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'Disease of disadvantage': scientists look to tackle parasitic disease in Aboriginal communities

Dechlan Brennan -

A poorly understood parasitic worm disease significantly impacting Indigenous communities is finally getting the attention it demands, researchers say.

Strongyloidiasis is a poorly understood parasitic worm disease most common in remote Australian communities, as well as in some returned travellers, refugees or asylum seekers.

Researchers from Flinders University consider strongyloidiasis is a disease of poverty, with one researcher arguing it's "better described as a disease of disadvantage".

"It is an indictment on successive governments that we still see cases of strongyloidiasis in Australia," Flinders University environmental health expert Professor Kirstin Ross said in a new Royal Society article.

Caused by the parasitic worm strongyloides stercoralis, which thrives in environments with poor sanitation, strongyloidiasis has a range of symptoms. Prof Ross says these include wasting and nutritional deficiencies and can be "fatal if infected people become immunocompromised or undergo steroid treatment".

"This disease is transmitted when plumbing or other environmental health hardware components are failing," she said.

"Non-overseas acquired cases are seen almost exclusively in Australian remote communities, where poorly constructed and/or poorly maintained toilets, laundries, wastewater systems or inadequate rubbish collection creates poor sanitation and possible contact with contaminated soil or faeces."

First Nations remote communities have some of the highest rates of Strongyloidiasis in the world and Prof Ross, who is part of a new $5 million Australian Government National Health and Medical Research Council (NHMRC) Synergy Grant project to tackle the problem, said the disease was not "seen in mainstream Australia, but is very common in Indigenous communities".

She said reducing the risk of transmission also requires access to potable water for drinking, bathing and laundry, arguing adequate funding is needed to address both Strongyloidiasis transmission and prevalence.

This includes giving remote communities control over housing design, construction and maintenance, as well as appropriate funding allocation, training opportunities and good governance.

Strongyloidiasis is a poorly understood parasitic worm disease most common in remote Australian communities (Image: supplied)

"Additionally, making strongyloidiasis a notifiable disease, together with using cases as a prompt for action, will help to eliminate this disease," she said.

In her article, 'Locally acquired strongyloidiasis in remote Australia: why are there still cases?' Prof Ross notes "the high rates of strongyloidiasis in First Nations communities in Australia are a result of longstanding, systemic inequalities."

"For decades, these communities have faced the challenges of housing overcrowding, inadequate housing maintenance including of water and wastewater hardware, and inadequate waste management, all of which contribute to the transmission of strongyloidiasis."

A new research project is aiming to eliminate strongyloidiasis and is seeking to determine the true burden of the disease in East Arnhem Land, what role animals play in transmission and will develop inexpensive and rapid diagnostic tests.

Professor Darren Gray is leading the project and a director of QIMR Berghofer's Population Health Program.

He previously said the research will pilot an elimination program at two sites. It combines treatment, improving sanitation and hygiene, as well as community engagement, education, veterinary management and surveillance.

In addition to eliminating strongyloidiasis, the program is expected to help reduce the impact of other common and preventable infections found in areas of poverty disproportionately impacting Indigenous Australians.

These include scabies and group A streptococcus, ultimately reducing the burden of rheumatic heart disease.

National Indigenous Times previously reported rheumatic heart disease was especially prevalent in otherwise healthy Indigenous people in the NT, and were exacerbated by "low socioeconomic status".

"This research is a game-changer for the control of infectious diseases of poverty globally and could ultimately contribute to the breaking of the poverty cycle by improving health and wellbeing and increasing educational attainment and economic output," Prof Gray said.

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