Completed Research Projects

Below are links to the information pages on the current KAMS and RCSWA research projects:

Aboriginal health research in the Kimberley

An exploration of perceptions, attitudes and concerns of stakeholders

Aboriginal health research in the remote Kimberley: An exploration of perceptions, attitudes and concerns of stakeholders

In late 2006 a local research review panel – the Kimberley Aboriginal Health Planning Forum (KAHPF) Research Subcommittee – was formed to improve research processes and encourage appropriate research. This was in response to concerns raised across the Kimberley, particularly from Aboriginal people and health services, about the health research being been carried out here.

The Research Subcommittee aims to encourage a coordinated approach to health research and promote research that is meaningful, useful and results in practical change and development within the region.

Why did we review the Research Subcommittee and its processes?

As the number of applications to the Research Subcommittee increased, concerns were raised by Kimberley organisations about the burden of research. Also some researchers criticised the processes of getting approval for their projects. The Research Subcommittee reported this to KAHPF and proposed to review its own activities.

How did we review the Research Subcommittee and its processes?

We conducted a retrospective audit of all the data from the Research Subcommittee from 1 January 2007 to 31 October 2013. All data used in the review of the Subcommittee were collected as part of the Subcommittee’s normal procedures.

We analysed text in the data collected to identify broad themes related to research in the region that reflected opinions, attitudes or insights of stakeholders. We then compared the perceptions, attitudes and concerns of local stakeholders connected to the Research Subcommittee with external stakeholders’ perspectives on the issues they faced conducting research in the Kimberley.

What did we find?

  • From 1 January 2007 to 30 June 2013 the Subcommittee received 95 proposals:
    • 60% were driven by researchers based outside the region (external researchers).
    • Local stakeholders raised concerns about 40% of all projects – most of these projects were driven by external researchers.
  • The major concerns of local stakeholders (22 people from 12 different Kimberley organisations) were:
    • Inadequate community consultation and engagement;
    • Burden of research on the region;
    • Negative impact of research practices;
    • Lack of demonstrable community benefit; and
    • Power and control of research in the region.
  • The major themes identified by external stakeholders (25 external researchers who completed the review form in mid-2013) were:
    • Unanticipated difficulties with consultation processes;
    • Conflict between importance of face-to-face visits and barriers to travel;
    • Perceiving research as a competing priority for health services; and
    • Time-consuming ethics processes.
  • External stakeholders also identified strategies for improving research practices in the Kimberley:
    • Importance of community support in building good relationships;
    • Employing local people;
    • Being flexible in approaches to research; and
    • Importance of allocating sufficient time for consultation and data collection.

What does this mean?

Health research in the Kimberley has improved in recent years, however significant problems remain. Prioritising research addressing genuine local needs is essential in closing the gap in Aboriginal health outcomes and life expectancy.

The long-term aim is for Kimberley health service connected researchers to identify priorities, lead, conduct and participate in the majority of Kimberley health research. For this to occur, a more radical move involving changing the research process is needed. Changes to funding processes (e.g. government research funding to go directly to health services rather than universities and giving researchers extra time for community consultation and feedback of results) could improve remote area Aboriginal health research.

What changes to the Research Subcommittee processes have resulted from this review?

Kimberley communities and organisations expect to be involved in the development of research proposals and for research to be based on local priorities. They have the right to be informed of the results of any project in which they were involved.

The Research Subcommittee wants to ensure that research conducted in the Kimberley is in line with local priorities and is supported by local communities and organisations. The Research Subcommittee encourages Kimberley communities and organisations to get in touch if they have any questions or concerns about research that is occurring / planning to occur in the Kimberley. Contact details are available on the Research Subcommittee website.

To hold researchers accountable we are in the process of updating the Research Subcommittee Project Form. Researchers will need to list any Kimberley projects that they have been involved in and if these have finished they will need to describe the feedback provided to the communities and organisations involved in their research.

We have updated the advice that we give researchers on the processes of conducting research in the Kimberley. We will continue to streamline processes (e.g. reporting requirements) with the WA Aboriginal Health Ethics Committee.

Publication:

Frieda Mc Loughlin, Nyssa T Hadgraft, David Atkinson and Julia V Marley. Aboriginal health research in the remote Kimberley: An exploration of perceptions attitudes and concerns of stakeholders. BMC Health Services Research 2014; 14:517.

Download

Plain Language Report

Advice for Researchers

Published Paper

Aged Care

Models of care to address unmet needs for older Indigenous people with dementia, their families & communities in remote northern Australia

Indigenous Dementia Services Study

Models of care to address unmet needs for older Indigenous people with dementia, their families & communities in remote northern Australia

Background

Despite many efforts, the gaps in services for Indigenous Australians living in remote communities continue. A recent study conducted in the Kimberley region of Western Australia by The University of Western Australia demonstrated a high prevalence of dementia in Aboriginal communities. This finding led to the development of this research project which was conducted in three stages. The first stage involved a literature review of service gaps and current care initiatives for remote Aboriginal community care for the frail aged and people with disabilities. The second stage involved a qualitative study to determine the unmet needs of Aboriginal people with dementia and their caregivers living in the Kimberley region. The third stage involved utilising the results from this study to develop and trial a community care model to meet the needs of the frail aged, and people of all ages with disabilities and mental illness living in remote Aboriginal communities.

Methods

The Unmet needs Study: A steering committee comprising past and present Aboriginal caregivers, remote community representatives, and service providers was formed to advise and guide the research project. Kimberley service providers (n=42), caregivers of Aboriginal people with dementia (n=16) and remote community-based HACC workers (n=15) were interviewed by Kimberley-based research staff to determine the scope of the services in the region and the unmet needs of people with dementia and their caregivers.

The Lungurra Ngoora Pilot Project: The model was developed based on the outcomes of the unmet need study. Focus groups were formed to maximise consultation, represent the needs of the community and to develop and endorse the project. The pilot involved provision of care to those who were traditionally in receipt of services by aged care, mental health and disability services. The pilot was funded by Home and Community Care (Department of Health WA), Western Australian Country Health-Mental Health Service and the Disability Services Commission. Utilising a mixed method approach of both quantitative and qualitative data, an evaluation of services was made at baseline, six months and twelve months in several key areas. Data were acquired based on tick sheet reports (weekly summaries of services provided in the community), from feedback forms from clients and carers, and testimonials from service providers and the community. These outcomes are supplemented by an independent evaluation report that is available below.

The study protocol was approved by Western Australian Aboriginal Health Information and Ethics Committee (WAAHIEC) and the University of Western Australia Ethics Committee for Human Research. Community council and individual approval was sought and gained.

Results

The Unmet needs Study: The results from the interviews strongly indicated many areas of unmet needs in the Kimberley. The key unmet needs identified were genuine community consultation, service coordination and communication, community based services, culturally secure services, Aboriginal workforce with local guidance and support, and education and training.

Lungurra Ngoora Pilot Project: In the twelve month period the client base grew from 8 clients to 22 clients utilizing services. The number of services provided grew from 140 services at baseline to 2395 services at twelve months. A total of 18,541 services were received by clients from 13th July 2009 – 11th June 2010. Greater collaboration and coordination of services occurred as well as high client and community satisfaction with the range of services (measured through feedback forms). Strong support was gained from local businesses who donated goods throughout the project. Looma Council reported strong approval for the consultative and on the ground nature of the service, and for the employment and ongoing training of community members. External service providers have reported increases in efficiency through co-owning a community-based service and marked improvements in the health and well-being of their clients.

Conclusion

There have been dramatic improvements in service delivery in Looma community over the trial period. The model of care, based on extensive research of community needs, can provide more effective and equitable remote service delivery to the frail aged, people of all aged with disabilities and mental illness, and their caregivers living in remote Aboriginal communities. The Lungurra Ngoora Community Care Service has been embraced by the Looma Community. Due to the nature of the model the project was flexible enough to withstand the challenges often faced in remote communities. There is potential for expansion of the key components of this model to other areas given genuine collaboration and consultation with interested communities.

Key Recommendations

The following recommendations were developed through extensive consultation with stakeholders both prior to and during the trial, and are crucial to the future success and sustainability of the model. These recommendations address the unmet needs identified in the second part of the project, namely genuine community consultation, service coordination and communication, community based services, culturally secure services, Aboriginal workforce with local guidance and support, and education and training.

  • Formal partnerships, cooperation and collaboration between service providers and community. The model ensures the formal collaboration of service providers with each other and the Aboriginal community at all levels. The steering committee co-funds and co-directs the project, assisted in the collaboration process by the independent facilitator. Organisations commit to and sign a service agreement which identifies the shared objectives that they co-developed and outlines their role. The values of mutual respect, ability to be flexible and innovative, and to work within a team are key attributes for the steering committee. The guidance of the steering committee and the local action group is invaluable for the success of the project.
  • Genuine community consultation, guidance and decision making. The community must be involved in all aspects of decision making including project design, consultation, management and feedback. Decreasing reliance on transient positions (such as the community CEO) through formal community council engagement at the strategic management level prevents regular changes in the administration staff from halting the delivery of services. The regular survey of community clients and caregivers on ways to improve the service is recommended.
  • An independent facilitator to ensure collaboration and assist with direction of common goals. If possible the role should be filled by a non-government organisation to assist in facilitating the variety of specialised service providers and industry to work together with the community and pool resources to provide one on-the-ground service, to mediate interests, to ensure a focus on community development and to engage local businesses. It is recommended that the facilitator holds the project funds and employs staff members to simplify administrative procedures.
  • Flexibility of service providers, staff and the service. The service needs to be flexible and responsive to the needs of clients, caregivers, the community and the staff. It is recommended that a pool of community-based workers are employed and trained to provide a range of services.
  • Culturally secure and community-based service. Employment of preferably Aboriginal staff members who are supported in the community and guidance from the community council capitalises on local knowledge and builds community capacity. It also enables the service to meet the specific needs of each community. It is recommended that the project coordinator works with the community council to identify and recommend potential workers from the community. This also enables positions to be filled quickly.
  • Community based support, mentorship, training and development of staff. It is recommended that steering committee and local action group members are actively encouraged at each meeting to identify new training opportunities and resources available to the community members and project staff and assist in accessing these. The community-based project coordinator provides day to day mentorship and support to the staff. The independent facilitator manages and supports the project coordinator with support from the community council. As transport is a key issue for clients and caregivers, all project staff should be supported to gain their driver’s licence where possible.
  • Ongoing advocacy for clients and families. The project coordinator provides one access point in the community for clients, caregivers, the council and service providers. This has assisted in the smooth delivery of services. Outstanding service delivery issues for clients and caregivers (such as installation of equipment, need for an interpreter or health care issues) can be efficiently followed-up by the project coordinator, or jointly coordinated at local action group meetings.

Publication

Smith K, Flicker L, Shadforth G, Carroll E, Ralph N, Atkinson D, Lindeman M, Schaper F, Lautenschlager NT, LoGiudice D.’Gotta be sit down and worked out together’: views of Aboriginal caregivers and service providers on ways to improve dementia care for Aboriginal Australians. Rural Remote Health; 2011;11(2):1650.

Download:

Lungurra Ngoora Community Care Final Report (3.2M .pdf)

Lungurra Ngoora Community Care Evaluation (351Kb .pdf)

IDSS Looma Presentation Oct 2009 (2.2M .pdf)

IDSS Newsletter July 2009 (1.8MB .pdf)

IDSS Newsletter December 2008 (3.6MB .pdf)

IDSS Newsletter April 2008 (2M .pdf)

IDSS Newsletter September 2008 (1.4MB .pdf)

IDSS Newsletter September 2007 (1.8MB .pdf)

Researchers:

  • Geraldine Shadforth, Project Officer
  • Anna Dwyer, Project Officer
  • Naomi Ralph
  • Kate Smith
  • Assoc Prof David Atkinson
  • Dr Dina LoGiudice, Geriatrician, National Ageing Research Institute, Vic
  • Prof Leon Flicker, Geriatrician, WA Centre for Health and Ageing, UWA
  • Prof Osvaldo Almeida, Old Age Psychiatrist, WA Centre for Health and Ageing, UWA
  • Prof Nicola Lautenschlager, Old Age Psychiatrist, WA Centre for Health and Ageing, UWA
  • Jocelyn Jones, Telethon Institute of Child Health Research

Kimberley Indigenous Cognitive Assessment tool (KICA)

Kimberley Indigenous Cognitive Assessment tool (KICA)

Aboriginal and Torres Strait Islander people have a unique cultural heritage. However prior to this study there was no validated tool to assess cognition in older Indigenous Australians. To address this deficiency, the researchers have developed a culturally appropriate assessment tool to help determine if an older Aboriginal and Torres Strait Islander person has dementia, and have completed a survey to determine the estimated number of people in remote areas of the Kimberley who manifest signs and symptoms of dementia and associated old age diseases. Preliminary data indicate that the frequency of dementia is higher than expected for people of this age group.

The Kimberley Indigenous Cognitive Assessment (KICA) was developed with Aboriginal health and aged care organizations, and comprises cognitive, informant and functional sections. The KICA tool is a reliable assessment tool for cognitive impairment in an Australian older traditionally living Aboriginal and Torres Strait Islander population.

For more information and to see the latest developments of the KICA tool visit the WA Centre for Health and Ageing.

Publications:

Smith K, LoGiudice D, Dwyer A, Thomas J, Flicker L, Lautenschlager NT, Almeida OP, and Atkinson D. Ngana minyarti? What is this? Development of cognitive questions for the Kimberley Indigenous Cognitive Assessment. Australas J Ageing 2007;26:115-119

LoGiudice D, Smith K, Thomas J, Lautenschlager NT, Almeida OP, Atkinson D, and Flicker L. Kimberley Indigenous Cognitive Assessment tool (KICA): development of a cognitive assessment tool for older indigenous Australians. Int Psychogeriatr 2006;18:269-280

Download:

Plain language report (12 KB .pdf)

Grey Nomads: Health and Health Preparation of Older Travellers in Remote Australia

Grey Nomads: Health and Health Preparation of Older Travellers in Remote Australia

Many older Australians now tour remote Australia (so called ‘grey nomads’). Anecdote suggests they place a burden on limited remote health services, however, this burden is poorly documented. As a first step toward addressing this burden, this study investigated a cohort of older Australians in the Kimberley. This study found that older patients are poorly prepared for travel in remote Australia. They have a chronic disease rate no less than the national prevalence and could represent a drain on local health resources. Solutions might include GP review before travel, bringing sufficient medication for the trip, review of vaccination requirements, and a health summary.

Publication:

Tate J, Mein J, Freeman H, and Maguire G. Grey nomads-health and health preparation of older travellers in remote Australia. Aust Fam Physician 2006;35:70-72.

Diabetes

Improving diabetes care and patient outcomes in Kimberley ACCHSs

Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services

Diabetes is a major health problem in Australia, particularly for Aboriginal people. Good diabetes health care can prevent the development of complications from diabetes and improve quality of life.

Caring for diabetes involves a healthy lifestyle (eating well and exercising regularly); treatment with medications that control sugar levels and other risk factors; and regular screening for the presence of diabetes complications.

Through a quality improvement intervention, we wanted to see how well patients with diabetes were being cared for at four ACCHSs in the Kimberley, and to identify strategies for improvement. We also wanted to evaluate the continuous quality improvement (CQI) cycle and identify strategies to improve the way this is conducted in Kimberley ACCHSs into the future.

This study described the service characteristics of DAHS (which was part of a long term CQI project) and three other Kimberley ACCHS. We also documented diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. During interviews with staff and focus groups with patients we discussed the audit results and strategies that could improve diabetes care.

Audit Findings:

  • Blood and urine tests that are recommended to be done yearly were done for most patients at three of the four ACCHS.  Other care processes such as foot checks and eye checks were not done as frequently as urine and blood tests.
  • Care processes such as blood pressure, weight and waist measurement, HbA1c testing, and assessment of lifestyle were done in most patients at least once in the year, but not many patients had these tests done as frequently as recommended (every 6 months).
  • Measurements of patient health status tended to be better at DAHS where there has been over ten years of CQI in diabetes care.

Suggestions identified by staff and patients for improving care:

  • Improving the computer based patient information system to make it easier for staff members when conducting diabetes care.
  • Improving the function of the multidisciplinary health care team and clarifying role descriptions.
  • There was particular emphasis on supporting an increased involvement of Aboriginal health workers in diabetes care delivery as they were seen as playing a very important role.
  • A need for increased staffing was identified at some of the health services.

Suggested strategies for improving the way that CQI is conducted in Kimberley ACCHSs:

  • Changes to the computer based patient information system to improve the accuracy of future audits, increase tracking of patients as they move between communities in the region, and improve ease-of-use.
  • Allocation of staffing resources where needed and clearer description of roles for chronic disease management programs.
  • Development of a role for a KAMSC regional quality improvement facilitator to assist ACCHSs with their quality improvement efforts.

Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management can increase service delivery rates and improve clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems

Publication:

Alice C Stoneman, David Atkinson, Maureen Davey and Julia V Marley. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Services Research 2014;14:481.

Downloads:

Download the plain language report (54KB .pdf)

Download the published paper (244KB .pdf)

Quality indicators of diabetes care at DAHS: 1999-2009

Quality indicators of diabetes care at DAHS: 1999-2009

International and Australian studies show that well structured approaches to diabetes care can improve short-term and intermediate patient outcomes. Derby Aboriginal Health Service (DAHS) is an Aboriginal community-controlled health service that was established in 1998. Key characteristics of DAHS include whole-of service involvement in internal CQI processes, use of electronic patient information and recall systems, and regional support and standardisation of care.

This study described the service characteristics of DAHS and documented diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. Over the 10 years of the study (1999-2009):

  • The proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded).
  • There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P < 0.001 for all) and there were small improvements in HbA1c levels that approached statistical significance (P = 0.05).

This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.

Publication:

To our knowledge, the following publication it the first published Australian study looking at 10 years of diabetes management in primary care at an individual health service:

Julia V Marley,Carmel Nelson, Vicki O’Donnell and David Atkinson. Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. Med J Aust 2012; 197 (7): 404-408.

Blood from a Finger-prick is OK to Test for Diabetes

Blood from a Finger-prick is OK to Test for Diabetes

Type 2 diabetes is responsible for a huge burden of disease in the Kimberley. Australian and international recommendations to exclude or diagnose diabetes stipulate the need to use laboratory blood glucose samples which can cause logistical problems and delays in diagnosis, particularly in remote communities. Being able to use capillary point-of-care (POC) glucometers to diagnose or exclude diabetes would make this process quicker and easier. This study demonstrated that POC capillary blood glucose analysers can be used as part of the process of diagnosing and excluding diabetes in remote rural communities using locally established capillary equivalence values.

This study led to changes to the diagnostic pathway for Type 2 diabetes in the Kimberley, and the Kimberley Chronic Disease Therapeutic Protocol for Type 2 Diabetes (2007). The results from this study also contributed to changes to the current National Evidence Based Guideline for Case Detection and Diagnosis of Type 2 Diabetes (2009).

Publication:

Marley JV, Davis S, Coleman K, Hayhow BD, Brennan G, Mein JK, Nelson C, Atkinson D, and Maguire GP. Point-of-care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia. Med J Aust 2007;186:500-503

Download:

Plain language report for staff (135 KB .pdf)

Plain language report community members (50 KB .pdf)

Kidney Disease

Peritoneal Dialysis Outcomes of Remote Kimberley origin Aboriginal Patients 2003-2010

Peritoneal dialysis outcomes of Aboriginal and Torres Strait Islander patients of remote Kimberley origin

Why was this study done?

Kidney disease requiring treatment such as dialysis or transplant in Aboriginal and Torres Strait Islander people living in remote areas of Australia is very common.  Dialysis can be either haemodialysis (HD) using a dialysis machine in a community building, or patient’s home or peritoneal dialysis (PD) where a plastic tube is surgically placed into the patient’s abdomen and the patient performs regular dialysis by running sterile fluid into and then draining the fluid out of their abdomen. This treatment is done in the patient’s own home.

Aboriginal and Torres Strait Islander, and non-Indigenous patient survival on PD in Australia appears to not be as good as patients receiving HD therapy, and outcomes are generally worse when compared with PD patients in other countries.  Peritonitis (abdominal infection) is a leading cause of PD failure and death for Australian PD patients.

The aim of this study was to compare treatment outcomes and death rates between Kimberley Aboriginal and Torres Strait Islander, other Aboriginal and Torres Strait Islander, and non-Indigenous patients on PD in Australia during 1st January 2003 to the 31st December 2010.

How was this study done?

We retrospectively identified Aboriginal and Torres Strait Islander patients of Kimberley origin and analysed secondary data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA); this group was compared with other Australian patients receiving PD treatment from 1 January 2003 to 31 December 2010.

During the seven years this study covered we found that:

  • Were more likely to be younger, female, and have other medical problems (eg diabetes) reported when they started dialysis than the non-Indigenous PD patients.
  • Had significantly shorter time to their first episode of peritonitis (11.2 v 21.5 months) and higher PD failure as a result (46.0 v 25.2 per 100 patient-years) than the non-Indigenous PD patients.
  • Had a significantly higher PD failure rate than other Aboriginal and Torres Strait Islander patients (46.0 v 31.4 per 100 patient-years) and nearly double the average peritonitis episodes previously reported for Aboriginal and Torres Strait Islander patients (2.0 v 1.15 per patient-year).
  • Had a median survival on PD that was only five months shorter than non-Indigenous patients (17.5 versus 22.4 months), despite more than three times the number of episodes of peritonitis previously reported for Australian PD patients (2.0 versus 0.6). They also had a similar death rate as non-Indigenous patients.
  • Had higher measured death rates per 100 patient-years compared with an earlier study (2003-2007) of Kimberley Aboriginal and Torres Strait Islander HD patients. However when analysed taking all factors that may have confused this assessment into consideration, the differences are not different in a statistical sense but it still raises concerns that mortality may be worse on PD than HD for Kimberley Aboriginal and Torres Strait Islander patients.

What does this mean?

  • PD continues to be a useful therapy to return people to their homes, however the demonstrated increased illness and a possible increase in deaths sounds a warning note.
  • As a result of this study, doctors have been more cautious in selecting Kimberley people who would benefit from starting on PD in the Kimberley and less people are on PD than there used to be.
  • Although PD can bring Kimberley patients closer to home, it is often only a short term treatment and patients can become quite ill on PD.
  • The risks and possibly short term nature of PD need to be carefully explained to patients in remote areas so they can consider all options before opting for PD.
  • Other options are expanding, with satellite HD now available in four Kimberley towns and home HD also possible in a number of places.

Publication:

Marley JV, Moore S, Fitzclarence C, Warr K, and Atkinson D. Peritoneal dialysis outcomes of Indigenous Australian patients of remote Kimberley origin. Aust J Rural Health 2014; 22:101-108.

Download:

Download the plain language report for patients (178 KB .pdf)

Download the plain language report for staff (113 KB .pdf)

Download the published paper (265KB .pdf)

Haemodialysis Outcomes of Remote Kimberley origin Aboriginal Patients 2003-2007

Haemodialysis outcomes of remote Kimberley origin Aboriginal and Torres Strait Islander patients

Why was this study done?

Over the past 20 years, there has been an epidemic of end-stage kidney disease among Aboriginal and Torres Strait Islander people in remote areas of Australia. There have been limited reports on the outcomes of Aboriginal and Torres Strait Islander people on dialysis in Australia, and those that have been published have generally documented poor patient survival when compared with non-Indigenous patients in Australia.

Satellite haemodialysis (HD) treatment has been provided in the Kimberley since the Kimberley Satellite Dialysis Centre (KSDC) opened in Oct-2002. Royal Perth Hospital (RPH) and KSDC have, between them, been responsible for the care of Kimberley patients requiring HD since that date. Therefore we wanted to:

  1. Describe the patients on renal replacement therapy (RRT) who originated from the Kimberley, and
  2. Compare the clinical outcomes and mortality rates of Aboriginal and Torres Strait Islander people of Kimberley origin receiving haemodialysis (HD) treatment with other subsets of Aboriginal and Torres Strait Islander HD patients (Northern Territory, Western Australia excluding the Kimberley region, the rest of Australia) and Australian non-Indigenous HD patients.

How was this study done?

We retrospectively identified Aboriginal and Torres Strait Islander patients of Kimberley origin and analysed secondary data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA); this group was compared with other Australian patients receiving HD treatment from 1 January 2003 to 31 December 2007.

During the five years this study covered we found that:

  • 77 Kimberley Aboriginal and Torres Strait Islander patients commenced maintenance RRT.
  • The average yearly incidence for the:
    • Kimberley was 1249 per million (95% CI, 1000–1560 per million).
    • NT was 1215 per million (95% CI, 1090–1354 per million).
  • 70% of Aboriginal and Torres Strait Islander RRT patients of Kimberley origin received HD treatment, 70% of which was provided in the Kimberley.
  • KSDC was well attended: 95.7% of the 27 414 planned HD treatment sessions were attended.
  • Larger proportions of all Aboriginal and Torres Strait Islander HD groups compared with non-Indigenous patients had reported comorbid conditions at the start of treatment (P < 0.0001), but the Kimberley HD group had significantly fewer reported comorbid conditions than the other Aboriginal and Torres Strait Islander HD groups (P < 0.05).
  • Overall, HD patients of Kimberley origin fulfilled the CARI guidelines at least as well as other groups.
  • Aboriginal and Torres Strait Islander HD patients of Kimberley origin had significantly lower crude mortality rates than all groups outside WA. The mortality rate ratio compared with non-Indigenous HD patients was 0.53 (95% CI, 0.35–0.80).
  • After adjusting for age, sex, and comorbid conditions, and with or without late referral, there were no significant differences in mortality rates between the Kimberley group and other groups. The mortality rate ratio compared with non-Indigenous HD patients was 0.80 (95% CI, 0.51–1.23).

What does this mean?

This is the first report showing similar mortality rates for Aboriginal and Torres Strait Islander people exclusively from a remote area of Australia and non-Indigenous Australians receiving HD treatment. Aboriginal community control of delivery of HD treatment in a remote location in partnership with good tertiary care can result in health outcomes similar to those of non-Indigenous patients while improving quality of life. While waiting for improved prevention to reduce the numbers of patients requiring dialysis, good quality care in culturally appropriate settings is essential. The continued creative expansion of culturally safe dialysis services in rural and remote areas of Australia needs to be a central part of providing equitable care to the growing number of Aboriginal and Torres Strait Islander people with end stage kidney disease.

Publication:

Marley JV, Dent HK, Wearne M, Fitzclarence C, Nelson C, Siu K, Warr K, and Atkinson D. Haemodialysis outcomes of remote Kimberley origin Aboriginal and Torres Strait Islander patients. Med J Aust 2010; 193:516-520

Download:

Download the plain language report for patients (178 KB .pdf)

Download the plain language report for staff (113 KB .pdf)

Audit of Kimberley Aboriginal Patients with Proteinuria, Chronic Kidney Disease and End Stage Kidney Disease

Audit of Kimberley Aboriginal Patients with Proteinuria, Chronic Kidney Disease and End Stage Kidney Disease

We audited the implementation of best-practice guidelines for patients at a Kimberley Aboriginal Community Controlled Health Service who have proteinuria and chronic kidney disease (CKD). We determined the extent to which regular patients at the clinic who were diagnosed with proteinuria or CKD were correctly assigned to computer care plans, and if the clinic followed the Kimberley Chronic Disease Protocols.

We found that:

  • Of the patients who had results that fitted the proteinuria or CKD care plan criteria, around half were correctly assigned to the corresponding care plan
  • Of the patients correctly assigned to these care plans about 80% were on some form of renoprotective drug
  • However only 40% of these patients were on the doses considered ideal for maximal benefit

These results have been presented to staff at the clinic to help them improve their chronic disease care.

Researchers:

  • Ryan Atkinson, Advanced Medical Science Project, University of Melbourne
  • Assoc Prof David Atkinson
  • Assoc Prof Julia Marley
  • Dr Carmel Nelson

Nutrition

Early Childhood Nutrition and Anaemia Prevention Project: Tjiitji Marrka Manguwa (TMM)

Early Childhood Nutrition and Anaemia Prevention Project – Tjiitji Marrka Manguwa

The Early Childhood Nutrition and Anaemia Prevention Project was a collaborative project across Northern Australia that aimed to determine the feasibility and acceptability of a community nutrition program to improve nutrition and prevent iron deficiency anaemia of Aboriginal infants and young children aged 6 months to 2 years. This involved home-based micronutrient fortification using a product called ‘Sprinkles’.

This pilot project was implemented in six remote Aboriginal communities across northern Australia (Northern Territory, North Queensland and Kimberley). Tjiitji Marrka Manguwa (kids will be strong) is the name of the Kimberley arm of the project and was based in Balgo in the Kutjungka region.

A very special thank you to the families who participated in the Early Childhood Nutrition and Anaemia Prevention Project and shared their stories in the evaluation of the project. Many thanks to the communities that participated in the project: Ngukurr, Borroloola, Jilkminggan, Ti Tree and Pmara Jutunta, Balgo and Kowanyama. The Early Childhood Nutrition and Anaemia Prevention Project would not have been possible without the dedication and enthusiasm of the community based workers and health professionals involved.

The key achievements from this project were:

  • High participation rate: 84% of the estimated 6 month – 2 year old population were enrolled in the project.
  • Increased understanding of the extent of anaemia in Aboriginal infants and young children and potential strategies which can be implemented to prevent and treat anaemia.
  • Insight in to the dietary patterns of Aboriginal infants and young children in remote northern Australian communities.
  • Adaptation of the WHO Infant and Young Child Feeding Counselling Course to meet the needs of health and community services workers supporting Aboriginal families in remote communities; this modified program is now available as Talking about Feeding Babies and Little Kids.
  • Improvements in the research capacity, nutrition knowledge and confidence of Aboriginal Community Based Workers (CBWs), establishing a valuable resource for future research and programs.
  • Good retention of Aboriginal CBWs, and the establishment of partnerships between non-Indigenous health practitioners and CBWs.

The key findings were:

  • Infants and young children had much higher rates of anaemia, and at an earlier age, than expected.
  • Adequate supply of ‘Sprinkles’ appears to maintain haemoglobin levels in non-anaemic children.
  • ‘Sprinkles’ and other program activities were accepted by the communities.
  • Adequate distribution of ‘Sprinkles’ was not achieved for widespread effect.
  • Community Based Workers were important in their communities but experienced difficulties in their role.
  • A limited variety of foods were consumed, in particular nutrient rich foods.
  • Implementation of nutrition counselling and education was limited.
  • Routine child health check/growth assessment and anaemia treatment protocols were poorly adhered to.

Publications:

Aquino D, Marley JV, Senior K, Leonard D, Helmer J, Joshua A, Huddleston A, Ferguson H, Hobson V, Hadgraft N. Early Childhood Nutrition and Anaemia Prevention Project: Summary Report. Darwin: The Fred Hollows Foundation, Indigenous Australia Program 2013.

Download:

Executive Summary (572 KB . pdf)

Summary Report (2 MB . pdf)

TMM Story Book (8MB .pdf)

Community Newsletter July 2011 (1.3 MB .pdf)

Researchers:

  • Carol Green
  • Deanne Hector
  • Loretta Mudgedell
  • Sophie Moora
  • Theresa Sunfly
  • Meleseini Tai-Roche
  • Robyn Smythe
  • Tracy Leon
  • Steve Stevetts
  • Danielle Aquino
  • Assoc Prof Julia Marley

Folate intake and blood folate levels in the Western Australian Aboriginal Population

Folate intake and blood folate levels in the Western Australian Aboriginal Population

Why was this study done?

  • Good folate levels before and during the early stages of pregnancy means a woman is less likely to have a baby with a neural tube defect (such as spina bifida, which is a hole in the spine).  The rate of Aboriginal babies born with a neural tube defect is much higher than non-Aboriginal babies.
  • Therefore, women should eat foods high in folate and/or take vitamin supplements before they get pregnant and in the early stages of their pregnancy.
  • In September 2009 Australia introduced regulations so that folic acid is added to wheat flour that is used to make bread. This means that all bread you buy from a shop contains folic acid and is called mandatory fortification.
  • The aim of this is to reduce the number of babies being born with neural tube defects.
  • We want to see if the mandatory fortification of flour for bread-making with folic acid will increase the blood folate levels of Aboriginal and non-Aboriginal people in WA. First we needed to see what the levels were before this mandatory fortification occurred (this is what this study is about). Later we will see what the levels are after mandatory fortification.
  • To do this, we obtained blood from Aboriginal and non-Aboriginal people before September 2009 to determine their red blood cell folate levels before mandatory fortification.

How was this study done?

Aboriginal people who presented at a health service were asked to take part in the study

  • Broome Regional Aboriginal Medical Service
  • Derbarl Yerrigan Health Service (Perth)
  • WA Country Health Service – Goldfields

Those who agree to take part were given information about the study, and if they agreed to participate, they gave informed consent. Participants were asked to completed a 5 minute questionnaire on diet and vitamin supplements, and gave a two 5 ml samples of blood to measure folate.

What were the results?

  • Some Aboriginal women (10%) and Aboriginal men (26%) have low levels folate in their red blood cells
  • 57% of women and 53% of men ate shop bought bread every day
  • 11% of women and 16% of men took vitamin supplements

What does this mean?

  • Adults need 400 mcg a day
  • Women during pregnancy need 600 mcg a day
  • With the new government regulation of businesses having to add folic acid to wheat flour that is used to make bread, we think that the number of Aboriginal babies born with neural tube defect will decrease.

Many thanks to the patients who took part in this study. Thanks to Mary Lane, and to all the clinical staff who helped with the study.  Without your help this research would not have been possible.

This study was a joint project between the Department of Health WA, Derbarl Yerrigan Health Service, Kimberley Aboriginal Medical Services Council, The University of WA and the Telethon Institute for Child Health Research.

If you have any questions or comments please direct them to Carol Bower by phone (08) 9489 7777 or email carolb@ichr.uwa.edu.au

Publication:

Maxwell SJ, Brameld KJ, Bower C,  D’Antoine H, Hickling S, Marley JV, O’Leary P. Baseline investigations of folate status in Aboriginal and non-Aboriginal West Australians prior to the introduction of mandatory fortification. Aust N Z J Obstet Gynaecol 2013; 53:26-31

Download:

Download the plain language report for participants (876 KB .pdf)

Download the folate brochure (1.5 MB .pdf)

Download the folate poster (1.3 MB .pdf)

Heart Disease

Getting Every Child's Heart OK (gECHO) Study

Getting Every Child’s Heart OK (gECHO) Study

The gECHO Study is a population based survey to document the extent of undiagnosed rheumatic heart disease. The aim of this project is to determine the prevalence of Rheumatic Heart Disease (RHD) among Aboriginal, Torres Strait Islander and non-Indigenous children by screening children age 5-14 for RHD. It also aims to determine the most sensitive and specific screening method for RHD and use this information to guide future screening programs.

The Kimberley is one of 4 sites across the north of Australia. In the Kimberley the aim is to screen school-aged children between ages 5-14 in approximately 8 remote communities. This will involve a 10 minute screening echocardiogram. If abnormalities are noted on this screening echocardiogram, these children will then progress to a full echocardiogram. The results of any abnormal echocardiograms will be referred on to the relevant doctors, specialists and other clinical staff for appropriate follow-up so that any children with previously undiagnosed RHD can be offered prophylaxis.

Data on the prevalence of RHD will be collected. This data will be used not only to report on the true prevalence of RHD in the Kimberley, but also the most sensitive and specific methods of screening and refine the current consensus case definition of RHD based on echocardiography-based diagnosis (ie: refine the diagnostic criteria for accurate echocardiographic screening).

Data collection has been completed.

Publication:

Remond, M. G.; Severin, K. L.; Hodder, Y.; Martin, J.; Nelson, C.; Atkinson, D.; Maguire, G. P.  Variability in disease burden and management of rheumatic fever and rheumatic heart disease in two regions of tropical Australia Intern Med J. 2012; in press.

Rheumatic Fever Follow-Up Study - RhFFUS

Rheumatic Fever Follow-Up Study – RhFFUS

RhFFUS follows in the footsteps of the earlier gECHO (getting Every Child’s Heart Okay) study, which found many children in northern and central Australia who had heart valve abnormalities of unclear and doubtful significance. In a setting where rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain amongst the highest in the world, it’s important to know whether these minor changes represent the earliest sign of RHD. RhFFUS will monitor the progress of children identified with minor heart valve abnormalities during the gECHO study to see whether they are at greater risk of developing RHD and/or contracting ARF.

The findings of RhFFUS will help inform the future response to RHD in this and other settings. In particular, it will allow primary health care providers (nurses, health workers and GPs) and specialists to understand the significance of subtle changes on echocardiography and to determine whether these represent the earliest changes of RHD or mere variations of normal heart anatomy. If children with an initial abnormal echocardiogram are shown to have an increased risk of ARF and/or progression to RHD, then a case may be made for identifying high risk children earlier through screening echocardiography and offering them benzathine penicillin antibiotic prophylaxis to prevent the development of RHD.

The Kimberley component of this project has been completed.

Publications:

Remond, M. G.; Atkinson, D.; White, A.; Hodder, Y.; Brown, A. D.; Carapetis, J. R.; Maguire, G. P.  Rheumatic Fever Follow-Up Study (RhFFUS) protocol: a cohort study investigating the significance of minor echocardiographic abnormalities in Aboriginal Australian and Torres Strait Islander children. BMC Cardiovasc Disord. 2012;12:111

Researchers:

  • A/Prof Graeme Maguire
  • Prof David Atkinson
  • Dr Andrew White
  • Prof Alex Brown
  • Prof Johnathan Carapetis

Ear Health

The NACCHO Ear Trial

The NACCHO Ear Trial

Chronic suppurative otitis media (CSOM), a disease of poverty, is very common among Australian Aboriginal children. In Aboriginal children, CSOM usually commences in infancy, causes hearing loss and has adverse effects on child development. This Aboriginal community controlled health services led research showed that twice-daily ear cleaning and topical ciprofloxacin is effective at community-level in achieving cure for CSOM. Healthcare providers to Aboriginal children with CSOM should be given special access to provide ototopical ciprofloxacin as first-line treatment.

Publications:

Couzos S, Lea T, Murray R, and Culbong M. ‘We are not just participants–we are in charge’: the NACCHO ear trial and the process for Aboriginal community-controlled health research. Ethn Health 2005;10:91-111

Couzos S, Lea T, Mueller R, Murray R, and Culbong M. Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community-based, multicentre, double-blind randomised controlled trial. Med J Aust 2003;179:185-190

Eye Health

The Kimberley Eye Health Study

The Kimberley Eye Health Study

The Kimberley eye program has been built up over more than two decades, with a host of factors contributing to its current form. The eye health services in the Kimberley region includes retinal screening performed by Aboriginal health workers (AHWs) and nurses using retinal cameras for diabetic patients, mobile optometry services in remote communities and a visiting ophthalmology team.

The aims of this study are:

  • To gather background information about the origins and history of eye health services and programs in the Kimberley region for the past 10 years;
  • To describe the current model of eye health services;
  • To evaluate outcomes of eye health services by analysing quantitative data from optometry, hospital and primary health care databases;
  • To identify the lack of particular services, such as retinal screening, and facilitate appropriate training for health workers in remote health clinics of need.

Progress to date:

  • Documented the history of eye health services in the Kimberley region;
  • Evaluated eye health services in the Kimberley and analysed diabetic retinal screening activities between 2004-2010;
  • Trained AHWs and nurses in how to operate a digital retinal camera and restored retinal screening programs across the Kimberley as part of chronic disease care;
  • Further developed eye data record-keeping in a centralised database (MMEx) for Kimberley Aboriginal Community Controlled Health Services;
  • Facilitated the forthcoming appointment of a regional eye coordinator and trainer for the region who will support and coordinate eye health services, provide ongoing training in retinal photography and help to report on retinal screening coverage;
  • Provided plain language reports of the study findings to all health services included in the study. We are currently writing up the findings for publication in a peer reviewed journal.

Researchers:

  • Dr May Sian Oh
  • Dr Carmel Nelson
  • Assoc Prof Julia Marley
  • Assoc Prof David Atkinson
  • Sue Metcalf
  • Philomena Lewis
  • Margie O’Neill
  • Dr Angus Turner
  • Dr Emma Griffiths
  • Dr Carole Reeve
  • Assoc Prof Richard Murray

Download:

Plain language report for staff (1.65 MB .pdf)

Sustained Retinal Screening Program

Sustained Retinal Screening Program

Type 2 diabetes mellitus and its complications affect up to 25% of Aboriginal adults. However, access to primary health care is often poor, with primary care providers serving Aboriginal populations often being overwhelmed by acute care needs. Implementing and sustaining culturally safe programs to screen for chronic disease and provide effective continuing care is therefore a significant challenge. This study demonstrated that a devolved program of screening for retinal complications of diabetes in a remote Aboriginal population can be successfully performed by Aboriginal health workers and nurses using non-mydriatic fundus cameras and sustained over time with regional program support. Data sharing across services, client recall lists and point-of-care prompts generated by patient information systems, together with policies that make primary health care providers responsible for care coordination, helped support timely screening while avoiding over-screening.

Publication:

Murray RB, Metcalf SM, Lewis PM, Mein JK, and McAllister IL. Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership. Med J Aust 2005;182:520-523

Smoking / Respiratory Disease

Be Our Ally Beat Smoking (BOABS) Study

Aboriginal people smoke at much higher rates than non-Aboriginal people and smoking is an important contributor to increased disease, hospital admissions and deaths in Aboriginal populations.

Quit smoking programs in Australia have not had the same impact on Aboriginal smokers as on non-Aboriginal smokers. It is important that improved techniques for assisting Aboriginal people to quit be developed and implemented as part of comprehensive strategies to improve Aboriginal health.

A range of strategies have been used to encourage Aboriginal people to quit smoking however there have been few good quality studies that show what approaches work best. More evidence of strategies that could work more widely in Aboriginal primary health care settings is needed if good policy is to be developed and implemented.

We conducted a NHMRC funded randomised controlled trial of smoking cessation strategies in Aboriginal community controlled health services (ACCHS) in the Kimberley. This trial was based in Derby Aboriginal Health Service (DAHS) and Ord Valley Aboriginal Health Service (OVAHS).

The BOABS Study was carried out by local, trained Aboriginal Research Staff based at DAHS and OVAHS. Participants who agreed to take part were randomly allocated to either a program following current Australian recommended primary care smoking cessation strategies (usual care) or a more intensive supported quit smoking intervention (outreach).

We found that:

  • 11% of the outreach group had quit smoking at 12 months – more than twice the quit rate of the group who received usual clinic care.
  • A meta-analysis of these findings and a comparable study of pregnant Aboriginal and Torres Strait Islander women showed that Aboriginal and Torres Strait Islander participants assigned to the intervention groups were 2.4 times (95% CI, 1.01-5.5) as likely to quit as participants assigned to usual care.

Challenges we encountered during the relatively complex BOABS Study included:

  • Complexities in conducting a randomised controlled trail such as recruiting sufficient number of participants and managing the project in two distant locations.
  • Providing appropriate training and support to Aboriginal researchers and ensuring high quality work across both sites.
  • Significant staff absences, staff shortages and high workforce turnover.
  • Determining where and how the project fitted in the clinics; resistance to change, and maintaining organisational commitment and priority for the project.

The keys to the success of the BOABS Study were:

  • Local development, ownership and participation.
  • Worker professional development and support.
  • Operating within a framework of cultural safety.

Culturally appropriate, multi-dimensional Indigenous quit smoking programs can be successfully implemented in remote primary health care. Intensive one-on-one interventions with substantial involvement from Aboriginal and Torres Strait Islander workers are likely to be effective in these settings.

Research to investigate complex interventions in Aboriginal health should not be limited to randomised clinical trials and funding needs to reflect the additional, but necessary, cost of providing for local control of planning and implementation. The questions now should be whether real world smoking cessation programs work in practice, whether they are cost effective and sustainable and to identify enablers and barriers to the integration of such programs into primary health care for Aboriginal and Torres Strait Islander peoples.

The priority should now be to implement and integrate a smoking cessation program, based on BOABS, within usual primary health care in the Kimberley and to demonstrate the effectiveness of this program to support people to quit smoking in a real world setting.

Publications:

Julia V Marley, Tracey Kitaura, David Atkinson, Sue Metcalf, Graeme P Maguire and Dennis Gray. Clinical trials in a remote Aboriginal setting: lessons from the BOABS smoking cessation study. BMC Public Health 2014; 14:579

Julia V Marley, David Atkinson, Tracey Kitaura, Carmel Nelson, Dennis Gray, Sue Metcalf, and Graeme P Maguire. The Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2014; 14:32

Julia V Marley, David Atkinson, Carmel Nelson, Tracey Kitaura, Dennis Gray, Sue Metcalf, Richard Murray and Graeme P Maguire. The protocol for the Be Our Ally Beat Smoking (BOABS) study, a randomised controlled trial of an intensive smoking cessation intervention in a remote Aboriginal Australian health care setting. BMC Public Health 2012; 12:232

Download:

Download the plain language report of the findings from the BOABS Study (54KB .pdf)

Download the plain language report of the lessons learnt from the BOABS Study (65KB .pdf)

Published Evaluation of BOABS (753KB .pdf)

Published Lessons Learnt from the BOABS Study (469 .pdf)

Published Protocol (938KB .pdf)

“Stop the Smokes” by Brian Hunter© (1.7 MB .wma)

SBS World News Interview 5th Februrary 2014

Researchers:

  • Sue Clarke
  • Edna Hester
  • Brian Hunter
  • Brett Nelson
  • Bevan Norman
  • Marian Lester
  • Keran List
  • Tara Page
  • Alaine Ross
  • Veronica Ryder
  • Roxanne Williams
  • Tracey Kitaura
  • Prof David Atkinson
  • Prof Dennis Gray
  • Assoc Prof Graeme Maguire
  • Assoc Prof Julia Marley
  • Sue Metcalf
  • Assoc Prof Richard Murray
  • Dr Carmel Nelson

Burden of Obstructive Lung Disease (BOLD)

Burden of Obstructive Lung Disease (BOLD)

The Kimberley is one of four Australian sites for the international BOLD study, an NHMRC funded study of lung function.  Obstructive lung disease is known to be more common among Aboriginal people, however the extent of this excess on a population basis has not been documented and care for Aboriginal people with obstructive lung disease is often less than optimal.  The Kimberley is the only BOLD site with a significant Aboriginal and Torres Strait Islander focus and this study is being carried out in conjunction with a pulmonary rehabilitation project which KAMSC and WACHS-K are also partners in and with smoking prevention programs currently underway. Results have been submitted for publication in peer reviewed journals.

Researchers:

  • David Reeve
  • Mary Lane
  • Assoc Prof David Atkinson
  • Assoc Prof Wendy Cavilla
  • Assoc Prof Graeme Maguire

Kimberley BOLD PLUS Project

Since 2009, the Kimberley BOLD project has collected prevalence and risk factor data on chronic obstructive pulmonary disease (COPD) in several communities in the Kimberley. Despite growing epidemiological data on COPD, little is known about the knowledge and views of Aboriginal and non-Aboriginal COPD patients on their disease and treatment, nor on the knowledge and attitudes of health professionals regarding COPD and how these may influence their clinical practice and implementation of local guidelines.

The aims of this project are to:

  • Investigate the knowledge, attitudes and practices of COPD patients in the Kimberley, and any significant differences between Aboriginal and non-Aboriginal patients;
  • Investigate the knowledge, attitudes and practices of clinicians treating COPD in the Kimberley, and perceived barriers and enablers to optimal COPD care; and
  • Conduct a clinical audit comparing the quality of care received by COPD patients in the Kimberley to the care recommended by the Kimberley Chronic Lung Disease Guidelines.

This data will help inform future strategies by Kimberley health organisations such as KAMSC, to improve staff education, communication between clinicians and patients, and systems of care including the use of the local guidelines, with the aim to improve COPD care in the Kimberley and in other Australian remote and/or Indigenous healthcare settings. Results have been submitted for publication in peer reviewed journals.

Researchers:

  • Prof David Atkinson
  • Assoc Prof Graeme Maguire
  • Nathania Burrie, James Cook University

Vaccination

Hepatitis B infections in vaccinated Kimberley Aboriginal people

Hepatitis B infections in vaccinated Kimberley Aboriginal people: 1984-2011

In 2011 the Kimberley Population Health Unit (KPHU) became aware of people in the Kimberley who had been reported to have hepatitis B infection even though they were born at a time which meant they should have been fully vaccinated at birth. This prompted a review of hepatitis B cases in the Kimberley region to see if there was any evidence of vaccine failure occurring.

All cases of hepatitis B infection are notified to the Western Australian Notifiable Infectious Disease Database (WANIDD). These notifications were cross referenced against immunisation records held by KPHU in an electronic database and in paper form. In any cases identified, we looked at maternal serology to see if chronic hepatitis B infection in the mother was the likely reason for infection.

From 1 January 1984 to 31 March 2011, we identified 17 cases of Aboriginal Kimberley residents with hepatitis B infection after vaccination:

  • In six cases there was evidence that the mother had chronic infection during pregnancy.
  • In seven patients there was no evidence that the mother had chronic infection when they were pregnant, suggesting they became infected in early childhood or through sexual activity and therefore vaccination failure was likely.
  • In four cases there was insufficient information to comment on how they became infected.

With the introduction of vaccination the rates of chronic infection are falling, however some children may acquire infection despite vaccination. In this population, infection is more likely to occur during pregnancy and delivery or in childhood than in adulthood.

Prevention and control strategies in the Kimberley therefore should include screening all antenates for hepatitis B infection, follow-up of high risk infants, high rates of vaccination coverage, appropriate opportunistic population screening, monitoring of vaccination status in notified cases and prevention of transmission from those with chronic infection to household contacts.

Publication:

Emma Griffiths, Carole Reeve, Julia V Marley. Hepatitis B notifications in a vaccinated cohort of Aboriginal people in the Kimberley region. Med J Aust 2014; 201:343-346

Download:

Download the plain language report (58 KB .pdf)

Workforce Needs

Medical Workforce Needs and Distribution in the Kimberley

Medical Workforce Needs and Distribution in the Kimberley

This study investigated the extent to which general practitioners in the Kimberley region are available for doctor-provided primary care and relates primary care availability to need and standardised population based on government statistics and interviews with general practitioners, local managers and regional employers and organisations. A shortfall of 20.6 full time general practitioner positions was identified and this was aggravated by a significant number of unfilled positions in the areas of greatest need. Overall the region had only half the primary care general practitioners needed. The Shire of Halls Creek at the time of survey had less than a quarter of the doctors required based on this analysis.

Steps to increase the Australian medical workforce have begun but resources to recruit, support and sustain this workforce are required. Aboriginal health workers and locally trained nurses competently provide much of the primary care but need greater resources to support the available medical care.