Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature

Background Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions. The objective of this systematic literature review was to examine the epidemiological evidence for a relationship between various hygiene and public health intervention strategies, separately or in combination, and the occurrence of common preventable childhood infectious diseases. The purpose was to determine what intervention/s might most effectively reduce the incidence of skin, diarrhoeal and infectious diseases experienced by children living in remote Indigenous communities. Methods Studies were identified through systematically searching electronic databases and hand searching. Study types were restricted to those included in Cochrane Collaboration Effective Practice and Organisation of Care Review Group (EPOC) guidelines and reviewers assessed the quality of studies and extracted data using the same guidelines. The types of participants eligible were Indigenous populations and populations of developing countries. The types of intervention eligible for inclusion were restricted to those likely to prevent conditions caused by poor personal hygiene and poor living environments. Results The evidence showed that there is clear and strong evidence of effect of education and handwashing with soap in preventing diarrhoeal disease among children (consistent effect in four studies). In the largest well-designed study, children living in households that received plain soap and encouragement to wash their hands had a 53% lower incidence of diarrhoea (95% CI, 0.35, 0.59). There is some evidence of an effect of education and other hygiene behaviour change interventions (six studies), as well as the provision of water supply, sanitation and hygiene education (two studies) on reducing rates of diarrhoeal disease. The size of these effects is small and the quality of the studies generally poor. Conclusion Research which measures the effectiveness of hygiene interventions is complex and difficult to implement. Multifaceted interventions (which target handwashing with soap and include water, sanitation and hygiene promotion) are likely to provide the greatest opportunity to improve child health outcomes in remote Indigenous communities

Falls, Falls Prevention and the Role of Physiotherapy and Exercise: Perceptions and Interpretations of Italian-Born and Australian-Born Older Persons Living in Australia

Exercise programmes are effective in reducing falls but few older people consider doing an exercise programme for falls prevention. This paper examines older people’s perceptions and experiences of falls, physiotherapy and exercise. Individual interviews were conducted with Australian-born and Italian-born older persons who had =1 fall in the past 12 months and completed a community-based physiotherapy programme. Although preventing further falls was considered important, participants were unsure whether falls were preventable. Few described evidence-based approaches such as exercise or medication reviews as strategies to prevent falls. Most participants thought that physiotherapy and exercise were beneficial in improving physical function. A clear explanation on the role of exercise for falls prevention, that many falls are preventable, and understanding of personal motivating and de-motivating factors for exercise for falls prevention are important for clinicians to consider in engaging this group of older people