Ricciardo Bernadette M, Kessaris Heather-Lynn, Nannup Noel, Tilbrook Dale, Farrant Brad, Michie Carol, Hansen Lorraine, Douglas Richelle, Walton Jacinta, Poore Ainslie, Whelan Alexandra, Barnett Timothy C, Kumarasinghe Prasad S, Carapetis Jonathan R, Bowen Asha C
University of Western Australia, Crawley, WA, Australia.
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.
Pilot Feasibility Stud. 2024 Jan 11;10(1):6. doi: 10.1186/s40814-023-01428-6.
Indigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study, we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association.
This project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0-18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, and swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study.
From 4 to 8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child's skin, hair and/or nails; and one-third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review.
This co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and the strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform the development of healthy skin messages for urban-living Aboriginal children.
在被殖民国家，原住民儿童面临着与因流离失所和被剥夺土地而产生的历史创伤以及持续存在的系统性种族主义相关的高健康差距率。皮肤感染及其并发症就是这样一种健康不平等现象，全球负担最重的是生活在偏远地区的澳大利亚原住民和/或托雷斯海峡岛民（以下简称原住民）儿童。然而，尽管城市化进程不断加快，但对于生活在城市的原住民儿童的皮肤感染负担却知之甚少。需要更多知识来为服务提供、治疗指南和全社区的健康皮肤策略提供信息。在这项试点研究中，我们旨在测试更大规模多地点观察性研究的可行性和设计，提供皮肤病发病率的初步描述，并生成关联的初步假设。
该项目是与当地（努恩加尔）长老共同设计的，旨在首次描述生活在城市的原住民儿童的皮肤健康和疾病情况。我们与一个城市原住民社区控制卫生组织（德巴尔·耶里根卫生服务中心）合作，对从候诊室招募的原住民儿童（0至18岁）进行了为期一周的横断面观察队列研究。参与者完成了一份问卷、皮肤检查、临床照片拍摄和拭子采集，并接受了适当的治疗。我们评估了试点研究的可行性和影响。
2021年10月4日至8日，我们招募了84名原住民儿童，其中80名（95%）生活在城市。在一位值得信赖的原住民健康从业者的带领下进行招募，大多数被邀请的家长（或照顾者）同意参与。在生活在城市的儿童中，超过一半（45/80，56%）的家长表示目前担心孩子的皮肤、头发和/或指甲；三分之一（26/80，33%）的家长报告孩子目前皮肤瘙痒。采用研究-服务模式，接受检查的生活在城市的参与者中有27%（21/79）在当天接受了机会性治疗，18%（14/79）被转诊以便后续复查。
这项共同设计的试点研究旨在了解生活在城市的原住民儿童的皮肤健康状况，该研究是可行且可接受的，观察到了较高的研究参与率以及随后对临床护理的参与度。共同设计以及原住民在领导和实施该项目中的大力参与至关重要。这项成功的试点研究为更大规模多地点观察性研究提供了信息，以便更准确地回答疾病负担问题，并为生活在城市的原住民儿童制定健康皮肤宣传信息提供参考。
