Disease In Indigenous Communities Research Articles

Culturally adapted cognitive assessment tool for Indigenous communities in Brazil: Content, construct, and criterion validity.

Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. Using a three-stage process and a stakeholder-engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter-rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S-CVI] 0.93) and relevance ratings (S-CVI 0.85) between expert panels. The identified cut-off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. Using a stakeholder-engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals.

Perceptions of Tree Diseases in Indigenous Communities: Native Alaskan and Hawaiian Insights

Abstract Concern for tree mortality and damage, and preferences for management interventions, reflect people’s values and cultures. We examine perceptions of tree diseases in two Indigenous communities to provide examples of the types of distress and attitudes that arise when tree diseases significantly damage cultural values. Summaries of yellow-cedar decline as perceived by Tlingit and Haida Alaska Natives and rapid ʻōhiʻa death (ROD) and Native Hawaiian culture underscore the interconnections between local people and local forests and the ways forest diseases can impart a loss of culture and connections to ancestors. The complex relationships between Indigenous people, ecosystems, and tree diseases highlight the importance of the inclusion of diverse viewpoints to inform natural resource planning and management so that it may be conducted equitably and ethically. Study Implications: Consideration of cultural and social impacts as criteria for prioritization of forest disease management requires knowledge of the types and intensity of impacts that forest diseases have on Indigenous and Western culture. A greater understanding of the diversity of perspectives toward forest diseases is needed to inform natural resource planning and management so that it may be conducted in an ecologically sound and inclusive manner.

Metabolomics insights into the polyketide-lactones produced by Diaporthe caliensis sp. nov., an endophyte of the medicinal plant Otoba gracilipes.

Plants of the genus Otoba have been the basis for the treatment of tropical diseases in indigenous communities of countries like Colombia. Despite the lack of knowledge about their bioactive principles, endophytic fungi derived from medicinal plants are a prolific source of innovative chemistry. We systematically investigated the secondary metabolite production of a previously undescribed species of Diaporthe, herein introduced as Diaporthe caliensis sp. nov., using different metabolomics approaches together with classical chemical screening. To get an outline of the chemical space produced by this fungus, an exploratory molecular networking (MN) analysis was undertaken. A major molecular family was found to contain the known 10-membered lactone phomol (1), together with other putative congeners as compound 3. After isolation by preparative high-performance liquid chromatography, we confirmed phomol (1) as the main reason for the antimicrobial activity of the crude extract. The unknown absolute configuration of 1 was determined by the synthesis of α-methoxy-α-trifluoromethylphenylacetyl (MTPA)-esters and chemical degradation experiments. Moreover, caliensolides A (2) and B (3) were isolated, and their structures were elucidated as novel butenolides structurally unrelated to 1. Overall, the initial MN analysis incorrectly clustered compounds 1 and 3 within a single molecular family, despite evident differences in chemical structures and biosynthetic origin. Contrariwise, the unsupervised substructure discovery algorithm MS2LDA provided a deeper understanding of the fragmentation patterns and correctly clustered the polyketide-lactones produced by D. caliensis sp. nov. Our findings encourage the exploration of Colombian fungal diversity, which as demonstrated here could result in the discovery of new natural products.IMPORTANCEThe integration of metabolomics-based approaches into the discovery pipeline has enabled improved mining and prioritization of prolific secondary metabolite producers such as endophytic fungi. However, relying on automated untargeted analysis tools might lead to misestimation of the chemical complexity harbored in these organisms. Our study emphasizes the importance of isolation and structure elucidation of the respective metabolites in addition to deep metabolome analysis for the correct interpretation of untargeted metabolomics approaches such as molecular networking. Additionally, it encourages the further exploration of endophytic fungi from traditional medicinal plants for the discovery of natural products.

Reciprocity in the intercultural conference space to improve Aboriginal oral health: A qualitative study.

Despite high rates of oral disease in Indigenous communities globally, progress is slow in implementing policies and practices so the depth of inequity is addressed and oral health outcomes improve. Indigenous communities are often poorly consulted in the process. This paper responds to this inequity by seeking to create a respectful intercultural space at international dental conferences where Aboriginal health practitioners and dental public health researchers can discuss ways forward for oral health in Indigenous communities. Participatory action research informed by Indigenist methodologies guided this research. Two roundtable discussions between Australian Aboriginal and non-Aboriginal participants were recorded, transcribed and analysed for themes related to problems and potential solutions to dental disease in Indigenous communities. Follow-up discussions on participants' reflections engaging in this intercultural space were recorded and analysed. Two Aboriginal health practitioners and five non-Aboriginal international dental public health researchers identified the importance of inclusion where intercultural engagement and collaboration with Indigenous Peoples were integral to conducting research in this context and improving oral health outcomes. Creating a safe, respectful space between Aboriginal health practitioners and non-Aboriginal dental public health researchers at an international conference fostered dialogue to better understand barriers and enablers to good oral health outcomes. Intercultural engagement and discussion is a step towards mutual understanding of oral health perspectives and experiences that can foster equity and enable more collaborative responses to improve oral health outcomes.

Identifying Environmental Determinants Relevant to Health and Wellbeing in Remote Australian Indigenous Communities: A Scoping Review of Grey Literature.

The high prevalence of preventable infectious and chronic diseases in Australian Indigenous populations is a major public health concern. Existing research has rarely examined the role of built and socio-political environmental factors relating to remote Indigenous health and wellbeing. This research identified built and socio-political environmental indicators from publicly available grey literature documents locally-relevant to remote Indigenous communities in the Northern Territory (NT), Australia. Existing planning documents with evidence of community input were used to reduce the response burden on Indigenous communities. A scoping review of community-focused planning documents resulted in the identification of 1120 built and 2215 socio-political environmental indicators. Indicators were systematically classified using an Indigenous indicator classification system (IICS). Applying the IICS yielded indicators prominently featuring the “community infrastructure” domain within the built environment, and the “community capacity” domain within the socio-political environment. This research demonstrates the utility of utilizing existing planning documents and a culturally appropriate systematic classification system to consolidate environmental determinants that influence health and disease occurrence. The findings also support understanding of which features of community-level built and socio-political environments amenable to public health and social policy actions might be targeted to help reduce the prevalence of infectious and chronic diseases in Indigenous communities.

Invasive Haemophilus influenzae disease in Northwestern Ontario First Nations communities: Case Series

We present clinical and microbiological data of 5 pediatric cases of invasive Haemophilus influenzae disease, which occurred over a period of 10 months in the service area of a regional hospital of Northwestern Ontario. Four cases of invasive H. influenzae type a (Hia) disease presented either as meningitis, non-complicated and complicated pneumonia, or soft tissue infection in children between 7 months and 6 years of age. Although the cases were from different communities with no known common exposure, the Hia isolates demonstrated similar phenotypic and genotypic characteristics. One case of invasive disease due to nontypeable H. influenzae (NTHi) presented as chorioamnionitis in an adolescent. The data emphasize the significance of Hia and NTHi as a cause of serious disease in Indigenous communities.

Socioeconomic profile and perceptions of Chagas disease in indigenous communities of the Paraguayan Chaco

Chagas disease continues to be a problem in indigenous communities of the Paraguayan Central Chaco because of the high infection prevalence. The study area presents great environmental and biological diversity, high temperatures, low rainfall, poverty and rapid vector reinfestation. This descriptive study analyzed the demographic and socioeconomic profiles and knowledge, beliefs and attitudes toward Chagas disease in four indigenous communities. A household survey was used as an instrument for gathering information from 270 families as well as a survey of social networks, in-depth interviews and focus groups with key informants and four participatory diagnoses. A high percentage of the studied population did not know about the disease (72%), but 80% of them identified the presence of the main vector in their homes. They had poor knowledge of the vector as an annoying bug to be eliminated (19%) and did not relate it to the disease. Half of the population thinks that there is no risk of contracting the disease, which could be curable (52.7%). Work activities were linked to Mennonite groups, and solidarity cooperation and mutual aid with exchanges of favors, mainly related to food, were common. There is no knowledge about Chagas disease in these communities because of different factors, including not associating symptoms with the disease, the predominance of ethnic languages, which limit the education process, and lack of access to public health. National Chagas Program efforts should be complemented by other programs with health education and improved learning conditions based on a comprehensive approach according to the rights and specific cultural characteristics of these populations.

A Community-Directed Integrated Strongyloides Control Program in Queensland, Australia.

This paper describes two phases of a community-directed intervention to address strongyloidiasis in the remote Aboriginal community of Woorabinda in central Queensland, Australia. The first phase provides the narrative of a community-driven ‘treat-and-test’ mass drug administration (MDA) intervention that was co-designed by the Community Health Service and the community. The second phase is a description of the re-engagement of the community in order to disseminate the key factors for success in the previous MDA for Strongyloides stercoralis, as this information was not shared or captured in the first phase. During the first phase in 2004, there was a high prevalence of strongyloidiasis (12% faecal examination, 30% serology; n = 944 community members tested) that resulted in increased morbidity and at least one death in the community. Between 2004–2005, the community worked in partnership with the Community Health Service to implement a S. stercoralis control program, where all of the residents were treated with oral ivermectin, and repeat doses were given for those with positive S. stercoralis serology. The community also developed their own health promotion campaign using locally-made resources targeting relevant environmental health problems and concerns. Ninety-two percent of the community residents participated in the program, and the prevalence of strongyloidiasis at the time of the ‘treat-and-test’ intervention was 16.6% [95% confidence interval 14.2–19.3]. The cure rate after two doses of ivermectin was 79.8%, based on pre-serology and post-serology tests. The purpose of this paper is to highlight the importance of local Aboriginal leadership and governance and a high level of community involvement in this successful mass drug administration program to address S. stercoralis. The commitment required of these leaders was demanding, and involved intense work over a period of several months. Apart from controlling strongyloidiasis, the community also takes pride in having developed and implemented this program. This appears to be the first community-directed S. stercoralis control program in Australia, and is an important part of the national story of controlling infectious diseases in Indigenous communities.

Policy Implications for Controlling Communicable Diseases in Indigenous Communities: Case of Strongyloidiasis in Australia

The objective of this paper is to document the knowledge and experiences of healthcare professionals and researchers in Australia about the barriers to controlling Strongyloides stercoralis in Australian Indigenous communities. Qualitative research methods were used to conduct in-depth semi-structured interviews, which were digitally recorded, transcribed, and participant-checked. Data were thematically analysed to identify significant themes. Five major themes were identified:1) Barriers to health/treatment;2) Access to healthcare;3) Policy;4) Learning opportunity; and5) Ideas for intervention.The findings suggest that Australian Indigenous communities will continue to suffer increased morbidity and mortality due to a lack of control or prevention of Strongyloides stercoralis. Issues such as institutional racism, improvements to health promotion, education, socioeconomic determinants, and health care system policy and procedures need to be addressed. This study identifies several direct implications for Indigenous health:The need for increased knowledge and understanding of the risks to health for Indigenous community members;The need for prevention policy development for neglected tropical diseases in Indigenous communities;The need for increased knowledge and understanding of the treatment, diagnosis, and healthcare access concerning Strongyloides stercoralis for health professionals and policymakers who work within Indigenous health;The need to raise awareness of systematic institutional racism in the control and prevention of neglected tropical diseases in Indigenous communities; andThe need for a health promotion framework that can provide the basis for multiple-level interventions to control and prevent Strongyloides in Indigenous communities.

What Indigenous Australian clients value about primary health care: a systematic review of qualitative evidence

Objective:To synthesise client perceptions of the unique characteristics and value of care provided in Aboriginal Community Controlled Health Organisations (ACCHOs) compared to mainstream/general practitioner services, and implications for improving access to quality, appropriate primary health care for Indigenous Australians. Method:Standardised systematic review methods with modification informed by ethical and methodological considerations in research involving Indigenous Australians. Results:Perceived unique valued characteristics of ACCHOs were: 1) accessibility, facilitated by ACCHOs welcoming social spaces and additional services; 2) culturally safe care; and 3) appropriate care, responsive to holistic needs. Conclusion:Provider‐client relationships characterised by shared understanding of clients' needs, Indigenous staff, and relationships between clients who share the same culture, are central to ACCHO clients' perceptions of ACCHOs' unique value. The client perceptions provide insights about how ACCHOs address socio‐economic factors that contribute to high levels of chronic disease in Indigenous communities, why mainstream PHC provider care cannot substitute for ACCHO care, and how to improve accessibility and quality of care in mainstream providers. Implications for public health:To increase utilisation of PHC services in Indigenous Australian communities, and help close the gaps between the health status of Indigenous and non‐Indigenous Australians, Indigenous community leaders and Australian governments should prioritise implementing effective initiatives to support quality health care provision by ACCHOs.

The changing epidemiology of invasive Haemophilus influenzae disease: Emergence and global presence of serotype a strains that may require a new vaccine for control

BackgroundMore than two decades after the implementation of the Hib conjugate vaccine in North America, Haemophilus influenzae serotype a (Hia) has emerged as a significant cause of invasive disease in Indigenous communities. However, little is known about the global presence of this pathogen. MethodsWe interrogated the H. influenzae Multi-Locus Sequence Typing (MLST) website (https://pubmlst.org/hinfluenzae/) by selecting for serotype a records. We also updated our previous literature review on this subject matter. ResultsHia has been reported from at least 35 countries on six major continents. However, most Hia diseases were associated with Indigenous communities. Clonal analysis identified two clonal populations with one typified as ST-23 responsible for most invasive disease in North America and being the predominant clone described on the H. influenzae MLST website. Incidence of invasive Hia disease in Indigenous communities in North America are similar to the rates of Hib disease reported prior to the Hib conjugate vaccine era. Hia causes severe clinical diseases, such as meningitis, septicaemia, pneumonia, and septic arthritis with case-fatality rates between 5.6% and 33% depending on the age of the patient and the genetic makeup of the Hia strain. ConclusionAlthough invasive Hia disease can be found globally, the current epidemiological data suggest that this infection predominantly affects Indigenous communities in North America. The clinical disease of Hia and the clonal nature of the bacteria resemble that of Hib. The high incidence of invasive Hia disease in Indigenous communities, along with potential fatality and severe sequelae causing long-term disability in survivors, may support the development of a new Hia conjugate vaccine for protection against this infection similar in design to the one introduced in the 1990s to control invasive Hib disease.

Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review.

To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices. A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar. We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success. Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.

FRI0187 Epidemiology Musculoskeletal Disorders and Rheumatic Diseases in Indigenous Communities of Oaxaca, Mexico: A Community-Based Study

BackgroundThe prevalence of musculoskeletal diseases in indigenous communities in Mexico is unknown. As a response to this challenge, the Latin American Study Group of Rheumatic Diseases in Indigenous Peoples (GLADERPO)...

The oral health of Indigenous children: A review of four nations

This review of the oral health of children in Australia, New Zealand, Canada and the USA demonstrates that significant oral health inequalities exist in each nation. Despite traditionally low levels of disease in Indigenous communities, dental caries is now highly prevalent and of increased severity among Indigenous children in comparison to their non-Indigenous counterparts. Early childhood caries is particularly prevalent. The high level of dental disease experience at an early age is associated with increased rates of general anaesthesia and greater risk of dental caries in later life. The rates and severity of dental caries experienced by young Indigenous children are even more alarming when we consider that dental caries is essentially a preventable disease. The success of specific preventive programmes is encouraging; these approaches should be further evaluated and implemented as part of broader health promotion programmes for Indigenous children and families in order to decrease current oral health disparities.

Rheumatic fever in Indigenous Australian children

Rheumatic heart disease (RHD) caused by acute rheumatic fever (ARF) is a disease of poverty, poor hygiene and poor living standards. RHD remains one of the major causes of childhood cardiac disease in developing nations. Within developed nations, there has been a dramatic drop in the prevalence of RHD because of the improvement of living standards, access to health care and the widespread availability of penicillin-based drugs. Despite a dramatic reduction of RHD in Australia overall, it continues to be a major contributor to childhood and adult cardiac disease in Indigenous communities throughout northern and central Australia. Currently, Australia has among the highest recorded rates of ARF and RHD in the world. The most accurate epidemiological data in Australia come from the Northern Territory's RHD control programme. In the Northern Territory, 92% of people with RHD are Indigenous, of whom 85% live in remote communities and towns. The incidence of ARF is highest in 5-14-year-olds, ranging from 150 to 380 per 100,000. Prevalence rates of RHD since 2000 have steadily increased to almost 2% of the Indigenous population in the Northern Territory, 3.2% in those aged 35-44 years. Living in remote communities is a contributing factor to ARF/RHD as well as a major barrier for adequate follow-up and care. Impediments to ARF/RHD control include the paucity of specialist services, rapid turnover of health staff, lack of knowledge of ARF/RHD by health staff, patients and communities, and the high mobility of the Indigenous population. Fortunately, the recently announced National Rheumatic Fever Strategy, comprising recurrent funding to the Northern Territory, Queensland and Western Australia for control programmes, as well as the creation of a National Coordination Unit suggest that RHD control in Australia is now a tangible prospect. For the disease to be eradicated, Australia will have to address the underpinning determinants of poverty, social and living conditions.

The changing phases of pandemic (H1N1) 2009 in Queensland: an overview of public health actions and epidemiology

A graded public health response was implemented to control the pandemic (H1N1) 2009 outbreak in Queensland. Public health measures to contain the outbreak included border control, enhanced surveillance, management of cases and contacts with isolation or quarantine and antivirals, school closures and public education messages. The first confirmed case in Australia was notified on 8 May 2009, in a traveller returning to Queensland from the United States. In Queensland, 593 laboratory-confirmed cases were notified with a date of onset between 26 April and 22 June 2009, when the Protect phase of the Australian Health Management Plan for Pandemic Influenza was implemented; 16 hospitalisations and no deaths were reported during this time. The largest number of confirmed cases was reported in the 10-19-years age group (167, 28% of cases), followed by the 20-29-years age group (153, 26% of cases). With ongoing community transmission, the focus has shifted from public health to the clinical domain, with an emphasis on protecting vulnerable groups. Considerable resources have been invested to prevent and control the spread of disease in Indigenous communities in Far North Queensland. The capacity of clinical services to cope with increased admissions, the potential for widespread antiviral resistance, and rollout of mass vaccination campaigns remain future challenges.

High Burden of Staphylococcal Disease in Indigenous Communities

Numerous studies in the past 2 decades have recorded an apparently high rate of Staphylococcus aureus infection in socalled indigenous populations in particular, a high rate of infection caused by methicillin-resistant strains of S. aureus (MRSA) [1], Such problems have been documented among Native Americans [2], Pacific Islanders in Hawaii [3], Alaskan Natives [4, 5], aboriginal Canadians (First Nations, Metis, and Inuit) [6, 7], Western Samoans and other Pacific Islanders living in Auckland, New Zealand [8, 9], and Australian Aboriginals [10]. In this context, the concept of indigenous populations stems from the modern histories of the United States, Canada, and Australia. These histories have many parallels, one of which is the displacement and resettlement of indigenous populations that had occupied these countries for the previous tens of thousands of years. These populations became the Fourth World, that is, the Third

HUMAN RIGHTS, BIOMEDICAL SCIENCE, AND INFECTIOUS DISEASES AMONG SOUTH AMERICAN INDIGENOUS GROUPS

Despite the efforts of international health agencies to reduce global health inequalities, indigenous populations around the world remain largely unaffected by such initiatives. This chapter reviews the biomedical literature indexed by the PubMed database published between 1963 and 2003 on South American indigenous populations, a total of 1864 studies that include 63,563 study participants. Some language family groupings are better represented than are others, and lowland groups are better represented than are highland groups. Very few studies focus on major health threats (e.g., tuberculosis, influenza), public health interventions, or mestizo-indigenous epidemiological comparisons. The prevalence rates of three frequently studied infections—parasitism, human T-cell lymphotropic viral infection (HTLV), and hepatitis—are extraordinarily high, but these facts have been overlooked by national and international health agencies. This review underscores the urgent need for interventions based on known disease prevalence rates to reduce the burden of infectious diseases in indigenous communities.

Patterns of health seeking behavior during episodes of childhood diarrhea: a study of Tzotzil-speaking Mayans in the highlands of Chiapas, Mexico

In Chiapas, Mexico, diarrheal disease causes the majority of all deaths in children under the age of five. Treatment of childhood diarrhea may be influenced by local beliefs and cultural practices. Few studies have attempted to quantitatively evaluate health seeking behavior (HSB) for diarrheal diseases in indigenous communities, while controlling for potential confounding factors such as parental education or socioeconomic status. A rapid ethnographic survey was conducted in Nabenchauc, Chiapas, to determine hypothetical HSB patterns for each of four major types of childhood diarrhea. Additionally, we examined the actual HSB for the last episode of childhood diarrheal illness within the household. One hundred households participated in the survey; 94 households with children <5 years old reported a mean of 1.9 diarrheal episodes during the preceding month. Households reported using a mean of 1.3 types of in-home remedies. Oral rehydration therapy (ORT) was used in <2% of the 368 HSB patterns elicited for the four types of diarrhea. HSB patterns utilized an eclectic combination of traditional, allopathic, local and distant health care options. A mean of 2.5 outside-the-home health care options were reported for each diarrheal type; the local grocery store was reported in 245 (67%) of the hypothetical HSB patterns and as a first option in 199 (54%). Maternal and/or paternal education had little impact on hypothetical HSB. Households with lower SES were more likely to report using local grocery stores as a first option and were less likely to use options outside the village. The rapid ethnographic survey approach allows for assessment of changes in the approach to health care option utilization in cultures incorporating new health care paradigms. Public health interventions targeting local stores may lead to increased use of ORT, thereby potentially reducing early morbidity and mortality due to childhood diarrhea.