Invited Review
Parasitic diseases of remote Indigenous communities in Australia

https://doi.org/10.1016/j.ijpara.2010.04.002Get rights and content

Abstract

Indigenous Australians suffer significant disadvantage in health outcomes and have a life expectancy well below that of non-Indigenous Australians. Mortality rates of Indigenous Australians are higher than that of Indigenous populations in developed countries elsewhere in the world. A number of parasitic diseases which are uncommon in the rest of the Australian population contribute to the high burden of disease in many remote Indigenous communities. High rates of infection with enteric parasites such as Strongyloides stercoralis, hookworm and Trichuris have been recorded and infection of the skin with the ecto-parasitic mite Sarcoptes scabiei is also a substantial problem. Secondary infection of scabies lesions, including with Staphylococcus aureus and group A Streptococcus, can produce serious sequelae such as rheumatic fever and post-streptococcal glomerulonephritis. Transmission of many parasites in many remote communities is facilitated by overcrowded living conditions and infrastructure problems which result in poor sanitation and hygiene. Improvements in environmental health conditions must accompany medical initiatives to achieve sustainable improvement in the health of Indigenous Australians.

Introduction

Indigenous people in Australia suffer significant disadvantage in health outcomes compared with non-Indigenous Australians (Australian Bureau of Statistics, 2004–2005). Despite some improvements, life expectancy for Indigenous Australians born in 2006 remains 16–17 years below that of the non-Indigenous population (Trewin and Madden, 2008). Diseases all but eradicated in the major population centres continue to cause significant morbidity and mortality in remote Indigenous communities. Mortality rates for Indigenous Australians are higher than those of Indigenous populations in developed countries elsewhere in the world such as New Zealand, the US and Canada (Australian Bureau of Statistics, 2004–2005). Childhood illnesses are of particular importance as more than 40% of the Australian Indigenous population is under 14 years of age, more than twice the proportion in the total Australian population (Trewin and Madden, 2008). Indigenous children are particularly affected by failure to thrive, faltering and stunted growth, and nutritional microcephaly is common (Ruben and Walker, 1995, Skull et al., 1997).

Indigenous Australians face a high burden of chronic diseases such as chronic renal disease, cardiovascular disease and diabetes. However as is the situation in many developing countries and Indigenous populations in other developed countries, infectious parasitic diseases remain an important cause of morbidity. Many parasitic diseases were likely introduced to the Australian Indigenous population relatively recently, through contact with Macassan traders and subsequently European settlers. Others, such as malaria, are considered to have been successfully eradicated from Australia. Of note, however, the last significant outbreak of malaria occurred in 1962 among indigenous Australians on Roper River Mission in the Northern Territory (Black, 1981).

Availability and accuracy of prevalence data for parasitic diseases in Indigenous Australians varies widely and is dependent on many factors such as: the availability, sensitivity and specificity of diagnostic techniques; the status of the disease as notifiable in some or all jurisdictions within Australia; and research studies conducted in the area. Even when accurate recent prevalence data is available, concurrent infection with multiple pathogens can mean that attribution of the specific contribution of individual pathogens to morbidity is difficult to assess. Despite these limitations, it is clear that several parasitic diseases contribute significantly to the overall burden of disease in Indigenous Australians, the most important of which are associated with gastrointestinal diseases and skin disorders (Table 1).

Section snippets

Gastrointestinal disease and diarrhoea

Diarrhoea is an important cause of morbidity and hospitalisation for Indigenous children in Australia. Traditional semi-nomadic, hunter-gatherer lifestyles and low population densities are likely to have offered some level of protection against gastrointestinal infection (Gracey, 1992). In contrast, the overcrowded living conditions and sanitation and hygiene problems currently present in many remote communities mean that diarrhoeal disease is now common, particularly in children (Currie and

Skin infections

It is likely that the skin disorders now prevalent in the Indigenous population in northern and central Australia were not present in traditional hunter-gatherer populations. Tinea is thought to have been introduced to Indigenous Australians via contact with Macassans on the north Australian coast (Green and Kaminski, 1973). Scabies is a far more recent introduction, having only become endemic in remote Indigenous communities in the last half century (reviewed in Currie and Carapetis (2000)).

Environmental factors

Indigenous Australians are disproportionately affected by both parasitic and non-parasitic diseases, with substantial impacts on their health. While improvements in health service resources and delivery are critical, they should be considered in the broader context of interdependent environmental factors which also affect health, such as crowding, adequate and safe water supply, hygiene and sanitation (Currie and Brewster, 2001).

Research in three remote communities demonstrated that residents

Conclusion

Parasitic diseases are responsible for significant morbidity in the Australian Indigenous population, with those living in remote communities most affected. It is fundamental that issues of environmental health are addressed concurrently with health service initiatives if long-term and sustainable improvements are to be made in the control of both infectious parasitic and non-parasitic diseases in remote Indigenous communities in Australia.

Acknowledgements

We thank Susan Pizzutto for providing the micrograph of the scabies mite and Annette Dougall and Robyn Marsh for critical review of the manuscript.

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