More needs to be done in preventing dangerous skin infections in Aboriginal children in the remote far north - new study

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Addressing the social determinants of health is ultimately needed for skin infection rates in Aboriginal and Torres Strait Islander children to be similar to their non-Aboriginal peers, according to the authors of a narrative review published in the MJA.

Ten observational studies over two decades in remote northern Australia have found that Aboriginal children have the highest documented prevalence of impetigo worldwide. The median prevalence of impetigo in remote Australian Aboriginal children is 45%, equating to almost half of all Aboriginal children in remote Australia with impetigo at any one time, while up to one-third of children will also have scabies. 

The prevalence of scabies documented in remote Aboriginal communities in the Northern Territory is high, ranging from 16.1% to 35%. 

Complications of untreated disease include invasive Staphylococcus aureus and Staphylococcus pyogenes infections and post-infectious sequelae of S. pyogenes. 

Risk factors for the development of invasive group A streptococcal disease from a superficial infection include younger age, concurrent viral infection, household crowding, strain virulence, and impaired host immunity. Serious sequelae include sepsis, skeletal infections, acute post-streptococcal glomerulonephritis, and acute rheumatic fever and rheumatic heart disease. 

The normalisation of skin infections in high burden settings means that skin infections are often ignored, minimised or not treated. Prevention of early and complex skin infections is a high priority for families and health care providers. Treatment strategies without community level interventions have been shown to be ineffective at reducing disease burden. Addressing the social determinants of health is ultimately needed for skin infections in Aboriginal children to reduce to parity with their non-Aboriginal peers.

One of the study's authors, Dr. Asha Bowen, said “as well as being painful and itchy, skin infections can lead to serious, life-threatening illnesses such as chronic heart and kidney disease. A big part of the problem is that skin infections often aren’t recognised and are left untreated. They have become so common that they are considered ‘normal’ even by health care providers and this is something we urgently need to change.”

“I’ve been looking at strategies to reduce the burden of skin infections so that kids have healthy skin and healthy lives,” Dr. Bowen said.

Dr Bowen noted a role for Aboriginal and Torres Strait Islander led research moving forward, particularly into the social and cultural determinants of health. “You don’t need research to show that [household] overcrowding is a problem for skin conditions and poor health outcomes – but research and evidence can and does help support change to policy and service delivery,” she said.