Strongyloidiasis and Health Promotion: a neglected area of Health Promotion Action

Dr. Jenni Judd, Professor Adrian Miller & Professor Rick Speare

Preliminary results/progress:There is little published evidence about public health and health promotion approaches to the control and prevention of strongyloidiasis in Australia. Applying the Framework for Health Promotion Action highlighted that evidence was needed in all action areas of the Framework. Using this framework has also assisted in mapping current strategies in each of these areas to highlight the gaps in health promotion and prevention interventions for strongyloidiasis.

Methods: We conducted a review of the current literature on Strongyloides and Health Promotion. We searched OvidSp, Scopus, and Web of Science using MESh terms and text words strongyloid* and health promotion; strongyloid and health education; strongyloid* and public health; strongyloid* and Australia. We applied the action areas of the Health Promotion Framework for Action3 to map current action in strongyloidiasis in Australia. The Framework operates from an individual (downstream) to a population focus (upstream) approach.

Introduction: Infection with the parasitic, small intestinal nematode Strongyloides stercoralis is endemic in many rural and remote Indigenous communities in Australia. In northern Australia prevalences of >25% are common1.. Strongyloidiasis is clinically important because of the unique ability of the parasite to reproduce and persist within an individual for decades with the potential for those with chronic infection to develop severe disseminated disease and die2. Strongyloides does not exist in the non-Indigenous population of Australia, except for travellers , refugees, or the military. There appeared to be limited information about the health promotion strategies for the management and prevention of strongyloidiasis2.

Conclusions: Strongyloides at a high prevalence (>25%) in any community is a marker of poverty and an issue of human rights in Australia, a wealthy country. Multiple interventions including better health promotion and prevention strategies will assist in addressing this disease that does not exist in the mainstream Australian population. Appropriate screening, early intervention and treatment and improved infrastructure will also assist in reducing this neglected issue.

.Key Message: The comprehensive application of the Health Promotion Framework for action highlights gaps and priorities for addressing strongyloidiasis in Australian Indigenous communities.

Framework for Health Promotion Action

Disease PreventionPrimary

SecondaryTertiary

Communication Strategies

Health InformationBehaviour Change

Campaigns

Health Education and Empowerment

KnowledgeUnderstanding

Skill development

Community and Health

DevelopmentEngagement

Community Action Advocacy

Infrastructure and Systems

ChangePolicy Legislation

Organisational Change

Primary Care Approaches

Lifestyle/behaviourist Approaches Socio-ecological approaches

Source: Murphy and Keleher, 2003

References:1. Adams M, Page W and Speare R, Strongyloidiasis: an issue in Aboriginal Communities, Rural and Remote Health 3(online), 2003. Available from: http://rrh.deakin.edu.au2. Johnston FH, Morris PS, Speare R, McCarthy J, Currie B, Ewald D, Page W, and Dempsey W, Strongyloidiasis: A Review of the evidence for Australian Practitioners, Aust. J.Rural Health (2005) 13, 247-254.3. Murphy B, and Keleher H, Framework for Health Promotion Action: A Discussion Paper for Course Development, School of Health and Social Development, Deakin University, Melbourne.4. Shield JM, Page W. Effective diagnostic tests and anthelmintic treatment for Strongyloides stercoralis make community control feasible. PNG Med J 2008;51(3/4):105-119.

Map of region where strongyloidiasis is endemic in Indigenous communities. 7th National Workshop on Strongyloidiasis, Freemantle, 20-21 Mar 2012 3

Downstream Upstream