Applied epidemiology in the Northern Territory 2012 - 2014

Abstract

The Northern Territory (NT) has a unique set of public health priorities due to its tropical climate, remote settings and high proportion of Indigenous people. In this setting I was placed as a Master of Applied Epidemiology (MAE) scholar within the Northern Territory's Centre for Disease Control (CDC) between 2012 and 2013. In this thesis, I present activities and projects undertaken at CDC which fulfil requirements of the MAE program. I discuss my participation in day-to-day public health activities of the CDC including surveillance of notifiable diseases and follow-up of people with infectious diseases. A large part of this role included responding to enquires from the general public and other health professionals; a requirement of the MAE program. I present two epidemiological projects, both of which conjointly fulfilled the requirement to analyse a public health dataset. In commencing the first project, I undertook a requisite literature review which identified the incidence of invasive group A streptococcal (iGAS) disease in Australia. My project comprised a case series in which I determined the incidence, risk factors, nature and outcomes of iGAS disease in the NT between 2011 and 2013. I found that incidence of iGAS disease in NT Indigenous and dialysis populations are amongst the highest reported. I presented these findings in an oral presentation at the 2013 Australian communicable diseases conference in Canberra. In a second epidemiological study, I undertook a cohort study to identify if refugees allocated to settlement in the NT between 2010 and 2011 received assessment and treatment (where indicated) for latent tuberculosis infection (LTBI). In investigating an acute public health problem, I participated in an investigation into an outbreak of notifications for Barmah Forest Virus (BFV) infection. We found the rise in notifications were due to an increase in false positive results from a widely used laboratory testing kit. A part of MAE requirements is to report on a project to a non-scientific audience. For this, I prepared a letter informing members of the public testing positive for BFV infection of our findings and recommendation for further follow-up. I present my evaluation of the tuberculosis surveillance system in Darwin which meets requirements to evaluate a public health system. I undertook a survey identifying firework-related injuries associated with annual "Territory Day" celebrations, when members of the public can legally buy and ignite fireworks. I published findings in the NT disease control bulletin. In fulfilment of teaching requirements, I prepared a 'lessons from the field' case study on 'how to write abstracts for conference presentation'. I facilitated discussion of this case study with my MAE peers. I present also my contribution to a workshop prepared and delivered by our MAE cohort to delegates attending the 2013 Australian communicable disease conference. We taught participants how to use EpiInfo7, a software tool with epidemiologic functionality. This thesis documents my MAE experience, fulfilment of requirements and findings of my investigations which benefit public health with a focus on vulnerable population groups of refugees and Indigenous people.