Australian Indigenous

Australian Indigenous HealthBulletin
Vol 4 No 4 October 2004 - December 2004: ISSN 1445-7253

A peer-reviewed electronic journal from the Australian Indigenous HealthInfoNet

Journal articles

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Adams K, Kavanagh A, Guthrie J (2004)
'Are you Aboriginal and/or Torres Strait Islander?': improving data collection at BreastScreen Victoria.
Australian and New Zealand Journal of Public Health;28(2):124-127

Objective: To evaluate the ascertainment and recording of clients' Indigenous status at BreastScreen Victoria (BSV) by assessing: staff compliance with best practice recommendations in ascertaining Indigenous status data collection practices; and the consistency of recording of Indigenous status between visits.

Methods: The Australian Bureau of Statistics/Australian Institute of Health and Welfare best practice recommendations for collecting Indigenous status data were compared against BSV practices. One hundred and thirty-three BSV staff were also surveyed about their practices of ascertaining Indigenous status. An audit of the consistency of recording Indigenous status at first and most recent visit to BSV was also conducted.

Results: Current ascertainment and recording of Indigenous status by BSV staff does not comply with best practice recommendations. A high proportion of staff were not ascertaining Indigenous status (34%), and/or perceived they were prevented from asking women whether they were Indigenous (53%). The consistency of recording of Indigenous status between women's visits was also low.

Implications: Our findings are likely to be found in other services where collection of Indigenous status data occurs. To improve data collection, services need to: ensure questions regarding Indigenous status comply with best practice recommendations; provide staff training regarding the importance of collecting the information; and improve Indigenous participation and control of data collection and dissemination.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health (view website)

Bailie RS, Carson BE, McDonald EL (2004)
Water supply and sanitation in remote Indigenous communities - priorities for health development
Australian and New Zealand Journal of Public Health;28(5):409-414

Objective: To review available national and State/Territory survey data on water supply and sanitation in remote Indigenous Australian communities and to discuss the findings in terms of priorities for health and infrastructure development.

Methods: Descriptive analysis of data on relevant variables from available data sources.

Results: All relevant published reports arose from only two data sources: the Community Housing and Infrastructure Needs Surveys, and from a Northern Territory-wide survey of community-owned dwellings. The data show that many communities do not have a reliable water supply and experience frequent and prolonged breakdown in sewerage systems. For example, 12% of communities of 50 people or more experienced five or more periods of water restrictions in a one-year period, and 10% of communities experienced sewage overflow or leakage 20 or more times in a one-year period. Items of basic household infrastructure regarded as essential for household hygiene are missing or not functional in many community-owned dwellings. For example, in about one-third of houses bathroom taps and toilet drainage required major repairs.

Conclusion and implications: Given the widely accepted importance of water and sanitation to health, the data support the contention that poor environmental conditions are a major cause of poor health in remote communities and provide some measure at a national level of the magnitude of the problem. Action to ensure easy access to adequate quantities of water and secure sanitation should receive greater priority. There is need for better quality information systems to monitor progress, equity and accountability in the delivery of water and sanitation services.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health (view website)

Bower C, Eades D, Payne J, D'Antoine H, Stanley F (2004)
Trends in neural tube defects in Western Australian in Indigenous and non-Indigenous populations.
Paediatric and Perinatal Epidemiology;18:277-280

This article compares trends in neural tube defects in Western Australian Indigenous and non-Indigenous infants, based on data from the WA Birth Defects Registry. Postpartum interviews with Indigenous women investigated the level of knowledge concerning folate supplementation during pregnancy. Although the findings indicated that folate health promotion strategies have been successful in reducing the risk of the condition in non-Indigenous children, the authors suggest that strategies have proved ineffective in reducing the condition in Indigenous children.

Australian Indigenous HealthInfoNet abstract

Brewster D (2004)
Iron deficiency in minority groups in Australia [editorial].
Journal of Paediatric Child Health;40:422-423

This articles documents the prevalence, risk factors, and treatment of iron deficiency in Aboriginal children in northern Australia, compared with other disadvantaged minority groups in Australia. The examination identifies that iron deficiency in Aboriginal children has been linked to poor cognitive function and deficits in psychomotor development, especially in children under 2 years of age. Risk factors for the onset of iron deficiency in Aboriginal children include: low birthweight; weaning practices; diet; and socio-economic disadvantage. The findings have implications for the development of appropriate food supplements.

Australian Indigenous HealthInfoNet abstract

Clough A, Jones P (2004)
Policy approaches to support local community control over the supply and distribution of kava in the Northern Territory (Australia).
Drug and Alcohol Review;23(1):117-126

This paper considers policies concerning kava supply, and looks at both the historical and current aspects. It also outlines the origins and rationale for the regulatory system currently being implemented. The paper is divided into three main areas of discussion: the establishment of informal kava supply networks and consolidation without regulation throughout the 1980s; a description of the 'black market' trade in kava and its control over kava supply; and a description of the implementation of new regulations under the Kava Management Act.

Australian Indigenous HealthInfoNet abstract

Condon JR, Barnes T, Cunningham J, Smith L (2004)
Improvements in Indigenous mortality in the Northern Territory over four decades.
Australian and New Zealand Journal of Public Health;28(5):445-451

Objective: To provide the first report of long-term mortality trends over recent decades for an Indigenous Australian population. Very little information is available about improvements over time, or lack thereof, in the health status of Indigenous Australians.

Methods: Internally consistent time series of deaths and population data were produced for the Indigenous population of the Northern Territory (NT) for 1966-2001. Time trends for Indigenous mortality rates and differentials between NT Indigenous and total Australian rates were examined for 1967-2000.

Results: NT Indigenous mortality declined in all age groups and both sexes. The decline was greatest in age group 0-4 (85%). In those aged five years and over, NT Indigenous mortality declined by 30% in females and 19% in males. However, these declines did not keep pace with the relative decline for the total Australian population, so that mortality rate ratios (NT Indigenous to total Australian) increased for all age groups except 0-4 years. NT Indigenous mortality declined for communicable, maternal, perinatal and nutritional conditions by 62%, and for injury by 33%, but did not decline for non-communicable diseases.

Conclusions: Indigenous mortality has improved in the NT in recent decades, but the relative gap between Indigenous and other Australians has increased.

Implications: Reductions in NT Indigenous mortality reported here may provide some reassurance that improvement in Indigenous health is possible and has occurred, but even greater effort will be required to accelerate the pace of improvement.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health (view website)

Cord-Udy N (2004)
The Medical Specialist Outreach Assistance Programme in South Australia at 2 years.
Australasian Psychiatry;12(2):161-165

This article examines the progress and achievements of psychiatric services provided by the Medical Specialist Outreach Assistance Program (MSOAP) in South Australia over a 2 year period. MSOAP has focussed particularly on service provision to remote areas in the far northern region of South Australia. The article suggests that psychiatric services visiting South Australia's rural and remote communities have expanded, and that children's and Indigenous services have improved significantly. It is anticipated that important developments in the funding of services will continue in the future.

Australian Indigenous HealthInfoNet abstract

Douglas MW, Lum G, Roy J, Fisher DA, Anstey NM, Currie BJ (2004)
Epidemiology of community-acquired and nosocomial bloodstream infections in tropical Australia: a 12-month prospective study.
Tropical Medicine and International Health;9(7):795-804

The study involved a 12-month prospective analysis of blood stream infections at the Royal Darwin Hospital in the tropical north of Australia in 2000. The isolates show that the most common infecting organisms were Staphylococcus aureus, Escherichia coli, and Burkholderia pseudomallei. The findings have implications for research into the effects of local environmental and patient characteristics on the range of organisms causing blood stream infections, as well as the role of antibiotic therapy.

Australian Indigenous HealthInfoNet abstract

Ford J, Henry R, Sullivan E (2004)
Comparison of selected reasons for hospitalization of children among children's/tertiary hospitals, Australia, 1996-97 and 1997-98.
Journal of Paediatrics and Child Health;40(7):374-379

This article describes admission patterns to children's/tertiary hospitals and other hospitals, and compares admissions to local and non-local specialist children's hospitals. The study involved a cross-sectional analysis of routinely collected data on hospitalisations in Australia between 1996-97 and 1997-98. The findings indicate that Indigenous children were more likely to be hospitalised for asthma, bronchitis, and gastroenteritis than non-Indigenous children. The authors suggest that the findings have implications for equality of access and availability of appropriate services for Indigenous children and their families.

Australian Indigenous HealthInfoNet abstract

Gilchrist D, Woods B, Binns CW, Scott JA, Gracey M, Smith H (2004)
Aboriginal mothers, breastfeeding and smoking.
Australian and New Zealand Journal of Public Health;28(3):225-228
View ANZJPH abstract

This study examined the smoking practices of a group of Aboriginal mothers during their pregnancy and for the period in the subsequent year that they breastfed their infants. Rates of smoking among the mothers, whose babies were delivered in Perth hospitals, were identified using interviews and questionnaires. It was found that although previous studies have indicated smoking as a factor connected with lower rates of breastfeeding, this was not the case for Aboriginal mothers and there was no difference in the percentage of smokers and non-smokers who initiated breastfeeding. The prevalence of smoking among the Aboriginal mothers was considerably greater than in an earlier survey of non-Aboriginal mothers in Perth. It was noted that high rates of smoking among Aboriginal mothers are likely to contribute to higher rates of low birth weight and other early childhood health problems in this population group. Smoking termination programs were recommended, particularly before and during pregnancy and during lactation.

Australian Indigenous HealthInfoNet abstract

Hanna JN, Hills SL, Humphreys JL (2004)
Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland.
Medical Journal of Australia;181(9):482-485
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Hull BP, McIntyre PB, Couzos S (2004)
Evaluation of immunisation coverage for Aboriginal and Torres Strait Islander children using the Australian Childhood Immunisation Register.
Australian and New Zealand Journal of Public Health;28(1):47-52

Objective: To estimate immunisation coverage for routinely administered vaccines among children using receipt of a particular Hib vaccine (PRP-OMP) as a proxy for Indigenous status.

Methods: Until May 2000, PRP-OMP was provided only for Indigenous children in all jurisdictions except the Northern Territory. In three one-year ACIR-derived birth cohorts, any child recorded on the ACIR as receiving one or more doses of PRP-OMP as the only Hib vaccine was presumed to be Aboriginal and Torres Strait Islander. Using this proxy, estimated numbers of Indigenous children were compared with Australian Bureau of Statistics estimates, and immunisation status for recommended vaccines was estimated at 12 and 24 months by jurisdiction and remoteness compared with children who received other Hib vaccines (presumed non-Indigenous).

Results: The numbers of Aboriginal and Torres Strait Islander children estimated using this 'proxy method' are approximately 42% of those estimated by the ABS. Immunisation coverage (among proxy Indigenous children) at 12 months (72-76%) and 24 months (64-73%) was considerably lower than others (90-94% and 81-88%, respectively). These children had significantly lower coverage when living in accessible areas than remote areas.

Conclusions and Implications: These data provide the first national measure of immunisation status and are likely to be a valid measure among those identified. Aboriginal and Torres Strait Islander immunisation coverage is 17% lower with the biggest gaps in urban areas, indicating the need for better quality data informing appropriate interventions.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health (view website)

Mayers NR, Couzos S (2004)
Towards health equity through an adult health check for Aboriginal and Torres Strait Islander people [editorial].
Medical Journal of Austalia;181(10):531-532
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McAullay D, Sibthorpe B, Knuiman M (2004)
Evaluation of a new diabetes screening method at the Derbarl Yerrigan Health Service.
Australian and New Zealand Journal of Public Health;28(1):43-46

Background and objectives: Diabetes is a major health problem for the Aboriginal population of Australia. Early detection is a key strategy to reduce the burden of diabetes. The aim of this study was to assess the acceptability, sensitivity and specificity, effectiveness and cost of a new method of screening for diabetes at Derbarl Yerrigan, the Aboriginal health service in Perth.

Methods: Between January and May 1999, all clients over the age of 30 years and not known to have diabetes were approached for HbA1c testing using the DCA 2000 analyser. Those whose HbA1c results indicated the need for follow-up were asked to return for confirmatory testing using the gold standard oral glucose tolerance test (OGTT). A questionnaire was administered to participants who did not return. A file audit was conducted over 15 non-consecutive days to determine screening, follow-up and the number of new cases diagnosed using the previous ad hoc approach to screening with a glucometer.

Results: 238 clients were approached and all agreed to participate and undertook the test. Of these, 37 were referred for follow-up diagnostic testing. Of these, only 14 had an OGTT. Among these 14, five were found to have diabetes and three were found to have impaired glucose tolerance. Of the remaining 23 participants, we were able to contact only six and administer the questionnaire to four. Poor follow-up meant that the sensitivity, specificity and cost-effectiveness of the test could not be assessed.

Conclusions and implications: The reasons for poor follow-up need to be investigated if Aboriginal health services are to be more successful at screening for diabetes.

Abstract reproduced with permission of the Australian and New Zealand Journal of Public Health (view website)

McDermott R, Tulip F, Sinha A (2004)
Sustaining better diabetes care in remote Indigenous Australian communities.
Quality and Safety in Health Care;13:295-298

This article examines the quality of diabetes care and service delivery to Indigenous diabetics in the Torres Strait region of Australia. The investigation comprised a three-year follow-up clinical audit of 21 primary health care centres and a review of hospital admissions within the previous 12 months. Treatment outcomes were assessed by measuring patients' weight, blood pressure, glycated haemoglobin, proteinuria, and albuminuria.

Findings indicated improvements in most diabetes care processes and reduced hospital admissions when local Indigenous health workers used registers, recall and reminder systems, and basic diabetes care plans, and were supported by specialist outreach services. Improvements were sustained, with an increase in the number of people on registers from 1999 to 2002. The article recommends that diabetes management priorities in remote settings include an emphasis on: availability and affordability of good diet; body weight management; and appropriate medication.

Australian Indigenous HealthInfoNet abstract

Mellor D, McCabe M, Ricciardelli L, Ball K (2004)
Body image and body dissatisfaction among Indigenous Australian adolescents.
Body Image;1(3):289-297

This article examines the body image concerns of Aboriginal adolescents between the ages of 12-16 years. Body image dissatisfaction was measured using the Body Image Scale and the Body Change Inventory Scale. It was found among the Indigenous adolescents surveyed, that there were no gender differences in body image importance and body image dissatisfaction. It was found however, that males placed more importance on muscle size and strength than females, and rural youth placed more importance on weight than urban youth. The findings suggest that Indigenous youth are less concerned and dissatisfied with body weight and shape than Caucasian adolescents.

Australian Indigenous HealthInfoNet abstract