The latest Medical Journal of Australia has an investigation of health issues affecting Indigenous Australians including crusted scabies, childhood obesity and lack of follow-up care.
Obesity rates in Aboriginal children in NSW are increasing at a higher rate than those in non-Indigenous children, according to the research.
The medical journal also reports the take up of Indigenous-specific health assessments is on the rise, but follow-up care is a problem.
Patients are provided with little information on why follow-up care is needed and negative past experiences, including racist attitudes of health service staff, particularly receptionists, highlight the need for cultural awareness training.
The researched showed Aboriginal children were less likely to eat breakfast, more likely to have soft drinks each day, have a television in their bedroom and have no screen time rules.
Dr Louise Hardy, senior research fellow in the Physical Activity, Nutrition and Obesity Research Group at the University of Sydney, reported on trends in the weight Aboriginal children in NSW schools.
In 2010, almost one in three NSW Aboriginal children aged 5 to 16 years was overweight/obese.
Researchers from the Menzies School of Health Research and The University of Melbourne examined the barriers to delivery and follow-up care in the $805 million federal Indigenous Chronic Disease Package (ICDP) which was introduced in 2010.
They found a general improvement in uptake of health assessments but follow-up was low and lack of information provided to patients as an issue.
The frequent movement of Indigenous people, limited access to transport, cost of access, and other out-of-pocket expenses were also found to be limiting factors.
Past racist attitudes of health service staff was also a factor.
Remote communities in northern Australia have the highest rate of crusted scabies in the world.
However, a long-term case management model of care trialled in the Northern Territory has the potential to reduce recurrence.
An evaluation in the medical journal says many do not seek care for treatment because of fear of stigmatisation and isolation.
In children, the weight loss and failure to thrive caused by recurrent scabies can be mistaken for parental neglect, sometimes leading to referrals to child and family services. The disfigurement caused by the disease can lead to bullying and isolation.
Current treatment protocols for crusted scabies involve isolation in hospital, which does not prevent re-infestation when the patient returns home.
Dr Buddhi Lokuge and his team from the East Arnhem Scabies Control Program (EASCP) developed a new preventive management protocol.
They actively sought out patients with crusted scabies and, after providing acute treatment, then enrolled them in preventive care, involving regular skin checks, frequent use of a keratolytic cream to reduce the build-up of keratin crusts, and regular use of an acaricide cream to kill the mites.
In an evaluation involving seven patients managed by the EASCP between August 2011 and June 2013, recurrences were reduced by 44%, episodes of hospitalisation dropped by 56% and there was an 80% reduction in length of stay in hospital.
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