Strongyloidiasis in Northern NSW

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Strongyloidiasis in Northern NSW

• Joanne Cooper
• CNC/Aboriginal Health
• North Coast Area Health Service

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Goorie Diabetes Complication Assessment clinic
(DCAC)
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What was the problem ?

• Type 2 Diabetes is common in Aboriginal
  communities, estimated at 10 to 30.
• In the general population 3.
• Many complications from Diabetes can be managed
  with effective community based primary health
  care. (McDermott, Tulip, Schmidt. 2004p512)

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Consultation with Elders and Health Professionals
to Identify Gaps

• Goorie people with Diabetes are not accessing
  mainstream health until acutely unwell.
• Absence of a Diabetes Complications and
  Assessment clinic

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Action needed

• More human resources required
• Monthly clinics proposed
• The clinic would be a Goorie Diabetes
  Complication and Assessment Clinic. (DCAC)

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Established a Partnership between

• Dharah Gibinj Aboriginal Medical Service Casino
• Acute facilities in Urbenville, Kyogle Casino,
  Coraki Bonalbo
• Northern Rivers Division of GPs
• North Rivers Pathology
• Lismore Base Hospital Renal Unit
• Casino Community Health Centre

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Aim increase access to Diabetes services for
Aboriginal people by 20 in the western area of
the North Coast Area Health Service.
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The Team consists of
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A typical day at the clinic
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Following the Goorie Diabetes Complication
Assessment Clinic we have a Case Conference
meeting.
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Health Outcomes

• In its first year (2004) 159 clients attended the
  Goorie DCAC
• a tenfold increase from 2003.
• In 2005 - 155
• In 2006 - 169
• In 2007 so far 85 clients have attended.

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• Aboriginal Health Workers and Health Education
  Officers vital to Goorie DCAC success.
• A holistic approach to health is also integral to
  the clinics success.

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To date we have had 568 occasions of service.

• All have received Case conference notes - sent to
  client, their GP and local health care facility.

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Strongyloides stercoralis
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• Each client undergoes biochemical and
  haematological screening, which showed a pattern
  of elevated eosinophils in a large number of
  samples. Initially only those with high
  eosinophils were tested for strongyloidiasis.
• A significant finding was that consistently high
  levels of strongyloidiasis was exhibited in all
  communities.

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• We then started testing each individual client
  that attended the DCAC and the levels of
  strongyloidiasis in those adults were elevated.
• The physician attending the DCAC was aware that
  strongyloidiasis had been found in Northern
  Rivers Areas before, and
• John Burrell, Staff Specialist Physician, speaks
  of it in Grand Rounds at Lismore Base Hospital in
  February 2000

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• Of the 194 clients tested between November 2004
  and December 2006,
• 62 were positive
• an infection rate of 32.

No. of clients
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• Of the 194 clients tested between November 2004
  and December 2006,
• 62 were positive
• an infection rate of 32.

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• Burrell speaks of a strongyloidiasis prevalence
  study in the 1960s that took place in the North
  coast area where the infection rate of
  strongyloidiasis was 30.

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• As a result a Strongyloides Working Party
  consisting of myself, Aboriginal Health Staff, a
  Pathology Microbiologist from North Coast Area
  Health, and staff from Northern Rivers Public
  Health has been established to further
  investigate this issue.

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Case study

• 46yr old female complaining of transient
  abdominal discomfort.
• Tested serology positive.
• Treated with Ivermectin.
• Unable to get follow-up testing to see if
  treatment effective.

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Case Study

• 94yr old male, became acutely unwell.
• Bleeding from the rectum old blood.
• Hb 6.4
• GP felt it was related to strongyloidiasis
• On researching client serologically positive to
  strongyloidiasis since 1999
• GP commenced treatment with 2 stat doses of
  Ivermectin, he is in the process of recovering.

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Related Issues

• Northern NSW Aboriginal communities can not
  access Section 100 of the PBS.
• Medication Concordance issues Scripts are
  written for treatment, but its unclear if scripts
  are filled medication taken ?
• Or if stat dose of treatment was unsuccessful to
  eliminate infection?
• Whether the initial infection is occurring in the
  local Aboriginal communities or if they have
  travelled up north, acquired the infection
  there?
• Environmental Public Health investigations into
  the sanitary conditions, needs to take place. To
  estimate the impact of these conditions on the
  infection rate.

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