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PubMed1991

Tuberculosis in Saudi Arabia: initial and secondary drug resistance among indigenous and non-indigenous populations.

Resistance to six anti-mycobacterial agents rifampicin, isoniazid, streptomycin, ethambutol, p-amino salicylic acid and cycloserine was studied. Variations in the resistance pattern among Saudi, non-Saudi and a stable National Guard King Khalid Hospital (NGKKH) population were investigated. A high percentage of relapse cases, 21%, was recorded. Among the NGKKH population this figure was much lower, 9.9%. Resistance to rifampicin alone was high at 7.2% followed by streptomycin 3.3%, isoniazid 1.8%, p-amino salicylic 1.2% and cycloserine 0.8%. Resistance to rifampicin alone was higher among 'new' cases whilst combined resistance to two or more drugs was seen more often in 'old' patients. Resistance was seen more frequently among non-Saudis, both 'old' and 'new'. An unusual finding was the prevalence of rifampicin resistance among non-pulmonary isolates.

Antitubercular Agents↗
PubMed2006

Jaw fractures in the indigenous and non-indigenous populations of Western Australia: 1999-2003.

Little data exist on the analysis of jaw fractures in Australia, and none in Western Australia. This study was a retrospective analysis of all hospitalizations for jaw fractures in Western Australia between the years 1999-2000 and 2002-2003. The aims were to determine the incidence, distribution between males and females, different age groups, aboriginal and non-aboriginal groups, and rural and urban populations. The economic impact of jaw fracture hospitalizations was also determined. Males were more likely (80.4%) than females to be admitted for a jaw fracture. Fractures of the mandible were more common (61.9%) than maxillary fractures (38.1%). Aboriginal persons had nearly 10 times more hospitalization rate than that of non-aboriginal persons. Fracture rates were significantly (P<0.05) higher in rural (61.9 per 100,000) than in urban areas. Over the 4-year study period the total costs for all jaw fracture hospitalizations exceeded US$ 7.6 million. This study clearly indicates the burden of jaw fractures on the Western Australian population, in terms of physical and economic impact.

Adolescent↗
PubMed2006

Indigenous children and receipt of hospital dental care in Australia.

OBJECTIVE: The aim of this study was to investigate dental procedures received under hospital general anaesthetic by indigenous and non-indigenous Australian children in 2002-2003. METHODS: Separation data from 1297 public and private hospitals were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for 2002-2003. The dependant variable was the admission rate of children receiving four categories of dental care (i.e. extraction, pulpal, restoration or other). The explanatory variables included sex, age group, indigenous status and location (i.e. major city, regional or remote). Rates were calculated using estimated resident population counts. RESULTS: The sample included 24 874 children aged from 2 to 14 years. Some 4.3% were indigenous (n = 1062). Admission rates for indigenous and non-indigenous children were similar, with indigenous males having 1.2 times the admission rate of indigenous females (P < 0.05). Indigenous children aged < 5 years had 1.4 times the admission rate of similarly aged non-indigenous children (P < 0.001) and 5.0 times the admission rate of 10-14-year-old indigenous children (P < 0.001). Remote-living indigenous children had 1.5 times the admission rate of their counterparts in major cities or regional areas (P < 0.001), and 1.4 times the admission rate of remote-living non-indigenous children (P < 0.01). The extraction rate of indigenous males was 1.3 times that of non-indigenous males (P < 0.01), and 1.2 times that of indigenous females (P < 0.05). Pre-school indigenous children had 2.2 times the extraction rate of similarly aged non-indigenous children (P < 0.001), and 5.3 times that of indigenous 10-14-year-olds (P < 0.001). The extraction rate of remotely located indigenous children was 1.5 times that of indigenous children in major cities (P < 0.01), and 1.8 times that of remote-living non-indigenous children (P < 0.001). CONCLUSIONS: In certain strata - particularly males, the very young and those in remote locations - indigenous children experienced higher rates of extractions than non-indigenous children when undergoing care in a hospital dental general anaesthetic setting.

Adolescent↗
PubMed2005

Fulfilling prophecy? Sexually transmitted infections and HIV in Indigenous people in Western Australia.

OBJECTIVE: To compare trends and rates of HIV and sexually transmitted infections in Indigenous and non-Indigenous people of Western Australia. DESIGN AND SETTING: Analysis of WA notification data for chlamydia, gonorrhoea, and primary and secondary syphilis in 2002, and for HIV infections from 1983 to 2002. MAIN OUTCOME MEASURES: Rates of HIV and sexually transmitted infection by Indigenous status. RESULTS: In 2002, there were 3046 notifications for chlamydia, 1380 for gonorrhoea and 64 for syphilis. When information on Indigenous status was available, Indigenous people accounted for 41% of chlamydia and 76% of gonorrhoea notifications, with Indigenous:non-Indigenous age-standardised rate ratios of 16 (95% CI, 14-17) and 77 (95% CI, 67-88), respectively. Indigenous people accounted for 90.6% of syphilis notifications (age-standardised Indigenous:non-Indigenous rate ratio, 242 [95% CI, 104-561]). From 1985 to 2002, HIV notification rates for non-Indigenous people in WA declined and rates for Indigenous people increased. From 1994 to 2002, there were 421 notifications of HIV infection in WA residents, 52 (12.4%) in Indigenous people and 369 (87.6%) in non-Indigenous people. Indigenous people accounted for 39% and 6.2% of all notifications in WA females and males, respectively. The Indigenous:non-Indigenous rate ratios were 18 (95% CI, 12-29) for females and 2 (95% CI, 1-3) for males. CONCLUSIONS: Indigenous Western Australians are at greater risk of HIV transmission than non-Indigenous people. Strategies to prevent further HIV infection in Indigenous Australians should include control of sexually transmitted infections.

Adolescent↗
PubMed2005

Reducing perinatal mortality among Indigenous babies in Queensland: should the first priority be better primary health care or better access to hospital care during confinement?

BACKGROUND: The perinatal mortality rate among Indigenous Australians is still double that of the rest of the community. The aim of our study was to estimate the extent to which increased risk of low birthweight and preterm birth among Indigenous babies in Queensland account for their continuing mortality excess. If a large proportion of excess deaths can be explained by the unfavourable birthweight and gestational age distribution of Indigenous babies, then that would suggest that priority should be given to implementing primary health care interventions to reduce the risk of low birthweight and preterm birth (eg, interventions to reduce maternal smoking or genitourinary infections). Conversely, if only a small proportion is explained by birthweight and gestational age, then other strategies might need to be considered such as improving access to high-quality hospital care around the time of confinement. METHODOLOGY: Population-based, descriptive study of perinatal mortality rates among Indigenous and non-Indigenous babies, in Queensland, stratified by birthweight and gestational age. RESULTS: Indigenous babies are twice as likely to die as their non-Indigenous counterparts (rate ratio1998-2002: 2.01; 95%ci 1.77, 2.28). However, within separate strata of birth weight and gestational age, Indigenous and non-Indigenous rates are similar. The Mantel-Haenszel rate ratio adjusted for birth weight and gestational age was 1.13 (0.99, 1.28). This means that most of the excess mortality in Indigenous babies is largely due to their unfavourable birth weight and gestational-age distributions. If Indigenous babies had the same birth weight and gestational age distribution as their non-Indigenous counterparts, then the relative disparity would be reduced by 87% and 20 fewer Indigenous babies would die in Queensland each year. CONCLUSION: Our results suggest that Indigenous mothers at high risk of poor outcome (for example those Indigenous mothers in preterm labour) have good access to high quality medical care around the time of confinement. The main reason Indigenous babies have a high risk of death is because they are born too early and too small. Thus, to reduce the relative excess of deaths among Indigenous babies, priority should be given to primary health care initiatives aimed at reducing the prevalence of low birth weight and preterm birth.

Journal Article↗
PubMed2006

Indigenous health and socioeconomic status in India.

BACKGROUND: Systematic evidence on the patterns of health deprivation among indigenous peoples remains scant in developing countries. We investigate the inequalities in mortality and substance use between indigenous and non-indigenous, and within indigenous, groups in India, with an aim to establishing the relative contribution of socioeconomic status in generating health inequalities. METHODS AND FINDINGS: Cross-sectional population-based data were obtained from the 1998-1999 Indian National Family Health Survey. Mortality, smoking, chewing tobacco use, and alcohol use were four separate binary outcomes in our analysis. Indigenous status in the context of India was operationalized through the Indian government category of scheduled tribes, or Adivasis, which refers to people living in tribal communities characterized by distinctive social, cultural, historical, and geographical circumstances.Indigenous groups experience excess mortality compared to non-indigenous groups, even after adjusting for economic standard of living (odds ratio 1.22; 95% confidence interval 1.13-1.30). They are also more likely to smoke and (especially) drink alcohol, but the prevalence of chewing tobacco is not substantially different between indigenous and non-indigenous groups. There are substantial health variations within indigenous groups, such that indigenous peoples in the bottom quintile of the indigenous-peoples-specific standard of living index have an odds ratio for mortality of 1.61 (95% confidence interval 1.33-1.95) compared to indigenous peoples in the top fifth of the wealth distribution. Smoking, drinking alcohol, and chewing tobacco also show graded associations with socioeconomic status within indigenous groups. CONCLUSIONS: Socioeconomic status differentials substantially account for the health inequalities between indigenous and non-indigenous groups in India. However, a strong socioeconomic gradient in health is also evident within indigenous populations, reiterating the overall importance of socioeconomic status for reducing population-level health disparities, regardless of indigeneity.

Alcohol Drinking↗
PubMed2003

Nutritional status of indigenous children younger than five years of age in Mexico: results of a national probabilistic survey.

OBJECTIVE: To compare the prevalence of undernutrition and anemia in indigenous and non-indigenous children < 5 years of age at the national level, by region and by urban and rural areas, and to evaluate the degree to which the socioeconomic condition of the family predicts the differences. MATERIAL AND METHODS: A national probabilistic survey was conducted in Mexico in 1999. Indigenous families were identified as those in which at least one woman 12-49 years of age in the household spoke a native language. The prevalence of undernutrition (stunting, wasting and underweight) and anemia was compared between indigenous and non-indigenous children. Probability ratios (PR) were used to compare prevalences in indigenous and non-indigenous children adjusting for socioeconomic status (SES) of the family and for other covariates. RESULTS: The prevalences of stunting and underweight were greater in indigenous than in non-indigenous children. At the national level and in urban areas the prevalences were three times greater and in rural areas approximately 2 times greater (p < 0.05). No differences were found in the prevalence of wasting (p > 0.05). The prevalence of anemia in indigenous children was one third greater than in non-indigenous children at the national level (p < 0.05) and was between 30 and 60% greater in urban areas and in the regions studied (p < 0.05) but was not statistically significant (p > 0.05) in rural areas. These differences were reduced to about half when adjusting for SES but remained significantly higher in indigenous children (p < 0.05). CONCLUSIONS: Indigenous children have higher probabilities of stunting and underweight than non-indigenous children. The differences are larger in urban areas and in higher socioeconomic geographic regions and are explained mostly by socioeconomic factors. The overall difference in the probability of anemia is small, is higher only in urban relative to rural areas, and is explained to a lesser degree by socioeconomic factors. Policy and programs should be designed and implemented to reduce the dramatic differences in nutritional status between indigenous and non-indigenous children in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Adolescent↗
PubMed2004

Impact of hepatitis A vaccination of Indigenous children on notifications of hepatitis A in north Queensland.

OBJECTIVE: To describe the impact of a hepatitis A vaccination program for Indigenous children in north Queensland. DESIGN: Enhanced surveillance of all notified cases of hepatitis A in north Queensland from 1996 to 2003. SETTING: North Queensland; population, 596 500 people, including about 6900 Indigenous children aged under five years. INTERVENTIONS: Hepatitis A vaccine was provided to Indigenous children in north Queensland from February 1999; two doses were recommended (at 18 months and 2 years of age), as was catch-up vaccination up to the sixth birthday. RESULTS: In the 4 years 1996-1999, 787 cases of hepatitis A were notified in north Queensland, 237 (30%) of which were in Indigenous people. The average annual notification rates in Indigenous and non-Indigenous people during this period were 110 and 25 cases per 100 000 persons, respectively. In the first 4 years after introduction of the vaccination program (2000-2003), 66 cases of hepatitis A were notified. Only nine of the 66 (14%) were in Indigenous people. The average annual notification rates in Indigenous and non-Indigenous people in 2000-2003 were 4 and 2.5 cases per 100 000 persons, respectively. CONCLUSION: Hepatitis A seems to have been eradicated from Indigenous communities in north Queensland very soon after the vaccination program began. The rapid decline in notifications in non-Indigenous as well as Indigenous people suggests the program quickly interrupted chains of transmission from Indigenous children to the broader community. To our knowledge this is the first evidence that a hepatitis A vaccination program targeting a high-risk population within a community can reduce disease in the broader community. Hepatitis A vaccine should be provided to other high-risk Indigenous children elsewhere in Australia.

Chemistry, Pharmaceutical↗
PubMed2004

Smoking behaviour among Indigenous secondary school students in North Queensland.

This study investigated smoking behaviour among Indigenous youth. A sample of schools (n = 12) in north Queensland with large proportions of Indigenous students was selected. Details about the prevalence of smoking behaviour in both Indigenous and non-Indigenous students (n = 883) were gathered. Data were also collected on the cultural, social, and psychological factors associated with cigarette smoking for Indigenous and non-Indigenous students. This survey indicated smoking rates for Indigenous and non-Indigenous students were 24% and 30%, respectively. The study found similarities between both groups regarding where they obtained their cigarettes (friends) and their reasons for not smoking (their parents and health). Results of this survey challenge the belief that Indigenous youth are significantly different in their smoking patterns and behaviours compared to non-Indigenous secondary school students in rural regions. It indicated the potential importance of school communities in promoting non-smoking behaviours among Indigenous students even in the face of strong normative pressures from elsewhere in the community. This survey can be used to monitor smoking prevalence among Indigenous secondary students in north Queensland, help guide the development of culturally appropriate school curriculum resources and contribute to the overall evaluation of smoking prevention and smoking cessation programs which are developed for Indigenous secondary school students.

Adolescent↗
PubMed2004

Improvements in Indigenous mortality in the Northern Territory over four decades.

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.

Adolescent↗
PubMed2005

Stage at diagnosis and cancer survival for Indigenous Australians in the Northern Territory.

OBJECTIVE: To investigate whether Indigenous Australians with cancer have more advanced disease at diagnosis than other Australians, and whether late diagnosis explains lower Indigenous cancer survival rates. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Indigenous and non-Indigenous people diagnosed with cancers of the colon and rectum, lung, breast or cervix and non-Hodgkin lymphoma in the Northern Territory of Australia in 1991-2000. MAIN OUTCOME MEASURES: SEER summary stage of cancer at diagnosis (local, regional or distant spread), cause-specific cancer survival rates and relative risk of cancer death. RESULTS: Diagnosis with advanced disease (regional or distant spread) was more common for Indigenous people (70%; 95% CI, 62%-78%) than for non-Indigenous people (51%; 95% CI, 53%-59%) with cancers of the colon and rectum, breast, cervix and non-Hodgkin lymphoma, but for lung cancer the opposite was found (Indigenous, 56% [95% CI, 46%-65%] v non-Indigenous, 69% [95% CI, 64%-75%]). Stage-adjusted survival rates were lower for Indigenous people for each cancer site. With few exceptions, the relative risk of cancer death was higher for Indigenous people for each category of stage at diagnosis for each cancer site. CONCLUSIONS: Health services apparently could, and should, be performing better for Indigenous people with cancer in the Northern Territory, and probably elsewhere in Australia. This study has demonstrated that data from cancer registers, enhanced with data on stage at diagnosis, can be used to monitor health service performance for Indigenous Australians in the Northern Territory; similar data is available in other States, and could be used to monitor health service performance for Indigenous people throughout Australia.

Breast Neoplasms↗
PubMed2006

The outcome of critically ill Indigenous patients.

OBJECTIVE: To investigate the short-term outcome of critically ill Indigenous patients. DESIGN AND PARTICIPANTS: Retrospective cohort study using de-identified audit data from a tertiary intensive care unit (ICU) in Western Australia for the 11-year period 1 January 1993 to 31 December 2003. MAIN OUTCOME MEASURES: Hospital mortality (crude, and adjusted for severity of illness). RESULTS: Of 16 757 ICU patients, 1076 (6.4%) were identified as Indigenous. The Indigenous patients were younger and more commonly had chronic liver and renal diseases. Indigenous people represented 3.2% of the population of Western Australia in 2001, but represented 3.1% and 9.5% of all elective and emergency ICU admissions, respectively. Diagnoses of sepsis, pneumonia, trauma, and cardiopulmonary arrest were common among critically ill Indigenous patients. Following emergency admission, the crude hospital mortality for Indigenous patients was higher (22.7% v 19.2%; crude odds ratio, 1.24; 95% CI, 1.04-1.47) than for non-Indigenous patients. The crude hospital mortality of critically ill Indigenous patients was lower than that predicted by the APACHE II prognostic model and was similar to that of non-Indigenous patients after adjusting for severity of illness and chronic health status. CONCLUSIONS: The pattern of critical illness affecting Indigenous Australians in Western Australia was different from that affecting non-Indigenous patients. The crude hospital mortality was high, but similar to that of non-Indigenous Australians after adjusting for severity of illness and chronic health status.

APACHE↗
PubMed2004

Asthma in the Australian Indigenous population: a review of the evidence.

INTRODUCTION: In 2001 national health survey data, Indigenous Australians reported asthma as the second most commonly experienced health condition. This systematic review was undertaken to determine the current evidence concerning asthma in the Aboriginal and Torres Strait Islander population. METHODS: The review was conducted according to Australian National Health and Medical Research Council guidelines. Relevant databases and Internet sites were searched with selection criteria inclusive of all study designs, outcome measures and interventions that investigated asthma in Australian Indigenous participants. Studies of Level 4 evidence were graded using the READER critical appraisal tool, in the absence of an instrument validated and specifically designed for the Indigenous Australian context. RESULTS: A total of 10 descriptive studies published in scientific journals were found, which were largely cross-sectional prevalence studies with rural and remote populations and retrospective reviews of hospitalisation data. There are no published scientific papers on the prevalence of asthma in Indigenous individuals dwelling in metropolitan areas. Other papers included a review, an editorial, and a number of abstracts and letters. Three national health surveys published by the Australian Bureau of Statistics were included. Inconsistency of results regarding the prevalence of asthma was common among studies. Asthma prevalence in rural children has been described as low as 0.5% and as high as 39.4%, and in rural adults in one study as 3.3%. In remote communities, asthma prevalence has been described as 15.8% for children, and for adults between 7% and 26%. National health survey data in the last 10 years has described overall prevalence of asthma in the Indigenous population in the range 15.3%-19%. Hospitalisation data for children with asthma in the Northern Territory showed that rural Indigenous children were admitted significantly less than urban non-Indigenous children, while a Western Australian study found that admissions for asthma were 3.1 times higher in Indigenous than non-Indigenous children, and rates were higher in non-metropolitan compared with metropolitan areas. A single descriptive study of an asthma management strategy utilised with good attendance rates on a remote Torres Strait Island has been published. It is unclear whether the divergence in research findings reflects a difference in prevalence of asthma across demographic regions and among different states and territories, or results from the lack of standardisation of epidemiological research methods used. CONCLUSIONS: Previous research efforts concerning asthma in the Australian Indigenous population are insufficient, although there has been an increasing number of studies published during the past decade. All studies undertaken reside at a low level on the hierarchy of evidence scale. There remains no consensus of scientific opinion around the prevalence and aetiology of asthma in Aboriginal and Torres Strait Islander individuals. Particularly lacking are quality studies on asthma management interventions. Extensive consultation with Indigenous communities is indicated in order to determine priorities for asthma research. Following this, well-funded studies of a high methodological quality and culturally appropriate design investigating asthma in the Indigenous population should be undertaken.

Journal Article↗
PubMed2004

Aged care services for indigenous people in the Australian Capital Territory and surrounds: analysing needs and implementing change.

OBJECTIVE: To ascertain and meet current and anticipated needs for residential care and other services by older Indigenous people in the Australian Capital Territory (ACT) and region. METHODS: With advice from a reference group, qualitative and quantitative data were gathered from 98 older (45 years and over) Indigenous people in the ACT and region during 1999/2000. Indigenous and non-Indigenous researchers worked closely throughout all phases of the research. We helped participants with immediate problems identified during the interviews and worked directly with the Government funding body to implement the findings. RESULTS: No one expressed a current need for residential services. In terms of future needs, 50% of respondents favoured an arrangement where an existing mainstream provider of aged care accommodated a cluster of Indigenous people in the same facility as non-Indigenous people. Thirty-two per cent preferred an Indigenous-run organisation. Our study also revealed a broad range of health problems and needs. Assessment using the Resident Classification Scale showed that 70% required a low level of care and 4% needed a high level of care. CONCLUSION: The research identified the needs and provided a health profile of older Indigenous people in the ACT and region. This then provided policymakers with evidence on which they acted to provide appropriate aged care services. IMPLICATIONS: Collaboration between Indigenous and non-Indigenous researchers can access high-quality information, and partnership between researchers and policymakers can improve Indigenous services.

Aged↗