Remote Australian Communities Research Articles

Inorganic trace contaminant removal from real brackish groundwater using electrodialysis

Abstract The removal of inorganic trace contaminants from a real brackish groundwater from a remote Australian community using electrodialysis was investigated. Systematic investigation of applied voltage and solution pH was aimed to elucidate removal and deposition mechanisms in a complex water. A higher applied voltage enhanced removal of arsenic (V), boron, lithium, selenium (VI) and uranium. The removal of boron, lithium, sulfate, uranium, calcium, magnesium, strontium, zinc and selenium was pH dependent while the removal of bromide, chloride, fluoride and nitrate was pH independent. The precipitation of insoluble species at high pH and their complexation with other contaminants resulted in membrane deposition in the form of scaling. This influenced system performance in regards to an increase in stack resistance and decrease in removal of total dissolved solids. The hydrated radius and strength of hydration shells played a less important role in the transport and removal of ions during electrodialysis of real water in comparison to other parameter such us ion concentration and solution pH. Results from this study showed that although electrodialysis is effective in the removal of contaminants from real waters, consideration needs to be given to its long-term practical applicability in regards to membrane scaling.

Lessons from a basic income programme for Indigenous Australians

This article examines the importance of basic income in supporting development and economic security in remote Australian Indigenous communities. Specifically we draw on the case of the Community Development Employment Programme (CDEP) and examine its significant basic income features: it provided economic security, flexible definitions of work, community control and a means to establish community development initiatives. We find that CDEP suited the economic and cultural circumstances of remote-living Aboriginal people whose livelihoods depend on a hybrid form of economy inclusive of customary (non-market) practices rather than market capitalism. We then trace shifts in Indigenous policy in recent times which saw the dismantling of CDEP in the name of ‘real’ employment, and we examine the consequences of this for Aboriginal people. We end by proposing the reinstatement of a more complete basic income scheme, initially for people in remote Indigenous communities in Australia who are in deepest poverty.

Framework guidelines for students - collaborative learning in distance education

This research study explores theoretical framework guidelines for students engaged in distanceeducation through collaborative learning. Distance education has played an important role in the provision ofeducational equity for distance learners who live in remote Australian communities. Engaging students andacademic staff will always enhance student-learning outcomes to ensure a positive experience in distanceeducation. It can be effectively achieved through collaborative learning for off-campus learners. In distanceeducation, academic staff and students encounters a number of challenges such as lack of student motivation, highstudent attrition rates, and a sense of isolation from a university community. Collaborative learning experienceswill enhance learner-staff and learner-learner interactions in distance learning, which can be achieved throughdeveloping a learning process. The learning process for distance learners involves student-learning strategy, Staffinteractive sessions, peer-to-peer support, e-assessment, and self-realization of graduate learning outcomes. Thisdistance learning process and framework guidelines are confined for Deakin University learning environment,however the expectations is that the distance learning will be more mainstream in future of learning and teachingin Australian institutions. The focus of this research is to develop framework guidelines by analyzing collaborativelearning experience of distance learners (off-campus) in a particular unit. It helps to analyze the barriers indistance education and finding ways to initiate collaborative programs in future. It also helps to fulfill the distancelearners’ expectations on program delivery.

Delivering an empowerment intervention to a remote Indigenous child safety workforce: Its economic cost from an agency perspective

BackgroundThe Family Wellbeing (FWB) program applies culturally appropriate community led empowerment training to enhance the personal development of Aboriginal and Torres Strait Islander people in life skills. This study sought to estimate the economic cost required to deliver the FWB program to a child safety workforce in remote Australian communities. MethodThis study was designed as a retrospective cost description taken from the perspective of a non-government child safety agency. The target population were child protection residential care workers aged 24 or older, who worked in safe houses in five remote Indigenous communities and a regional office during the study year (2013). Resource utilization included direct costs (personnel and administrative) and indirect or opportunity costs of participants, regarded as absence from work. ResultsThe total cost of delivering the FWB program for 66 participants was $182,588 ($2766 per participant), with 45% ($82,995) of costs classified as indirect (i.e., opportunity cost of participants time). Training cost could be further mitigated (∼30%) if offered on-site, in the community. The costs for offering the FWB program to a remotely located workforce were high, but not substantial when compared to the recruitment cost required to substitute a worker in remote settings. ConclusionAn investment of $2766 per participant created an opportunity to improve social and emotional wellbeing of remotely located workforce. This cost study provided policy relevant information by identifying the resources required to transfer the FWB program to other remote locations. It also can be used to support future comparative cost and outcome analyses and add to the evidence base around the cost-effectiveness of empowerment programs.

Strongyloides seroprevalence before and after an ivermectin mass drug administration in a remote Australian Aboriginal community.

BackgroundStrongyloides seroprevalence is hyper-endemic in many Australian Aboriginal and Torres Strait Islander communities, ranging from 35–60%. We report the impact on Strongyloides seroprevalence after two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community.MethodsUtilizing a before and after study design, we measured Strongyloides seroprevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined changes in serostatus. Serodiagnosis was undertaken by ELISA that used sonicated Strongyloides ratti antigen to detect anti-Strongyloides IgG. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 10–42 days if Strongyloides and/or scabies was diagnosed; others followed a standard alternative algorithm. A questionnaire on clinical symptoms was administered to identify adverse events from treatment and self-reported symptoms associated with serostatus.FindingsWe surveyed 1013 participants at the baseline population census and 1060 (n = 700 from baseline cohort and 360 new entrants) at month 12. Strongyloides seroprevalence fell from 21% (175/818) at baseline to 5% at month 6. For participants from the baseline cohort this reduction was sustained at month 12 (34/618, 6%), falling to 2% at month 18 after the second MDA. For new entrants to the cohort at month 12, seroprevalence reduced from 25% (75/297) to 7% at month 18. Strongyloides positive seroconversions for the baseline cohort six months after each MDA were 2.5% (4/157) at month 6 and 1% at month 18, whilst failure to serorevert remained unchanged at 18%. At 12 months, eosinophilia was identified in 59% of baseline seropositive participants and 89% of seropositive new entrants, compared with 47%baseline seronegative participants and 51% seronegative new entrants. Seropositivity was not correlated with haemoglobin or any self-reported clinical symptoms. Clinical symptoms ascertained on the day of treatment and 24–72 hrs after, did not identify any adverse events.SignificanceTwo community ivermectin MDAs delivered 12 months apart by trained Aboriginal researchers in collaboration with non-Indigenous researchers resulted in a sustained and significant reduction in Strongyloides seroprevalence over 18 months. Similar reductions were seen in the baseline cohort and new entrants.

Prescribing for people with acute rheumatic fever.

Acute rheumatic fever and its consequence, rheumatic heart disease, remain important problems in remote indigenous Australian communities. Aboriginal and Torres Strait Islander people living in urban settings, Maori and Pacific Islanders, and immigrants from developing countries are also likely to be at elevated risk. Guidelines and resources are available for healthcare professionals working with at-risk populations, and for patients with acute rheumatic fever or rheumatic heart disease and their families. There have been some recent changes in Australian recommendations for antibiotic use, dose of aspirin, first-line choice for management of severe Sydenham’s chorea, and prevention of endocarditis. For individuals diagnosed with acute rheumatic fever, the recommended treatment to prevent recurrences and development of rheumatic heart disease is benzathine penicillin G administered as an intramuscular injection every four weeks.

Effectof25%SodiumReductiononSalesof aTop-SellingBreadinRemoteIndigenousAustralian CommunityStores:AControlledInterventionTrial.

Reducing sodium in the food supply is key to achieving population salt targets, but maintaining sales is important to ensuring commercial viability and maximising clinical impact. We investigated whether 25% sodium reduction in a top-selling bread affected sales in 26 remote Indigenous community stores. After a 23-week baseline period, 11 control stores received the regular-salt bread (400 mg Na/100 g) and 15 intervention stores received the reduced-salt version (300 mg Na/100 g) for 12-weeks. Sales data were collected to examine difference between groups in change from baseline to follow-up (effect size) in sales (primary outcome) or sodium density, analysed using a mixed model. There was no significant effect on market share (−0.31%; 95% CI −0.68, 0.07; p = 0.11) or weekly dollars ($58; −149, 266; p = 0.58). Sodium density of all purchases was not significantly reduced (−8 mg Na/MJ; −18, 2; p = 0.14), but 25% reduction across all bread could significantly reduce sodium (−12; −23, −1; p = 0.03). We found 25% salt reduction in a top-selling bread did not affect sales in remote Indigenous community stores. If achieved across all breads, estimated salt intake in remote Indigenous Australian communities would be reduced by approximately 15% of the magnitude needed to achieve population salt targets, which could lead to significant health gains at the population-level.

Riding the rural radio wave: The impact of a community-led drug and alcohol radio advertising campaign in a remote Australian Aboriginal community.

Aboriginal people experience a higher burden of disease as a consequence of drug and alcohol (D&A) abuse. Although media campaigns can be a popular tool for disseminating health promotion messages, evidence of the extent to which they reduce the impact of substance abuse is limited, especially for rural Aboriginal communities. This paper is the first to examine the impact a locally designed D&A radio advertising campaign for Aboriginal people in a remote community in Western NSW. A post-intervention evaluation. The radio campaign was implemented in Bourke, (population 2465, 30% Aboriginal). Fifty-three community surveys were completed. The self-reported level of awareness of the campaign and the number of self-referrals to local D&A workers in the intervention period. Most respondents (79%) reported they listen to radio on a daily basis, with 75% reporting that they had heard one or more of the advertisements. The advertisement that was remembered best contained the voice of a respected, local person. There was one self-referral to local health services during the intervention timeframe. The community-led radio advertising campaign increased community awareness of substance abuse harms, but had limited impact on formal help-seeking. This paper highlights the value of radio as a commonly used, trusted and culturally relevant health promotion medium for rural communities, especially when engaging local respected Aboriginal presenters.

Safety and Efficacy of Warfarin Therapy in Remote Communities of the Top End of Northern Australia

Warfarin remains a widely used anticoagulant but application in the remote context is not well documented. This study aimed to assess in more detail whether warfarin is being utilised effectively in Australia's most isolated and remote areas. Retrospective cohort analysis of 2013 captured international normalised ratio (INR) results from people engaged in long term warfarin usage within a number of remote Northern Australian communities. Assessment of monitoring, effectiveness of dosing and complication rates was undertaken. A cohort of 167 patients was established. On average, warfarin was utilised within therapeutic range 52% of the time. Monitoring frequency averaged 16 days. Major bleeding and thrombo-embolism occurred at rates of 5.8 and 4.1 per 100 patient years respectively. Therapeutic utilisation of warfarin in this setting is close to accepted rates but has room for improvement. Monitoring was acceptable and complication rates were not disproportionately high. This study indicates that warfarin is being used with reasonable safety and efficacy in remote regions, but further research is needed.

Fluctuations in money availability within an income cycle impacts diet quality of remote Indigenous Australians.

To consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians. Community-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP. All scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes. The modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.

An evaluation of the telehealth facilitation of diabetes and cardiovascular care in remote Australian Indigenous communities: - protocol for the telehealth eye and associated medical services network [TEAMSnet] project, a pre-post study design

BackgroundDespite substantial investment in detection, early intervention and evidence-based treatments, current management strategies for diabetes-associated retinopathy and cardiovascular disease are largely based on real-time and face-to-face approaches. There are limited data re telehealth facilitation in type 2 diabetes management. Therefore, we aim to investigate efficacy of telehealth facilitation of diabetes and cardiovascular disease care in high-risk vulnerable Aboriginal and Torres Strait Islanders in remote/very remote Australia.MethodsUsing a pre-post intervention design, 600 Indigenous Australians with type 2 diabetes will be recruited from three primary-care health-services in the Northern Territory. Diabetes status will be based on clinical records. There will be four technological interventions: 1. Baseline retinal imaging [as a real-time patient education/engagement tool and telehealth screening strategy]. 2. A lifestyle survey tool administered at ≈ 6-months. 3. At ≈ 6— and 18-months, an electronic cardiovascular disease and diabetes decision-support tool based on current guidelines in the Standard Treatment Manual of the Central Australian Rural Practitioner’s Association to generate clinical recommendations. 4. Mobile tablet technology developed to enhance participant engagement in self-management. Data will include: Pre-intervention clinical and encounter-history data, baseline retinopathy status, decision-support and survey data/opportunistic mobile tablet encounter data. The primary outcome is increased participant adherence to clinical appointments, a marker of engagement and self-management. A cost-benefit analysis will be performed.DiscussionRemoteness is a major barrier to provision and uptake of best-practice chronic disease management. Telehealth, beyond videoconferencing of consultations, could facilitate evidence-based management of diabetes and cardiovascular disease in Indigenous Australians and serve as a model for other conditions.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404 was retrospectively registered on 22/03/2016

Anaemia Health Literacy of Community Members and Health Practitioners Knowledge of Best Practice Guidelines in a Remote Australian Aboriginal Community

Anaemia is a critical public health problem in Australian Aboriginal and Torres Strait Islander people for which the health literacy of community members and health practitioners is unknown. Worldwide, pregnant women and children have the highest anaemia rates and are the major groups targeted for screening and intervention programs. In the Northern Territory, Australia, 15% of Aboriginal mothers are anaemic during pregnancy and up to 25 % of children aged 0-5 years are anaemic, with the highest prevalence of 31% identified in those aged 6-11 months. Anaemia can have adverse effects on physical and cognitive development in the early years and has long-term implications for the development of chronic diseases later in life. The aim of this study was to assess anaemia health literacy of community members and health practitioner's knowledge of anaemia best practice guidelines in a remote Aboriginal community where English is not the first language. Focus groups and individual interviews were conducted with 39 community members and 12 health practitioners. Among community members there were mixed levels of anaemia health literacy with the majority assessed as having 'good' literacy. Health practitioners had a 'very good' level of anaemia knowledge that was excellent for one group.

An Approach for Enhancing Adoption, Use and Utility of Shared Digital Health Records in Rural Australian Communities.

Internationally, shared digital health records are considered an important addition to improving modern health care provision. Australia launched its version, My Health Record (MyHR), in 2012 but has experienced low adoption and challenges in practical implementation and evaluation. Individuals living with complex and chronic conditions in rural and remote communities often experience challenges in obtaining equitable access to health care provision. They are also supposed to face additional barriers to adopting and using eHealth services. This paper reports on research investigating adoption, use and utility of MyHR, in rural remote Australian community settings. Based on this research an approach for improving national roll out of MyHR is presented. The approach highlights a means to understand and engage communities with complex care needs, to support their adoption and use of digital tools. It also draws attention to holistic methods for evaluating and assessing impact at individual, community and health care provision levels.

Linguistic cues for recipient design in an Indigenous Australian conversational narrative

This article presents an examination of some of the linguistic and interactional features of a story emerging from talk in a remote Indigenous Australian community. In the data used here, the storyteller is an elderly Garrwa woman in Borroloola who speaks Garrwa and Kriol. The focus is on how the addition of a non-community member to the field of interaction affected the way the storyteller recounted events from a situation within the previous 24 hours. This is seen not only in what events are told, but also how the teller tailored her story to her audience in the context of telling — a recognition that stories are interactively achieved. Here I examine how she accommodated the knowledge states of her audience, how recipients responded and how this in turn affected the trajectory of the storytelling.

Whole genome sequencing to investigate a putative outbreak of the virulent community-associated methicillin-resistant Staphylococcus aureus ST93 clone in a remote Indigenous community.

We report two cases of severe pneumonia due to clone ST93 methicillin-resistant Staphylococcus aureus (MRSA) presenting from a remote Australian Indigenous community within a 2-week period, and the utilization of whole genome sequences to determine whether these were part of an outbreak. S. aureus was isolated from 12 of 92 nasal swabs collected from 25 community households (including the two index households); one isolate was ST93. Three of five skin lesion S. aureus isolates obtained at the community were ST93. Whole genome sequencing of the ST93 isolates from this study and a further 20 ST93 isolates from the same region suggested that recent transmission and progression to disease had not taken place. The proximity in time and space of the two severe pneumonia cases is probably a reflection of the high burden of disease due to ST93 MRSA in this population where skin infections and household crowding are common.

A space to learn: A community-based approach to meaningful adult learning and literacy in remote Indigenous Australia

If young adults in remote Indigenous Australian communities are to acquire the knowledge and skills necessary to participate effectively in mature roles in their own and the wider community, then educators will need to pay attention not only to the provision of schooling and formal adult-literacy tuition, but also to how language, literacy, and technological know-how are acquired through socialization and learning as a lifelong process. In this article, Inge Kral and Jerry Schwab take a social practice approach to reading (and writing) by looking at how Indigenous youth use alphabetic and digital literacies in everyday life and in community settings beyond school. Their proposition is that, in addition to pedagogy, it is meaningful practice across the lifespan that determines competence. Drawing on ethnographic research, Kral and Schwab outline a “learning centre” model, suggesting that it provides a template not only for transformative practice but also for achieving an appropriate blend of formal and nonformal approaches to adult learning in the remote context.

Strengthening food systems with remote Indigenous Australians: stakeholders' perspectives.

It is well accepted that actions to enhance food security and nutrition outcomes in remote Indigenous Australian communities have limited success when focusing on single factors and could far better be addressed by working across the whole food system. The formation of multi-sector groups to collectively work towards improved food security could facilitate this approach. This study sought to elicit the perceptions of a range of stakeholders on the enablers, barriers and perceived benefits of a multi-sector participatory approach that was developed and trialled with four communities to improve food security. Semi-structured interviews were used to collect data from 60 persons and transcripts were examined using thematic analysis. Findings revealed that there is support in engaging a diverse range of stakeholders in a process of community-led action to support incremental improvement. The employment and support of local community co-ordinators, the multi-sectoral and structured approach, the use of participatory tools, and the facilitation approach were identified as key enablers. Main barriers cited were competing demands and time restraints while a slowing in momentum and lack of timely communication of actions for follow-up were areas needing improvement. Perceived changes in the availability and accessibility of healthy food and improvements in retail practice were believed by participants to derive from (i) creating a supportive environment; (ii) bringing people together; and, (iii) increasing knowledge and capacity. This study offers insight into understanding where the opportunities are in supporting a multi-sectoral approach to improving food security in remote Indigenous Australia.

Exploring Community Attitudes Towards Sharing of Bushfire Information Online

This research describes outcomes from a project that aimed to present near real-time bushfire information to remote and regional Australian communities susceptible to bushfires through an intuitive and easy to use interface. This project arose as a response to calls for increased information sharing amongst communities and individuals in the wake of several severe fire events in Australia. Several rounds of user engagement were undertaken, which informed the design of an application that came to be known as MyFireWatch, which was launched as an officially-supported publicly-accessible web application. Previous research in Australia regarding bushfire information suggests that user-sourced data can provide rich, timely and meaningful information. Yet the MyFireWatch research, the first of its kind in Australia to ascertain community attitudes to user-sourced disaster information, found that user attitudes varied. This paper describes those user attitudes and how they pose both challenges and opportunities for organisations who provide publicly-accessible disaster information.

General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines

ObjectivesThis study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009. MethodsWe continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine. ResultsMean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist. ConclusionsThe general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.

Why are men less tested for sexually transmitted infections in remote Australian Indigenous communities? A mixed-methods study

Gender disparities in testing rates for sexually transmitted infections (STIs) have been identified as one potential factor sustaining high rates of STIs and repeat infections in the Northern Territory of Australia, especially in remote Indigenous communities. The study aimed to investigate the reasons for these disparities utilising a mixed-method study design. We conducted an audit on client information at a remote community health clinic, focus-group discussions with young men in the same community and interviews with experienced remote area clinicians. The clinic audit found a significantly higher proportion of female residents of the community than males visited the clinic (72.8 versus 55.3%, p < 0.005). Women were also more likely to be tested for STIs than men when visiting the clinic (49.7 versus 40.3%, p = 0.015). Major barriers to men’s seeking STI testing included a sense of shame from being seen visiting the clinic by women, men’s lack of understanding of STIs and the need for testing, and inadequate access to male clinicians. Increasing men’s access to healthcare and STI testing requires offering testing at a gender-sensitive and separate locations, and community-based sexual health promotion to increase knowledge of STIs.