GD04: A systematic literature review to identify the barriers of managing skin infections in the Australian Aboriginal and Torres Strait Islander communities

Posters

Aswan Tai^1,2 and Bernd Rechel²

¹Peter MacCallum Cancer Centre, Melbourne, Australia; and ²European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK

The health inequalities faced by the Australian Aboriginal and Torres Strait Islander communities pose a major public health challenge. Skin and soft-tissue infections are one of the health conditions more common in these communities. Although rarely fatal, infections such as impetigo and scabies are among the most prevalent skin conditions worldwide and contribute substantially to the Global Burden of Disease. High infection rates (90% for impetigo and 50% for scabies) have been recorded in remote communities in some area of Australia in children of Aboriginal and/or Torres Strait Islander descent (Bowen AC, Mahé A, Hay RJ et al. The Global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLOS ONE 2015; 10: e0136789). The aim of our study was to explore the barriers of managing skin infections, scabies and impetigo in these remote communities in order to develop recommendations to support case management. A systematic review was conducted across four electronic databases – Embase, MEDLINE, Global Health and CINAHL – to identify relevant literature that met the inclusion criteria based on the PRISMA statement and checklist. Studies in English, published after 1980, concerned with barriers to managing bacterial skin infections, and focusing on access to diagnosis and treatment of skin infections in the Australian Aboriginal and Torres Strait Islander communities, were selected. In total, 282 articles were identified after the initial search. Twelve articles remained after the application of inclusion and exclusion criteria. Barriers to managing skin infections in the Australian Aboriginal and Torres Strait Islander communities were identified at client (patient), provider (healthcare worker) and health system (organizational) level. Multiple studies recognized the difficulty in accessing health services due to distance (most of the communities reside in regional or rural regions). Another common theme found at the patient level was normalization of skin infections, as well as other attitudes and beliefs. The painful benzathine penicillin G for impetigo treatment was also a reason for delayed client presentation. The lack of medical support and training represented an issue at both healthcare worker and organizational level. The tension between modern medicine and traditional bush medicine was raised at the healthcare level. Rapid staff turnover and organizational instability, which affect health services due to a lack of continuity of care, were noted at an organizational level. We conclude that there is an urgent need for more rigorous, large-scale studies to identify barriers to managing skin infections in the Australian Aboriginal and Torres Strait Islander communities. Unless the underlying barriers to the diagnosis and treatment of skin infections are addressed, they will continue to be a major health burden in these communities.