DeLacy Jack, Dune Tinashe, Macdonald John J
Children's Hospital Westmead Clinical School, The University of Sydney & The Sax Institute (Study of Environment on Aboriginal Resilience and Child Health), Glebe, Australia.
School of Health Sciences, Western Sydney University, Sydney, Australia.
BMC Public Health. 2020 Apr 15;20(1):492. doi: 10.1186/s12889-020-08570-3.
Aboriginal and Torres Strait Islander children experience some of the highest rates of otitis media in the world. Key risk factors for otitis media in Aboriginal children in Australia are largely social and environmental factors such as overcrowded housing, poverty and limited access to services. Despite this, little is known about how to address these risk factors. A scoping content review was performed to determine the relationship between social determinants of health and otitis media in Aboriginal and Torres Strait Islander children as described by peer-reviewed and grey literature.
Search terms were established for location, population and health condition. The search terms were used to conduct a literature search using six health research databases. Following the exclusion process, articles were scoped, analysed and categorised using scoping parameters and a social determinants of health framework.
Housing-related issues were the most frequently reported determinants for otitis media (56%). Two articles (4%) directly investigated the impact of social determinants of health on rates of otitis media within Aboriginal and Torres Strait Islander children. The majority of the literature (68%) highlights social determinants as playing a key role in the high rates of otitis media seen in Aboriginal populations in Australia. There were no intervention studies targeting social determinants as a means to reduce otitis media rates among Aboriginal and Torres Strait Islander children.
This review identifies a disconnect between otitis media drivers and the focus of public health interventions within Aboriginal and Torres Strait Islander populations. Despite consensus that social determinants play a key role in the high rates of otitis media in Aboriginal and Torres Strait Islander children, the majority of intervention studies within the literature are focussed on biomedical approaches such as research on vaccines and antibiotics. This review highlights the need for otitis media intervention studies to shift away from a purely biomedical model and toward investigating the underlying social determinants of health. By shifting interventions upstream, otitis media rates may decrease within Aboriginal and Torres Strait Islander children, as focus is shifted away from a treatment-focussed model and toward a more preventative model.
澳大利亚原住民和托雷斯海峡岛民儿童的中耳炎发病率位居世界前列。澳大利亚原住民儿童患中耳炎的主要风险因素大多是社会和环境因素，如住房拥挤、贫困以及获得服务的机会有限。尽管如此，对于如何应对这些风险因素却知之甚少。本研究进行了一项范围界定性文献综述，以确定经同行评审的文献和灰色文献中所描述的原住民和托雷斯海峡岛民儿童健康的社会决定因素与中耳炎之间的关系。
确定了关于地点、人群和健康状况的检索词。使用这六个检索词在六个健康研究数据库中进行文献检索。经过排除过程后，使用范围界定参数和健康的社会决定因素框架对文章进行范围界定、分析和分类。
与住房相关的问题是最常报告的中耳炎决定因素（56%）。两篇文章（4%）直接调查了健康的社会决定因素对原住民和托雷斯海峡岛民儿童中耳炎发病率的影响。大多数文献（68%）强调社会决定因素在澳大利亚原住民人群中高中耳炎发病率中起关键作用。没有针对社会决定因素作为降低原住民和托雷斯海峡岛民儿童中耳炎发病率手段的干预研究。
本综述发现，在原住民和托雷斯海峡岛民人群中，中耳炎的驱动因素与公共卫生干预的重点之间存在脱节。尽管人们一致认为社会决定因素在原住民和托雷斯海峡岛民儿童的高中耳炎发病率中起关键作用，但文献中的大多数干预研究都集中在生物医学方法上，如疫苗和抗生素研究。本综述强调，中耳炎干预研究需要从纯粹的生物医学模式转向调查健康的潜在社会决定因素。通过将干预措施向上游转移，原住民和托雷斯海峡岛民儿童的中耳炎发病率可能会降低，因为重点从以治疗为中心的模式转向了更具预防性的模式。
