Australian First Nations communities have one of the highest global rates of strongyloidiasis– a poorly understood gastrointestinal infection caused by a parasitic worm – according to researchers from Flinders University.
Infection by the nematode, Strongyloides stercoralis, causes a range of symptoms including wasting, nutritional deficiencies, and failure to thrive in kids, and can be fatal if infected people become immunocompromised or undergo steroid treatment.
Information indicates that parasites synthesise several steroid hormones, such as ecdysteroids (an anabolic booster used in some exercise products), sex steroids, and corticosteroids, which can directly impact a parasite’s reproduction and moulting cycles.
The disease is transmitted by contact with faeces because of poor sewerage provision—including failing onsite wastewater systems—and contact with waste stabilisation ponds or other treatment systems, or faeces resulting from alfresco defecation, or contact with rubbish, particularly nappies.
A new $5 million NHMRC Synergy Grant project has been launched to tackle the problem, which environmental health expert Professor Kirstin Ross said in a new Royal Society article, was “an indictment on successive governments in Australia.”
“The disease is not seen in mainstream Australia, but is very common in Indigenous communities,” she pointed out.
“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.
“Providing adequate funding, together with giving First Nations communities control over housing design, construction and maintenance, and control over funding allocation, governance, and training opportunities, are essential steps to addressing the housing and environmental health hardware problems that cause strongyloidiasis transmission.
“Additionally, making strongyloidiasis a notifiable disease, together with using cases as a prompt for action, will help to eliminate this disease.”
A landmark study of First Nations communities’ environmental health hardware found that poor maintenance contributed significantly to the break-down of these basic facilities, with overcrowded housing diminishing the capacity for environmental health hardware to cope with the demand – often resulting in ‘alfresco defecation.’
“Notably, the study found that only 10% of poor functioning was the result of vandalism or misuse, which is commonly held to be one of the main reasons for poor functioning of environmental health hardware,” Professor Ross said.
“While this study was published some years ago, it is clear that this situation remains unchanged in many communities. Further, a study based on the same approach found that there was a 40% reduction in hospital separations of people from homes that had had their environmental health hardware repaired.”
“Although strongyloidiasis is considered a tropical disease, we have argued elsewhere that it is better described as a disease of disadvantage,” Professor Ross said.
More than a billion people worldwide carry parasitic nematode worms in their intestines, with Strongyloides stercoralis estimated to be present in more than 600 million people and a recent study of seven remote communities in central Australia, found that Strongyloides prevalence was 27%.
“Yet strongyloidiasis is still an overlooked disease that many doctors are not familiar with, and while infections with these worms are fairly well tolerated most of the time, they can take a deadly turn in people with a weakened immune system,” she said.
“This means that clinicians working with First Nations communities need to be made aware of the disease and this is a role for medical associations and universities, although significant effort has been made by the working group Strongyloides Australia.”