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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00008-0. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Blake TL, Chang AB, Marchant JM, McElrea MS. Respiratory health profile of Indigenous Australian children and young adults. J Paediatr Child Health 2020; 56:1066-1071. [PMID: 32096321 DOI: 10.1111/jpc.14817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 12/01/2022]
Abstract
AIM National data report respiratory illness to be the most common chronic illness in Australian Indigenous people aged <35 years but multi-centre data on specific diseases is sparse. Respiratory health is now known to be an independent predictor of future all-cause mortality and cardiovascular disease. We aimed to describe the respiratory health profile (clinical and spirometry data) of randomly recruited Indigenous Australian children and young adults from several sites. METHODS As part of the Indigenous Respiratory Reference Values study, 1278 Australian Indigenous children and young adults (aged 3-25 years) were recruited from nine communities (Queensland, n = 8; Northern Territory, n = 1). Self-reported and medical records were used to ascertain respiratory history. Participants were classified as 'healthy' if there was no current/previous respiratory disease history. Spirometry was performed on all participants and assessed according to forced expiratory volume at 1 s impairment. RESULTS Medical history data were available for 1245 (97.4%) and spirometry for 1106 participants (86.5%). Asthma and bronchitis were the most commonly reported respiratory conditions (city/regional 19.5% and rural/remote 16.8%, respectively). Participants with a history of any respiratory disease or those living in rural/remote communities had lower lung function compared to the 'healthy' group. Almost 52.0% of the entire cohort had mild-moderate forced expiratory volume at 1 s impairment (47.7% in 'healthy' group, 58.5% in 'respiratory history' group). CONCLUSION The high prevalence of poor respiratory health among Indigenous Australian children/young adults places them at increased risk of future all-cause mortality and cardiovascular disease. Respiratory assessments including spirometry should be part of the routine evaluation of Indigenous Australians.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Collaro AJ, Chang AB, Marchant JM, Rodwell LT, Masters IB, Chatfield MD, McElrea MS. Pediatric Patients of Outreach Specialist Queensland Clinics Have Lung Function Improvement Comparable to That of Tertiary Pediatric Patients. Chest 2020; 158:1566-1575. [PMID: 32387516 DOI: 10.1016/j.chest.2020.03.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/04/2020] [Accepted: 03/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inequitable access to quality health care contributes to the known poorer outcomes of people living in regional/remote areas (compared with urban-based), especially for First Nations people. Integration of specialist outreach services within primary care is one strategy that can reduce the inequity when modeled to the needs and available resources of target communities. RESEARCH QUESTION To evaluate whether respiratory outreach clinics in regional and remote Queensland are as effective as tertiary respiratory services at improving the lung function of children. STUDY DESIGN AND METHODS From existing databases, we obtained spirometry data of children (aged 3-18 years) seen at Indigenous-focused outreach clinics in regional and remote Queensland and Brisbane-based pediatric tertiary hospitals over the same contemporary period (October 2010 to July 2019). We compared the change in spirometry z scores (Δz) at follow-up for both groups of children. RESULTS Lung function significantly improved in both groups: Tertiary hospital (n = 2,249; ΔzFEV1 = 0.22, 95% CI, 0.17 to 0.27; ΔzFVC = 0.23, 95% CI, 0.18 to 0.28); outreach (n = 252; ΔzFEV1 = 0.35, 95% CI, 0.22 to 0.48; ΔzFVC = 0.36, 95% CI, 0.23 to 0.50). No significant intergroup differences were found in ΔzFEV1 (0.13; 95%CI, -0.02 to 0.28; P = .10) or ΔzFVC (0.14; 95% CI, -0.02 to 0.29; P = .08) improvement from baseline. In both groups, the proportion of children with zFEV1 > 0 at follow-up (hospital = 31.7%; outreach = 46.8%) significantly increased (hospital P = .001; outreach P = .009) from baseline (hospital = 27.2%; outreach = 35.3%). Numbers of children with zFEV1 > 0 significantly increased for asthma and bronchiectasis outreach subgroups, and for children with asthma in the hospital-based group. INTERPRETATION Comparable significant lung function improvement of children was seen in Indigenous-focused outreach remote/regional clinics and paediatric tertiary hospitals. This suggests that effective clinical care is achievable within the outreach setting.
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Affiliation(s)
- Andrew J Collaro
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia.
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Child Health Division, Menzies School of Health Research, NT, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Ian B Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, NT, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia
| | - Margaret S McElrea
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
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Culturally Appropriate Outreach Specialist Respiratory Medical Care Improves the Lung Function of Children in Regional and Remote Queensland. Lung 2020; 198:361-369. [PMID: 32078041 DOI: 10.1007/s00408-020-00332-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Indigenous Respiratory Outreach Care (IROC) is a culturally appropriate specialist respiratory service established to deliver multidisciplinary respiratory care to regional and remote Queensland communities. Our objective was to evaluate the impact of an outreach specialist respiratory service on the spirometry of children attending IROC clinics, particularly Indigenous children with asthma and bronchiectasis. METHODS Retrospective single-arm cohort study of 189 children who performed spirometry at twelve sites across regional and remote Queensland between October 2010 and December 2017. Each child's baseline spirometry was compared to their best spirometry at follow-up visit occurring within (1) 12 months of their most recent visit with at least 12 months of specialist care and; (2) each year of their first 3 years of care. RESULTS Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) z-scores improved significantly across the whole group from baseline to follow-up (change in z-scores (Δz) of FEV1 = 0.38, 95% CI 0.22, 0.53; ΔzFVC = 0.36, 95% CI 0.21, 0.51). In subgroup analyses, lung function significantly improved in Indigenous children (n = 141, ΔzFEV1 = 0.37, 95% CI 0.17, 0.57; ΔzFVC = 0.36, 95% CI 0.17, 0.55) including those with asthma (n = 117, ΔzFEV1 = 0.41, 95% CI 0.19, 0.64; ΔzFVC = 0.46, 95% CI 0.24, 0.68) and bronchiectasis (n = 38, ΔzFEV1 = 0.33, 95% CI 0.07, 0.59; ΔzFVC = 0.26, 95% CI - 0.03, 0.53). Significant improvements in FEV1 and FVC were observed within the first and second year of follow-up for Indigenous children, but not for non-Indigenous children. CONCLUSION The IROC model of care in regional and remote settings leads to significant lung function improvement in Indigenous children with asthma and bronchiectasis.
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Blake TL, Chang AB, Chatfield MD, Marchant JM, Petsky HL, McElrea MS. Fractional Exhaled Nitric Oxide Values in Indigenous Australians 3 to 16 Years of Age. Chest 2019; 156:239-246. [PMID: 30910638 DOI: 10.1016/j.chest.2019.02.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) levels can identify eosinophilic asthma phenotypes. We aimed to determine Feno values of healthy Aboriginal and/or Torres Strait Islander (Indigenous) Australians, differences between these Indigenous ethnic groups, and appropriateness of published cutoff values. METHODS We measured Feno levels in 1,036 Indigenous Australians (3-16 years of age). Participants were classified into healthy (ie, no asthma or atopy history) or asthmatic and/or atopic groups. RESULTS Median Feno values and distribution did not differ between Indigenous ethnicities. For healthy participants < 12 years of age (n = 390), 7.2% of our cohort fell into the inflammatory zone of the American Thoracic Society (ATS), National Institute for Health and Care Excellence (NICE), and British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines (cutoff 35 parts per billion [ppb]), but only 3.8% fell into this category when using the Global Initiative for Asthma (GINA) guidelines (50 ppb). Similarly, when using the NICE and BTS/SIGN guidelines (40 ppb) for participants 12 to 16 years of age (n = 213), more healthy participants fell into the inflammatory zone compared with the ATS and GINA guidelines (50 ppb) (9.9% vs 4.7%, respectively). CONCLUSIONS Feno values for healthy Indigenous Australians children (3-16 years of age) are likely higher than published white-based values. The GINA recommended cutoff value (> 50 ppb) appears the most appropriate for identifying healthy Indigenous children but requires confirmation from a larger study.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD.
| | - Anne B Chang
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Darwin, NT
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT; The University of Queensland, Brisbane, QLD
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
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Kealoha MK, Sinclair SL, Richardson KK. Mālama nā makua i nā keiki me ka hānō: Native Hawaiian Parents Caring for Their Children with Asthma (Part 2). Asian Pac Isl Nurs J 2019; 4:97-107. [PMID: 31583264 PMCID: PMC6753847 DOI: 10.31372/20190403.1020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: Native Hawaiian children have the highest prevalence of asthma among all ethnicities in Hawai'i. Mālama Part 2 describes continuing research, exploring contemporary native Hawaiian parents' perspective, and experience of caring for their children with asthma in the context of uncertainty while living on the islands of Hawai'i, Kaua'i, Maui, Moloka'i and Lāna'i. Design: Descriptive qualitative approach by means of directed content analysis using focus groups was applied to this study. Eight open-ended questions elicited asthma history, asthma management, and how the Hawaiian culture affects parents' health practices. Directed content analysis applied Mishel's Uncertainty in Illness Theory (UIT) to guide data collection, organization, and analysis. Sample: Thirty-three native Hawaiian parents with a child with asthma met in 9 separate focus groups during 2012-2015 on the islands of Hawai'i, Kaua'i, Maui, Moloka'i, and Lāna'i. Results: The study's findings were congruent with the first Mālama study results of focus groups on O'ahu. Contextual influences including indigenous worldview, cultural values, history, and assimilation and acculturation factors affected native Hawaiian parents' perceptions and experiences with conventional asthma care. Moreover, Hawaiian parents living on islands outside of metropolitan O'ahu reported geographic barriers that contributed to their uncertainty. Conclusion: Political action is required for comprehensive medical care, health education, and nursing services to be delivered to families living on all islands. Integrating Hawaiian cultural values, involving 'ohana, and applying complementary alternative therapies as well as standard asthma management will strongly support native Hawaiian parents caring for their children with asthma.
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Harfield SG, Davy C, McArthur A, Munn Z, Brown A, Brown N. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review. Global Health 2018; 14:12. [PMID: 29368657 PMCID: PMC5784701 DOI: 10.1186/s12992-018-0332-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. Method This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Results Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified – accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. Conclusion While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models. Electronic supplementary material The online version of this article (10.1186/s12992-018-0332-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen G Harfield
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia. .,School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia. .,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
| | - Carol Davy
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alexa McArthur
- Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zachary Munn
- Joanna Briggs Institute, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Ngiare Brown
- Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Education and School of Medicine, University of Wollongong, Wollongong, NSW, Australia
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McCallum GB, Chang AB, Wilson CA, Petsky HL, Saunders J, Pizzutto SJ, Choo Su S, Shah S. Feasibility of a Peer-Led Asthma and Smoking Prevention Project in Australian Schools with High Indigenous Youth. Front Pediatr 2017; 5:33. [PMID: 28303238 PMCID: PMC5332358 DOI: 10.3389/fped.2017.00033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The high global burden of asthma and tobacco smoking among Indigenous people may potentially be reduced by appropriate interventions that target prevention of tobacco smoke uptake and improved asthma management. The latter includes targeted treatment based on airway inflammation. We undertook a feasibility study in two Darwin schools with a high proportion of Indigenous youth to determine the feasibility of an innovative, peer-led, school-based education program called the Asthma and Smoking Prevention Project (ASPP). A subset of children with reported persistent respiratory symptoms were also clinically evaluated to determine the lower airway inflammatory profile and optimize asthma management. METHODS The ASPP is founded on an evidence-based three-step program and targets improving asthma management and preventing the uptake of tobacco smoking. The program uses a student-centered approach in which senior students (peer leaders) deliver the ASPP to Grade 7 students using activities, videos, and games. Students completed questionnaires related to asthma and smoking at baseline and 3 months after program delivery. Students with respiratory symptoms at 3 months were invited for a comprehensive clinical evaluation and tests including sputum induction. RESULTS The ASPP was well received. Of the 203 students involved, 56 (28%) were Indigenous and 70% completed baseline and follow-up questionnaires. Self-reported asthma was high (19%), 10% of students reported smoking and 63% reported exposure to tobacco at home. Of the 22 students who were clinically evaluated, 41% were Indigenous. Clinically important airway inflammation was high; 23% had Fractional Exhaled Nitric Oxide Levels ≥35 ppb, 88% had airway neutrophilia (>15%), and 29% had airway eosinophilia (>2.5%). Optimization of medication and management was required in 59% of students. CONCLUSION Our study has demonstrated the implementation of the ASPP was well received by the schools as well as by the students. The high prevalence of clinically important airway inflammation and suboptimal asthma management highlights the need for a community-based study on persistent respiratory symptoms in adolescents to reduce the burden of chronic lung disease particularly for Indigenous Australians.
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Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Children's Health Queensland, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cate A Wilson
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Helen L Petsky
- Children's Health Queensland, Queensland University of Technology , Brisbane, QLD , Australia
| | | | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Siew Choo Su
- Children's Health Queensland, Queensland University of Technology , Brisbane, QLD , Australia
| | - Smita Shah
- Primary Health Care Education and Research Unit, Western Sydney Local Health District , Sydney, NSW , Australia
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Valery PC, Whop LJ, Morseu-Diop N, Garvey G, Masters IB, Chang AB. Carers' perspectives on an effective Indigenous health model for childhood asthma in the Torres Strait. Aust J Rural Health 2015; 24:170-5. [PMID: 26692037 DOI: 10.1111/ajr.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe parents'/carers' views of the characteristics of a clinical service model shown to improve asthma outcomes. DESIGN A randomised controlled study on education intervention for childhood asthma by Indigenous health care workers. SETTING Thursday Island, Horn Island and Bamaga. PARTICIPANTS Thirty-five children received the intervention and 53 were in the control group. At the last study visit 12 months after enrolment, carers were asked to give feedback about the clinical service delivered by paediatric respiratory physicians and the asthma education intervention. INTERVENTION Additional asthma education. MAIN OUTCOME MEASURES Carers' responses to the open-ended questions were analysed separately by three Indigenous investigators who assigned codes and developed the themes. These were then cross-checked and combined to develop an overall interpretation of the data. RESULTS The carers (n = 81) of 88 children in the Torres Strait region of North Queensland reported positively to the clinical service delivery. Service was rated as excellent = 26.8%, very good = 51.2%, good = 19.5% and poor = 2.4%. Parents'/carers' views about the clinical service model were grouped into seven themes: clear communication by health professionals, service delivery, professional approach, clear transfer of knowledge and education/clinical knowledge of asthma, established rapport/caregiver satisfaction, importance of coming into the local community, and areas of concern for the carers/parents. CONCLUSION Community-based perspectives of an effective health service model include empowered Indigenous health care workers currently attached to the medical specialist service with elements of high expertise and appropriate cultural awareness that enabled clear communication and transfer of knowledge.
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Affiliation(s)
- Patricia C Valery
- Menzies School of Health Research, Northern Territory, Australia.,QIMR Berghofer Medical Research Institute, Population Health, Brisbane, Queensland, Australia
| | - Lisa J Whop
- Menzies School of Health Research, Northern Territory, Australia
| | | | - Gail Garvey
- Menzies School of Health Research, Northern Territory, Australia
| | - Ian B Masters
- Lady Cilento Children's Hospital, Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Australia
| | - Anne B Chang
- Menzies School of Health Research, Northern Territory, Australia.,Lady Cilento Children's Hospital, Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, Australia
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Giarola BF, McCallum GB, Bailey EJ, Morris PS, Maclennan C, Chang AB. Retrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: a single centre study. J Paediatr Child Health 2014; 50:286-90. [PMID: 24372675 DOI: 10.1111/jpc.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2013] [Indexed: 11/27/2022]
Abstract
AIM Indigenous Australians with asthma have higher morbidity and mortality compared with non-Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non-Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma. METHODS Retrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non-Indigenous children. RESULTS Median age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non-Indigenous children (45.7%). The difference in proportions was -0.41 (95% confidence interval (CI) -0.60, -0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non-Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge. CONCLUSION Unlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non-Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).
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Affiliation(s)
- Blake F Giarola
- Northern Territory Flinders Medical School, Darwin, Northern Territory, Australia
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Abstract
Asthma is the most common chronic disease in children in many low- and middle-income countries. In these settings, the burden of childhood asthma is increasing and is associated with severe disease. There are a number of challenges to providing optimal management of childhood asthma in such settings. These include under-diagnosis of childhood asthma, access to care, ability of healthcare workers to manage asthma, availability and affordability of inhaled therapy, environmental control of potential triggers, education of healthcare providers and of the public, and cultural or language issues. International and national guidelines for childhood asthma have been produced, but implementation remains a real challenge. Access to and affordability of essential inhaled asthma drugs, especially low-dose inhaled corticosteroids and short-acting bronchodilators, are major challenges to effective asthma control in many countries. A low-cost spacer made from a plastic bottle is effective for use with a metered-dose inhaler, but use must be included in asthma educational initiatives. Educational programs for healthcare personnel and for the public that are culturally and language appropriate are needed for effective implementation of asthma guidelines. Socioeconomic and structural barriers to care within health services remain obstacles to achieving optimal treatment of asthma for many children.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
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Valery PC, Masters IB, Taylor B, Laifoo Y, O'Rourke PK, Chang AB. An education intervention for childhood asthma by Aboriginal and Torres Strait Islander health workers: a randomised controlled trial. Med J Aust 2010; 192:574-9. [PMID: 20477733 DOI: 10.5694/j.1326-5377.2010.tb03640.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 02/25/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the outcomes of an education intervention for childhood asthma conducted by Australian Indigenous health care workers (IHCWs). DESIGN AND SETTING Randomised controlled trial in a primary health care setting on Thursday Island and Horn Island, and in Bamaga, Torres Strait region of northern Australia, April 2005 to March 2007. PARTICIPANTS 88 children, aged 1-17 years, with asthma diagnosed by a respiratory physician (intervention group, 35; control group, 53; 98% Indigenous children). INTERVENTIONS Children were randomly allocated to: (i) three additional asthma education sessions with a trained IHCW, or (ii) no additional asthma education. Both groups were re-assessed at 12 months. MAIN OUTCOME MEASURES Primary endpoint: number of unscheduled visits to hospital or a doctor caused by asthma exacerbation. SECONDARY OUTCOMES measures of quality of life (QoL) and functional severity index; asthma knowledge and understanding of asthma action plans (AAPs); and school days missed because of wheezing. RESULTS The groups were comparable at baseline (except for asthma severity, which was adjusted for in the analysis). There were no significant differences in the primary outcome (number of unscheduled medical visits for asthma). School children in the intervention group missed fewer school days because of wheezing (100% < 7 days v 21% of those in the control group missed 7-14 days). Significantly more carers in the intervention group could answer questions about asthma medication, knew where their AAP was kept (84% v 56%), and were able to describe the plan (67% v 40%). In both the intervention and control groups (before-and-after comparison), there was a significantly reduced frequency of asthma exacerbations, as well as an improved QoL score and functional severity index, with no significant differences between the groups. CONCLUSIONS A community-based asthma education program conducted by trained IHCWs improves some important asthma outcomes in Indigenous children with asthma. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN012605000718640.
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Affiliation(s)
- Patricia C Valery
- Queensland Institute of Medical Research, and Australian Centre for International and Tropical Health, University of Queensland, Brisbane, QLD, Australia.
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13
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Abstract
Children from Indigenous populations experience more frequent, severe, and recurrent lower respiratory infections as infants and toddlers. The consequences of these infections are chronic lung disorders manifested by recurrent wheezing and chronic productive cough. These symptoms are aggravated more frequently by active and passive tobacco smoke exposure among Indigenous groups. Therapies for these symptoms, although not specific to children of Indigenous origins, are described as is the evidence for their use.
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Affiliation(s)
- Gregory J Redding
- Department of Pediatrics, University of Washington School of Medicine, WA, USA.
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14
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Jenkins CR, Chang AB, Poulos LM, Marks GB. Asthma in Indigenous Australians: so much yet to do for Indigenous lung health. Med J Aust 2009; 190:530-1. [PMID: 19450189 DOI: 10.5694/j.1326-5377.2009.tb02550.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 03/23/2009] [Indexed: 11/17/2022]
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Valery PC, Chang AB, Masters IB, Stirling J, Laifoo Y, Twist A. Stable prevalence of asthma symptoms in school-aged children in the Torres Strait region. Respirology 2008; 13:447-51. [PMID: 18399871 DOI: 10.1111/j.1440-1843.2008.01239.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE To (i) determine if the prevalence of asthma has altered in two previously studied communities and (ii) obtain baseline measures in two further communities in the Torres Strait region, Australia. METHODS A population-based cross-sectional study of school-aged children was conducted. Five schools in four communities were selected: 361 children aged 5-17 years participated. The study used the same epidemiological tool that had been utilized to measure asthma prevalence (locally adapted International Study of Asthma and Allergy in Childhood questionnaire). RESULTS The overall response rate was 30%; response rates in individual communities ranged from 23% to 100%. The prevalence of self-reported wheezing in the last 12 months decreased from 10.7% to 6.6% (P = 0.109) on Thursday Island and from 3.1% to zero (P = 0.358) on Warraber Island. The percentage of children with asthma symptoms was lower in this current study but changes were not statistically significant. Overall self-reported prevalence of ever wheezing was 12.5%; 5.4% reported wheezing in the previous 12 months, 5.9% reported wheezing after exercise and 12.2% reported ever having asthma. There was considerable inter-community variation in the prevalence of symptoms. CONCLUSIONS Asthma prevalence in school-aged children living in the Torres Strait region remains high but, as in mainstream Australian children, the prevalence is stable.
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Affiliation(s)
- Patricia C Valery
- Queensland Institute of Medical Research, The Australian Centre for International and Tropical Health and Nutrition, University of Queensland, Brisbane, Queensland, Australia.
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Valery PC, Masters IB, Chang AB. Snoring and its association with asthma in Indigenous children living in the Torres Strait and Northern Peninsula Area. J Paediatr Child Health 2004; 40:461-5. [PMID: 15265188 DOI: 10.1111/j.1440-1754.2004.00428.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Respiratory health of Indigenous and minority ethnic groups in affluent countries is poorer than their non-minority counterparts and sleep disorders are no exception. In children, obstructive sleep apnoea has the potential to result in serious long-term consequences. In 1999, we studied 1650 children and adolescents living in the Torres Strait and the Northern Peninsula Area, Australia. Here we report prevalence of snoring in these communities and relate its association with asthma symptoms. METHODS A population-based cross-sectional study was conducted in the Torres Strait region. Five indigenous communities were randomly selected and information was collected using a structured face-to-face interview based on a standardized questionnaire. There was a 98% response rate, and 1650 children, 0-17 years of age, were included in the study. RESULTS Overall, the prevalence of snoring was 14.2% (95% CI 12.5-15.9); 3.6% (95% CI 2.7-4.6) reported snorting, and 6% (95% CI 4.9-7.2) reported restless sleep. The prevalence of snoring was significantly higher among males (17.1% for males and 10.8 for females, P = 0.005). Children were five times more likely to have experienced snoring and snorting if they reported wheezing in the last 12 months. CONCLUSION We conclude that the prevalence of symptoms suggestive of obstructive sleep problems is relatively high in children of this region. This highlights the need for awareness among the community patients and physicians about the problem of obstructive sleep-disordered breathing, especially in children with asthma, and for the need for further studies to measure prevalence of sleep breathing disorders among Indigenous Australians.
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Affiliation(s)
- P C Valery
- Queensland Institute of Medical Research, Population and Clinical Sciences Division, The Australian Centre for International and Tropical Health and Nutrition, University of Queensland.
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Valery PC, Purdie DM, Chang AB, Masters IB, Green A. Assessment of the diagnosis and prevalence of asthma in Australian indigenous children. J Clin Epidemiol 2003; 56:629-35. [PMID: 12921931 DOI: 10.1016/s0895-4356(03)00081-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Although the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire has been used in many countries and has been validated previously, it has not been used in Australian Indigenous communities. We endeavoured to assess its performance when administered in Aboriginal and Torres Strait Islander communities. METHODS In a cross-sectional study, we assessed the ISAAC's questionnaire when administered face-to-face in Indigenous communities in the Torres Strait region, Australia. RESULTS Comparing responses to the questionnaire with clinical assessment of 260 Indigenous children by a pediatric respiratory physician, sensitivity (87%) was high, but specificity (51%) and positive predictive value (33%) were low. Using a logistic regression model, we determined which questions were most useful in predicting a clinical diagnosis of asthma. Using a predictive equation, asthma was detected with 79% sensitivity and 77% specificity, and the calculated weighted estimate of asthma prevalence in the region was 16.3%. CONCLUSION Our findings reveal that although the ISAAC questionnaire is a reasonably sensitive tool for both epidemiologic and clinical studies of asthma in Indigenous communities, its value is enhanced when used in conjunction with a predictive model. We have also shown that asthma is prevalent in the Torres Strait region.
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Affiliation(s)
- Patricia C Valery
- Queensland Institute of Medical Research, Population and Clinical Sciences Division, 300 Herston Road, Queensland 4006, Australia.
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Valery PC, Chang AB, Shibasaki S, Gibson O, Purdie DM, Shannon C, Masters IB. High prevalence of asthma in five remote indigenous communities in Australia. Eur Respir J 2001; 17:1089-96. [PMID: 11491149 DOI: 10.1183/09031936.01.00099901] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Data on the prevalence of asthma in children residing in remote indigenous communities in Australia are sparse, despite the many reports of high prevalence in nonindigenous children of this country. Two previous Australian studies have had poor participation rates, limiting interpretation of their results. A study of children in the Torres Strait and Northern Peninsula Area of Australia was conducted to document the prevalence of asthma symptoms. Five indigenous communities were randomly selected and trained interviewers, who were local indigenous health workers, recruited participants using a house-by-house approach. Information was collected by a structured face-to-face interview based on a standardized questionnaire constructed from the protocol International Study of Asthma and Allergy in Childhood; 1,650 children were included in the study with a 98% response rate. Overall, the prevalence of self-reported ever wheezing was 21%; 12% reported wheezing in the previous year; and 16% reported ever having asthma. There was significant variation in the prevalence of asthma symptoms between communities. It is concluded that there are significant intercommunity variations in the prevalence of asthma symptoms in remote communities and that the prevalence in these communities is as high as in nonindigenous groups.
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Affiliation(s)
- P C Valery
- Epidemiology and Population Health Division, Queensland Institute of Medical Research, Royal Brisbane Hospital, Australia
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