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The  respiratory  health  of  urban  Aboriginal  and/or  Torres  Strait  Islander  children  in  

Queensland,  Australia  

Kerry-­‐Ann  O’Grady,  Kerry  Hall,  Anna  Bell,  Melissa  Dunbar,  Jennie  Anderson,  Anita  Kemp,  Jan  Hammill,  Peter  Newcombe,  Maree  Toombs,  

Anne  Chang  

Faculty/Presenter  Disclosure  

*  Kerry-­‐Ann  O’Grady,  Kerry  Hall  and  the  other  authors  have  no  relevant  financial  relationships  with  the  manufacturer(s)  of  commercial  services  discussed  in  this  CME  activity  

AND  

*  Kerry-­‐Ann  and  Kerry  do  not  intend  to  discuss  an  unapproved/investigative  use  of  a  commercial  product/device  in  my  presentation  

*  We  acknowledge  the  traditional  owners  of  the  land  on  which  stand,  the  Algonquin  nation,    and  those  of  where  our  research  takes  place,  the  Jagera,  Turrbal  &  Gubbi  Gubbi  nations  

 *  We  pay  our  respect  to  Elders  past,  present  &  future  

*  For  brevity  in  this  presentation,  we  refer  to  Australia’s  Aboriginal  &  Torres  Strait  Islander  peoples  collectively  as  Indigenous  &  apologise  for  any  offence  this  may  cause  

Traditional  acknowledgement  

*  Aboriginal  &  Torres  Strait  Islander  Australia  *  Acute  respiratory  illnesses  in  Australian  Indigenous  children  *  The  TLSiMMkids  Study  *  Methods  *  Risk  &  Impact  *  Characteristics  of  study  cohort  *  Preliminary  data  *  Challenges  &  successes  *  Future  directions  

Overview  

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*  669,900  people:  3%  of  the  Australian  population  in  20111  *  Largest  number  live  in  urban/inner  regional  areas  *  Largest  proportion  of  total  population  by  area  is  remote  

*  Only  11%  of  all  Australian  Indigenous  health  research  addresses  urban  population  

Aboriginal  &  Torres  Strait  Islander  Australians  

Brisbane,  QLD  

1.  Aust  Bureau  of  Statistics,  2011  

Queensland  Population  

1.  Aust  Bureau  of  Statistics,  2011  

Selected  socio-­‐demographics2  

2.    Aust  Bureau  of  Statistics,  2006  

Indigenous   Non-­‐Indigenous  

Average  household  size   3.4  persons   2.5  persons  

Average  children  <  15yrs  per  household   1.2   0.5  

Post-­‐school  qualifications   15.3%   44.5%  

Unemployment   13.3%   4.6%  

Households  in  lowest  income  quintile   40%   19%  

Households  with  internet   45%   65.5%  

Households  with  motor  vehicle   79.5%   92.3%  

Respiratory  health3  

3.  O’Grady  et  al,  Aust  Health  Review,  2011  

*  Data  on  incidence  &  burden  are  limited  *  Remote  areas:  highest  reported  rates  of  ALRI  and  pneumonia  

hospitalisations  worldwide4  

*  ALRI  ED  presentations  2.6  x  higher  for  urban  Indigenous  children  in  Western  Australia  than  non-­‐Indigenous5  

*  Most  common  reason  for  presentation  to  remote  community  clinics  in  

first  12  months  of  life  (average  1/fortnight)6  

*  Point  prevalence  of  respiratory  symptoms:    52%7  remote  &  45%8  urban  

*  Predominantly  runny  nose  &  cough  

*  Limited  data  on  risk  factors  and  impact  of  disease.  

   

Acute  respiratory  illness  (ARI)  

4.O’Grady  et  al,  MJA,  2010;  5.  Moore  et  al,  BMC  Pub  Health,  2012;  6.  Clucas  et  al,  Bull  WHO,  2008;  7.  O’Grady  et  al,  JTMIH,  2012;  8.  Hall  et  al,  QCMRI  Student  Expo,  2014    

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Repeat  infections  in  infancy  associated  with  long  term  lung  disease9      

*  Persistent  cough  post  ARI  may  be  marker  of  undiagnosed  

chronic  lung  disease  

*  20%  of  children  presenting  to  ED  with  ARI  will  develop  chronic  cough10  

*  30%  of  those  who  develop  chronic  cough  have  underlying  disease10  

*  Limited  data  on  predictors  of  chronic  cough  post  ARI  

   

Acute  respiratory  illness  (ARI)  

9.  Valery  et  al,  PIDJ    2004    10.  Drescher  et  al,  In  prep,  2015  

Tooth  &  Lung  Sickness  in  Murri  Medical  Kids  

TLSiMM  Kids  Study  

Artist:  Indala  2012  

*  Aims  *  Understand  the  risks  for,  and  impacts  of,  RI  from  an  

urban  Indigenous  perspective    *  Understand  the  epidemiology,  aetiology,  social  and  

economic  impacts  and  outcomes  of  RI  in  urban  Indigenous  children  

 

TLSiMM  Kids  *  Objectives    *  To  determine  Indigenous  perceptions  of  risk  for,  and  impact  of,  RI  in  children,  

their  families  and  communities  

*  To  determine  the  incidence  of  RI  &  chronic  cough  (≥  4  weeks  duration)    over  a  two  year  period  amongst  urban  Indigenous  children  registered  with  an  Aboriginal  Medical  Service  

 *  To  determine  the  prevalence  of  chronic  lung  disease  amongst  children  with  RI  

presenting  to  an  urban  Aboriginal  Medical  Service  

*  To  identify  predictors  for  the  development  of  RI  &  chronic  cough  amongst  children  presenting  to  an  urban  Aboriginal  Medical  Service  

*  To  identify  the  viral  and  bacterial  respiratory  pathogens  associated  with  RI  and  the  development  of  chronic  cough  in  urban  Indigenous  children  

*  To  identify  the  cultural,  social  and  economic  impact  of  paediatric  RI  on  urban  Indigenous  families,  health  service  providers  and  their  communities  

TLSiMM  Kids  

*  Methods  *  Study  1:  Qualitative  study  using  Indigenous  

methodologies  to  explore  risk  and  impact    *  Study  2:  Cohort  study  of  children  aged  <  5  years  

registered  with  urban  medical  service  &  followed  for  12  months  

*  Overseen  by  Indigenous  Research  Reference  Group  

TLSiMM  Kids  

*  Yarning  sessions  with  parents/carers  of  children  with  RI    *  Narrative  enquiry  approach  *  consistent  with  Indigenous  methodologies,  particularly  

importance  of  story  telling    *  4  yarning  sessions  (24  participants  in  total)  conducted  by  

Indigenous  researchers  

*  5th  yarn  held  with  members  of  Indigenous  Research  Reference  Group  to  validate  findings  

Study  1  (Anna  Bell,  MPhil)  

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Study  1  –  Protective  factors   Study  1  –  Risk  factors  

Study  1  –  Impact  of  RI  

*  Deep  beliefs  and  past  experiences  impact  upon  how  RI  is  perceived.    This  in  turn,  heavily  influences  how  they  manage  RI  in  their  children.  

*  Participants  did  not  view  RI  as  something  separate  from  their  daily  lives  *  part  of  a  larger  narrative  of  that  included  their  daily  struggle  to  

maintain  a  sense  of  balance,  wellbeing  and  control  under  often  very  trying  circumstances.  

*  Imperative  for  health  care  professionals  involved  in  the  care  of  Indigenous  children  to  be  aware  of  these  health  beliefs  and  perceptions  

Study  1  -­‐  Conclusions  

*  Prospective  cohort  study  of  Indigenous  children  aged  <  5  years  registered  with  Murri  Medical  

*  Children  followed  monthly  for  12  months  

*  If  ARI  develops,  enter  weekly  follow-­‐up  for  4  weeks  *  Children  with  cough  >  4  weeks  undergo  medical  respiratory  review  

Study  2  –  Cohort    (Kerry  Hall,  PhD  candidate)  

*  Demographics  *  Social,  cultural,  family  and  environmental  factors  *  Maternal  and  paternal  exposures  before  &  during  pregnancy  *  Respiratory  and  other  illness  histories  *  Health  care  seeking  behaviours  *  Vaccination  status  *  Clinical  measures  *  Direct  and  indirect  costs  of  illness  *  Changes  in  above  factors  over  time  *  Nasal  swabs  at  baseline,  weekly  during  ARI,  and  monthly  

Study  2  –  Data  collection  

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*  169  children  recruited  to  date  (target  241)  *  35  completed  study  *  51  withdrawals  –  withdrew  consent/lost  to  follow-­‐up  *  83  ongoing    *  137  ARI  reported  

Study  2  -­‐  Progress   Study  2  –  Child  characteristics  

Despite  respiratory  illnesses  accounting  for  (30.6%)  of  the  overall  reported  reasons  for  presentation  to  Murri  Medical:      

*  any  respiratory  symptom  was  present  in  44.6%  of  children  *  runny  nose  in  30%  *  any  cough  37.7%  *  dry  23.7%  *  wet  42.1%  *  variable  34.2%  

Study  2  –  Preliminary  data  (n  =  101)   Study  2  –  Early  micro  data  (n  =  67)  

Detec%on   Respiratory  Symptom  Posi%ve  

Respiratory  Symptom  Nega%ve  

 

RR  (95%)  

Bacteria  +ve  only  (n=27)   13  (48%)   8  (52%)   1.2  (0.6  –  2.3)  

Virus  +ve  only  (n  =  2)   1  (50%)   1  (50%)   1.3  (0.2  –  6.4)  

Virus  and  bacteria  +ve  (n  =  18)   13  (72%)   5  (28%)   1.8  (1.0  –  3.3)*  

None  (n  =  20)   8  (40%)   12  (60%)   Ref  

*  P  =  0.058  

47/67  (70.1%)  posi0ve  for  any  organism,  45  (67%)  bacteria  posi0ve,  20  (29.4%)  virus  posi0ve,  18  (26.4%)  both  virus  and  bacteria  posi0ve    

*  Building  relationships  and  trust  with  families  

*  High  mobility  of  families  impacts  on  follow-­‐up  

*  Changing  care  patterns  of  children  within  the  family  

*  Limited  availability  of  phones  &  internet  

*  Massive  competing  priorities  for  families/community    

Study  2  -­‐  Challenges  

*  Indigenous  staff  and  students  doing  the  work!!!!!!  *  Critical  factor  in  engaging  and  retaining  families  *  Walking  the  same  path  and  talking  on  the  same  page  

*  Strong  relationships  built  with  many  families  *  Flexibility  in  approach  

*  The  holistic  atmosphere  and  approach  of  Murri  Medical  *  Commitment  of  MM  team  to  research  *  Extends  to  community  support  of  the  research  

Study  2  -­‐  Successes  

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*  High  prevalence  of  respiratory  symptoms  *  ?  Opportunities  for  interventions  when  children  present  for  other  reason  

 

*  High  carriage  of  respiratory  organisms  

*  High  prevalence  of  risk  factors  (particularly  smoking)  

Study  2  –  Summary  to  date  

*  RCT  on  early  intervention  in  chronic  cough  commencing  *  Expanded  primary  health  care  partners  

*  Development  of  validated  QoL  instruments  for  Aboriginal  and  Torres  Strait  Islander  peoples  

*  Collaborative  partnership  to  address  both  dental  and  respiratory  health  

Future  plans  

*  Our  families  *  Murri  Medical  Team  *  Queensland  Paediatric  Infectious  Diseases  Laboratory  *  Indigenous  Research  Reference  Group  *  Prof  Keith  Grimwood  

Funding  *  QCMRI  Project  Grant  *  UQ  Foundation  Research  Excellence  Award  *  QLD  Government  Smart  Futures  Fellowship  *  NHMRC  Career  Development  Fellowship  *  QUT  Indigenous  Health  Start-­‐Up  Grant  *  Australian  Government  Australian  Postgraduate  Award  *  Centre  for  Research  Excellence  in  Lung  Health  for  Aboriginal  &  Torres  

Strait  Islander  children  

Acknowledgements