Evaluation of a Regional Healthy Skin Program in Remote Aboriginal Communities of Australia's Northern Territory (EAHSP)

East Arnhem Healthy Skin Project: A Regional Collaboration to Reduce Scabies, Skin Sores and Associated Chronic Diseases, Including Rheumatic Fever and Renal Disease, Among Australian Aboriginal Communities

The purpose of this study is to determine whether a coordinated regional approach to healthy skin programs in six remote Aboriginal communities can demonstrate, not only a reduction in the burden of scabies and streptococcal skin sores, but also broad health benefits, including primary prevention of some chronic diseases that occur at particularly high rates in Australian Aboriginal communities.

The primary objectives of the Program are:

• Demonstrate a reduction in scabies and skin sores on a regional basis
• Demonstrate the broader public health effects of Healthy Skin Programs, particularly those relating to chronic diseases such as rheumatic fever and renal diseases
• Build on the existing Indigenous capacity by assisting in the development of new knowledge and skills to improve the health and well being of Indigenous communities
• Establish the feasibility of incorporating Healthy Skin Programs into existing health service delivery

Study Overview

• Status: Completed
• Conditions: Streptococcal Infections; Scabies; Pyoderma; Impetigo

Detailed Description

There are standard government recommendations for the conduct of healthy skin programs within the Northern Territory (NT), where the key component involves a single mass treatment for scabies of all residents in the region followed by regular monitoring of skin infections with treatment of individuals as new cases arise. The key features of the guidelines include:

• Community planning and collaborative effort;
• Development of local educational resources;
• Single whole community treatment day for scabies with permethrin (5%);
• Community "clean up" involving house cleaning, linen and rubbish collection;
• Emphasis on housing functionality and "washing kids" to maintain low rates of skin sores; and
• Regular monitoring of scabies and skin sores, usually in a target group such as children

Previous programs have been successful in controlling scabies and related skin infections in the NT but have been limited to single communities with varying levels of success. In collaboration with communities in the East Arnhem Region, we propose to conduct a coordinated Healthy Skin Program. By concentrating on one region, the project has an increased likelihood of success because reinfection due to mobility between communities will be minimised, and because the project will be recognised as a collaboration between multiple communities.

The program is structured into three distinct components:

• Implementation of the program within the participating communities;
• Evaluation of the program against specific outcomes; and
• Integration of the program into routine service delivery.

• Study Type: Observational
• Enrollment (Actual): 2329

Contacts and Locations

Study Locations

• Australia
  • Northern Territory
    • Casuarina, Northern Territory, Australia, 0811
      • Menzies School of Health Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 15 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Residents aged <15 years of participating communities in a remote region of the Northern Territory

Description

Inclusion Criteria:

• All children aged <15 years in the participating communities

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Indigenous children aged <15 years; Indigenous children aged <15 years within participating communities of the Northern Territory

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Reduced prevalence of scabies among children in the participating communities from 30% (expected prevalence pre-program) to <10% at least 2 years following the introduction of the program	2 years
Reduced prevalence of skin sores among children in the participating communities from 50% (expected prevalence pre-program) to <25% at least 2 years following the introduction of the program	2 years

Secondary Outcome Measures

Outcome Measure	Time Frame
Reduced severity of skin sores among children in the participating communities from 40% classified as moderate/severe (expected pre-program) to <15% classified as moderate/severe at least two years following the introduction of the program	2 years

Collaborators and Investigators

• Sponsor: Menzies School of Health Research
• Collaborators: Murdoch Childrens Research Institute; University of Melbourne; Cooperative Research Centre for Aboriginal Health
• Investigators: Principal Investigator: Ross M Andrews, PhD, Menzies School of Health Research; Principal Investigator: Jonathan R Carapetis, PhD, MBBS, Menzies School of Health Research; Principal Investigator: Bart Currie, MBBS, DTM&H, Menzies School of Health Research; Principal Investigator: Christine Connors, MBBS, Northern Territory Govermnent Department of Health and Families; Principal Investigator: Shelley Walton, PhD, Menzies School of Health Research; Principal Investigator: Colin J Parker, MBBS, Australasian College of Dermatologists

Publications and helpful links

General Publications

• Andrews RM, Kearns T, Connors C, Parker C, Carville K, Currie BJ, Carapetis JR. A regional initiative to reduce skin infections amongst aboriginal children living in remote communities of the Northern Territory, Australia. PLoS Negl Trop Dis. 2009 Nov 24;3(11):e554. doi: 10.1371/journal.pntd.0000554.

Study record dates

Study Major Dates

• Study Start: September 1, 2004
• Primary Completion (Actual): August 1, 2007
• Study Completion (Actual): August 1, 2007

Study Registration Dates

• First Submitted: April 20, 2009
• First Submitted That Met QC Criteria: April 20, 2009
• First Posted (Estimate): April 21, 2009

Study Record Updates

• Last Update Posted (Estimate): April 21, 2009
• Last Update Submitted That Met QC Criteria: April 20, 2009
• Last Verified: April 1, 2009

More Information

Terms related to this study

• Keywords: Scabies; Impetigo; Pyoderma; Streptococcal infections
• Additional Relevant MeSH Terms: Skin Diseases; Infections; Bacterial Infections; Bacterial Infections and Mycoses; Gram-Positive Bacterial Infections; Parasitic Diseases; Ectoparasitic Infestations; Skin Diseases, Parasitic; Skin Diseases, Infectious; Staphylococcal Infections; Skin Diseases, Bacterial; Mite Infestations; Staphylococcal Skin Infections; Scabies; Streptococcal Infections; Pyoderma; Impetigo
• Other Study ID Numbers: 41 17May2004