Title: Strongyloidiasis in Northern NSW
1Strongyloidiasis in Northern NSW
- Joanne Cooper
- CNC/Aboriginal Health
- North Coast Area Health Service
2Goorie Diabetes Complication Assessment clinic
(DCAC)
3What was the problem ?
- Type 2 Diabetes is common in Aboriginal
communities, estimated at 10 to 30. - In the general population 3.
- Many complications from Diabetes can be managed
with effective community based primary health
care. (McDermott, Tulip, Schmidt. 2004p512)
4Consultation with Elders and Health Professionals
to Identify Gaps
- Goorie people with Diabetes are not accessing
mainstream health until acutely unwell. - Absence of a Diabetes Complications and
Assessment clinic
5Action needed
- More human resources required
- Monthly clinics proposed
- The clinic would be a Goorie Diabetes
Complication and Assessment Clinic. (DCAC)
6Established a Partnership between
- Dharah Gibinj Aboriginal Medical Service Casino
- Acute facilities in Urbenville, Kyogle Casino,
Coraki Bonalbo - Northern Rivers Division of GPs
- North Rivers Pathology
- Lismore Base Hospital Renal Unit
- Casino Community Health Centre
7 Aim increase access to Diabetes services for
Aboriginal people by 20 in the western area of
the North Coast Area Health Service.
8The Team consists of
9A typical day at the clinic
10Following the Goorie Diabetes Complication
Assessment Clinic we have a Case Conference
meeting.
11Health Outcomes
- In its first year (2004) 159 clients attended the
Goorie DCAC - a tenfold increase from 2003.
- In 2005 - 155
- In 2006 - 169
- In 2007 so far 85 clients have attended.
12- Aboriginal Health Workers and Health Education
Officers vital to Goorie DCAC success. - A holistic approach to health is also integral to
the clinics success.
13To date we have had 568 occasions of service.
- All have received Case conference notes - sent to
client, their GP and local health care facility.
14Strongyloides stercoralis
15- Each client undergoes biochemical and
haematological screening, which showed a pattern
of elevated eosinophils in a large number of
samples. Initially only those with high
eosinophils were tested for strongyloidiasis. - A significant finding was that consistently high
levels of strongyloidiasis was exhibited in all
communities.
16- We then started testing each individual client
that attended the DCAC and the levels of
strongyloidiasis in those adults were elevated. -
- The physician attending the DCAC was aware that
strongyloidiasis had been found in Northern
Rivers Areas before, and -
- John Burrell, Staff Specialist Physician, speaks
of it in Grand Rounds at Lismore Base Hospital in
February 2000
17- Of the 194 clients tested between November 2004
and December 2006, - 62 were positive
- an infection rate of 32.
No. of clients
18- Of the 194 clients tested between November 2004
and December 2006, - 62 were positive
- an infection rate of 32.
19- Burrell speaks of a strongyloidiasis prevalence
study in the 1960s that took place in the North
coast area where the infection rate of
strongyloidiasis was 30.
20- As a result a Strongyloides Working Party
consisting of myself, Aboriginal Health Staff, a
Pathology Microbiologist from North Coast Area
Health, and staff from Northern Rivers Public
Health has been established to further
investigate this issue.
21Case study
- 46yr old female complaining of transient
abdominal discomfort. - Tested serology positive.
- Treated with Ivermectin.
- Unable to get follow-up testing to see if
treatment effective.
22Case Study
- 94yr old male, became acutely unwell.
- Bleeding from the rectum old blood.
- Hb 6.4
- GP felt it was related to strongyloidiasis
- On researching client serologically positive to
strongyloidiasis since 1999 - GP commenced treatment with 2 stat doses of
Ivermectin, he is in the process of recovering.
23Related Issues
- Northern NSW Aboriginal communities can not
access Section 100 of the PBS. - Medication Concordance issues Scripts are
written for treatment, but its unclear if scripts
are filled medication taken ? - Or if stat dose of treatment was unsuccessful to
eliminate infection? - Whether the initial infection is occurring in the
local Aboriginal communities or if they have
travelled up north, acquired the infection
there? - Environmental Public Health investigations into
the sanitary conditions, needs to take place. To
estimate the impact of these conditions on the
infection rate.
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