Dengue or Kokobera? A case report from the Top End of the Northern Territory

In early April 1998, the Centre for Disease Control in Darwin was notified of a possible case of dengue which appeared to have been acquired in the Northern Territory. Because dengue is not endemic to the Northern Territory, locally acquired infection has significant public health implications, particularly for vector identification and control to limit the spread of infection. Dengue IgM serology was positive on two occasions, but the illness was eventually presumptively identified as Kokobera infection. This case illustrates the complexity of interpreting flavivirus serology. Determining the cause of infection requires consideration of the clinical illness, the incubation period, the laboratory results and vector presence. Waiting for confirmation of results, before the institution of the public health measures necessary for a true case of dengue, was ultimately justified in this case. This is a valid approach in the Northern Territory, but may not be applicable to areas of Australia with established vectors for dengue

Apunipima baby basket program: a retrospective cost study

Background: The Baby Basket initiative was developed by Apunipima Cape York Health Council (ACYHC) to address poor maternal and child health (MCH) in Cape York, the northernmost region of Queensland. While positive outcomes for Indigenous MCH programs are reported in the literature, few studies have a strong evidence base or employ a sound methodological approach to evaluation. The aim of the cost study is to identify the resources required to deliver the Baby Basket program in the remote communities of Cape York. It represents an initial step in the economic evaluation of the Apunipima Baby Basket program. The aim of this study was to report whether the current program represents an effective use of scarce resources. Method: The cost study was conducted from the perspective of the health providers and reflects the direct resources required to deliver the Baby Basket program to 170 women across 11 communities represented by ACYHC. A flow diagram informed by interviews with ACYHC staff, administrative documents and survey feedback was used to map the program pathway and measure resource use. Monetary values, in 2013 Australian dollars, were applied to the resources used to deliver the Baby Basket program for one year. Results: The total cost of delivering the Baby Basket progam to 170 participants in Cape York was $148,642 or approximately,$874 per participant. The analysis allowed for the cost of providing the Baby Baskets to remote locations and the time for health workers to engage with women and thereby encourage a relationship with the health service. Routinely collected data showed improved engagement between expectant women and the health service during the life of the program. Conclusion: The Apunipima Baby Basket cost study identifies the resources required to deliver this program in remote communities of Cape York and provides a framework that will support prospective data collection of more specific outcome data, for future cost-effectiveness analyses and cost-benefit analyses. An investment of $874 per Baby Basket participant was associated with improved engagement with the health service, an important factor in maternal and child health

Paths to improving postpartum care among Australian Aboriginal and Torres Strait Islander women after gestational diabetes

Background: Indigenous women in far north Queensland are less likely than non-Indigenous women to present for post-partum screening after gestational diabetes mellitus (GDM) despite a fourfold increased risk of type 2 diabetes within eight years of the pregnancy. Aim: To understand barriers and enablers to post-natal follow-up. Methods: We conducted interviews with Indigenous women with previous GDM, focus groups with Indigenous healthworkers and workshops with other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data was analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of 'capability', 'motivation' and 'opportunity'. Enabling strategies are presented under 'intervention' and 'policy' headings. Results: Participants generated twenty-eight enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Conclusions: Understanding Indigenous women's perspectives, developing strategies with healthworkers, and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. However, we need to better understand how to effectively support Indigenous women and communities during the postpartum period

Paths to improving postpartum care among Australian Aboriginal and Torres Strait Islander women after gestational diabetes

Background: Indigenous women in far north Queensland are less likely than non-Indigenous women to present for post-partum screening after gestational diabetes mellitus (GDM) despite a fourfold increased risk of type 2 diabetes within eight years of the pregnancy. Aim: To understand barriers and enablers to post-natal follow-up. Methods: We conducted interviews with Indigenous women with previous GDM, focus groups with Indigenous healthworkers and workshops with other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data was analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of 'capability', 'motivation' and 'opportunity'. Enabling strategies are presented under 'intervention' and 'policy' headings. Results: Participants generated twenty-eight enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Conclusions: Understanding Indigenous women's perspectives, developing strategies with healthworkers, and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. However, we need to better understand how to effectively support Indigenous women and communities during the postpartum period

Grey nomads: health and health preparation of older travellers in remote Australia

BACKGROUND 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. METHODS Two groups were approached to participate in the survey: travellers aged 50 years or over and staying in caravans, motor homes or tents at Fitzroy Crossing, Western Australia; and local primary health care providers. RESULTS All 260 travellers approached responded The prevalence of chronic diseases in those aged 65 years or over was 68%; 57% had sufficient chronic medications for the entire trip; 19% had a list of long term medications; and 9% of those With chronic diseases had a health summary from their usual general practitioner. Sixty four local health providers responded: 95% rated health summaries highly (particularly if they included an active problem list. past history, current medications, and allergies). DISCUSSION 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

A case presenting diagnostic difficulties : making sense of flavivirus serology in the Top End of the Northern Territory

In early April 1998 the Centre for Disease Control (CDC) in Darwin was notified of a case with positive dengue serology. The illness appeared to have been acquired in the Northern Territory (NT). Because dengue is not endemic to the NT, locally acquired infection has significant public health implications, particularly for vector identification and control to limit the spread of infection. Dengue IgM serology was positive on two occasions but the illness was eventually presumptively identified as Kokobera infection. This case illustrates some important points about serology. The interpretation of flavivirus serology is complex and can be misleading, despite recent improvements. The best method of determining the cause of infection is still attempting to reconcile clinical illness details with incubation times and vector presence, as well as laboratory results. This approach ultimately justified the initial period of waiting for confirmatory results in this case, before the institution of public health measures necessary for a true case of dengue

Primary prevention of cardiovascular disease in minority Indigenous populations: a systematic review

Introduction: Cardiovascular disease (CVD) is the commonest cause of death across the globe; incidence and prevalence rates are increasing. Together, CVD and diabetes mellitus are responsible for a quarter of the health gap observed between Aboriginal Australians and Torres Strait Islanders, and non-Indigenous Australians. Numerous programs have been proposed and implemented to Close the Gap; ideally, these should be evidence-based. Objective: The aim of this review is to evaluate primary prevention measures and programs that aim to reduce CVD risk in minority Indigenous populations around the world. Methods: A search of PubMed, the Cochrane Library and the Elsevier Scopus Database was initially conducted using the terms “cardiovascular disease”, “population groups”, “primary prevention”, "health services, indigenous”, "indigenous health", "risk assessment" and “risk management”. Results were then assessed per inclusion/exclusion criteria. A second reviewer independently evaluated the publications and review process to ensure agreement. Results: The initial search produced 37 publications; 19 met the inclusion criteria and were incorporated into a comparative table. Most were descriptive, mixed-methods, audit or intervention studies. Heterogeneity of study design prevented statistical analysis. Conclusion: Addressing CVD risk in minority Indigenous populations is a multifactorial challenge; there is substantial room for improvement in routine risk assessment and management. Holistic approaches need to embrace local cultural perceptions of health and wellbeing. Validated risk reduction tools, individualised management plans, polypills and computer based decision support tools are promising to improve outcomes for those at risk