How we partnered with local communities to halve skin ulcers among Aboriginal children in remote WA

Aboriginal children living in remote communities have what is called highest rate skin ulcers, or impetigo, in the world. Almost one by two you have ever had skin ulcers.

Skin sores are a highly contagious bacterial skin infection that can be itchy and painful, but often go unnoticed by children. Parents are more concerned about the developing pus and broad crust.

Scabies, another skin infection, also disproportionately affects children in remote Indigenous communities in Australia (as many as every third).

There are Aboriginal children in the Kimberley region of Western Australia 34 times are more likely than non-Aboriginal children to be admitted to hospital with a skin infection in the first year of life. Untreated skin infections can lead to other health problems, including sepsis, rheumatic fever and kidney disease.

With this in mind, over the last five years we have been working with nine communities in the Kimberley region on a comprehensive skin health program. Each community has a remote health clinic staffed by nurses, Aboriginal health workers and doctors.

Today, we published two new studies showcasing the progress we have made in reducing skin infections among children in these communities. Since we started the program, the incidence of skin ulcers has halved, from around four in ten children to around two in ten children.

STOP program

We partnered with health organizations and Aboriginal community-controlled schools in the Kimberley region and co-created a project program called STOP. It means “see, treat and prevent.”

Initially, we focused on diagnosing and treating skin ulcers and scabies. However, community members emphasized the need for a forceful emphasis on prevention and health promotion too.

The SToP model involved training health care workers in remote clinics, community members, and school staff to recognize skin infections. Healthcare professionals have also been trained to provide patients with cutting-edge, evidence-based treatments skin wounds AND scabies.

Preventive actions included recording, among others: hip-hop video with children, developing eight unique books about healthy skin in local languages ​​and talked to community members. They consistently emphasized the importance of investing in environmental healthincluding housing maintenance to support fit lifestyles.

As part of the SToP program and to track its outcomes, over 770 children aged zero to 15 had regular skin checks over the four years from 2019 to 2022. We visited each of the nine communities up to three times a year and carried out more than 3,000 checks skin.

One limitation of our study is that the study was completed during the pandemic. Regional travel bans forced it to be suspended for several months in 2020.

The primary goal was to halve the severity of pressure ulcers in school-age children. We also tracked the prevalence of impetigo and scabies in younger children up to four years of age, as well as general clinical signs of skin infections.

Our results, published in the journal Lancet Child and adolescent health today confirm that skin pressure sores decreased in the first year of school-age children’s lives, and the improvement persisted throughout the study.

In all communities, the number of skin ulcers decreased from four in ten children at the start of the study to two in ten children at the end. Most of this decline occurred in 2019, when skin checks began.

The number of scabies also fell, but less than one in ten children were found to have them during the study.

The most essential and probably most effective part of the study was the skin checks. Community members want these activities to continue for all ages and not just the children in the study.

The number of presentations to remote health clinics for skin infections in each community increased during the study and remained high. This suggests that community engagement and a focus on fit skin has reached all age groups.

Despite training and resource development, uptake of recommended treatments in the clinic was low.

At the outset of the study, we anticipated that the most effective strategy would be preventive treatment, supported by training in the latest evidence-based treatments available. It turned out that this didn’t happen at all. The reason may be high turnover of clinic staff and long-standing treatment preferences.

Holistic approach

Although our study was published today, its results were first presented to community members in 2023. Over 85 community members were able to share their interpretation of the SToP results with us. They strengthened the story we could tell in our published newspapers.

Second article, v clinical e-medicineprovides a comprehensive, multi-method assessment of the study. Through this process, community members and service providers helped our research team understand the study results and critical factors for success.

Future research should continue to engage with local Aboriginal communities and allow community voices to inform all aspects of research.

The SToP study combined Western medical approaches with community voices to better inform skin disease control where the risk of skin ulcers and scabies was high. The results were positive.

We hope that in the future there will be opportunities to implement such activities in more Indigenous communities across Australia. First, various KEEP your resources are available. Hearty skin books have been shared with other communities to be translated into local contexts and languages.

The skin is the largest organ of the body and is always apparent. Improving your skin health can prevent other, more earnest health consequences while contributing to your overall well-being.