Tuberculosis care designed with barramarrany (family): Participatory action research that prioritised partnership, healthy housing and nutrition.

ISSUE ADDRESSED: Ongoing tuberculosis (TB) transmission in Aboriginal communities in Australia is unfair and unacceptable. Redressing the inequity in TB affecting Aboriginal peoples is a priority in Australia's Strategic Plan for Tuberculosis Control. Improving TB care needs not to just identify barriers but do something about them. Privileging the voices of Aboriginal people affected by TB is essential to identify effective and enabling strategies. METHODS: A barramarrany (Aboriginal family) affected by recurring TB partnered with TB and Environmental Health teams using a participatory action research (PAR) methodology to improve housing health hardware and nutrition alongside biomedical TB prevention and care. A combination of the Ottawa Charter for Health Promotion; the International "End TB" Strategy; and Aboriginal barramarrany leadership, worldviews and traditional values guided actions to reduce TB transmission. RESULTS: Together the partners improved housing hardware and access to nutritious food, so the barramarrany could create a setting for good health and wellbeing. These actions supported the barramarrany to regain the physical, social and emotional wellbeing to deal with day-to-day challenges and stresses. The barramarrany were able to better sustain supportive relationships; grow, prepare and eat healthy food; and participate in health care activities. The barramarrany could better engage with medical approaches for TB and four barramarrany members completed TB treatment. The PAR action-project enabled and supported early TB diagnosis, treatment and prevention. CONCLUSION: Amplifying the voices of Aboriginal people and shared ownership of TB diagnosis, treatment and prevention by the barramarrany, was underpinned with principles of self-determination, capacity building and social justice. This PAR action-project provides further evidence that improving housing and nutrition can assist in Ending TB while improving wellbeing. SO WHAT?: Our action-research project undertaken within a PAR framework demonstrates the implementation of End TB Strategies by utilising the Ottawa Charter's five actions to promote health, by understanding and centralising the social determinants of health.

Can Public Spaces Effectively Be Used as Cleaner Indoor Air Shelters during Extreme Smoke Events?

During extreme air pollution events, such as bushfires, public health agencies often recommend that vulnerable individuals visit a nearby public building with central air conditioning to reduce their exposure to smoke. However, there is limited evidence that these "cleaner indoor air shelters" reduce exposure or health risks. We quantified the impact of a "cleaner indoor air shelter" in a public library in Port Macquarie, NSW, Australia when concentrations of fine particulate matter (PM2.5) were elevated during a local peat fire and nearby bushfires. Specifically, we evaluated the air quality improvements with central air conditioning only and with the use of portable high efficiency particulate air (HEPA) filter air cleaners. We measured PM2.5 from August 2019 until February 2020 by deploying pairs of low-cost PM2.5 sensors (i) inside the main library, (ii) in a smaller media room inside the library, (iii) outside the library, and (iv) co-located with regulatory monitors located in the town. We operated two HEPA cleaners in the media room from August until October 2019. We quantified the infiltration efficiency of outdoor PM2.5 concentrations, defined as the fraction of the outdoor PM2.5 concentration that penetrates indoors and remains suspended, as well as the additional effect of HEPA cleaners on PM2.5 concentrations. The infiltration efficiency of outdoor PM2.5 into the air-conditioned main library was 30%, meaning that compared to the PM2.5 concentration outdoors, the concentrations of outdoor-generated PM2.5 indoors were reduced by 70%. In the media room, when the HEPA cleaners were operating, PM2.5 concentrations were reduced further with a PM2.5 infiltration efficiency of 17%. A carefully selected air-conditioned public building could be used as a cleaner indoor air shelter during episodes of elevated smoke emissions. Further improvements in indoor air quality within the building can be achieved by operating appropriately sized HEPA cleaners.

Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018.

BACKGROUND: In 2018, an outbreak of leptospirosis was identified among raspberry workers from a mixed-berry farm in New South Wales, Australia. Initial testing had not revealed a cause, but eventually leptospirosis was detected via polymerase chain reaction (PCR). Further serological testing detected Leptospira borgpetersenii serovar Arborea, of which rodents are the predominant reservoir. Leptospirosis is rare in Australia, with outbreaks usually related to flooding. We conducted an investigation to identify risk factors for infection, to inform control measures. METHODS: Cases were detected through laboratory notifications, hospital-based syndromic surveillance, awareness-raising among farm employees and clinician alerts. Confirmed cases had a four-fold rise in antibody titre or single titre ≥400 on microscopic agglutination test, and a positive IgM. Probable cases had a positive Leptospira PCR or IgM, and possible cases had a clinically compatible illness. We conducted a case-control study among raspberry workers on the farm and compared reported exposures between cases and seronegative controls. We assessed environmental risks on-site and tested rodents for leptospirosis. RESULTS: We identified 84 cases over a 5-month period (50 confirmed, 19 probable and 15 possible). Compared with controls, cases were less likely to wear gloves and more recently employed. Cases also more commonly reported always having scratched hands, likely from the thorns on raspberry plants. We observed evidence of rodent activity around raspberry plants and three of thirteen trapped mice tested positive for Leptospira Arborea. Control measures included enhanced glove use, doxycycline prophylaxis and rodent control. CONCLUSIONS: This is the largest known outbreak of leptospirosis in Australia. Workers were likely exposed through scratches inflicted during harvesting, which became contaminated with environmental leptospires from mice. Leptospirosis should be considered an occupational risk for raspberry workers, requiring protective measures. Chemoprophylaxis may assist in controlling outbreaks. PCR assists in the early diagnosis and detection of leptospirosis and should be included in surveillance case definitions.