Communities In Northern Territory Research Articles

Automated Diabetic Retinopathy Diagnosis for Improved Clinical Decision Support.

We report on the prediction performance of artificial intelligence components embedded into a telehealth platform underlying a newly established eye screening service connecting metropolitan-based ophthalmologists to patients in remote indigenous communities in Northern Territory and Queensland. Two AI-based components embedded into the telehealth platform were evaluated on retinal images collected from 328 unique patients: an image quality alert system and a diabetic retinopathy detection system. Compared to ophthalmologists, at an individual image level, the image quality detection algorithm was correct 72% of the time, and 85% accurate at a patient level. The retinopathy detection algorithm was correct 85% accurate at an individual image level, and 87% accurate at a patient level. This evaluation provides assurances for future service models using AI to complement and support decisions of eye health assessment teams.

Stop contrast acquisition in child Kriol: Evidence of stable transmission of phonology post Creole formation.

Many Aboriginal Australian communities are undergoing language shift from traditional Indigenous languages to contact varieties such as Kriol, an English-lexified Creole. Kriol is reportedly characterised by lexical items with highly variable phonological specifications, and variable implementation of voicing and manner contrasts in obstruents (Sandefur, 1986). A language, such as Kriol, characterised by this unusual degree of variability presents Kriol-acquiring children with a potentially difficult language-learning task, and one which challenges the prevalent theories of acquisition. To examine stop consonant acquisition in this unusual language environment, we present a study of Kriol stop and affricate production, followed by a mispronunciation detection study, with Kriol-speaking children (ages 4-7) from a Northern Territory community where Kriol is the lingua franca. In contrast to previous claims, the results suggest that Kriol-speaking children acquire a stable phonology and lexemes with canonical phonemic specifications, and that English experience would not appear to induce this stability.

Evaluating the role of asymptomatic throat carriage of Streptococcus pyogenes in impetigo transmission in remote Aboriginal communities in Northern Territory, Australia: a retrospective genomic analysis

Streptococcus pyogenes, or group A Streptococcus (GAS), infections contribute to a high burden of disease in Aboriginal Australians, causing skin infections and immune sequelae such as rheumatic heart disease. Controlling skin infections in these populations has proven difficult, with transmission dynamics being poorly understood. We aimed to identify the relative contributions of impetigo and asymptomatic throat carriage to GAS transmission. In this genomic analysis, we retrospectively applied whole genome sequencing to GAS isolates that were collected as part of an impetigo surveillance longitudinal household survey conducted in three remote Aboriginal communities in the Northern Territory of Australia between Aug 6, 2003, and June 22, 2005. We included GAS isolates from all throats and impetigo lesions of people living in two of the previously studied communities. We classified isolates into genomic lineages based on pairwise shared core genomes of more than 99% with five or fewer single nucleotide polymorphisms. We used a household network analysis of epidemiologically and genomically linked lineages to quantify the transmission of GAS within and between households. We included 320 GAS isolates in our analysis: 203 (63%) from asymptomatic throat swabs and 117 (37%) from impetigo lesions. Among 64 genomic lineages (encompassing 39 emm types) we identified 264 transmission links (involving 93% of isolates), for which the probable source was asymptomatic throat carriage in 166 (63%) and impetigo lesions in 98 (37%). Links originating from impetigo cases were more frequent between households than within households. Households were infected with GAS for a mean of 57 days (SD 39 days), and once cleared, reinfected 62 days (SD 40 days) later. Increased household size and community presence of GAS and scabies were associated with slower clearance of GAS. In communities with high prevalence of endemic GAS-associated skin infection, asymptomatic throat carriage is a GAS reservoir. Public health interventions such as vaccination or community infection control programmes aimed at interrupting transmission of GAS might need to include consideration of asymptomatic throat carriage. Australian National Health and Medical Research Council.

Early Childhood Pneumonia Is Associated with Reduced Lung Function and Asthma in First Nations Australian Children and Young Adults.

Background: Some but not all previous studies report that pneumonia in children aged less than five years is associated with lower lung function and elevated risk of respiratory disease. To date, none have explored these associations in at-risk populations such as First Nations Australians, whose incidence of early childhood pneumonia is among the highest reported in the world. Methods: This cross-sectional study included 1276 First Nations Australian children/young adults aged 5–25 years recruited from regional/remote Queensland and Northern Territory communities and schools. Associations between pneumonia and both spirometry values and asthma were investigated using linear and logistic regression. Results: Early childhood pneumonia was associated with lower FEV1 and FVC Z-scores, but not FEV1/FVC% Z-scores, when occurring before age three (FEV1 β = −0.42, [95%CI −0.79, −0.04]; FVC β = −0.62, [95%CI −1.14, −0.09]), and between three and five years (β = −0.50, [95%CI −0.88, −0.12]; β = −0.63, [95%CI −1.17, −0.10]), compared to those who never had pneumonia. Similarly, pneumonia occurring when aged before age three years (OR = 3.68, 95%CI 1.96–6.93) and three to five years (OR = 4.81, 95%CI 1.46–15.8) was associated with increased risk of asthma in later childhood. Conclusions: Early childhood pneumonia is associated with lung function deficits and increased asthma risk in later childhood/early adulthood in First Nations Australians. The disproportionate impact of pneumonia on at-risk children must be addressed as a priority.

Effects of turnover and stability of health staff on quality of care in remote communities of the Northern Territory, Australia: a retrospective cohort study

ObjectivesTo evaluate the relationship between markers of staff employment stability and use of short-term healthcare workers with markers of quality of care. A secondary objective was to identify clinic-specific factors...

‘We're Hands-On People’: Healing Diabetes in the Absence of Traditional Healers in an Aboriginal Community in Northern Territory, Australia.

This study of a remote Aboriginal community in Australia’s Northern Territory in 2014 sought to understand diabetes from a local Aboriginal perspective. Participants drew on a variety of holistic healing methods in the absence of an individual or individuals identified as holding a healing role in the community. The study offers an alternative to the common assumption that all communities can identify specific individuals as Aboriginal healers who are central to maintaining Aboriginal beliefs and wellbeing who contribute to holistic health (Clarke 2008; Maher 1999; McDonald 2006; Seathre 2013; Williams 2011). This research found the seven adult Aboriginal diabetes patients participating in the longitudinal ethnographic study actively engaged in self-healing strategies. Moreover, diabetes clinicians could combine local remedies and biomedical treatment to heal diabetes within the clinic, as well as actively engaging the patient in their own treatment, effective to reduce the symptoms and prevalence of diabetes in Aboriginal populations.

Maternal Anaemia in Pregnancy: A Significantly Greater Risk Factor for Anaemia in Australian Aboriginal Children than Low Birth Weight or Prematurity.

To identify maternal and perinatal risk factors associated with childhood anaemia. A retrospective cohort studywas conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004-2014 in Community A and 2010-2014 in Community B and C, and their respective motherswere recruited into the study.Maternal and child datawere linked to providea longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was theprevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6months. Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08-9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21-5.70) were associated with an increased risk of childhood anaemia at 6months of age. This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

Povidone-iodine ear wash and oral cotrimoxazole for chronic suppurative otitis media in Australian aboriginal children: study protocol for factorial design randomised controlled trial

BackgroundChronic suppurative otitis media (CSOM) is a significant health issue affecting Aboriginal Australians. Long-term hearing loss can cause communication problems, educational disadvantage, and social isolation. Current standard treatment for CSOM in our region is twice daily dry mopping of the pus from the ear canal followed by instillation of ciprofloxacin antibiotic ear drops for up to 16 weeks, or until the discharge resolves for a period of 3 days. The treatment is long, laborious and fails to resolve ear discharge in 70% of cases in remote communities. Bacterial pathogens also persist. Povidone-iodine ear wash is the preferred method of clearing ear discharge in Western Australia. However, evidence of its effectiveness is lacking. In systematic reviews, topical antibiotics (ciprofloxacin) have been shown to be more effective than oral antibiotics or topical antiseptics. Currently, it is unclear whether there are any benefits of combining these treatments.MethodsThis protocol describes a 2 × 2 factorial randomised controlled trial of two different interventions (povidone-iodine ear wash and oral cotrimoxazole), given as adjunctive therapy to standard treatment for CSOM. 280 children, between 2 months and 17 years of age, Indigenous or non-Indigenous, living in participating Northern Territory (NT) communities are randomised to standard treatment (dry mopping and ciprofloxacin drops) plus one of two topical treatments (dilute povidone-iodine ear wash or no wash) and one of two oral medication treatments (16 weeks of cotrimoxazole or placebo).DiscussionCurrent treatment of CSOM in our region shows that eradication of bacterial pathogens from the middle ear space and dry ears is often not achieved. This trial will evaluate the efficacy of adjunctive treatments of antiseptic ear washes and oral antibiotics. Clinical, microbiological and hearing outcomes will be reported.Trial registrationThis trial (ACTRN12614000234617) was registered with ANZCTR on 05 April 2014.

Mentoring as a tool to engage Aboriginal youth in remote Australian communities: a qualitative investigation of community members, mentees, teachers, and mentors’ perspectives

Sport-based mentoring programs have been used across many contexts to engage young people in education. In this research, we explored the influence that an Aboriginal controlled organisation’s youth mentoring program has on three remote Aboriginal communities in Northern Territory, Australia. We used a composite set of culturally sensitive methods by including artefacts from the community members and mentees, informal interviews with community, and semi-structured conversations with mentors and schoolteachers. The findings demonstrate the positive feelings, many benefits, and relationships that had been established between mentors and mentees, the organisation and community over time. However, participants also suggested that it would be beneficial to engage mentors in activities with students not in the school system, and adults in the broader community. Despite some identified challenges, the mentoring program was perceived to be successful in engaging remote Aboriginal children in school and developing future career aspirations.

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia.

To identify the risk factors for preterm birth, low birthweight and small for gestational age babies among remote-dwelling Aboriginal women. The study included 713 singleton births from two large remote Aboriginal communities in Northern Territory, Australia in 2004-2006 (retrospective cohort) and 2009-2011 (prospective cohort). Demographic, pregnancy characteristics, labour and birth outcomes were described. Multivariate logistic regression analysis was conducted and adjusted odds ratios were reported. The preterm birth rate was 19.4%, low birthweight rate was 17.4% and small for gestational age rate was 16.3%. Risk factors for preterm birth were teenage motherhood, previous preterm birth, smoker status not recorded, inadequate antenatal visits, having pregnancy-induced hypertension, antepartum haemorrhage or placental complications. After adjusting for gender and birth gestation, the only significant risk factor for low birthweight was first time mother. The only significant risk factor for small for gestational age baby was women having their first baby. Rates of these events are high and have changed little over time. Some risk factors are modifiable and treatable but need early, high quality, culturally responsive women centred care delivered in the remote communities themselves. A different approach is recommended.

An evaluation of an Australian Aboriginal controlled-community organization’s remote sports-based programme: a qualitative investigation

Current research suggests that Aboriginal-controlled organizations should play a larger role in developing and implementing sports-based programmes for Aboriginal young people. In this paper, we explore the influence of an Aboriginal-controlled organization and its government-funded remote sports-based programme on Aboriginal participants and non-Aboriginal stakeholders. We consider whether this sports-based programme is meeting the needs of a remote community in Northern Territory, Australia, and argue that the influence of the Aboriginal controlled organization is somewhat minimized, due to the constraints of government policy and associated funding, which focus on the socioeconomic agenda of reducing gaps between Aboriginal and non-Aboriginal Australians in health, education and employment. The Aboriginal community members and youth would appreciate the Aboriginal-controlled organization working more closely with them to improve the influence of the programme by paying respect to the local Aboriginal culture, social systems and knowledge.

Acute rheumatic fever spike in a remote Aboriginal community in the Northern Territory: another challenge to Closing The Gap initiatives

Acute rheumatic fever spike in a remote Aboriginal community in the Northern Territory: another challenge to Closing The Gap initiatives

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal Community in Northern Territory, Australia

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal Community in Northern Territory, Australia

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal community in Northern Territory, Australia

Prevalence of scabies and strongyloidiasis before and after MDA in a remote Aboriginal community in Northern Territory, Australia

Screening for hepatitis B in East Arnhem Land: a high prevalence of chronic infection despite incomplete screening

Infection with hepatitis B virus (HBV) is common in Aboriginal Australians, but current seroprevalences in Northern Territory communities are unknown. We performed an audit of HBV serology on a convenience sample of 112 adults at an East Arnhem Land Health Service. Complete HBV serology was only available in 26 (23%) patients. Evidence of HBV exposure (core antibody-positive) was found in 43 of 68 (63%) patients tested, and current HBV infection (surface antigen-positive) was found in nine of 76 (12%). HBV is an incompletely defined, under-resourced and substantial public health problem in Aboriginal Australians.

PR06 MANDIBULAR FRACTURES IN INDIGENOUS AUSTRALIANS IN NORTHERN TERRITORY

Aim: The aim of this study is to examine the epidemiology of Mandibular fractures in the indigenous Australians and define any commonly occurring patterns.Patients and Methods: A retrospective series of 485 patients with Mandibular fractures admitted to the maxillofacial unit during the period January 1999 to June 2003 were analysed. Demographic data on patient's age, sex, aetiology, alcohol consumption at the time of injury, urban/rural status were recorded and assessed.Results: The epidemiology of an unselected series of Mandibular fractures is defined in this study. The overall incidence of Mandibular fractures was 54.5 cases per 100,000 populations per year. The incidence in indigenous Australians was 155 cases per 100,000 populations per year (2nd highest in the world). 72% of the patients were Aboriginal. 72% of the patients were male and 28% female. 90% of the females were indigenous. Most fractures were caused by assault (82.5%). 92% of the aboriginal women with mandibular fractures were assaulted. 69.9% of the patients were under the influence of alcohol at the time of injury. 6.18% of patients in this series had a recurrent mandibular fracture. In 5% of the patients the presenting symptom was an abscess from the mandibular fracture.Conclusions: The incidence and causes of mandibular fractures reflect trauma patterns (assaults and domestic violence) with in the aboriginal community in Northern Territory. Strategies to identify risk factors linked to Assaults and Domestic Violence and to help families to reduce the incidence of violence and alcoholism are integral to addressing this problem.

The Molecular Epidemiology of Ocular Chlamydia trachomatis Infections in Western Australia: Implications for Trachoma Control

We studied the serovar distribution of Chlamydia trachomatis in patients with clinical eye disease in Western Australia. Most disease occurred in indigenous communities and was caused by trachoma serovars Ba and C. Serovar Ba was genetically homogeneous throughout Western Australia and identical to strains previously described in indigenous communities in Northern Territory. This finding probably results from movement of these populations, and suggests that a widely coordinated, rather than local or regional, approach is needed to control trachoma in mobile populations. Serovar C strains within Western Australia were homogeneous but distinct from those in Northern Territory, possibly because of inherent differences in transmissibility or differences in population movements among communities carrying the different serovars. Genital serovars were occasional causes of eye diseases in infants, adolescents, and adults in trachoma-endemic areas. These serovars should be considered in the differential diagnosis of acute follicular conjunctivitis in these groups.

Community Involvement in Aboriginal Schools

The following paper is based on experiences gained in schools in North East Arnhem Land. While it is likely that the situations as described are applicable to other areas, the authors do not claim that there will always be direct comparisons. Too often the wider Australian community regards Aboriginals as one people with one set of common needs whereas even limited experience soon reveals a great diversity amongst these people in terms of language, customs and environment and consequently a great diversity of needs and necessary solutions.In schools throughout Australia the desirability of and need for community involvement become more apparent every day. To quote the Karmel report Schools in Australia,“After almost one hundred years of public schooling a reappraisal of the relationship of the school to the wider society is taking place in Australia, as it is in most industrialized nations. The isolation of schools is being questioned as is also the idea that education should be confined to formal institutions and concentrated heavily upon those who have not yet entered employment.”We have now reached the stage where the desirability of community involvement in education can be taken by most as a self evident truth and we can look”back in wonder at the times when such an idea was radical or not even considered.In Aboriginal communities in the Northern Territory the opportunities for involving the community in the school are probably greater than in the wider Australian society. For example, the families are easy to contact, they are generally open to suggestion and they do not have preconceived notions as to the “proper” way in which a school should be run. However, too often we have taken community involvement to mean the fund raising activities of Parents’ Committees and left the real problems of initiating genuine involvement well alone. (The activities of the School Council at Hermannsburg are a notable exception; there may be others).