Applied Epidemiology in Aboriginal and Torres Strait Islander Health

Abstract

My placement for the Master of Philosophy in Applied Epidemiology (MAE) degree was with the Evidence and Evaluation section, within the Indigenous Health Division, Australian Government Department of Health. In this thesis, I present projects undertaken which fulfil the requirements of the MAE program. Data analysis project: The Northern Territory Aboriginal Health Key Performance Indicators (NT AHKPIs) are a collection of key performance indicators that measure primary health care (PHC) performance. I conducted a descriptive analytical study of the NT AHKPIs. The data that inform the NT AHKPIs are not currently in the public domain, this chapter is therefore a closed chapter. Evaluation project: I evaluated the NT AHKPIs to assess the extent to which the NT AHKPIs are addressing their intended goals and to determine whether they were being used for other purposes; my approach to the evaluation was utilisation focused. Preliminary findings show that the KPIs are useful to inform service planning and continuous quality improvement, but there is room for improvement. Findings were reported back to the NT AHKPI steering committee to inform ongoing strengthening of the NT AHKPI system. Epidemiological study: Anaemia in Aboriginal and Torres Strait Islander children in the NT is a public health problem. I undertook a study to describe the application of best practice guidelines for screening and management of children aged 6 months to 3 years with anaemia in the NT. Findings show that of 5,543 children, 63% were screened for anaemia. The prevalence of anaemia was 40% - a ‘severe’ public health problem as defined by the World Health Organisation (WHO). A very low proportion of anaemic children were recorded as treated according to best practice guidelines, however, our findings are subject to multiple potential biases and these findings need to be validated. Outbreak investigation: I was a member of the Communicable Disease Network Australia team that investigated an unusual cluster of Ralstonia bacteraemia from 1 April to 26 June 2014 in three states in Australia. The objectives of this investigation were to assess the possibility of a causal association between the administration of propofol and Ralstonia bacteraemia, and to identify sources of the infections. The propofol solution passed all sterility and contamination tests, but 18% of the flip-off caps and external surfaces of the rubber stoppers were contaminated with a variety of bacterial species including R. mannitolylitica. These isolates were genetically indistinguishable from three out of eight isolates from patients with R. mannitolylitica bacteraemia. Findings from this study highlighted the need for proper aseptic techniques when administering intravenous injections. I spent ten weeks in Sierra Leone supporting the WHO’s response to the Ebola virus disease outbreak (EVD). I summarise my role and responsibilities in the outbreak, including a description of our investigation of a cluster of cases with EVD.