SH3/CMTs/Skin infections in remote Aboriginal communities

See Hazel Mitchell's lecture on skin infections.

Buzzwords with ATSI

• Spirit and integrity
  • Respect
  • Reciprocicty
  • Responsibility
  • Survival and protection
  • Equality

• Summary of the ecological model
• Scabies: mite, burrows under skin, lays eggs, itch --> scratch --> break skin --> infection; can't wash off scabies (hygiene stigma).
  • Risks: overcrowding, heat (sweating, incubation, don't want to put cream on), water supply, humidity, hygiene, poor nutrition
  • Scabies: GAS --> 1) RHD 2) APSGN
  • Rx: 5% permethrin over whole body
  • Wash bedding, sheets
  • Treat everyone else
  • Easy to miss infections
  • Can't get scabies from cat/dog
  • Dx usually based on history

• Parasites: lives in/on another organism; don't respond to antibiotics - "one way" gain for parasite e.g. ticks, lice, worms
• Helminths are worm parasites e.g. hookworms, round worms, flukes, tapeworms
• Fungal infections (e.g. ringworm) are another form of parasite

APSGN

• IgA immune complexes get stuck in glomeruli and cause inflammation
• APSGN - acute post strep glomerulonephritis
  • Hematuria (often the first sign)
  • Oliguria
  • Oedema
  • Ascites
  • Hypertension
  • General
  • Acute renal necrosis due to injury of capillary or capillary thrombosis
• Hospital admission for a few days - check blood, urine
• Administer diuretics
• Antibiotic treatment doesn't cure APSGN because it's not the strep that's causing it

ARF

• Immune complexes to GAS can cross-react with heart muscle, causing ARF

• Some kinds of GAS are more likely to trigger APSGN (can come in epidemics)
• ARF can't cause epidemics because it's more about a specific cross reaction between the host and the organism

Risk factors in Aboriginal community

• Prevalence of scabies in the aboriginal community is much higher due to risk factors
• Aboriginal communities have much higher levels of overcrowding
• If you don't remove the risk factors, you get reinfection

• See the big diagram that summarises ecological model for Aboriginal renal disease in one of the articles
• PSGN - in populations that have higher levels of PSGN, they have higher risk of end stage renal disease later on

Interventions - Arnhem land

• Active surveillance programme (homes and schools to check for scabies and pyoderma)
• Checkups for children; applying permethrin cream
• Started because the local community wanted to do something about scabies
• They have poor fruit supply etc (despite fish). There was huge interference with bush food

• Housing interventions are difficult to carry out because the houses need to be refreshed often, and you also need to replace the old inappropriate houses
• Unhealthy food not more expensive than city, healthy food much more expensive

• Adherence is poor for this - teenagers and adults don't do the permethrin treatment
  • Skin infections become "normal", and adolescents are unadherent.
  • Higher threshold before seeking care

• Outcomes: scabies prevalence not decreased BUT pyoderma rates reduced (which causes the complications). Good empowerment: learning from the health care workers
  • Communities that had more infection had more improvement
  • Remote communities - kids are bored with nothing to do (impacts on energy levels, fun)
  • "No school no pool" (but this assumes that they have control over whether they go to school - it might double disadvantage someone)

Interventions - WA

• Arid, dry, hot environment
• Remote communities
• Study looked at indicators for infections (skin, ear, respiratory tract, trauma)
• Post-swimming pools
• Antibiotic scripts, clinic visits

Assessing cost effectiveness study

• Checked cost effectiveness of a whole lot of health interventions
• Used aboriginal definition of health (community health; life-death-life cycle)
  • Individual health gain
    • DALY
    • Individual empowerment (more able to deal with their lives and overcome challenges (don't force treatments onto people)
  • Community health gain
    • Social and emotional wellbeing; include whole community
    • E.g. pool: jobs, exercise
  • Cultural security
    • Dont compromise their cultural rights, views, values and expectations of Aboriginals
  • Equity
    • Access to services
    • Differentials in population health outcome

• equity vs equality
  • equity strives for equality
  • equity = provide more resources to achieve equality.

• People have the feeling that these interventions won't change anything so they don't participate

Other places with scabies

• Nursing homes