Remote Australia Online

Background/Aims To examine the causes of officially reported deaths from several categories among Aboriginal and non-Aboriginal people in a statistical division of north-west Australia from 2002 to 2011. Methods A cross-sectional analysis of official Death Registration data to calculate mortality rate ratios (Aboriginal against non-Aboriginal) for that decade in six major International Classification of Disease (ICD)-10 categories. The study setting was the West Kimberley Health District in the far north of Western Australia. Results Death rates of Aborigines relative to non-Aborigines were much higher, by more than 10 times in some categories. Most of the excess deaths in these categories were due to circulatory diseases, injury and poisonings, neoplasms, diabetes, respiratory, and genitourinary conditions. Conclusion This study has documented the heavy burden of mortality in West Kimberley Aborigines compared with the pattern found in non-Aboriginal people living in the same region.

Objective To describe the frequencies of acute kidney injury (AKI) and of associated diagnoses in Indigenous people in a remote Western Australian region. Design Retrospective population-based study of AKI events confirmed by changes in serum creatinine levels. Setting, participants Aboriginal and Torres Strait Islander residents of the Kimberley region of Western Australia, aged 15 years or more and without end-stage kidney disease, for whom AKI between 1 June 2009 and 30 May 2016 was confirmed by an acute rise in serum creatinine levels. Main outcome measures Age-specific AKI rates; principal and other diagnoses. Results 324 AKI events in 260 individuals were recorded; the median age of patients was 51.8 years (IQR, 43.9?61.0 years), and 176 events (54%) were in men. The overall AKI rate was 323 events (95% CI, 281?367) per 100 000 population; 92 events (28%) were in people aged 15?44 years. 52% of principal diagnoses were infectious in nature, including pneumonia (12% of events), infections of the skin and subcutaneous tissue (10%), and urinary tract infections (7.7%). 80 events (34%) were detected on or before the date of admission; fewer than one-third of discharge summaries (61 events, 28%) listed AKI as a primary or other diagnosis. Conclusion The age distribution of AKI events among Indigenous Australians in the Kimberley was skewed to younger groups than in the national data on AKI. Infectious conditions were common in patients, underscoring the significance of environmental determinants of health. Primary care services can play an important role in preventing community-acquired AKI; applying pathology-based criteria could improve the detection of AKI.

This essay draws on ethnographic research with Aboriginal Australians living in the parks and bush spaces of a Northern Australian city to analyze some new governmental measures by which remoteness comes to irrupt within urban space and to adhere to particular categories of people who live in and move through this space. To address this question in contemporary Northern Australia is also to address the changing character of the Australian government of Aboriginal people as it moves away from issues of redress and justice toward a state of emergency ostensibly built on settler Australian compassion and humanitarian concern. It also means engaging with the mediatization of politics and its relation to the broader, discursive shaping of such spatial categories as remote and urban. I suggest that remoteness forms part of the armory of recent political efforts to reshape Aboriginal policy in Northern Australia. These efforts leverage remoteness to diagnose the ills of contemporary Aboriginal society, while producing remoteness itself as a constitutive feature of urban space.

In Aboriginal Northern Australia, request programs are a ubiquitous, marked format for Indigenous radio broadcasting. Emerging from the activist drive of Indigenous media producers, and often instrumentally geared toward connecting prison inmates with their families and communities, such request programs invariably involve performative ?shout-outs? to close and extended kin. These programs bring together a lengthy history of Aboriginal incarceration and the geographic dispersal of kin networks with country and rock musics, the charged meaning of family in contemporary Indigenous Australia, and the emergent expressive idioms of radio requests. The essay discusses the performative, mediated interweaving of speech and country song in such request programs, analyzing their significance as recursive forms of an emergent, Indigenous public culture.

In this article, we set up a dialogue between two theoretical frameworks for understanding the developing relationships between indigenous Australians and the encapsulating Australian society. We argue that the concept of 'the intercultural' de-emphasizes the agency of Aboriginal people and the durability of their social relations and value orientations. We develop the concept of relative autonomy in apposition. Our primary focus is on the Yolngu people of eastern Arnhem Land and on the impact that recent Australian government policy - in particular the Northern Territory 'Intervention' - has had on the relatively autonomous trajectory of their society. The view from relative autonomy enables an understanding of the history of Yolngu interaction with outsiders and Yolngu responses to government policy. We argue that unless relative autonomy is understood and taken into account, governments will fail to develop policies that engage Yolngu in the process of regional development.

Background Surgical services for children in the Northern Territory of Australia are routinely performed by general surgeons with specific paediatric training, supported by paediatric surgeons. In Australasia, indications for appropriate transfer of elective routine surgery in children to tertiary paediatric surgical centres have been contentious. To transfer all elective paediatric cases from rural locations would have significant social and financial consequences for families and the health system. This study reviews clinical outcomes for elective surgery for two common conditions managed by an integrated service of general surgeons and visiting paediatric surgeons, and compares them with published outcomes from paediatric centres. Method A retrospective audit of children undergoing orchidopexy under the age of 5 years or inguinal herniotomy under the age of 1 year at the Royal Darwin Hospital and Darwin Private Hospital between January 2005 and 2016 was conducted. Results During the study period, 66 boys underwent 80 orchidopexies at a mean age of 22.3 months (±20.4 SD). A recurrence rate of 5.5%, severe atrophy rate of 1.3% and total atrophy rate of 5.5% were achieved. Sixty-three children underwent 65 inguinal herniotomies at a mean age of 2.5 months (±4.2). A testicular maldescention and atrophy rate of 1.8% and recurrence rate of 0% was achieved. Conclusion Children managed with this model of care had complication rates equivalent to or slightly higher than published gold standards. Considering the family disruption, cultural, financial implications and threat to compliance that transfer across vast distances entails, this model provides acceptable outcomes.

Background: Strongyloides stercoralis is a soil-transmitted helminth, hyperendemic in remote Aboriginal and Torres Strait Islander communities in northern Australia with estimates of prevalences up to 60%. Hyperinfection in the setting of immunosuppression is a rare but well-recognised cause of significant morbidity and mortality. However, the morbidity associated with chronic uncomplicated infection is less well characterised, including in the remote Aboriginal community context. Aim: To determine the morbidity associated with Strongyloides seropositivity in a hyperendemic remote community. Methods: This retrospective case-control study measured the prevalence of symptoms potentially attributable to Strongyloides infection and their association with seropositivity. Records of primary healthcare presentations were reviewed for symptoms in the 12 months before and after an anti-helminth mass drug administration (MDA) in a remote Australian Aboriginal community. Conditional logistic regression was used to determine whether symptoms in the 12 months prior to MDA were associated with Strongyloides seropositivity. McNemar's test was then used to compare the prevalence of symptoms within the seropositive group before and after the MDA to assess whether treatment had any effect. Results: One hundred and seventy-five Strongyloides seropositive cases were matched with 175 seronegative controls. The prevalence of cough (16% vs 23%), abdominal pain (5% vs 6%), weight loss/malnutrition (4% vs 4%) diarrhoea (3% vs 3%) and urticaria (2% vs 3%) were similar among cases and controls. There was no association between Strongyloides seropositivity and any symptom. Among seropositive participants, the prevalence of symptoms was not reduced after MDA despite a reduction in seroprevalence from 21% to 5%. Conclusion: Within the limits of this investigation, Strongyloides seropositivity does not appear to be associated with significant morbidity in this population. There is no evidence to support population-based screening or treatment programs to reduce morbidity in the general community population. Emphasis must still remain on identifying and managing those few individuals with immunosuppression that predisposes them to potentially life-threatening hyperinfection.

Issue Addressed Indigenous women continue to experience reproductive health inequities. While enhancing health literacy is suggested as an approach for reducing disparities and increasing equity, there is a paucity of literature exploring Indigenous women's conceptualisation of reproductive health literacy. This paper demonstrates one approach to developing a reproductive health literacy framework for Yol?u (Indigenous) women in a remote Northern Australian setting. Methods Using a decolonising participatory action research approach, a senior Yol?u researcher led interviews, group story sharing sessions, historic site visits and on-country cultural demonstration sessions with participants on reproductive health topics. Data were collected in the participants? first language(s) and occasionally in English. Data were digitally recorded on camera, Dictaphone, video and in handwritten notes. The senior Yol?u researcher worked with a Yol?u interpreter to translate the data into English. Data underwent a progressive verbal relational content analysis to map and build a framework. Results A reproductive health literacy framework that privileges Yol?u reproductive knowledge, practices and language was successfully co-designed. The framework was embedded in the metaphor of Pandanus mat and uses key cultural domains of Yol?u identity as a connecting foundation to women's reproductive knowledges and ceremonial milestones. Conclusions The framework offers a culturally responsive and multilingual approach to sensitively discuss and operationalise reproductive health literacy. The framework empowers Yol?u cultural identities; accounts for both Yol?u and Western medical knowledges; and honours participants? requests for ?Two-Way? learning. So What? This research demonstrates an innovative approach to co-designing a culturally responsive framework for reproductive health literacy in a complex and multilingual context. Such approaches offer a promising way forward for empowering Indigenous women to define reproductive health literacy and contribute to improving their reproductive health outcomes.

Coroner's reports, police records and the state crash database provided information on 65 crash fatalities in the Kimberley region of Western Australia from 1990 to 1994. Passengers travelling in the open load space of utility trucks comprised 18 per cent of fatalities. Open-load-space passenger fatalities were associated with open highway or community access road travel. The fatality rate for the region was 41.5 per 100 000 population and the rate ratio for Aboriginal to non?Aboriginal fatalities was 2.5. Only 50 of the 65 identified deaths were included in official crash statistics. State crash statistics do not provide information on the position of passengers in road crashes.

Summary Fire has been a critical component of Aboriginal culture and natural resource management in Australia for millennia. Aboriginal fire management in Northern Australia is widespread and, in some more remote areas, has continued relatively undisrupted despite widespread changes in tenure and land use. For the Wik people of Western Cape York, there has been a continued connection to their culture and traditional lands. Recently, Wik traditional owners have formed a ranger program which has secured funding to manage contemporary land management issues. This includes the landscape-scale management of fire for biodiversity conservation and greenhouse gas abatement. Because the work is being conducted by Aboriginal people, with consent from traditional owners and on their traditional lands, there is an assumption that the activities are compatible with historical traditional land management and cultural practices. In this study, we use participatory action research to compare contemporary fire management with the current understanding of traditional Aboriginal fire management to assess objectively the compatibility of these two paradigms. We do this by combining the experience and understanding of traditional owners with anthropological and ecological perspectives. We find that contemporary fire management is applied across traditional cultural boundaries using methods such as aerial incendiaries. Financial incentives and contractual obligations associated with fire management are externally driven or include modern considerations such as the protection of infrastructure. In contrast, traditional fire management was the prerogative of traditional owners and was applied at fine scales for specific outcomes. Fire management was governed by rules that determined how people moved across the landscape and how resources were partitioned and shared. Supporting the implementation of Aboriginal burning alongside current fire management practices could lead to significant community engagement in such activities and is likely to have much better biodiversity and social outcomes.

A locally-relevant 'market basket' has been devised to help to assess the cost of usual food purchases for Aborigines who live in the Kimberley region. The range of foods in the market basket is relatively restricted, especially for fresh vegetables. In some communities, basic food items cost over 40% more than they would in the Perth metropolitan area. Price differentials and other difficulties encourage unsatisfactory dietary patterns for Aborigines in the region. A food-voucher system is proposed as one possible way to help to overcome serious nutritional imbalances for pregnant women and their infants and young children who are especially vulnerable to nutritional deficiencies. This proposal is likely to be politically unpopular, so other ways should be sought to help to improve the health of Aboriginal mothers and their children.

This study has documented the weights and heights of 1887 Aboriginal schoolchildren from communities throughout the Kimberley region of Western Australia. The data have been analysed in relation to age and sex. Median weights and heights of the Aboriginal children approximated the 10th percentile for weight, and the 25th percentile for height of non-Aboriginal WA children. The data show that Aboriginal children who live in the more remote communities of the Kimberley region were smaller in weight and height than were those who lived in the towns. Retrospective data indicate that these differences between children from remote and town communities were present at their birth and through childhood. Median body mass indices (BMIs) approximated the 10th percentile values for BMI of non-Aboriginal children in the earlier years. The expected increase in BMI with age occurred later in Aboriginal children (at 11-12 years) than in non-Aboriginal children (eight years); in the older Aboriginal children (older than 11?12 years) median values approximated 25th percentile values of non-Aboriginal boys and 50th percentile values of non-Aboriginal girls of the same age.

Background: Community-acquired pneumonia (CAP) results in significant morbidity in central and north-western Australia. However, the nature, management and outcome of CAP are poorly documented. The aim of the study was to describe CAP in the Kimberley and Central Desert regions of Australia. Methods: Prospective and retrospective cohort studies of inpatient management of adults with CAP at Alice Springs Hospital and six Kimberley hospitals were carried out. We documented demographic data, comorbidities, investigations, causes, CAP severity, outcome and concordance between prescribed and protocol-recommended antibiotics. Results: Two hundred and ninety-three subjects were included. Aboriginal Australians were overrepresented (relative risk 8.1). Patients were notably younger (median age 44.5 years) and disease severity lower than in urban Australian settings. Two patients died within 30 days of admission compared with expected mortality based on Pneumonia Severity Index predictions of seven deaths (X2, P= 0.09). Disease severity and outcome did not differ between regions. Management differences were identified, including significantly more investigations, higher rates of critical care and broader antibiotic cover in Central Australia compared with the Kimberley. Sputum culture results showed Gram-negative organisms in both regions. However, Streptococcus pneumoniae was the most frequent organism isolated in the Kimberley and Haemophilus influenzae in Central Australia. Conclusion: CAP in this setting is an Aboriginal health issue. The low mortality observed and results of microbiology investigations support the use of existing antibiotic protocols. Larger studies investigating CAP aetiology are warranted. Addressing social and environmental disadvantage remains the key factors in dealing with the burden of CAP in this setting.

Background: Little is known about the epidemiology of respiratory syncytial virus (RSV) infection in arid desert regions and in the Aboriginal population. We describe the seasonality and epidemiology of RSV infection in Central Australia, an arid area with a large Aboriginal population. Methods: Five-year retrospective study from 2000 through 2004 of children less than 2 years old admitted to Alice Springs Hospital with documented RSV infection. Results: RSV infection was documented in 173 children <2 years old admitted over a 5-year period, 165 community-acquired and 8 nosocomial. The annual incidence rate of community-acquired RSV infection in hospitalised Central Australian children <2 years old was 20.4 per 1000. The rate in Aboriginal children of 29.6 per 1000 children was significantly greater than in non-Aboriginal children of 10.9 per 1000 (P < 0.0001). Associated risk factors were common; 52% of infected children had at least one other comorbidity. Younger children had more severe illness and longer duration of hospital stay. RSV-related illness peaked in winter but infections occurred throughout the year, and the winter predominance was less marked than in temperate climates. Conclusions: In the arid, desert region of Central Australia, RSV infection occurs throughout the year, but is more frequent in winter and more common in Aboriginal children. These data are important for understanding RSV epidemiology in desert regions, and for planning active or passive RSV immunoprophylaxis in these and other similar populations.

Aim To determine the prevalence of respiratory syncytial virus (RSV) in the Top End of the Northern Territory and investigate potential drivers of seasonality including rainfall and humidex (humidity and heat index). Methods We performed a retrospective audit of laboratory confirmed cases of RSV from January 2012 to August 2014. Demographic details including age, sex and ethnicity were examined. RSV cases were correlated with monthly rainfall and humidex. Results There were 272 positive isolates detected from 4305 clinical samples (positivity rate 6.3%). The majority of cases occurred in children <12 months (n = 151, 55.5%), with a higher burden of disease seen in Indigenous compared to non-Indigenous infants in this age category (P < 0.005). The prevalence of RSV in the 0-5 years age category was 58/10 000 children per annum. Indigenous patients had higher prevalence rates (88.8/10 000 population per annum) and younger onset of infection (7.5 months; Interquartile range (IQR) 3-19 months compared to 13 months for non-Indigenous children; IQR 5 months to 2.4 years). RSV cases correlated most strongly with rainfall in the preceding month (r = 0.72). Conclusions The Top End of the Northern Territory has a distinct RSV season that correlates with rainfall and humidex, which differs from Southern Australian disease patterns.

Objective: To investigate the epidemiology and outcome of adult community-acquired pneumonia (CAP) in tropical Australia. Methods: A prospective study was performed of all adult patients with CAP admitted to the Royal Darwin Hospital, a major hospital in tropical northern Australia. A standard definition of CAP was used and data collected on demographics, risk factors, history, examination, investigations, treatment and outcome. Locally-developed treatment guidelines were used. Results: One hundred and sixty-seven adults were included in the analysis. Aboriginal people were over-represented, younger and were more likely to have risk factors for CAP. The most frequent pathogens isolated were Streptococcus pneumoniae and Burkholderia pseudomallei. ‘Atypical pneumonia’ organisms were uncommon. Treatment guidelines included penicillin for mild pneumonia but emphasised coverage of Burkholderia pseudomallei in those with risk factors, especially during the monsoon season. The mortality rate from pneumonia was low with three deaths in 167 cases (1.8%). Conclusions: International guidelines for the management of CAP have been based on populations and organisms from temperate regions and may not necessarily be applicable to tropical regions. Guidelines based upon local epidemiology must therefore be developed. This study illustrates how mortality can be minimised using a process of determining local CAP etiology, developing treatment guidelines and auditing patient management.

Background: Trachoma is a significant public health problem in the Kimberley region of Western Australia. The prevalence of follicular trachoma in the region has been well documented and control of active trachoma is well established. In contrast, trichiasis prevalence in recent years is less well documented. This study aimed to determine trichiasis prevalence in the Kimberley population and to document an appropriate intervention. Methods: A collaborative programme was established involving the Kimberley Public Health Unit, Kimberley Aged Care Services and the visiting ophthalmology service. After training, medical students screened the aged-care population for trichiasis and the aged-care services staff were educated about identification and referral procedures for patients with trichiasis. The Kimberley Public Health Unit was responsible for ensuring specialist assessment, and correction, of trichiasis and appropriate post-treatment follow up. Results: A total of 597 Kimberley Aboriginal people aged 50 years or more were screened for trichiasis, representing 42% of that age group. Trichiasis was suspected in 40 people. Of the 28 people with suspected trichiasis who underwent ophthalmological assessment, 17 were found to have trachomatous trichiasis. The observed prevalence of trachomatous trichiasis was 2.8%. The trichiasis screening programme has been adopted by most aged-care organizations in the Kimberley. Conclusions: The results show that trichiasis continues to affect elderly Aboriginal people, especially those from Halls Creek Shire. Health professionals and aged-care workers should be alert to the possibility of this preventable cause of blindness and work collaboratively to ensure that patients receive timely and appropriate treatment.

Background: Trachoma is one of the leading causes of blindness worldwide, resulting from conjunctival scarring, upper lid entropion and trichiasis, leading to corneal scarring and opacification. This study was designed to investigate the current prevalence of cicatricial trachoma in an indigenous population within Central Australia and help determine whether trachoma remains a public health issue. Methods: Participants aged 40 and over were recruited from patients attending one of 16 remote ophthalmology clinics held at indigenous communities in Central Australia within the Northern Territory. Once informed consent had been obtained, each patient underwent examination for evidence of trachomatous scarring, trachomatous trichiasis and corneal opacities. Results were collated and compared with previous prevalence surveys. Results: Among the sample (n = 181), there were 97 patients (54%; 95% CI 46.7-61.3) with trachomatous scarring, 15 patients (8%; 95% CI 2.8-13.2) with trichiasis and 5 patients (3%; 95% CI 0.5-5.5) with corneal opacities. Conclusion: This study suggests that, although the prevalence of the cicatricial and blinding consequences of trachoma may be decreasing in patients aged 40 years or greater, when compared with the current prevalence in other areas of Australia, trachoma still remains a public health issue in Central Australia.

Background Acute rheumatic fever (ARF) and its sequelae, rheumatic heart disease (RHD) are now uncommon in the general Australian population. However, these preventable and treatable diseases continue to affect Aboriginal Australians disproportionately, especially in remote communities. In the Kimberley region of Western Australia (WA), the prevalence of RHD is approximately 1% among Aboriginal residents. Yet an accurate and comprehensive picture of RHD-related mortality is lacking. Aim This study aims to determine the mortality burden attributable to ARF and RHD in the Kimberley using linked hospitalisation and death registry data. Methods A retrospective cohort study was undertaken comprising all Kimberley residents with a WA hospital admission for ARF or RHD between 1970 and 2010, linked with the WA Death Register. We manually classified RHD-attributable deaths (?definite? or ?probable?) to determine mortality burden. Hospitalisation prior to death, including valvular surgery was also ascertained. Results There were 35 RHD-attributable deaths in the Kimberley between 1990 and 2010, with 94% occurring in Aboriginal people. Their median age of death was 40 years. The age-standardised RHD annual death rate was 15.6 per 100?000 with a total of 1100 premature years of life lost before age of 75 within this group. Conventional International Classification of Diseases-generated mortality data underestimated mortality burden. Conclusion RHD remains a significant cause of premature mortality for Aboriginal people in the Kimberley, with mortality rates unmatched in the general Australian population since the first half of the 20th century. Efforts to reduce progression of this disease through RHD Register and Control Programs are crucial alongside action to address underlying socioeconomic and environmental inequities.

Objective: To determine the mortality burden of rheumatic heart disease (RHD) in the Kimberley. Methods: A retrospective medical record audit was conducted for patients identified by the Western Australian (WA) RHD Program as deceased between 2001 and 2010. Patients with documented evidence strongly suggesting or confirming RHD were included in the study. Crude and age-standardised death rates were calculated. Results: A total of 34 patients were identified as having RHD, 15 of whom died of RHD-attributable causes and 93% of whom were Aboriginal. The most common causes of death were arrhythmias and heart failure. The mean age at death of Aboriginal people was 41 years. The age-standardised death rate in Aboriginal people attributable to RHD in the Kimberley was 12.5 per 100,000 people per year, which is 1.6 times the rate of Indigenous Australians nationally. RHD contributed to 342 potential life years lost over the 10-year period. Conclusion: RHD contributes to significant premature mortality and higher rates of death in Aboriginal people in the Kimberley, which is consistent with other areas of northern Australia. While the recent establishment of the WA RHD Program will endeavour to improve mortality and morbidity due to RHD in the Kimberley, further research and investment is needed to address this disease of socioeconomic disadvantage.

Objective: To describe the epidemiology of hospitalisations due to acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in the Kimberley region of Western Australia (WA) and use these data to improve completeness of the WA RHD Register. Methods: Retrospective analysis of Kimberley regional hospitalisation data for hospitalisations coded as ARF/RHD from 01/07/2002 to 30/06/2012, with individual follow-up of those not on the register. Annual age-standardised hospitalisation rates were calculated to determine hospitalisation trend. Results: There were 250 admissions among 193 individuals. Of these, 53 individuals (27%) with confirmed or probable ARF/RHD were not on the register. Males were less likely to be on the register (62% versus 79% of females, p<0.01), as were those hospitalised with ARF without heart involvement (68% versus 87% of other ARF diagnoses, p<0.01). ARF/RHD hospitalisation rates decreased by 8.8% per year (p<0.001, rate ratio = 0.91, 95%CI 0.87-0.96). Conclusions and implications: Using hospitalisation data is an effective method of identifying cases of ARF/RHD not currently on the register. This process could be undertaken for initial case finding in areas with newly established registers, or as regular quality assurance in areas with established register-based programs. Reasons for the observed decrease in hospitalisation rates remain unclear and warrant further investigation.

Studies were carried out on erythrocyte, granulocyte and lymphocyte zinc content of aboriginal children at the La Grange settlement in the north-west area of the Kimberley. Forty-eight children, 34 boys and 14 girls between 6 and 13 years were studied. Only the boys were investigated for white blood cell (WBC) zinc. Twenty-five Caucasian children volunteered to give blood for control studies. Two approaches were made concerning zinc analyses, atomic absorption spectroscopy and proton induced x-ray emission. It was found that lymphocyte, granulocyte and erythrocyte zinc content were significantly reduced in aboriginal boys aged 6 to 13 years. Since the turnover of white blood cells is relatively fast, it follows that the zinc content of these cells may be a true index of current zinc status confirming previous observations.

Objective: To describe the clinical spectrum of Red-back spider (RBS) envenomation in children up to 12 years of age. Methods: Retrospective case notes review of children with a discharge diagnosis of RBS bite from January 1992 to June 2001. The setting was Alice Springs Hospital, the main paediatric hospital for the whole region of Central Australia. The patients were 54 children, comprising 39 Aboriginal and 15 non-Aboriginal children. Results: Forty-six (85%) children had systemic envenomation. The three most common systemic features are irritability, hypertension and sweating; 35 (65%) children had all three systemic features. Forty-five (83%) received antivenom therapy. The clinical characteristics and outcomes showed no significant difference between children  4 and > 4 years of age. Conclusions: There is a high incidence of systemic envenomation due to RBS bite in children in Central Australia. The triad of irritability, hypertension and sweating in a previously well child is highly suggestive of latrodectism.

Background: There are limited data on the epidemiology and viral aetiology of bronchiolitis in Central Australia and respiratory syncytial virus (RSV) immunoprophylaxis in an Australian population. Objective: To (i) determine the incidence and the viral aetiology of bronchiolitis hospitalisations and (ii) report on the usage of RSV immunoprophylaxis in selected high-risk infants and children in Central Australia. Methodology: A retrospective review was performed of all hospital separations for bronchiolitis for a three-year period, 1998-2000. Respiratory viruses in the nasopharyngeal aspirates were identified from the cases in the year 2000. A combined retrospective chart review and prospective follow up study was undertaken of all the infants and children who received RSV immunoprophylaxis at the Alice Springs Hospital, Central Australia. Results: Incidence of bronchiolitis hospitalisation in infants for 1998, 1999 and 2000 were 176, 200 and 180 per 1000, respectively. Nine high-risk children had RSV immunoprophylaxis on a total of 46 occasions and there were two mild RSV-related illnesses in them. None had severe lower respiratory tract illness. Conclusion: The incidence of bronchiolitis in Central Australia is extremely high. The usage of RSV immunoprophylaxis may be justified in selected high-risk children living in high endemic areas.

Background Pancreatitis and diabetes are common among Aboriginal people of Central Australia. The contribution of pancreatitis to the development of Post-Pancreatitis Diabetes-Mellitus (PPDM) is not known. Aims To describe among Aboriginal and non-Aboriginal people living in Central Australia, (i) the prevalence and aetiology of Acute (AP) and Chronic Pancreatitis (CP) and, (ii) diagnosis of new onset diabetes after pancreatitis. Methods Retrospective medical record review of patients ≥15 years admitted to hospitals in the Central Australia Health Service between 2009 and 2018 with pancreatitis. Prevalence as a proportion of the resident population and aetiology of AP and CP were determined. Diagnosis of new onset diabetes after admission with pancreatitis was assessed. Results Of the 638 patients assessed, 73% were Aboriginal and 48% female. The annual prevalence in 2009 and 2018 for AP was 171 and 203 per 100 000 persons, and for CP was 206 and 114 per 100 000 persons, respectively. Rates were high in Aboriginal people. Alcohol aetiology was most common in Aboriginal people at (66%) and biliary aetiology in non-Aboriginal people (37%). A diagnosis of diabetes after pancreatitis was detected in 125 of 438 (29%) patients who did not have diabetes diagnosis previously recorded, and 20 of the 22 tested for diabetes-associated antibodies were negative, fitting criteria for PPDM. Conclusion Prevalence of AP and CP in Central Australia was higher in Aboriginal than non-Aboriginal people. Few patients with diabetes recorded after pancreatitis had appropriate PPDM diagnostic testing. Inter-disciplinary education on the diagnosis of PPDM is required.