A large-scale Australian skin study has halved the rate of skin infections experienced by Aboriginal children living in remote communities, with regular skin checks key to the stunning result.
Led by The Kids Research Institute Australia and Aboriginal health organisations in close partnership with nine Aboriginal communities in Western Australia’s Kimberley region, the five-year SToP Trial set out to identify the best possible methods to See, Treat and Prevent painful skin sores and scabies.
Left untreated, skin infections can cause life-threatening illnesses including rheumatic heart disease (RHD), sepsis and kidney disease – all of which disproportionately affect Aboriginal and Torres Strait Islander Australians.
“Skin sores, or impetigo, are a massive problem – our previous research has shown children living in Australia’s remote Aboriginal communities have the highest rates of impetigo in the world,” SToP Trial lead Professor Asha Bowen said.
“These painful and itchy infections are so common they were seen as ‘normal’ and often left untreated, which can lead to life-threatening illnesses.”
Researchers worked closely with community members and local health services – including Kimberley Aboriginal Medical Services, Nirrumbuk Environmental Health and Services, and the WA Country Health Service-Kimberley – to complete skin check-ups and yarn about the best approaches for local treatment and sharing prevention messages.
Led by Professor Bowen – Head of the Healthy Skin and ARF Prevention team at the Wesfarmers Centre of Vaccines and Infectious Diseases, based at The Kids, Professor at The University of Western Australia and Paediatrician at Perth Children’s Hospital – the team followed 915 children and visited schools in nine communities three times per year over the study period.
“The magnitude of the project was huge,” Professor Bowen said. “We completed 3,084 skin checks over the four-year period and covered over 45,000 kms travelling to 81 community visits in order to gain a full picture of how skin infections affect kids and their families.”
The findings, published today in The Lancet Child & Adolescent Health and eClinicalMedicine, reveal that while the rate of skin infections early in the study period was close to 40 per cent, this had been reduced to 20 per cent – two in every ten children – by the end of the trial.
“Our aim for the SToP Trial was to decrease the burden of skin sores by 50 per cent – an outcome we are proud to have achieved,” Professor Bowen said.
“The results demonstrated that improved detection through skin surveillance in schools played the biggest role in achieving our outcome – having a strong focus on regular skin checks, communicating these results to the school, clinic and families, and really elevating skin health as a priority were the key factors we were able to identify in the SToP Trial.
“Ultimately, I would like to see Aboriginal children living in remote communities having the same rates of skin sores as any other child in Australia, which means getting it down to around one in every 20 children.
“The prevention side of our research highlighted the importance of environmental health and the availability of suitable, well-maintained living conditions, so we really need to advocate for solid investment in healthy housing and regular maintenance in order to achieve this.”
One Arm Point Community Navigator for the StoP Trial, Mayala Bardi Jawi woman Ms Janella Isaac, said using the approach of empowering community members to assist with engaging with families and building their own capacity meant the research project was welcomed with open arms.
“Working with community navigators to assist with the delivery of health messages, bringing the community together at BBQs and having the same researchers return to the same place for each visit made all the difference in building relationships with the families involved,” Ms Isaac said.
“For my own children, participating in the study helped us in a big way – they were really engaged in learning how to prevent skin infections both for themselves and future generations.”
First author Dr Hannah Thomas said the involvement of kids and local communities in the Kimberley had been absolutely pivotal, ensuring everyone worked together towards the goal of healthy skin.
“We really wanted to empower the children to prioritise their own health, so in addition to skin checks and efforts to improve treatment we embedded a number of interactive projects for the kids to get involved in,” Dr Thomas said.
“This included a hip-hop video filmed on the Dampier Peninsula that shared healthy skin messages in the children’s own words, co-designing workshop materials in the classroom, and developing healthy skin story books featuring language, photos and artwork created by the students.
“Together, these resources create a legacy that combines western medicine and traditional cultural knowledge that will help communities maintain healthy skin.”