Skin infection, housing and social circumstances in children living in remote Indigenous communities: testing conceptual and methodological approaches

BACKGROUND: Poor housing conditions in remote Indigenous communities in Australia are a major underlying factor in poor child health, including high rates of skin infections. The aim of this study is to test approaches to data collection, analysis and feedback for a follow-up study of the impact of housing conditions on child health. METHODS: Participation was negotiated in three communities with community councils and individual participants. Data were collected by survey of dwelling condition, interviews, and audit health centre records of children aged under seven years. Community feedback comprised immediate report of items requiring urgent repair followed by a summary descriptive report. Multivariate models were developed to calculate adjusted incidence rate ratios (IRR) for skin infections and their association with aspects of household infrastructure. RESULTS: There was a high level of participation in all communities. Health centre records were inadequate for audit in one community. The records of 138 children were available for development of multivariate analytic models. Rates of skin infection in dwellings that lacked functioning facilities for removing faeces or which had concrete floors may be up to twice as high as for other dwellings, and the latter association appears to be exacerbated by crowding. Younger children living in older dwellings may also be at approximately two-fold higher risk. A number of socioeconomic and socio-demographic variables also appear to be directly associated with high rates of skin infections. CONCLUSION: The methods used in the pilot study were generally feasible, and the analytic approach provides meaningful results. The study provides some evidence that new and modern housing is contributing to a reduction in skin infections in Aboriginal children in remote communities, particularly when this housing leads to a reduction in crowding and the effective removal of human waste

Exploring cross-sectional associations between common childhood illness, housing and social conditions in remote Australian Aboriginal communities

Background:\ud There is limited epidemiological research that provides insight into the complex web of causative and moderating factors that links housing conditions to a variety of poor health outcomes. This study explores the relationship between housing conditions (with a primary focus on the functional state of infrastructure) and common childhood illness in remote Australian Aboriginal communities for the purpose of informing development of housing interventions to improve child health.\ud \ud Methods:\ud Hierarchical multi-level analysis of association between carer report of common childhood illnesses and functional and hygienic state of housing infrastructure, socio-economic, psychosocial and health related behaviours using baseline survey data from a housing intervention study.\ud \ud Results:\ud Multivariate analysis showed a strong independent association between report of respiratory infection and overall functional condition of the house (Odds Ratio (OR) 3.00; 95%CI 1.36-6.63), but no significant association between report of other illnesses and the overall functional condition or the functional condition of infrastructure required for specific healthy living practices. Associations between report of child illness and secondary explanatory variables which showed an OR of 2 or more included: for skin infection - evidence of poor temperature control in the house (OR 3.25; 95%CI 1.06-9.94), evidence of pests and vermin in the house (OR 2.88; 95%CI 1.25-6.60); for respiratory infection - breastfeeding in infancy (OR 0.27; 95%CI 0.14-0.49); for diarrhoea/vomiting - hygienic state of food preparation and storage areas (OR 2.10; 95%CI 1.10-4.00); for ear infection - child care attendance (OR 2.25; 95%CI 1.26-3.99).\ud \ud Conclusion:\ud These findings add to other evidence that building programs need to be supported by a range of other social and behavioural interventions for potential health gains to be more fully realised

Affirming and reaffirming Indigenous presence: contemporary Aboriginal and Torres Strait Islander community, public and institutional architecture in Australia

The design of specific buildings to house Australian Aboriginal and Torres Strait Islander cultural artefacts, artworks, activities or organisations, has become important in Australian architecture since the 1960s. A growing number of buildings—and new architectural types—have been devised to support, display and safeguard Indigenous cultures and to accommodate Indigenous organisations that have become more prevalent since self-determination. These new public, institutional and community building typologies provide an architecture that often speaks to the both the Indigenous and non-Indigenous population. This chapter examines a number of different types of Indigenous institutional, public and community buildings, surveying architectural precedents within the genres of keeping houses and cultural centres, museums, art centres, educational and health projects. Some of Australia’s leading architects, Indigenous and non-Indigenous, have contributed to these works, seeking to create architecture that better fits the needs of Indigenous users, to participate in the recognition of the unjust treatment of Indigenous Australians, and to dignify contemporary Indigenous cultures through architectural excellence. Public, institutional and community buildings that cater to and purport to represent or make visible Indigenous communities have developed their own typologies during the twentieth century and continue to do so. The need for Indigenous input for buildings to function according to needs and expectations, and to reconcile decades of exclusion and racism still poses challenges for policy makers and architects alike. Evidence-based design that demonstrates improved health and wellbeing and educational outcomes in culturally appropriate buildings is occurring, but integration between research and design is needed, along with greater post-occupancy evaluation, and a commitment to learn from designs and their effect on Indigenous peoples and communities. Architecture and placemaking that celebrates cultural identity, fits with Indigenous socio-spatial and cultural needs, and is devised by or with Indigenous peoples, is an important aspect of making Indigenous cultures visible and demonstrating Indigenous resistance and resilience in contemporary Australia