Remote Communities In Northern Australia Research Articles

Enteric pathogen infection and consequences for child growth in young Aboriginal Australian children: a cross-sectional study

BackgroundTo determine the prevalence of enteric infections in Aboriginal children aged 0–2 years using conventional and molecular diagnostic techniques and to explore associations between the presence of pathogens and child growth.MethodsCross-sectional analysis of Aboriginal children (n = 62) residing in a remote community in Northern Australia, conducted from July 24th - October 30th 2017. Stool samples were analysed for organisms by microscopy (directly in the field and following fixation and storage in sodium-acetate formalin), and by qualitative PCR for viruses, bacteria and parasites and serology for Strongyloides-specific IgG. Child growth (height and weight) was measured and z scores calculated according to WHO growth standards.ResultsNearly 60% of children had evidence for at least one enteric pathogen in their stool (37/62). The highest burden of infection was with adenovirus/sapovirus (22.9%), followed by astrovirus (9.8%) and Cryptosporidium hominis/parvum (8.2%). Non-pathogenic organisms were detected in 22.5% of children. Ten percent of children had diarrhea at the time of stool collection. Infection with two or more pathogens was negatively associated with height for age z scores (− 1.34, 95% CI − 2.61 to − 0.07), as was carriage of the non-pathogen Blastocystis hominis (− 2.05, 95% CI - 3.55 to − 0.54).ConclusionsInfants and toddlers living in this remote Northern Australian Aboriginal community had a high burden of enteric pathogens and non-pathogens. The association between carriage of pathogens/non-pathogens with impaired child growth in the critical first 1000 days of life has implications for healthy child growth and development and warrants further investigation. These findings have relevance for many other First Nations Communities that face many of the same challenges with regard to poverty, infections, and malnutrition.

One Health promotion and the politics of dog management in remote, northern Australian communities

Community perspectives are rarely sought or integrated into dog management policy and practice. Dog management in remote communities in Australia has focused on reducing the number of dogs, which is often implemented by visiting veterinarians, despite widely-held opinions that fly-in-fly-out services provide only temporary solutions. We conducted participatory research in a group of remote communities in northern Australia to explore how dog-related problems arise and are managed, and explain their impacts from a One Health perspective. Over the course of a year, 53 residents from a range of backgrounds contributed through in-depth interviews with key community service providers, and informal semi-structured discussions with community residents. Free-roaming dogs have broader impacts on canine and human health than previously documented. Dog-keeping norms that enable free-roaming can enhance human and dog wellbeing and intra-family connectivity. This can also cause disengagement and conflict with other residents, leading to resentment and occasionally violence towards dogs. Dog-related problems are underpinned by constraints associated with remote-living, governance and differing sociocultural norms. Focusing on dog population reduction detracts from the welfare benefits and sociocultural value of free-roaming dogs and undermines community-determined management that can overcome constraints to support local values and co-promote canine and human wellbeing.

Skin infections in Australian Aboriginal children: a narrative review.

Summary Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities.Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications.Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings.The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin.Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.

Investigation of the temporal roaming behaviour of free-roaming domestic dogs in Indigenous communities in northern Australia to inform rabies incursion preparedness

Australia is canine rabies free but free-roaming, domestic dog populations in remote northern communities are at risk of an incursion due to proximity to rabies-endemic south-east Asia. Unrestricted contact between dogs could facilitate rabies spread following an incursion, and increase the impact on both dogs and people. Whilst dog vaccination is the foundation of rabies prevention, control strategies could be enhanced by understanding the temporal pattern of roaming and associated risk factors, so that movement restrictions can be targeted. Global positioning system datasets from 132 dogs in eight Indigenous communities in the Torres Strait and Northern Peninsula Area (NPA) of Australia were analysed using regression methods. The influence of risk factors (including age, sex, location, season and hour of day) on dogs’ distance from their residences were assessed. Dogs roamed furthest in the NPA and during the dry season. Daily peaks in mean roaming distance were observed at 1000–1100 hrs and 1700–1800 hrs in the Torres Strait, and 1700–1800 hrs in the NPA. These findings demonstrate that understanding community-specific temporal roaming patterns can inform targeted movement restrictions during an outbreak of rabies in remote communities in northern Australia.

Opportunistic pathogens and large microbial diversity detected in source-to-distribution drinking water of three remote communities in Northern Australia.

In the wet-dry tropics of Northern Australia, drinking water in remote communities is mostly sourced from bores accessing groundwater. Many aquifers contain naturally high levels of iron and some are shallow with surface water intrusion in the wet season. Therefore, environmental bacteria such as iron-cycling bacteria promoting biofilm formation in pipes or opportunistic pathogens can occur in these waters. An opportunistic pathogen endemic to northern Australia and Southeast Asia and emerging worldwide is Burkholderia pseudomallei. It causes the frequently fatal disease melioidosis in humans and animals. As we know very little about the microbial composition of drinking water in remote communities, this study aimed to provide a first snapshot of the microbiota and occurrence of opportunistic pathogens in bulk water and biofilms from the source and through the distribution system of three remote water supplies with varying iron levels. Using 16s-rRNA gene sequencing, we found that the geochemistry of the groundwater had a substantial impact on the untreated microbiota. Different iron-cycling bacteria reflected differences in redox status and nutrients. We cultured and sequenced B. pseudomallei from bores with elevated iron and from a multi-species biofilm which also contained iron-oxidizing Gallionella, nitrifying Nitrospira and amoebae. Gallionella are increasingly used in iron-removal filters in water supplies and more research is needed to examine these interactions. Similar to other opportunistic pathogens, B. pseudomallei occurred in water with low organic carbon levels and with low heterotrophic microbial growth. No B. pseudomallei were detected in treated water; however, abundant DNA of another opportunistic pathogen group, non-tuberculous mycobacteria was recovered from treated parts of one supply. Results from this study will inform future studies to ultimately improve management guidelines for water supplies in the wet-dry tropics.

Calculation of the age of the first infection for skin sores and scabies in five remote communities in northern Australia.

Prevalence of skin sores and scabies in remote Australian Aboriginal communities remains unacceptably high, with Group A Streptococcus (GAS) the dominant pathogen. We aim to better understand the drivers of GAS transmission using mathematical models. To estimate the force of infection, we quantified the age of first skin sores and scabies infection by pooling historical data from three studies conducted across five remote Aboriginal communities for children born between 2001 and 2005. We estimated the age of the first infection using the Kaplan-Meier estimator; parametric exponential mixture model; and Cox proportional hazards. For skin sores, the mean age of the first infection was approximately 10 months and the median was 7 months, with some heterogeneity in median observed by the community. For scabies, the mean age of the first infection was approximately 9 months and the median was 8 months, with significant heterogeneity by the community and an enhanced risk for children born between October and December. The young age of the first infection with skin sores and scabies reflects the high disease burden in these communities.

Control of chronic Strongyloides stercoralis infection in an endemic community may be possible by pharmacological means alone: Results of a three-year cohort study.

ObjectivesTo assess the effect of treatment with ivermectin on the prevalence of S. stercoralis infection in an Australian Aboriginal population over a three year period, and to assess the validity of using a lower ELISA cut-off in diagnosis.MethodsA three-year cohort study of 259 adult Australian Aboriginals living in a remote community in northern Australia. S stercoralis infection was diagnosed using commercial ELISA testing, and employed a lower threshold for treatment than that recommended. Follow up was conducted at 6 months and 3 years following ivermectin treatment.FindingsTreatment with ivermectin was highly effective and resulted in a sustained fall in the prevalence of infection in the study group (Initial prevalence 35.3%, 3 year prevalence 5.8%, McNemar’s chi2 = 56.5, p<0.001). Results of treatment suggested use of a lower ELISA threshold for treatment was valid in this setting. Follow up identified a small group of subjects with persistently positive ELISA serology despite repeated treatment.InterpretationControl of S. stercoralis infection in this cohort appears to be feasible using pharmacological treatment alone.

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.

Modelling the impacts of water efficient technologies on energy intensive water systems in remote and isolated communities

Essential service providers face unique challenges that are specific delivering a secure and safe water and energy supply to remote communities such as islands and isolated mainland townships. Many remote communities rely on energy intensive water supply systems which are inherently costly to operate. Water demand management programmes such as retrofitting households with water-efficient devices and appliances are one way of reducing the water-energy costs in these communities. This paper presents modelling results from a comparison between business as usual and a scenario where water-efficient strategies were retrofitted in households in three remote communities in Northern Australia. The modelling demonstrated considerable savings to both the water and energy average daily consumption and associated economic costs though reduced reliance on desalination plants and bore pumping. The retrofit scenario was shown to reduce water demand by between 14 and 39 ML/y and total energy demand in off-grid communities by between 83 and 208 MWh/y. Cost reductions for delivering treated water to households ranged between around AUD$11,000 and AUD$70,000 per year, depending on uptake rates of the retrofit programme by each community. This paper forms part of Stage 1 of the Remote and Isolated Communities Essential Services (RICES) project. Stage 2 will confirm many of the assumptions underlying the modelling and build on the smart metering datasets and community engagement process currently underway in Stage 1. The overall outcome of the RICES project is to ensure that such strategies are practical to implement on a broader scale to ultimately achieve more sustainable water and energy efficient off-grid communities.

Remote links: Redesigning maternity care for Aboriginal women from remote communities in Northern Australia – A comparative cohort study

Objectiveto compare the quality of care before and after the introduction of the new Midwifery Group Practice. Designa cohort study. Settingthe health centers (HCs) in two of the largest remote Aboriginal communities (population 2200–2600) in the Top End of the Northern Territory (NT), each located approximately 500km from Darwin. The third study site was the Royal Darwin Hospital (RDH) which provides tertiary care. Methodsa 2004–06 retrospective cohort (n=412 maternity cases) provided baseline data. A clinical redesign of maternity services occurring from 2009 onwards focused on increasing Continuity of Carer, Communication, Choice, Collaboration and Co-ordination of Care (5Cs). Data from a 2009–11 prospective cohort (n=310 maternity cases) were collected to evaluate the service redesign. Outcome measures included indicators on the quality of care delivery, adherence to recommended antenatal guidelines and maternal and neonatal health outcomes. Findingsstatistically significant improvements were recorded in many areas reflecting improved access to, and quality of, care. For example: fewer women had <4 visits in pregnancy (14% versus 8%), a higher proportion of women had routine antenatal tests recorded (86% versus 97%) and improved screening rates for urine (82% versus 87%) and sexual tract infections (78% versus 93%). However, the treatment of conditions according to recommended guidelines worsened significantly in some areas; for example antibiotics prescribed for urine infections (86% versus 52%) and treatment for anaemia in pregnancy (77% versus 67%). High preterm (21% versus 20%), low birth weight (18% versus 20%) and PPH (29% versus 31%) rates did not change over time. The out of hospital birth rate remained high and unchanged in both cohorts (10% versus 10%). Conclusionthis model addresses some of the disparities in care for remote-dwelling Aboriginal women. However, much work still needs to occur before maternity care and outcomes are equal to that of non-Aboriginal women. Targeted program interventions with stronger clinical governance frameworks to improve the quality of care are essential. A complete rethink of service delivery and engagement may deliver better results.

Obesity, albuminuria, and gamma-glutamyl transferase predict incidence of hypertension in indigenous Australians in rural and remote communities in northern Australia.

Objective:To describe the incidence of hypertension in a cohort of Australian Aboriginal and Torres Strait Islanders.Method:A follow-up study conducted among 1831 indigenous population aged 15 years and over without hypertension at baseline from 19 communities in North Queensland during 1997–2008. Main measurements included baseline and follow-up weight, waist circumference, blood pressure, fasting glucose, lipids (triglycerides and cholesterol), gamma-glutamyl transferase, urinary albumin creatinine ratio, self-reported tobacco smoking, alcohol intake and physical activity.Results:Hundred cases of hypertension developed over 2633.4 person-years giving a crude incidence of hypertension of 22.6 (16.2–31.4) per 1000 person-years in females and 60.0 (47.1–76.6) per 1000 person-years for males. Age standardized overall incidence was 51.9 per 1000 person-years. Aboriginal participants were twice as likely as Torres Strait Islanders to develop hypertension, which increased with age. Obesity (BMI >30) strongly predicted incident hypertension independently of age or sex (adjusted hazard ratio 2.9, 95% confidence interval 1.9–4.8). Albuminuria and elevated gamma-glutamyl transferase increased the risk of hypertension (adjusted hazard ratio 1.4–1.7) in this population.Conclusion:Incidence of hypertension in indigenous Australian adults is nearly double than that of the general Australian population. High background prevalence of obesity, diabetes and albuminuria contributes to this excess. As well as early detection and management of high blood pressure, albuminuria and diabetes in primary care settings, attention should be equally focused on community-level prevention and management of obesity.

Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults

ObjectiveTo explore the relationship between infection with Strongyloides stercoralis and the likelihood of having type 2 diabetes mellitus (T2DM). MethodsCross-sectional survey of 259 Aboriginal adults living in a remote community in northern Australia during 2013. Prior infection with S. stercoralis was determined by ELISA testing on serum. Main outcomes were eosinophil count, T2DM diagnosis, HbA1c, BMI, fasting lipids, Hb, blood pressure. FindingsNinety two participants (36%) had prior infection with S. stercoralis and 131 (51%) had T2DM. Those with previous S. stercoralis infection (ELISA titre ≥0.3) were 61% less likely to have a diagnosis of T2DM than those uninfected, adjusted for age, triglycerides, blood pressure and BMI using propensity score (adjusted OR=0.39, 0.23–0.67, P=0.001).Interpretation: In this remote community where prevalence of both S. stercoralis and T2DM is very high, infection with S. stercoralis appears to be associated with a significantly reduced risk of T2DM in adults. A plausible immunological mechanism has been identified in animal models. If confirmed, this result may have practical implications for the prevention of T2DM and associated metabolic disorders in humans. This finding should be explored further with larger longitudinal studies in transitional populations where the risk of both conditions is high. FundingNo external funding was required for this study.

Female Indigenous entrepreneurship in remote communities in northern Australia

Little is known about Australian Indigenous female entrepreneurship. Misconceptions typifying Australian Indigenous businesses are community enterprises are encumbered by research limitations, generalisations and stereotyping; the material is seldom voiced by Australian Indigenous people; and few sources detail the challenges for grass roots female Indigenous entrepreneurs in remote Australian Aboriginal communities that maintain patriarchal cultures. In this paper is described how 21 Indigenous female entrepreneurs in a remote region of northern Australia have tailored their businesses to comply with the regulatory and statutory framework of the dominant society while preserving sensitivity to the traditional cultural norms, rules, and obligations. The data were independently corroborated by Indigenous and non Indigenous men of recognised standing in the region. These empirical observations provide foundation for better informed judgements about the business environment in remote regions of Australia, which is fundamental when developing policies for delivering sustainable female Indigenous small businesses.

Developing an instrument for assessing fidelity of motivational care planning: The Aboriginal and Islander Mental health initiative adherence scale.

PurposeThe aim of this study was to design and trial an Adherence Scale to measure fidelity of Motivational Care Planning (MCP) within a clinical trial. This culturally adapted therapy MCP uses a client centered holistic approach that emphasises family and culture to motivate healthy life style changes.MethodsThe Motivational Care Planning-Adherence Scale (MCP-AS) was developed through consultation with Aboriginal and Islander Mental Health Initiative (AIMhi) Indigenous and non-Indigenous trainers, and review of MCP training resources. The resultant ten-item scale incorporates a 9-Point Likert Scale with a supporting protocol manual and uses objective, behaviourally anchored criteria for each scale point. A fidelity assessor piloted the tool through analysis of four audio-recordings of MCP (conducted by Indigenous researchers within a study in remote communities in Northern Australia). File audits of the remote therapy sessions were utilised as an additional source of information. A Gold Standard Motivational Care Planning training video was also assessed using the MCP-AS.ResultsThe Motivational Care Planning-Adherence Scale contains items measuring both process and content of therapy sessions. This scale was used successfully to assess therapy through observation of audio or video-recorded sessions and review of clinical notes. Treatment fidelity measured by the MCP-AS within the pilot study indicated high fidelity ratings. Ratings were high across the three domains of rapport, motivation, and self-management with especially high ratings for positive feedback and engagement, review of stressors and goal setting.ConclusionsThe Motivational Care Planning-Adherence Scale has the potential to provide a measure of quality of delivery of Motivation Care Planning. The pilot findings suggest that despite challenges within the remote Indigenous community setting, Indigenous therapists delivered therapy that was of high fidelity. While developed as a research tool, the scale has the potential to support fidelity of delivery of Motivation Care Planning in clinical, supervision and training settings. Larger studies are needed to establish inter-rater reliability and internal and external validity.

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery.

BackgroundRemote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.MethodsA mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004–2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians’ perspectives on barriers to effective remote health service delivery.ResultsData from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians’ to impact upon the quality of service delivery.ConclusionAmong Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians’ adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

Factors affecting the quality of antenatal care provided to remote dwelling Aboriginal women in northern Australia

Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women.Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004–2006 (n=412). Medical records from remote health centres and the regional hospital were audited.Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for follow-up of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care.Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes.

Talking books for children's home use in a minority Indigenous Australian language context

&lt;span&gt;Members of the Kunibídji community are the traditional owners of the lands and seas around Maningrida, a remote community in Northern Australia. Most of the 200 members of the Kunibídji Community speak Ndjébbana as their first language. This study reports on the complexities of transforming technology to provide Kunibídji children with access to digital texts at home. The printed Ndjébbana texts that were kept at school were transformed to Ndjébbana talking books displayed on touch screen computers in the children's homes. Some results of the children's interaction around these touch screens are presented as well as some quantitative results of the computer viewing in the homes. The processes of rejecting technological determinism, upholding linguistic human rights of speakers of minority languages and viewing technology as practice rather than a set of artefacts are discussed in this paper. The results of this study hightlight the need for speakers of minority Indigenous Australian languages to have access to texts in their threatened languages on technologies at home.&lt;/span&gt;

Telecommunications infrastructure facilitating sustainable development of rural and remote communities in Northern Australia

Telecommunications access in the rural and remote areas of Australia has come under considerable scrutiny in recent years. In the past decade, various Federal Government reports and inquiries have citied inadequate infrastructure, lack of service provision, the high cost of access and “thin” markets as key impediments. Whilst these difficulties are not restricted to rural and remote Australia, they tend to impact disproportionately on regional communities, notably in education and health service provision. Particularly at risk are the indigenous communities in rural and remote regions of Australia. In this paper telecommunications infrastructure is perceived as the lynch-pin for achieving sustainable economic and social development. It is suggested that without appropriate development of information infrastructure, the disparities already experienced by rural and remote communities will be further exacerbated as the reliance of goods and services over computer-mediated networks increases. The paper offers a new paradigm that will assist in maintaining a competitive telecommunications environment and facilitate the sustainable social and economic development of rural and remote communities.

NUTRITION, BODY SIZE AND KIDNEY DIMENSIONS IN ABORIGINAL CHILDREN

BackgroundStandards for normal kidney dimensions by age and sex are available and usually relate to age or body height. The relationship of kidney dimensions with age or body size however are less clear if the child is stunted or wasted of had poor nutrition in early life when renal growth is maximal. Adverse early life nutrition has been linked to risk of renal as well as cardiovascular disease in adult life. We sought to study the kidney growth in children from an Aboriginal community where undernutrition in early life as well as renal disease in adult life are extremely common.Methods:We measured kidney length, width and depth using a standardized ultrasound method in 298 Aboriginal children (157 male and 141 female) aged 5‐18 years living in a remote community in Northern Australia. Anthropomorphic measurements were also made. Kidney volumes were calculated from measurements of length(L) width(W) and depth(D) using the ellipsoid formula KV = L x D x W X 0.523. We compared kidney lengths and volumes with published standards.Results:Proportions of children below the 10th %ile of NCHS growth standards are 35% weight for age, 21% height for age and 14% weight for height. All children studied had kidney lengths for age less than the 50th centile of Currarino’s (1984) standards and 80.1% were below the 50th centile reported by Rosenbaum (1983). In contrast, kidney length for body height was similar to that reported by Dinkel (1985) and Christophe (1986) as was kidney volume for body weight to Dinkels’ study (1985).Conclusion:Kidney dimensions in this high risk population are small for age but comensurate with body size. Expected kidney growth for children who are stunted or wasted should be compared to standards for height rather than age. Small volume kidneys for age may predispose to increased risk of renal disease later if other insults such as infection, diabetes and obesity occur.

Anti-streptokinase antibodies and streptokinase resistance in an Aboriginal population in northern Australia.

Thrombolytic treatment with streptokinase in acute myocardial infarction has proven to be safe and effective in Caucasian populations with relatively low levels of anti-streptokinase IgG and streptokinase resistance. Higher levels of antibodies, as seen in previous recipients of streptokinase therapy, cause more adverse reactions and may result in lower efficacy. To examine the levels of anti-streptokinase IgG and streptokinase resistance in a population subjected to endemic streptococcal infections. Thirty Aboriginal adults from a remote community in Northern Australia with endemic streptococcal infections and 15 non-Aboriginal adults from an urban community without endemic infections participated in this study. Aboriginal adults exhibited levels of anti-streptokinase IgG and streptokinase resistance that, respectively, were almost 20 and 15 times greater than the values of non-Aboriginal adults. At least 23% of Aboriginal adults had sufficiently high levels of streptokinase resistance to neutralise a standard 1.5 million unit dose of streptokinase. Aboriginal adults from a remote community had dramatically elevated levels of anti-streptokinase IgG and in vitro streptokinase resistance. Prospective studies are needed to assess the clinical relevance of streptokinase resistance in populations from areas with endemic streptococcal infection.