Water Journal : Water Journal July 2012
public health refereed paper technical features 74 JULY 2012 water and Campylobacter. It is especially telling that Shigellosis, a disease long considered synonymous with poverty, is a key culprit. A review of National Disease Surveillance Statistics between 2002 and 2007 reveals Shigellosis notification rates among Indigenous Territorians are 15 times higher than in non-Indigenous Territorians and 73 times the general Australian average. Hospitalisation and notification rates likely under-represent the true prevalence of diarrhoeal disease, however. An alternative estimate can be derived from a child health survey conducted in 2004--2005. This survey of carers for 618 Indigenous children aged 0 to 7 years across 10 remote communities found 30.6% had experienced diarrhoea in the previous fortnight. Comparative analysis should be treated with caution due to issues of seasonality, reliability of two-week recall periods, and the non- representative nature of the sample. Nonetheless, the proportion of carers who reported diarrhoea is high even by developing world standards. When age-adjusted for children less than two years, the Indigenous figure of 40% exceeds the diarrhoea prevalence recorded for each of the 60 developing countries that have been subject to Demographic and Health Surveys since 2000 (Figure 4). Trachoma In 2010, screening of 4,441 Indigenous children aged less than 15 years across 64 'at-risk' NT communities found an overall prevalence of 12%, with regional prevalence ranging from 1% to 27% (Figure 5). In contrast, trachoma was eliminated from the non-Indigenous population more than 70 years ago. Sadly, Australia is now the only developed nation in the world where the disease remains endemic. Furthermore, levels of infection among Indigenous children in at-risk communities appear to be higher than the average prevalence in trachoma-endemic areas across the developing world (Figure 6). Scabies The NTER CHCs, which included 10,605 individual check-ups (constituting 65% of the 0--14-year age group throughout remote NT), observed scabies in 8.4% of children aged 0--14, with ranges from 5.5% to 11.6% (Figure 7). These figures fall at the upper end of the 5--10% prevalence range found in developing countries. Long-term sequelae On the spectrum of health conditions, a bout of diarrhoea, an irritating eye infection or itchy skin might seem somewhat minor. In contrast to the developing world where diarrhoea remains the second most common cause of death for children under five, not a single child death due to diarrhoeal disease has been recorded in the NT for at least a decade (Figure 9). This represents a major turnaround from the 1960s when intestinal infection was the biggest killer of Indigenous children in the NT. Although this decline should be celebrated, recurring reinfection of water-washed diseases continues to have insidious long-term consequences that extend well beyond childhood. Frequent episodes of non-fatal intestinal infection at a young age can lead to a vicious cycle of malnutrition and growth faltering, and can impair cognitive function later in childhood. Similarly, trachoma can lead to scarring and, eventually, blindness. Scabies underlies 50%-- 70% of Group A streptococcal pyoderma, which in turn can cause episodes of acute rheumatic fever (ARF) and, ultimately, rheumatic heart disease (RHD), a cause of premature death among Indigenous Australians. Efforts to reduce the prevalence of water-washed infections could, therefore, produce a modern-day Mills-Reinicke effect, whereby immediate improvements in water-related disease are followed up by reductions in other illness not traditionally considered to be water-related. In light of this, it is important to note that Indigenous rates of malnutrition, growth retardation, vision impairment, ARF, RHD and renal impairment are far in excess of the non-Indigenous population in Australia. Access to Water and Sanitation Infrastructure in Remote NT The recent release of the Joint Monitoring Program (JMP) report by UNICEF/WHO heralded the welcome news that the Millennium Development Goal (MDG) to "halve the proportion Figure 3. Hospital separations for intestinal infectious disease (principal diagnosis). Figure 4. Percentage of children under age two who had diarrhoea in the previous two weeks. Figure 5. Prevalence of active trachoma among NT Indigenous children screened in 'at-risk' communities: 2010. Figure 6. Estimated prevalence of active trachoma in endemic areas in the developing world.
Water Journal August 2012
Water Journal May 2012