Applied epidemiology in the Kimberley

Abstract

Aboriginal and Torres Strait Islander populations in remote Western Australia (WA) face many challenges in relation to public health. It was in this setting that I was placed as a Master of Philosophy in Applied Epidemiology (MAE) scholar, based at the Kimberley Population Health Unit (KPHU), WA Country Health Service, where I had previously worked as a Medical Officer. In this thesis I present field epidemiology projects with a focus on remote Aboriginal and Torres Strait Islander health. These projects were designed to fulfil the key requirements of the MAE award. In investigating an acute public health problem, I lead the investigation and response to an outbreak of pandemic strain influenza A(H1N1) virus in a remote community in the northern Kimberley. Through this project, I fulfilled the requirement for an oral presentation at an international or national conference, by presenting on this work at the 7th Bi-regional Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) conference in Vietnam. I also developed a paper for publication in the peer reviewed scientific literature titled: "An outbreak of influenza A(H1N1)pdm09 in a remote Aboriginal community" which was accepted by the Australian and New Zealand Journal of Public Health. Further, I developed a lay summary of the outbreak report which was provided to the community affected by the outbreak, thus completing the MAE requirement of a report to a non-scientific audience. I provide an evaluation of a public health surveillance system, titled "Evaluation of the Western Australia Rheumatic Heart Disease Register". My major epidemiology project, which fulfilled the requirement to design and conduct an epidemiological study, was also in the field of rheumatic heart disease, but focussed on it's cause, acute rheumatic fever. This investigation of an acute rheumatic fever epidemic across WA was titled "Acute Rheumatic Fever Increase in Western Australia". To analyse a public health dataset, I used an existing clinical data set to examine practitioner and patient adherence to best practice guidelines for people with chronic heart failure attending primary health care services in the Kimberley region. This project was titled "Adherence with a Chronic Heart Failure Guideline in the Kimberley region, Western Australia". In addition to these projects, I completed a literature review as a requirement of the MAE award, titled: "Chronic Disease Management in Remote Aboriginal Communities in Australia". To achieve MAE teaching competencies, I was involved in several teaching sessions, including designing, coordinating and running a "lessons from the field" which focused on disease registers, and delivering a group teaching program to epidemiology and public health students titled: "Framework for Interpreting Time Series Data". During my MAE experience I contributed to the work of KPHU through these epidemiological projects. The work documented in this thesis contributed to the understanding of the epidemiology of communicable and non-communicable disease in the Aboriginal and Torres Strait Islander population in WA, with a particular focus on remote health and recommendations for improved health service delivery.