Rotavirus is the leading cause of diarrhoea morbidity and mortality for young children worldwide. In 2006, oral Rotarix rotavirus vaccine was licensed for use in Australia. However, despite high vaccine uptake, Aboriginal and Torres Strait Islander children living in rural and remote Australia remain more than 20 times more likely to be hospitalised with rotavirus gastroenteritis than children living in other Australian states and territories.

The ORVAC study – Optimising Rotavirus Vaccine for Aboriginal Children, is the first study to evaluate both the immunological and clinical impact of a ‘booster dose’ rotavirus vaccine schedule. This adaptive clinical trial randomises Aboriginal and Torres Strait Islander children 6 to 11 months old in the Northern Territory to receive an additional ‘booster’ dose of oral rotavirus vaccine or placebo. The primary outcome is decreased medical presentations with gastroenteritis in the first three years of life.

This real-world pragmatic clinical trial is conducted under the guidance of Aboriginal Elder and Cultural Advisor, Ms Ada Parry, and Aboriginal members of staff including Gregoriana Parker, Lorraine Gilbert and Gloria Baliva. It is run in partnership with both NT Government Primary Care Clinics and Aboriginal Community Controlled Health Services in the Northern Territory.

We anticipate that a successful trial outcome – evidence that a booster dose of oral rotavirus vaccine leads to decreased medical attendances with gastroenteritis – would lead to a direct change in rotavirus vaccine policy for Australian Aboriginal and Torres Strait Islander children and have implications for rotavirus vaccine policy in other high burden low-resource settings in Africa and Asia.

1. Insight into the persisting high burden of rotavirus gastroenteritis for Australian Aboriginal and Torres Strait Islander children, despite high vaccine uptake.
2. Understand the importance of cultural guidance, advice and partnership when conducting research with Australian Aboriginal and Torres Strait Islander populations.
3. Learn about pragmatic adaptive trial design and it's role in policy-driven research.

Introduction: Malaria remains a major public health burden in Africa with Nigeria carrying a significant portion of the burden. It is a significant cause of fatality among under-fives. Central to the integrated approach to malaria eradication are the preventive measures. High level awareness and adoption of these preventive measures is a cheap and effective way to malaria eradication in a low resource setting. Being able to identify the factors that will improve malaria prevention awareness and adoption among the general populace is a big concern to primary care physician in sub-Saharan Africa whose role in malaria eradication cannot be over emphasised.
This study aimed to identify the factors that determine the level of malaria prevention awareness and its adoption.
Method: It was descriptive cross-sectional study carried out in the Paediatrics out-patient unit of the State Hospital Abeokuta between April and July 2017. Participants were care-givers of children aged one month to five years selected by systematic random sampling. Data obtained included the socio-demographic details, awareness of malaria fever, its prevention and adoption.
Results: There were 348 participants. The level of malaria awareness and its prevention method was high; three hundred and five (87.6%) and two hundred and ninety three (85.4%) respectively. Fifty (14.6%) were not aware of any prevention method while the commonest method mentioned was insecticide treated nets. (ITN)
One hundred and forty- two (41.4%) did not adopt any malaria preventive measure.
The occupation and the educational status of the caregivers had significant association with the level of awareness of malaria preventive measures while the child’s age and caregiver’s occupation had significant association with the level of adoption of these preventive measures.
Conclusion: Malaria eradication may not be achievable if the level of preventive method awareness and its adoption is low among the general population especially sub-Saharan Africa.

1. Malaria awareness in a typical low resource setting.

2. Why Malaria still remained a health burden in sub-Saharan Africa..

3. What can be done to change the narrative.
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Background: Between 1964 and 1996, the 10-year survival of patients having valve replacement surgery for rheumatic heart disease (RHD) in the Northern Territory, Australia was 68%. As medical care has evolved since then, this study aimed to determine whether there has been a corresponding improvement in the region’s RHD patients’ 10-year survival.
Methods: A retrospective study of Aboriginal RHD patients in the Northern Territory, Australia, having their first valve surgery between 1997 and 2016. Survival was examined using Kaplan—Meier and Cox regression analysis.
Findings: The cohort included 281 adults and 61 children. The median (interquartile range (IQR)) age at first surgery was 31 (18-42) years; 173/342 (51%) had a valve replacement. Of 281 adults, 204 (73%) had at least one preoperative comorbidity. There were 93/342 (27%) deaths during a median (IQR) follow-up of 8 (4-12) years. The overall 10-year survival was 70% [95% confidence interval (CI): 64-76], while it was 62% [95%CI (53-70)] in those having a valve replacement. Preoperative comorbidity was associated with earlier death, the risk of death increasing with each comorbidity (hazard ratio (HR): 1·3 (95%CI: 1·2-1·5), p<0·001). Preoperative chronic kidney disease (HR: 6·1 (95%CI: 2·8-13·3), p<0·001), coronary artery disease (HR: 2·3 (95%CI: 1·1-5·0), p=0·037) and pulmonary artery systolic pressure >50mmHg before surgery (HR: 2·1 (95%CI: 1·3-3·5), p=0·002) independently predicted death.
Interpretation: Survival after RHD surgery in this region of Australia has not improved. Although the patients were young, many had multiple comorbidities which influenced long-term outcomes. The increasing prevalence of complex comorbidity in the region is a barrier to achieving optimal health outcomes.

Added value of this study
• Despite recent advances in surgical technique, perioperative care, and the management of medical comorbidities in Australia’s universal health system, the survival of Aboriginal people requiring RHD valve replacement surgery in the region between 1997 and 2016 has fallen to 62%.
• Half of the premature deaths were related to comorbidities; the risk increased with each additional comorbidity.
• Although the median age of adults at the time of initial RHD surgery was only 35, almost three-quarters already had significant comorbidity, while 40% had multiple comorbidities.
• Pulmonary artery systolic pressure ≥ 50mmHg was one of three independent predictors of long-term outcome.
Implications of all the available evidence
• The results provide a rationale for integrating RHD care with the prevention and longitudinal management of the other chronic diseases common in the Aboriginal population.
• The study suggests earlier surgery before pulmonary artery systolic pressure becomes dangerously elevated may reduce RHD-related death.

Background:
The Northern Territory (NT) is a vast region of Australia with a population of around 250,000 people in a geographical area of over 1 million square kilometres. 30% of the NT population are Aboriginal, and there are a number of small remote communities with majority Aboriginal populations served by primary health care centres.

Most Australians express a preference to die at home. In remote NT, end of life care at home is typically delivered by the local primary health care team with consultation by specialist palliative care services based in regional centres as required. Local care is provided by a multidisciplinary team that may include Aboriginal Health Practitioners and community workers, remote area nurses, and general practitioners.

Aim:
1. To present learnings from work as a general practitioner with a special interest in palliative care in remote Northern Territory.
2. To share practical and adaptable tips for palliative care practice relevant to other remote or low resource settings.

Content:
This clinical practice session will use short clinical vignettes of both malignant and non-malignant palliative care presentations to illustrate practical tips for palliative care work in the remote setting. With a focus on end of life care, it will cover essential topics including symptom control, managing the impacts of heat and resource shortages, and the importance of self-care for remote primary care staff.

Attendees to this session will enhance their understanding of:
1. The role of the multidisciplinary team in remote palliative care delivery.
2. Specific prescribing considerations for end of life care at home in the remote setting.
3. The importance of staff wellbeing in end of life care.

Understanding how general practice (GP) registrars define, develop, and perceive cultural safety could assist identifying areas where cultural safety is lacking or needs improvement.

Methods:

Our research explored the following questions:

1. How do GP registrars define and develop cultural safety?

2. What do registrars view as unique to consultations with Indigenous patients?

3. Which of the components of the Australian Health Practitioner Regulation Agency (AHPRA) definition of cultural safety are identifiable by a GP registrar?

All GP registrars undertaking training with JCUGP were invited to participate in the study.

Data collection was in three parts:

1: Survey with demographic details, experience, cultural capability measurement tool, measurement of attitude change scale and self-reflection and insight scale

2: Semi-structured interviews exploring registrar understanding of cultural safety

3: Detailed exploration of registrars’ perception of key areas identified in the cultural safety literature

Survey data was descriptively analysed. Interviews were studied using a content analysis approach.

Results:

26 registrars completed the survey.  16 registrars completed both the survey and the interview.  

 Most registrars described cultural safety as being aware of and respecting cultural beliefs and customs.  Registrars described four main factors that contribute to their development of cultural safety: shared or similar life experiences, cultural safety training, experiential learning, and critical reflection. Most registrars considered that a Western medical model of health care did not meet the needs of patients.  However, nearly half of the registrars indicated they would treat Aboriginal and Torres Strait Islander patients the same as all other patients. No registrars referred to the AHPRA consensus state of cultural safety or explicitly indicated that cultural safety should be determined by Aboriginal and Torres Strait Islander people.

Discussion:

This study identifies a gap between registrars’ perception of cultural safety compared to those of the APHRA definition.

1. Awareness of the gap between registrar perception of cultural safety and those of the AHPRA definition
2. Recognition of how registrars define and develop cultural safety

The aim of the presentation is to highlight the important role of general practitioners in addressing the health needs of Aboriginal and Torres Strait communities in Victoria, Australia. The content of the presentation focuses on how GPs can work effectively in Aboriginal Community Controlled Health Services to deliver high-quality, culturally safe, and integrated team care while maintaining their own wellbeing.

The presentation's goals include providing an overview of the governance and service delivery of these services, highlighting the importance of both cultural and clinical competence of GPs working in this sector, and offering practical tips and developed resources to help GPs develop a culturally safe and responsive approach.

The presentation also aims to discuss the complexity of care and the role of GPs in delivering integrated team care and wrap-around support, as well as wellbeing initiatives for GPs working in the sector. By the end of the presentation, participants should have an understanding of how to work effectively in Aboriginal Community Controlled Health Organisations, deliver integrated team care, and maintain their own wellbeing while providing care to others.

Lastly, the presentation aims to promote cultural safety and highlight the essential role of Aboriginal Community Controlled Health Organisations in Victoria in providing quality care and support to Aboriginal and Torres Strait Islander communities.

1. Develop a stronger understanding of Aboriginal Community Controlled Health services in Victoria
2. Enhanced understanding of the complexity of care and the role of the GP in integrated team care, including working with Aboriginal Health Workers and Practitioners
3. Understanding of the wellbeing initiatives in the Aboriginal Community Controlled Health sector in Victoria, including self-care