Reducing recurrence of bacterial skin infections in Aboriginal children in rural communities: new ways of thinking, new ways of working

Abstract

Abstract.Reports from health workers, school staff and community members in rural NSW suggested that bacterial skin infections are a significant health issue for Aboriginal children and their families, affecting quality of life and contributing to poor school attendance. Current NSW treatment guidelines do not incorporate important sociocultural factors or ways of living in Aboriginal communities. The aim of this qualitative study was to gain a deeper understanding of the experience of parents and carers of Aboriginal children affected by skin infections and of other community members, health workers and school staff, and what actions have been considered successful or unsuccessful in reducing the recurrence of infection. This study used a Participatory Action Research methodology. Interviews and focus groups were conducted with 38 health workers and managers, school staff, community members and parents and carers. Themes that emerged included: (i) skin infections have become normalised; (ii) skin infections are, in part, a consequence of transgenerational trauma; (iii) skin infections are interwoven with social determinants; (iv) families have survived but more could thrive; and (v) something can and should be done about the problem. The findings of this study will inform the development of more effective and acceptable options to reduce skin infections in Aboriginal children.

Are scabies and impetigo “normalised”? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections

“…Measuring potential under-recognition of skin infection at a patient and community level and exploring factors that contribute should be a focus of future studies. Certainly the phenomenon of normalisation has been described at the community level[21, 24] and may present a major barrier to health seeking and access to appropriate treatment in resource limited settings with endemic disease[25, 52]. It follows that any strategies to improve recognition and treatment of skin infection must consider and partner with the members of the communities which are affected[21].…”

“…Certainly the phenomenon of normalisation has been described at the community level[21, 24] and may present a major barrier to health seeking and access to appropriate treatment in resource limited settings with endemic disease[25, 52]. It follows that any strategies to improve recognition and treatment of skin infection must consider and partner with the members of the communities which are affected[21]. Moreover, ongoing efforts to address the social determinants which lead to the disproportionate load borne by people of Aboriginal ethnicity, particularly those living in remote communities, remain of great importance[8, 21].…”

“…It follows that any strategies to improve recognition and treatment of skin infection must consider and partner with the members of the communities which are affected[21]. Moreover, ongoing efforts to address the social determinants which lead to the disproportionate load borne by people of Aboriginal ethnicity, particularly those living in remote communities, remain of great importance[8, 21]. On a broader scale, skin infections are neglected at a global level with regard to prioritizing funding and policy development despite causing significant morbidity and mortality in resource-limited settings[53].…”

“…Normalisation is a term to describe that in contexts of high burden, but not life-threatening disease, clinicians may not specifically diagnose or treat scabies, impetigo, pediculosis or tinea when a patient presents to a health care provider for a reason other than skin infection because these infections are so common they are regarded as normal and are thus ignored or forgotten. The term normalisation has been used previously in the Australian[21–23] and international[24] literature to describe this hypothesized phenomenon in regions with endemic skin infection. Clinician under-recognition of scabies was suggested in the findings of one previous study in a population with high prevalence of scabies[25] but thus far normalisation of impetigo has not been demonstrated in the clinical setting.…”

Aboriginal and Torres Strait Islander health

“…For Aboriginal and Torres Strait Islander peoples this message would be self-evident, and Maclean et al present evidence that interventions promoting expression of cultural identities have beneficial effects (MacLean et al 2017). Taking a community wide approach to address social determinants and strengthen cultural identity was more effective than narrow biomedical approaches in addressing youth suicide (Cox et al 2014), pyoderma (Thomas et al 2017), the content of health assessments (Spurling et al 2017), and food insecurity (Murray et al 2014). For example, in Queensland, McCalman et al found that support groups which promote social cohesion for Aboriginal men could lead to a variety of improvements including social and emotional wellbeing (McCalman et al 2010).…”