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Strongyloidiasis in Northern NSW

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Title: Strongyloidiasis in Northern NSW


1
Strongyloidiasis in Northern NSW
  • Joanne Cooper
  • CNC/Aboriginal Health
  • North Coast Area Health Service

2
Goorie Diabetes Complication Assessment clinic
(DCAC)
3
What 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)

4
Consultation 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

5
Action needed
  • More human resources required
  • Monthly clinics proposed
  • The clinic would be a Goorie Diabetes
    Complication and Assessment Clinic. (DCAC)

6
Established 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.
8
The Team consists of
9
A typical day at the clinic
10
Following the Goorie Diabetes Complication
Assessment Clinic we have a Case Conference
meeting.
11
Health 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.

13
To date we have had 568 occasions of service.
  • All have received Case conference notes - sent to
    client, their GP and local health care facility.

14
Strongyloides 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.

21
Case 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.

22
Case 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.

23
Related 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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