A community-based program aimed at reducing the burden of skin disease across remote communities in Australia's Northern Territory has been successful according to a study published November 24 in the open-access journal PLoS Neglected Tropical Diseases. The three-year ecological study was conducted and reported by researchers at the Darwin-based Menzies School of Health Research, the Northern Territory Department of Health And Families, the Australasian College of Dermatologists, and Murdoch Childrens Research Institute.

The World Health Organization estimates that at least 111 million children in the world suffer from skin sores (pyoderma) and that many of these children also have scabies. The scabies mite is a parasite that burrows into the skin and is believed to play an important underlying role in causing the skin sores. These skin infections are contagious and can lead to serious complications, such as blood poisoning (sepsis), kidney disease, and heart disease.

Working with five remote communities and associated out-stations in remote East Arnhemland, the program ran for three years and included annual community treatment days for scabies and house-to-house visits by trained local community workers to provide skin checks and education about healthy skin. More than 6000 skin assessments were conducted on almost 2500 children across the region during the three years.

Highlighting the effectiveness of the program, co-author and Menzies researcher Ross Andrews noted, "When this work first started, 47 children out of every 100 seen each month were found to have skin sores, and many had multiple sores. By the end of the program, the skin sore burden had reduced substantially - equivalent to saving 14 children each month from having skin sores and seven children each month from having multiple skin sores."

Speaking to the success of the program, Andrews added, "There is still a long way to go, but, on balance, we think this is a good news story. This is not just a story of a positive impact against skin disease but also a story of local employment, local training, and local action to address a serious public health problem for the community."

Andrews acknowledged that even though the program had achieved impressive reductions in the rates of skin sores, there was no apparent impact against scabies and the overall health burden from skin infections still remained unacceptably high.

"We are continuing to work with remote Aboriginal communities in the area to look at more acceptable treatments for skin sores and other approaches to more effectively control scabies," he said. For sustainable impacts over the long term, there is no doubt that more needs to be done to address the underlying causes - such as poor housing, overcrowding, difficulties with sanitation, and poor educational outcome."

FINANCIAL DISCLOSURE: The East Arnhem Regional Healthy Skin Project received funding support from the Rio Tinto Aboriginal Foundation, the Ian Potter Foundation, the Australian Government Office of Aboriginal and Torres Strait Islander Health, and the Cooperative Research Centre for Aboriginal Health. The Australasian College of Dermatologists received funding support from the Commonwealth Government Department of Health and Aging. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

COMPETING INTERESTS: The authors have declared that no competing interests exist.

"A Regional Initiative to Reduce Skin Infections amongst Aboriginal Children Living in Remote Communities of the Northern Territory, Australia."
Andrews RM, Kearns T, Connors C, Parker C, Carville K, et al. (2009)
PLoS Negl Trop Dis 3(11): e554. doi:10.1371/journal.pntd.0000554

PLoS Neglected Tropical Diseases

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