (3a) intervention are reported, and the level of exposure the children had to the programme during the study period is analysed. Child outcomes were assessed on the Brigance Early Childhood Screen II for 149 children aged from 24 to 56 months. Children’s language and early learning were associated with intervention dosage. Higher exposure to Conversational Reading and LearningGames predicted stronger language and overall development for young children. This study demonstrates that this intervention can be delivered effectively in playgroups in remote settings and is a meaningful and robust strategy to support early childhood learning, with potential to improve educational outcomes for young Aboriginal children in remote communities.

Informing Social Work Practice with Theory: Reflections on the Protection of Aboriginal Children in Remote Communities of Australia

Abstract Recent reforms to the Australian child-protection sector have widened its scope from solely a statutory child-protection system to a public-health model to increase the number of agencies involved in the provision of services for children who are deemed ‘vulnerable’ or ‘at risk’. Nevertheless, the number of Aboriginal children in the sector continues to increase. This paper argues that the reflective basis of social work practice in Australia contains a lack that evades consideration of the ‘projective identifications’ informing practice. Social workers are more likely to achieve safety outcomes for children when such projections are acknowledged and tendered to in their reflective practice.

Fine motor skills in a population of children in remote Australia with high levels of prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder

BackgroundMany children in the remote Fitzroy Valley region of Western Australia have prenatal alcohol exposure (PAE). Individuals with PAE can have neurodevelopmental impairments and be diagnosed with one of several types of Fetal Alcohol Spectrum Disorder (FASD). Fine motor skills can be impaired by PAE, but no studies have developed a comprehensive profile of fine motor skills in a population-based cohort of children with FASD. We aimed to develop a comprehensive profile of fine motor skills in a cohort of Western Australian children; determine whether these differed in children with PAE or FASD; and establish the prevalence of impairment.MethodsChildren (n = 108, 7 to 9 years) were participants in a population-prevalence study of FASD in Western Australia. Fine motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, which provided a Fine Motor Composite score, and evaluated Fine Manual Control (Fine Motor Precision; Fine Motor Integration) and Manual Coordination (Manual Dexterity; Upper-Limb Coordination). Descriptive statistics were reported for the overall cohort; and comparisons made between children with and without PAE and/or FASD. The prevalence of severe (≤ 2nd percentile) and moderate (≤16th percentile) impairments was determined.ResultsOverall, Fine Motor Composite scores were ‘average’ (M = 48.6 ± 7.4), as were Manual Coordination (M = 55.7 ± 7.9) and Fine Manual Control scores (M = 42.5 ± 6.2). Children with FASD had significantly lower Fine Motor Composite (M = 45.2 ± 7.7 p = 0.046) and Manual Coordination scores (M = 51.8 ± 7.3, p = 0.027) than children without PAE (Fine Motor Composite M = 49.8 ± 7.2; Manual Coordination M = 57.0 ± 7.7). Few children had severe impairment, but rates of moderate impairment were very high.ConclusionsDifferent types of fine motor skills should be evaluated in children with PAE or FASD. The high prevalence of fine motor impairment in our cohort, even in children without PAE, highlights the need for therapeutic intervention for many children in remote communities.

Teach Our Children: Stroke Education for Indigenous Children, First Nations, Ontario, Canada, 2009-2012.

BackgroundBecause of the heightened risk for stroke among indigenous people, we conducted this multiyear community case study from 2009 through 2012 to address stroke education needs among children aged 11 to 13 years residing in northern urban, rural, and remote First Nations in Ontario, Canada. The goal was to determine what young people understand about stroke and to develop an age-appropriate and culturally appropriate educational product.Community ContextThis project responded to First Nations requests that we educate their young people about the signs and symptoms of stroke and the need for early response. Ten First Nations and 4 indigenous health organizations took part; 7 contributed to the educational product.MethodsThis study was developed under the guidance of the Northwestern Ontario Regional Stroke Network Aboriginal Advisory Committee. It employed indigenous researchers and facilitators to ensure that methods used (questions assessing children’s knowledge of stroke and their ideas on how best to deliver messages) reflected the cultural values of participating study sites.OutcomeIndigenous children had limited knowledge about stroke and its signs, symptoms, and consequences; children in remote communities were better informed than those in other locations. Educators agreed that a DVD was the most effective way to deliver stroke information to children in this age group. The principal outcome from this 3-year community engagement was an 11.5-minute DVD titled Act F-A-S-T 1-2-3!. Follow-up indicated that the educational tool continued to be used to educate indigenous children and adults about stroke signs and symptoms, the need for early response, and risk reduction.InterpretationAlthough indigenous communities are each unique in their culture and traditions, all have a strong commitment to improving health and are generous in their support for research that addresses their needs. Our study provides examples of the engagement and participatory research strategies that were effective, the practical supports required, limitations to the study, and how barriers to stroke education can be overcome.

Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities

BackgroundDespite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). AimsThis study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. Methods and proceduresChildren born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. Outcomes and resultsNeurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0–279.0). Conclusions and implicationsNeurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.

The development of a culturally appropriate school based intervention for Australian Aboriginal children living in remote communities: A formative evaluation of the Alert Program® intervention.

Although previous research has demonstrated the benefits of targeting self-regulation in non-Aboriginal children, it is unclear whether such programs would be effective for Aboriginal children attending school in remote communities. Some of these children have been diagnosed with a fetal alcohol spectrum disorder (FASD) impairing their ability to self-regulate. The aim of this article is to describe a three phase formative process to develop and pilot a curriculum version of the Alert Program® , a promising intervention for improving self-regulation that could be used in remote community schools. This modified version of the program will be subsequently tested in a cluster randomised controlled trial. A mixed methods approach was used. Modifications to the Alert Program® , its delivery and evaluation were made after community and stakeholder consultation facilitated by a senior Aboriginal community researcher. Changes to lesson plans and program resources were made to reflect the remote community context, classroom environment and the challenging behaviours of children. Standardised study outcome measures were modified by removing several questions that had little relevance to the lives of children in remote communities. Program training for school staff was reduced in length to reduce staff burden. This study identified aspects of the Alert Program® training, delivery and measures for evaluation that need modification before their use in assessing the efficacy of the Alert Program® in remote Aboriginal community primary schools.

Telehealth language assessments using consumer grade equipment in rural and urban settings: Feasible, reliable and well tolerated

Introduction Telehealth can be an effective way to provide speech pathology intervention to children with speech and language impairments. However, the provision of reliable and feasible standardised language assessments via telehealth to establish children’s needs for intervention and to monitor progress has not yet been well established. Further, there is limited information about children’s reactions to telehealth. This study aimed to examine the reliability and feasibility of conducting standardised language assessment with school-aged children with known or suspected language impairment via a telehealth application using consumer grade computer equipment within a public school setting. Method Twenty-three children (aged 8–12 years) participated. Each child was assessed using a standardised language assessment comprising six subtests. Two subtests were administered by a speech pathologist face-to-face (local clinician) and four subtests were administered via telehealth. All subtests were completed within a single visit to the clinic service, with a break between the face to face and telehealth sessions. The face-to-face clinician completed behaviour observation checklists in the telehealth and face to face conditions and provided feedback on the audio and video quality of the application from the child’s point of view. Parent feedback about their child’s experience was elicited via survey. Results There was strong inter-rater reliability in the telehealth and face-to-face conditions (correlation coefficients ranged from r = 0.96–1.0 across the subtests) and good agreement on all measures. Similar levels of attention, distractibility and anxiety were observed in the two conditions. Clinicians rated only one session of 23 as having poor audio quality and no sessions were rated as having poor visual quality. Parent and child reactions to the use of telehealth were largely positive and supportive of using telehealth to assess rural children. Discussion The findings support the use of telehealth in the language assessment of school-aged children using a web application and commercially available computer equipment. This reliable and innovative service delivery model has the potential to be used by speech pathologists to provide assessments to children in remote communities.

Improving health and education outcomes for children in remote communities: A cross-sector and developmental evaluation approach

Early childhood is one of the most influential developmental life stages. Attainments at this stage will have implications for the quality of life children experience as they transition to adulthood. Children residing in remote Australia are exposed to socioeconomic disadvantage that can contribute to developmental delays and resultant poorer education and health outcomes. Complex contributing factors in far west New South Wales have resulted in children with speech and fine motor skill delays experiencing no to limited access to allied health services for a number of decades. More recently, growing awareness that no single policy, government agency, or program could effectively respond to these complexities or ensure appropriate allied health service access for children in these communities has led to the development of the Allied Health in Outback Schools Program, which has been operational since 2009. The program is underpinned by cross-sector partnerships and a shared aspirational aim to improve the developmental outcomes of children to enhance their later life opportunities. It was identified early that the initiative had the potential to deliver mutually beneficial outcomes for communities and participating partner organisations.Over the last five years the program has been the catalyst for partnership consolidation, expansion and diversification. The developmental evaluation approach to continuous program adaptation and refinement has provided valuable insights that have informed health and education policy and enabled the program to be responsive to changing community needs, emerging policy and funding reforms.This article explores the evolution of the program partnerships, their contribution to program success and longevity, and their capacity to respond to an emergent and dynamic environment. The authors propose that a community-centred and developmental approach to program innovation and implementation in remote locations is required. This is based on the premise that contemporary linear, logic-based policy development and funding allocations, with predetermined program deliverables and outcomes, are no longer capable of responding appropriately to the complexities experienced by remote communities.Keywords: allied health, remote communities, cross-sectoral partnerships, service learning

Influences of indigenous language on spatial frames of reference in Aboriginal English

The Aboriginal English spoken by Indigenous children in remote communities in the Northern Territory of Australia is influenced by the home languages spoken by themselves and their families. This affects uses of spatial terms used in mathematics such as ‘in front’ and ‘behind.’ Speakers of the endangered Indigenous Australian language Iwaidja use the intrinsic frame of reference in contexts where speakers of Standard Australian English use the relative frame of reference. Children speaking Aboriginal English show patterns of use that parallel the Iwaidja contexts. This paper presents detailed examples of spatial descriptions in Iwaidja and Aboriginal English that demonstrate the parallel patterns of use. The data comes from a study that investigated how an understanding of spatial frame of reference in Iwaidja could assist teaching mathematics to Indigenous language-speaking students. Implications for teaching mathematics are explored for teachers without previous experience in a remote Indigenous community.

Impact of swimming on chronic suppurative otitis media in Aboriginal children: a randomised controlled trial

To measure the impact of 4 weeks of daily swimming on rates of ear discharge among Aboriginal children with a tympanic membrane perforation (TMP) and on the microbiology of the nasopharynx and middle ear. A randomised controlled trial involving 89 Aboriginal children (aged 5-12 2013s) with a TMP, conducted in two remote Northern Territory Aboriginal communities from August to December 2009. 4 school weeks of daily swimming lessons (45 minutes) in a chlorinated pool. Proportions of children with ear discharge and respiratory and opportunistic bacteria in the nasopharynx and middle ear. Of 89 children randomly assigned to the swimming or non-swimming groups, 58 (26/41 swimmers and 32/48 non-swimmers) had ear discharge at baseline. After 4 weeks, 24 of 41 swimmers had ear discharge compared with 32 of 48 non-swimmers (risk difference, - 8% (95% CI, - 28% to 12%). There were no statistically significant changes in the microbiology of the nasopharynx or middle ear in swimmers or non-swimmers. Streptococcus pneumoniae and non-typeable Haemophilus influenzae were the dominant organisms cultured from the nasopharynx, and H. influenzae, Staphylococcus aureus and Pseudomonas aeruginosa were the dominant organisms in the middle ear. Swimming lessons for Aboriginal children in remote communities should be supported, but it is unlikely that they will substantially reduce rates of chronic suppurative otitis media and associated bacteria in the nasopharynx and middle ear. However, swimming was not associated with increased risk of ear discharge and we found no reason to discourage it. Australian New Zealand Clinical Trials Registry ACTRN12613000634774.

Sleep and academic performance in Indigenous Australian children from a remote community: An exploratory study

Disruptions to sleep in childhood are associated with poor behaviour and deficits in academic performance and executive function. Although academic performance of indigenous children from remote communities in Australia is documented as well below that of non-indigenous children, the extent of sleep disruption and its contribution to academic performance among this population has not been assessed. This pilot study aimed to objectively assess the sleep of remote indigenous children and the association between sleep disruption and both academic performance and executive function. Twenty-one children from a remote Australian indigenous community aged 6-13 years wore actigraphy for two consecutive nights, reported subjective sleepiness, and were objectively assessed for academic performance (Wechsler Individual Achievement Test, 2nd Edition) and executive function (NEuroloPSYcological Assessment-II). Results show marked reduction in sleep time, sleep fragmentation, academic performance and auditory attention compared with non-indigenous norms. Sleep duration was not associated with performance, possibly because of reduced sleep and performance observed across the entire group. Sleep fragmentation was associated with reduced reading and numerical skills (P < 0.05). The sleep of indigenous children in remote communities is an important area of future inquiry, and our initial findings of poor sleep and an association between sleep disruption and academic performance may have important implications for intervention strategies aimed at 'closing the gap'. Further studies should assess a broader range of demographic, social and economic factors to better understand the associations reported here and guide future intervention.

Naplan language assessments for Indigenous children in remote communities

The National Assessment Program - Literacy and Numeracy (NAPLAN) assessments are designed to assess literacy and numeracy of all Australian school children in years 3, 5, 7 and 9, and to act as diagnostics as to whether children are meeting intended educational outcomes. Tests began in May 2008, and have been run annually since then. Results of the 2008 tests indicated that Indigenous children in remote communities had the lowest test scores, and results were used to make a policy decision that effectively scrapped bilingual education in the Northern Territory. In this paper, we evaluate the literacy component of the NAPLAN test for Year 3, and the language samples for each year level. Literacy components assess reading, writing and language conventions (grammar, spelling and punctuation), and we focus on the reading and language conventions components. We argue that the NAPLAN tests need to be very carefully monitored for appropriateness for the assessment of children living in remote Indigenous communities. This is because tests are standardised on groups of English language speaking children. The content of some sample tests relies on cultural knowledge which Indigenous children cannot be expected to have. Spelling tests need to be monitored to ensure that they are testing spelling rather than grammatical knowledge. Finally, it is difficult to create language convention tests which are truly diagnostic because of the mixed test population of native English speakers, ESL learners and EFL learners in remote Indigenous communities.

The Nonserotypeable Pneumococcus: Phenotypic Dynamics in the Era of Anticapsular Vaccines

Nonserotypeable pneumococci (NSP) are commonly carried by Australian Indigenous children in remote communities. The purpose of this study was to characterize carriage isolates of NSP from Indigenous children vaccinated with the seven-valent pneumococcal conjugate vaccine (PCV7) and to use these data to guide decisions on reporting of NSP. A total of 182 NSP were characterized by BOX typing, antibiogram analysis, and multilocus sequence typing (MLST) of common BOX types. NSP positive for the wzg capsule gene were analyzed by a multiplex PCR-based reverse line blot hybridization assay (mPCR/RLB-H) targeting capsule genes to determine the serotype. Among 182 NSP, 49 BOX types were identified. MLST of 10 representative isolates found 7 STs, including ST448 (which accounted for 11% of NSP). Non-penicillin susceptibility was evident in 51% of the isolates. Pneumococcal wzg sequences were detected in only 23 (13%) NSP, including 10 that contained an approximately 1.2-kb insert in the region. mPCR/RLB-H identified serotype 14 wzy sequences in all 10 NSP, and 1 also contained a serotype 3-specific wze sequence. Among the remaining 13 wzg-positive NSP, few belonged to the serotypes represented in PCV7. It appears that most NSP identified in Australian Indigenous children are from a true nonencapsulated lineage. Few NSP represented serotypes in PCV7 that suppress capsular expression. High rates of carriage and penicillin resistance and the occasional presence of capsule genes suggest a role for NSP in the maintenance and survival of capsulated pneumococci. To avoid the inflation of pneumococcal carriage and antibiotic resistance rates, in clinical trials, we recommend separate reporting of rates of capsular strains and NSP and the exclusion of data for NSP from primary analyses.

Survival of pneumococcus on hands and fomites

BackgroundPneumococcal hand contamination in Indigenous children in remote communities is common (37%). It is not clear whether this requires frequent inoculation, or if pneumococci will survive on hands for long periods of time. Thus the aim of this study was to determine the survival time of pneumococci on hands and fomites.FindingsThe hands of 3 adult volunteers, a glass plate and plastic ball were inoculated with pneumococci suspended in two different media. Survival at specified time intervals was determined by swabbing and re-culture onto horse blood agar. Pneumococci inoculated onto hands of volunteers were recovered after 3 minutes at 4% to 79% of the initial inoculum. Recovery from one individual was consistently higher. By one hour, only a small number of pneumococci were recovered and this was dependent on the suspension medium used. At subsequent intervals and up to 3 hours after inoculation, < 10 colony forming units were recovered from hands. On a glass plate, pneumococcal numbers dropped an average 70% in the two hours after inoculation. Subsequently, < 100 colony forming units were recovered up to 15 hours after inoculation.ConclusionThe poor survival of pneumococci on hands suggests that the high prevalence of pneumococcal hand contamination in some populations is related to frequent inoculation rather than long survival. It is plausible that hand contamination plays a (brief) role in transmission directly, and indirectly through contamination via fomites. Regular hand washing and timely cleansing or removal of contaminated fomites may aid control of pneumococcal transmission via these routes.