Indigenous health

Approach to indigenous health

**common exam topic**

**In your management plan, must mention aboriginal health worker**

Common clinical problems in children

Perinatal

• Low birthweight
• Asphyxia
• Infections 

Preschool

• Failure to thrive
• Malnutrition 
• Anaemia -- check for hookworm 
• Respiratory infection 
• Diarrhoea disease
• hepatitis B
• Skin infection/infestation 
• scabies
• Urinary tract infection 
• Meningitis 
• Joint and bone infection 
• Chronic suppurative otitis media 
• Trachoma

Later childhood and adolescence

• Bacterial and viral infections 
• Parasitic infestation 
• Streptococcal infection:
• Rheumatic fever
• Glomerulonephritis
• Trauma 
• Substance abuse
• Chronic suppurative otitis media 

Adults

• Diabetes
• Cardiovascular disease
• Injury (and youth suicide)
• Kidney disease
• STIs
• Mental health
• Poor nutrition 
• Ear infections 
• Women's problems

Socioeconomic

• Education of aboriginal children
• Housing 
• Water supply
• Alcohol and substance misuse
• Domestic violence and sexual abuse
• Child abuse 
• Gambling 
• Unemployment

Immunisation schdule

• Normal 
• Aboriginal and Torres Strait Islander People 

Ear infection (Indigenous)

Ear infections

** Acute otitis media should be treated early and aggressively with antibiotics to prevent chronic suppurative otitis media, which is very difficult to cure once established.**

Treatment guidelines as per the CARPA standard treatment manual:

Chronic suppurative otitis media (CSOM)

• Large perforation with pus (discharge) for more than 2 weeks
• or small perforation and pus (discharge) for 6 weeks or more 
• if pus (discharge)started in last 6 weeks - treat as AOMwiP
• Clean with tissue spears or syringe with povidone iodine diluted 1:20
• Give ciprofloxacin ear drops 5 drops 2-4 times a day
• Teach parents to clean /dry mop ears with tissue spears, put in drops
• Talk with parents about stimulating speech and language in young child - lots of talking, going to preschool, child care, early learning program 
• Review weekly 
• Continue ciprofloxacin until CSOM resolved - no pus for more than 3 days
• If still discharge after 3 months -- persistent CSOM
• Refer to ENT 
• Hearing test 
• May need IV antibiotic 

Approach to Scabies

key points:

1. Usually present with intense itching
2. Caused by Sarcoptes scabiei. The female mite burrows beneath the skin in order to lay eggs. The eggs hatch into tiny mites and spread out over the skin and live for only about 30 days
3. The mite antigen, in its excreta, causes a hypersensitivity rash.
4. Diagnosis is by microscopic examination of skin scrapings or by response to treatment
5. Usually spread through close contacts. Children need to be kept away from school until they complete the course of treatment.
6. According to therapeutic guideline, the treatment of choice is permethrin 5% leave on for at least 8 hours or benzyl benzoate for 24 hrs repeat after 1 week. Usually permethrin is better tolerated and less drying.
7. In kids less than 6 months, the current recommendation from therapeutic guideline is still permethrin 5 % but it also stated that permethrin is currently not licensed to be used for this purpose.
8. Other treatment for children under 6 months: sulphur 10%in white paraffin once daily for 2-3 days or chromatin 10% topically once daily for 2 -3 days
9. In immunocompromised patients, it can become crusted scabies, essentially means huge number of mites in the body known as norwegian scabies. Try to get expert opinion, treat with ivermectin 200 mcg/kg as a single dose plus topical treatment.

References:
John murtagh 5th edition
eTG