East Arnhem Healthy Skin project

The East Arnhem Healthy Skin Project (EAHSP) aimed to reduce the prevalence of scabies, skin sores and tinea in five remote Aboriginal communities, as these conditions are endemic in children aged under 15 years.

Skin infections are most commonly due to Group A streptococcal bacteria. These have been linked with outbreaks of acute post streptococcal glomerulonephritis (kidney disease) and the very high rates of rheumatic fever and rheumatic heart disease. Indeed, Indigenous Australians have one of the highest rates of rheumatic heart disease and renal disease in the world. To reduce the prevalence of skin infections the EAHSP conducted a comprehensive healthy skin program that included annual mass community scabies treatment days and routine screening and treatment of skin infections.

• The chart audit component of the study identified a previously undocumented burden of scabies and skin sores starting within the first few months of life. As a result community workers have become more involved with screening and education in the baby clinics as well as continuing the work in the community.
• Skin sore prevalence reduced substantially over the three-year study period from 46.1% in the first 18 months to 27.6% in the last 18 months. The reduction in skin sores was evident for all age groups but remains unacceptably high.
• Scabies prevalence remained constant over the three-year study period at 13.5%. Additional work undertaken with CRCAH support showed low levels of treatment uptake were a contributing factor to ongoing scabies transmission and suggest that this was probably also the case during annual mass community scabies treatment days.
• In households where there was a person with scabies, almost 10% of susceptible individuals acquired scabies during a 4-week follow-up period. There were very low levels of treatment uptake reported among household contacts (44%), but those individuals who did not acquire scabies were almost 6 times more likely to belong to a household where everyone in the house had used the scabies treatment cream.
• The study was the first to monitor tinea prevalence over time in Aboriginal children in the NT finding an average monthly prevalence of 15.3%.

In 2008/09 the Healthy Skin Project Leaders and the CRC for Aboriginal Health updated the project’s healthy skin resources to raise awareness about the impact of skin conditions in Aboriginal and Torres Strait Islander communities throughout Australia, with the objective to support health services and practitioners to recognise and treat skin conditions.

These resources went through a lengthy quality assurance process to make sure lessons learnt from the research undertaken in the East Arnhem region of the Northern Territory were transferred to a national audience; to other Aboriginal and Torres Strait Islander communities across Australia; to health services and to government.

The Healthy Skin package – a policy brief, the Final Report on the East Arnhem Healthy Skin project, and a flipchart to support Aboriginal Health Workers and health practitioners to recognise and treat skin conditions – was disseminated in October 2009 to the community controlled health sector and other organisations providing health services to Aboriginal and Torres Strait Islander people, as well as government and education.

Related resources:

• Andrews, R. M., Kearns, T., Connors, C., Parker, C., Carville, K., et al. 2009, ‘A Regional Initiative to Reduce Skin Infections amongst Aboriginal Children Living in Remote Communities of the Northern Territory, Australia’, PLoS Neglcted Tropical Diseases, 3(11), e554. doi:10.1371/journal.pntd.0000554.
• Healthy Skin Policy Brief (August 2009). The policy brief incorporates key findings from many years of work by researchers and health practitioners within Menzies School of Health Research, the Queensland Institute of Medical Research, and the Murdoch Children’s Research Institute at the University of Melbourne. Key messages from the research highlight what worked, what didn’t, and recommendations for action.
• Flipchart: Recognising & Treating Skin Conditions. Please note this contains photographs of skin conditions that may be confronting to people who have not seen these before, and it is not a publication for broad dissemination The flipchart resource contains photographs of skin conditions and is a valuable resource for Aboriginal Health Workers, health practitioners and community workers to improve recognition and treatment of skin conditions.
• East Arnhem Regional Healthy Skin Project: Final Report 2008. This report provides a summary of the project and contains monthly data, results from the research and draws some conclusions from the project which potentially supports other communities and researchers to undertake similar initiatives to reduce skin conditions.
• Health Skin Story
• Scabies Flip Chart
• Reducing Skin Infections in Aboriginal Communities fact sheet