Remote Australia Online

Introduction: Recruiting and retaining a highly skilled medical workforce in rural and remote communities is challenging1,2. In Western NSW Local Health District (Australia), a Virtual Rural Generalist Service (VRGS) was established to support rural clinicians in providing safe and high quality care. The service leverages the unique skillset of rural generalist doctors to provide hospital-based clinical services in communities without a local doctor or where local doctors request additional support. Method: Presenting observations and outcomes during the first 2 years of operationalising VRGS. Results: This presentation reports on the success factors and challenges in developing VRGS to supplement face-to-face care in rural and remote communities. In its first 2 years, VRGS has provided over 40,000 patient consultations across 30 rural communities. The service has delivered equivocal patient outcomes compared with face-to-face care and has been COVID-19 resilient during a period where existing fly-in-fly-out workforce has been unable to travel due to border restrictions in Australia. Discussion: Outcomes of the VRGS can be mapped to the quadruple aim3, focusing on improving patient experience, improving the health of populations, increasing the effectiveness of healthcare organisations and ensuring sustainable health care into the future. The findings described regarding VRGS can be translated to support both patients and clinicians in rural and remote settings worldwide.References1 Humphreys JS, Jones JA, Jones MP, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice.

The availability and use of telehealth to support health care access from a distance has expanded in response to the COVID-19 pandemic. Telehealth services have supported regional and remote health care access for many years and could be augmented to improve health care accessibility, acceptability and overall experiences for both consumers and clinicians. This study aimed to explore health workforce representatives’ needs and expectations to move beyond existing telehealth models and plan for the future of virtual care.

Background: Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of the food retailer. Methods: A convergent mixed-method design was used and data were interpreted using the Consolidated Framework for Implementation Research (CFIR). The study was conducted alongside a randomised controlled trial in partnership with the Arnhem Land Progress Aboriginal Corporation (ALPA). Adherence data were collected for the 20 consenting Healthy Stores 2020 study stores (ten intervention /ten control) in 19 communities in remote Northern Australia using photographic material and an adherence checklist. Retailer implementation experience data were collected through interviews with the primary Store Manager for each of the ten intervention stores at baseline, mid- and end-strategy. Deductive thematic analysis of interview data was conducted and informed by the CFIR. Intervention adherence scores derived for each store assisted interview data interpretation. Results: Healthy Stores 2020 strategy was, for the most part, adhered to. Analysis of the 30 interviews revealed that implementation climate of the ALPA organisation, its readiness for implementation including a strong sense of social purpose, and the networks and communication between the Store Managers and other parts of ALPA, were CFIR inner and outer domains most frequently referred to as positive to strategy implementation. Store Managers were a ‘make-or-break’ touchstone of implementation success. The co-designed intervention and strategy characteristics and its perceived cost–benefit, combined with the inner and outer setting factors, galvanised the individual characteristics of Store Managers (e.g., optimism, adaptability and retail competency) to champion implementation. Where there was less perceived cost–benefit, Store Managers seemed less enthusiastic for the strategy. Conclusions: Factors critical to implementation (a strong sense of social purpose; structures and processes within and external to the food retail organisation and their alignment with intervention characteristics (low complexity, cost advantage); and Store Manager characteristics) can inform the design of implementation strategies for the adoption of this health-enabling food retail initiative in the remote setting. This research can help inform a shift in research focus to identify, develop and test implementation strategies for the wide adoption of health-enabling food retail initiatives into practice.

Red cell (RC) alloantibodies occur on exposure to non-self RC antigens in transfusion and pregnancy (typically IgG and clinically significant) or in association with non-RC immune environmental factors (typically IgM and not clinically significant). In Australia, the risk of RC alloimmunisation in First Nations peoples is unknown. We assessed the epidemiology, specificity, and antecedents of RC alloimmunisation via a data linkage retrospective cohort study of Northern Territory (NT) intensive care unit (ICU) patients (2015–2019). Of 4183 total patients, 50.9% were First Nations. In First Nations versus non-First Nations patients, the period prevalence of alloimmunisation was 10.9% versus 2.3%, with 390 versus 72 prevalent alloantibodies detected in 232 versus 48 alloimmunised patients, of which 135 (34.6%) versus 52 (72.2%) were clinically significant specificities. Baseline and follow-up alloantibody testing were available for 1367 patients, in whom new incident clinically significant alloantibodies developed in 4.5% First Nations versus 1.1% non-First Nations patients. On Cox proportional hazards modelling, adjusted hazard ratios (HR) showed First Nations status (HR 2.67 (95% CI 1.05–6.80), p = 0.04) and cumulative RC unit transfusion exposure (HR 1.03 (95% CI 1.01–1.05), p = 0.01) were independent predictors of clinically significant alloimmunisation. First Nations Australian patients are at increased risk of alloimmunisation due to RC transfusion, underscoring the importance of very judicious use of RC transfusions and shared decision-making with patients. Further studies are recommended to explore the role of other (non-RC) immune host factors, given the relative high prevalence of non-clinically significant IgM alloantibodies within alloimmunised First Nations patients.

Australian children from regional, rural and remote (RRR) areas exhibit lower educational outcomes than their peers in metropolitan areas. The mechanisms driving the comparatively poorer educational outcomes of children in RRR areas, however, are not well understood. This paper proposes and tests two sets of factors that may be responsible for these disparities: population socio-demographic composition and school climate. Using rich survey and linked administrative data from the Longitudinal Study of Australian Children (n = 9,248 observations), we estimate the relative contribution of these sets of factors to RRR children?s disadvantage in NAPLAN numeracy test scores. Our results indicate that both socio-demographic and school climate factors account for part of the educational disparities between children in RRR and metropolitan areas. These findings suggest that hybrid policy approaches that tackle both the social determinants of educational success and use schools as an intervention site are required to close the achievement gap.

The politics of the sacred in cyber country: Deconstructing the "primitive"

Australia has the world’s third highest life expectancy at 84.3 years. However, this national average masks the fact that the ‘lucky country’ has some rather less lucky residents. In every state and territory, those in regional and remote areas have life expectancies several years lower than in the city. New South Wales (NSW) is a stark example of this divide. Life expectancy in Far West NSW is 79.1 years compared to 84.5 years in Sydney. This more than five-year gap has grown from relative parity at the turn of the millennium to the current gap. Today, a person in far west NSW is more than twice as likely to die prematurely (under 75) than someone in Sydney. While there are many possible reasons for this discrepancy, overall, people die of the same causes in urban and remote parts of NSW; a comparison of the top causes of death in each area reveals that the top 10 are almost identical. However, regional and remote people are dying younger and from preventable causes at much higher rates than those in Sydney. Deaths considered ‘potentially avoidable’ are more than two and a half times as common in the far west than in the state’s capital. It has been known for years that there is a suicide issue in regional Australia. Suicide rates in far west NSW—already more than twice as high than those in Sydney—are continuing to rise, while those in urban areas remain steady. But while suicide is a significant problem, it is only the tenth leading cause of death in the region. Suicide tends to take people at a younger age than other causes and as a result can disproportionally skew life expectancy, having said this there are other factors likely at play. In 2022, a NSW Parliamentary Inquiry into health outcomes and access to services in rural, regional, and remote NSW found that people outside urban areas had significantly poorer health outcomes, inferior access to health services, and faced substantial financial challenges to access services. This divide between life expectancy in the cities and in the country is a problem that extends beyond far western NSW. The city/country divide exists across Australia, and it is growing. Inequity between Australians living in capitals and remote areas is a significant problem that demands government intervention, particularly concerning overwhelmed and under resourced health systems.

This chapter examines the changing status of regional commercial television between 1981 and 1986. The period was notable for several developments which, on the surface, appeared to reaffirm the role of regional television in its existing form. These included the Fraser Coalition government’s stalling of plans to introduce pay television in the lead-up to the 1983 election; the Australian Broadcasting Tribunal’s (ABT) 1983 inquiry into localism in broadcasting; the Hawke Labor government’s 1983 Supplementary Licence Scheme (SLS) which offered the means to increase viewer options while maintaining the status quo; the government’s 1984 decision to establish a zone-based Remote Commercial Television Service (RCTS) controlled by regional stations; and the first community-based efforts at Indigenous broadcasting. This apparent commitment to localism coupled with the sector’s strong financial position gave the regionals an ultimately false sense of security. This chapter argues the government’s 1984 decision to establish a zonal rather than national satellite television beam was the sector’s sixth liminal moment. The regionals believed that the RCTS, in conjunction with the SLS, would provide the means to expand the number of services in their markets while preserving their valuable monopolies. These conditions brought the first increase in localism since services began in the 1960s and a further slowing of declines in independence.

Objective: Expansion of opportunities for ophthalmology training beyond the 'big smoke' is anticipated to support the future distribution of ophthalmologists in regional, rural and remote areas of Australia. However, little is known about what enables supervision outside of metropolitan tertiary hospital settings that would contribute to positive training experiences for specialist medical trainees and encourage them to leave the 'big smoke' once qualified. The aim of this study was therefore to explore the perceived enablers of ophthalmology trainee supervision in regional, rural and remote health settings across Australia. Setting: Australia. Participants: Ophthalmologists working in regional, rural or remote health settings with experience and/or interest in supervising ophthalmology trainees (n = 16). Design: Qualitative design involving semistructured interviews. Results: Seven key enablers of ophthalmology trainee supervision in regional, rural and remote health settings were identified: adequate physical infrastructure, resources and funding to host a trainee; availability of online curriculum and teaching resources so as to ensure equity of training opportunities; pre-established training posts, driven by supervision 'champions'; a critical mass of ophthalmologists to help share the supervisory load; relationships and support between training posts, the training network and the Specialist Medical College; alignment of trainee competence and attitude with the needs of the training setting; and the recognition of reciprocal benefits for supervisors through supporting trainees, including workforce support and renewal. Conclusion: With training experiences beyond the 'big smoke' anticipated to influence future ophthalmology workforce distribution, implementation of enablers of trainee supervision should occur in regional, rural and remote health settings wherever possible.

Steve Jodrell’s Shame (1987) remains remarkably accurate in its depiction of gendered violence in rural/regional/remote (RRR) Australia. However, viewing the film as a normative statement reveals a complex relationship where the RRR becomes a constructed space giving credence to urban anxieties. Viewed through critical legal theory and a Foucauldian lens, the film depicts the RRR as a psychiatric space where the rule of law is deployed against a rule of unlaw, and legal technicians constitute and reconstitute the law from knowledge into legal discourse ready for reabsorption outside the RRR space. This approach renders the law as inert and constituted and overlooks the law’s own contribution to injustice, especially in issues of gendered violence, as highlighted in recent law reform and social justice developments. While the film’s allegorising of the RRR is disrupted in its ending, its final lines reveal an unshaken belief in law—another universalising technology.

Most teachers recognise the benefits of meeting face-to-face for professional learning activities. However, for teachers in remote locations in Australia the vast distances that need to be travelled for such meetings are prohibitive. Videoconferencing has the potential to provide these teachers with quality professional learning experiences. This paper aims to highlight the challenges that inhibit the use of videoconferencing for professional learning experiences for those most likely to benefit, the teachers in remote schools. Firstly, is a description of the potential for the use of videoconferencing to enable and enhance professional learning experiences for teachers, especially in remote locations. Secondly, is a synopsis of the videoconferencing facilities available for teachers in schools in each of the five states involved in the national project. Especially important is the difference between what is possible for remote schools compared to their urban counterparts. Thirdly, is the anticipated professional connection of teachers in a national project on the use of social computing to enhance learning in remote Australia. Finally, the actual experiences of teachers from the schools in each state involved in the project shows how the challenges of remote location connection to videoconference links hampered teacher participation in the professional learning experiences.

The role of a clinical champion in a wound care project was examined in terms of an emancipatory processes framework. During the project the role changed significantly, as the needs of the project changed. In the early phase of the project, the clinical champion's role was that of team leader. During the middle phase of the project, the clinical champion's role changed to health services advocate and coach. During the final phase of the project, the clinical champion's role changed again, to that of salesperson and academic. Experience with the clinical issue being addressed by the new service, and clear motivation to complete the project, thereby seeing the new service established, allowed the clinical champion to motivate the team to overcome the difficulties in the change process.

Despite some challenges, those in rural, regional and remote parts of our country report higher rates of life satisfaction than in our cities. It is critical for our society, our identity and our economy that we have populations in these areas farming our fibre, mining our minerals and tending our traditional lands. However, it is also well-established that rural, regional and remote Australians consistently experience poorer health, with those living in the most remote areas demonstrating the worst health outcomes. People in these communities have poorer access to health care services, including hospital services and comprehensive primary healthcare services, travel greater distances to receive such services, experience higher rates of ill health and potentially preventable hospitalisations, and demonstrate higher levels of mortality, morbidity and health and disease risk factors. In ‘Best for the Bush, Rural and Remote Health Base Line, 2022' the latest data on the health of rural, regional and remote Australians is presented alongside RFDS aeromedical retrieval data and evidence on service gaps, to identify the issues that most urgently need attention from service providers, funders and policy makers. Disparities in health outcomes and service access for those living in rural, regional and remote areas compared to those in our major cities have existed for many years. Moving the conversation to pursue solutions and action requires a sound understanding of the health issues impacting rural, regional and remote Australia and the specific gaps in service provision that need to be addressed as the highest priority.

This research supports the self-determined growth of marginalised remote Australian Aboriginal tourism and the people and communities that underpin it. The complex contexts from which Aboriginal tourism has grown has resulted in it being marginalised, suffering low domestic demand and receiving nominal academic attention. Aboriginal tourism operators have been particularly neglected in research. However, the disappearance of traditional international markets due to COVID-19 has brought into focus the need to better understand how to support the industry and build domestic demand. We adopt a 'critical turn' approach to researching remote Aboriginal tourism in order to deliver new growth perspectives centred on operator narratives. Our Aboriginal-led research adopts an Indigenist research method to examine nine operators' experiences against marketing brand growth literature that is being applied for the first time in this context. The findings provide an understanding of diverse marketing issues. They privilege the operator voice and thus support their visibility, space and opportunity. We recommend continuing to centre operator perspectives in building and empowering the industry for future growth.

Introduction Group A Streptococcus (GAS) causes pharyngitis (sore throat) and impetigo (skin sores) GAS pharyngitis triggers rheumatic fever (RF) with epidemiological evidence supporting that GAS impetigo may also trigger RF in Australian Aboriginal children. Understanding the concurrent burden of these superficial GAS infections is critical to RF prevention. This pilot study aimed to trial tools for concurrent surveillance of sore throats and skins sore for contemporary studies of RF pathogenesis including development of a sore throat checklist for Aboriginal families and pharynx photography. Methods Yarning circle conversations and semi-structured interviews were performed with Aboriginal caregivers and used to develop the language and composition of a sore throat checklist. The sore throat story checklist was combined with established methods of GAS pharyngitis and impetigo surveillance (examination, bacteriological culture, rapid antigen detection and serological tests) and new technologies (photography) and used for a pilot cross-sectional surveillance study of Aboriginal children attending their health clinic for a routine appointment. Feasibility, acceptability, and study costs were compiled. Results Ten Aboriginal caregivers participated in the sore-throat yarning circles; a checklist was derived from predominant symptoms and their common descriptors. Over two days, 21 Aboriginal children were approached for the pilot surveillance study, of whom 17 were recruited; median age was 9 years [IQR 5.5–13.5], 65% were female. One child declined throat swabbing and three declined finger pricks; all other surveillance elements were completed by each child indicating high acceptability of surveillance assessments. Mean time for screening assessment was 19 minutes per child. Transport of clinical specimens enabled gold standard microbiological and serological testing for GAS. Retrospective examination of sore throat photography concorded with assessments performed on the day. Conclusion Yarning circle conversations were effective in deriving culturally appropriate sore throat questionnaires for GAS pharyngitis surveillance. New and established tools were feasible, practical and acceptable to participants and enable surveillance to determine the burden of superficial GAS infections in communities at high risk of RF. Surveillance of GAS pharyngitis and impetgio in remote Australia informs primary RF prevention with potential global translation.

The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants’ satisfaction with rural placements; (2) their challenges with gaining employment; and (3) considerations regarding ‘going rural’ for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.

This report examines the availability and accessibility of vocational education and training (VET) for students outside of Australia's capital cities. These initial findings will help inform future research and analysis in this area. Key findings include: (1) training is driven to a large extent by local industries with higher enrolments in agricultural and engineering-related training when compared with major cities; (2) training in essential services, such as health and education, has an equal weighting across major cities and regions; (3) VET students in regional Australia are more likely to be Aboriginal and/or Torres Strait Islander students or from a lower socioeconomic background than their counterparts from major cities; and (4) student satisfaction is consistently high across regions and over time.

Objective This study explored approaches of government policymakers to health policy evaluation (HPE) in Australian rural and remote settings. Methods Semi-structured interviews captured experiences and insights of 25 policymakers in the Northern Territory Department of Health. Data were thematically analysed using an inductive approach to coding and theme development. Results We identified five main themes about HPE in rural and remote settings: (1) centring the rural and remote context; (2) balancing ideology, power and evidence; (3) working with community; (4) strengthening policy workforce capabilities in monitoring and evaluation; and (5) valuing evaluation through leadership. Conclusion HPE is complex in any setting, however, policymakers navigate unique complexities in rural and remote health contexts. HPE can be enabled by developing policymaker and leadership capabilities in rural and remote settings and supporting co-design with communities.

Background Physical activity (PA) is important for cancer survivors. Trials of remotely delivered interventions are needed to assist in reaching under-served non-metropolitan cancer survivors. The objective of this study was to ascertain whether wearable technology, coupled with health coaching was effective in increasing PA in breast and colorectal cancer survivors living in regional and remote areas in Australia. Methods Cancer survivors from 5 states were randomized to intervention and control arms. Intervention participants were given a Fitbit Charge 2 and received up to 6 telephone health coaching sessions. Control participants received PA print materials. Accelerometer assessments at baseline and 12 weeks measured moderate-to-vigorous PA (MVPA), light PA, and sedentary behavior. Results Eighty-seven participants were recruited (age = 63 ± 11 years; 74 (85%) female). There was a significant net improvement in MVPA of 50 min/week, favoring the intervention group (95% confidence interval (95%CI): 13.6–86.1, p = 0.007). There was also a net increase in MVPA bouts of 39.5 min/week (95%CI: 11.9–67.1, p = 0.005), favoring the intervention group. Both groups improved light PA and sedentary behavior, but there were no between-group differences. Conclusion This is the first study to demonstrate that, when compared to standard practice (i.e., PA education), a wearable technology intervention coupled with distance-based health coaching, improves MVPA in non-metropolitan cancer survivors. The results display promise for the use of scalable interventions using smart wearable technology in conjunction with phone-based health coaching to foster increased PA in geographically disadvantaged cancer survivors.

Introduction: Rural generalist anaesthetists (RGAs) are central to the delivery of health care in much of rural and remote Australia. This article details a systematic review of the literature specifically asking the question, 'What is the current evidence of the 'safety' of anaesthesia delivered by RGAs?' Methods: Six databases were searched using terms including 'safety', 'rural', 'anaesthetics', 'general practitioners', and associated search terms. Relevant articles were assessed for rigour, and information was summarised using qualitative grid analysis that included information on the study setting, participants, methods, limitations and key result areas. The primary author developed key themes from the data, which were refined in discussion with other authors. Results: The safety of RGAs was described using five concepts: appropriate training and leadership, rates of complications, volume or scope of practice, access to equipment, and case selection. Conclusion: RGAs are pivotal in the delivery of health care in rural and remote communities. The sparse literature available on RGA safety is broadly grouped into five areas. There is a need to characterise and describe the role of RGAs, review and revise training and education, recognise RGA scope of practice and understand how RGAs lead the management of safety and risk in their practice.

It has been suggested that the gestural accuracy used by speakers of Australian Aboriginal languages like Guugu Yimidhirr and Arrernte to indicate directions and represent topographic features is a consequence of absolute frame of reference being dominant in these languages; and that the lackadaisical points produced by North American English speakers is an outcome of relative frame being dominant in English. We test this claim by comparing locational pointing in contexts of place reference in conversations conducted in two Australian Aboriginal languages, Murrinhpatha and Gija, and in Australian English spoken by non-Aboriginal residents of a small town in north Western Australia. Pointing behaviour is remarkably similar across the three groups and all participants display a capacity to point accurately regardless of linguistic frame of reference options. We suggest that these speakers’ intimate knowledge of the surrounding countryside better explains their capacity to accurately point to distant locations.

This literature review contributes to Phase I of the collaborative project ‘Investigating blue carbon opportunities in the NT’ (CDU, UQ & NAILSMA), which is co-funded by the INPEX operated Ichthys LNG. The objective of this review is to examine the applicability of the recently developed emissions offset methodology (Tidal Restoration of Blue Carbon Ecosystems Method, Australian Government, 2022), and consider additional methods that relate to coastal and freshwater wetland restoration and associated emissions.

Objectives: The dissemination of Escherichia coli–producing extended-spectrum β-lactamase (ESBL-Ec) is evident in the community. In this population-based spatial analysis, we sought to describe the distribution of ESBL-Ec and to identify predictors of incidence in the community. Methods: The study population was defined as individuals with the ESBL-Ec isolate in Queensland, Australia, from 2010 to 2019. Annual choropleth maps and a global Moran index were constructed to describe ESBL-Ec distribution. Getis-Ord Gi* was performed to identify “hot spots” of statistical significance. Using demographic factors and incidence per postal area from 2016, multivariable analyses with or without spatially structured random effects were performed. Results: In total, 12,786 individuals with ESBL-Ec isolate were identified. The incidence rate increased annually from 9.1 per 100,000 residents in 2010 to 49.8 per 100,000 residents in 2019. The geographical distribution changed from random to clustered in 2014. Hot spots were more frequently identified in the Outback and Far North Queensland, where remote communities and hotter weather are prevalent. Multivariable spatial analysis suggests that communities with higher socioeconomic status (RR, 0.66; 95% CI, 0.55–0.79 per 100 units) and employment in the agricultural industry (RR, 0.79; 95% CI, 0.67–0.95 per 10%) were protective of lower ESBL-Ec incidence. After accounting for multiple demographic factors, the residual, structured, random-effects model indicated that hot spots were still detected in more remote communities but also in several city regions. Conclusions: The change in distribution of ESBL-Ec across Queensland suggests the presence of area-level specific risk factors that enhance spread in the community. Risk factors for spread appear different between remote and city settings, and future research should be tailored to understand the respective area-level risk factors. Factors such as local temperature, antibiotic consumption, and access to services should be validated. Future public health measures to reduce transmission should be focused on the identified hot spots.

Collecting diet quality and food security data with remote Aboriginal and Torres Strait Islander communities: results and reflections from a remote food security project

Growth faltering in early childhood is the failure to gain weight at a rate consistent with height growth. Significant growth faltering results in wasting (weight <80 per cent standard weight for height) and this poses a serious risk to the health and wellbeing of young children. Early childhood development sets a base for subsequent learning, behaviour and health over the life cycle. Low birth weight and poor infant nutrition are associated with chronic disease later in life. There is accumulating evidence that stunting, microcephaly, iron deficiency and borderline zinc and Vitamin A status during the vulnerable brain growth spurt period of 0 to two years has detrimental effects on immune, intestinal and cognitive functions. The reasons for growth faltering are numerous. Underlying organic disease is one evident cause, however, in most cases a number of factors are thought to combine to interfere with normal growth. Growth faltering is a common problem among Australian Indigenous children, and is frequently associated with low birth weight, social disadvantage (including low socio-economic circumstances, low levels of education, poor housing conditions and unsanitary living environments), poor diet, nutrition-infection interactions and enteric pathogens. Only a small minority of cases were found to be caused by abuse or neglect. In the case of Australian Indigenous children living in remote communities a common cause of growth failure is thought to be an insufficient intake of weaning foods.