Strongyloides stercoralis: Systematic Review of Barriers to Controlling Strongyloidiasis for Australian Indigenous Communities

Abstract

Background Strongyloides stercoralis infects human hosts mainly through skin contact with contaminated soil. The result is strongyloidiasis, a parasitic disease, with a unique cycle of auto-infection causing a variety of symptoms and signs, with possible fatality from hyper-infection. Australian Indigenous community members, often living in rural and remote settings, are exposed to and infected with S. stercoralis. The aim of this review is to determine barriers to control of strongyloidiasis. The purpose is to contribute to the development of initiatives for prevention, early detection and effective treatment of strongyloidiasis.Methodology/Principle FindingsSystematic search reviewing research published 2012 and earlier was conducted. Research articles discussing aspects of strongyloidiasis, context of infection and overall health in Indigenous Australians were reviewed. Based on the PRISMA statement, the systematic search of health databases, Academic Search Premier, Informit, Medline, PubMed, AMED, CINAHL, Health Source Nursing and Academic was conducted. Key search terms included strongyloidiasis, Indigenous, Australia, health, and community. 340 articles were retrieved with 16 original research articles published between 1969 and 2006 meeting criteria. Review found barriers to control defined across three key themes, (1) health status, (2) socioeconomic status, and (3) health care literacy and procedures.Conclusions/SignificanceThis study identifies five points of intervention: (1) develop reporting protocols between health care system and communities; (2) test all Indigenous Australian patients, immunocompromised patients and those exposed to areas with S. stercoralis; (3) health professionals require detailed information on strongyloidiasis and potential for exposure to Indigenous Australian people; (4) to establish testing and treatment initiatives within communities; and (5) to measure and report prevalence rates specific to communities and to act with initiatives based on these results. By defining barriers to control of strongyloidiasis in Australian Indigenous people, improved outcomes of prevention, treatment of strongyloidiasis and increased health overall are attainable.

Policy Implications for Controlling Communicable Diseases in Indigenous Communities: Case of Strongyloidiasis in Australia

“…The findings of this research indicate a notable lack of knowledge about strongyloidiasis. Kaminsky, Reyes-Garcia, and Zambrano (2016) described issues in Honduras similar to those Miller et al (2014) described in Australia, including a failure to recognize symptoms, an inadequate knowledge of treatment protocol, and a lack of interest in defining and raising awareness of S. stercoralis infection in the community.…”

“…Communities: Case of Strongyloidiasis in Australia 151 difficulty of detection, and inadequate knowledge/treatment (e.g., medication dosage) are, but a few of the main barriers presented (Miller et al 2014). The barriers to controlling infectious diseases for health improvement at the personal level in rural and remote Indigenous communities include 1. communication difficulties between health staff and Indigenous patients based on the lack of a shared understanding of disease causation and the simple fact that English is not the first language for many people in remote locations (Trudgeon 2000;McConnel 2003;Cheng, Blum and Spain 2004); 2. fear of disclosure of culturally sensitive illnesses (Newman et al 2007) 3. fear of discrimination (Lowe et al 1995;Trudgeon 2000;Newman et al 2007); 4. remoteness from essential specialised health services (Gruen, Weeramanthri and Bailie 2002;McGrath 2006); 5. lack of the funds needed to purchase medication and equipment (Couzos and Davis 2005;Couzos 2005); 6. the need for education in maternal and child health (Molyneux 2006); 7. the need for involvement from other government sectors and agencies (Molyneux 2006); 8. the need for the establishment of surveillance, diagnosis, monitoring, and evaluation systems (Molyneux 2006);and 9.…”

“…In a systematic review of the barriers to the control of strongyloidiasis, Miller et al (2014) described the need for a detailed, clinical picture in order to manage S. stercoralis in Australia, including prevalence rates, evidence, and community-based public health approaches to control strongyloidiasis. This study explores the barriers to the implementation of infectious disease interventions for diagnosing, treating, and preventing strongyloidiasis from the perspective of experienced healthcare professionals with extensive medical knowledge and experience in the field of researching and/or diagnosing and treating strongyloidiasis.…”

“…As shown in Miller et al (2014), racial disparity and living conditions comprise the situational context influencing the key barriers. Continued unsanitary living conditions in communities increases S. stercoralis exposure.…”

“…A systematic review of the peer-reviewed literature published between 1969 and 2010 has presented the status of strongyloidiasis for Australian Indigenous community members and summarized the barriers to its control (Miller et al 2014). The main barriers to management are health status, socioeconomic status, healthcare literacy, and procedures.…”