Healthy skin is important for maintaining overall physical health and wellbeing. However, remote-living Aboriginal children in Australia have disproportionally high rates of impetigo and scabies, with the downstream consequences of sepsis, skeletal infections, rheumatic fever /rheumatic heart disease and glomerulonephritis. Each of these conditions are driven by two causal pathogens of impetigo: Streptococcus pyogenes and Staphylococcus aureus. We aimed to reduce the burden of impetigo and scabies to address overall health, by evaluating the impacts of this community-engaged, holistic skin control program.
The SToP Trial was a large stepped-wedge cluster randomised control trial of ‘See’, ‘Treat’, and ‘Prevent’ skin health activities from 2019-2023 in the Kimberley region of Western Australia. Nine remote communities were divided into four clusters. Surveillance activities occurred at ten time-points over four years, and those identified with skin infections referred to the clinic for treatment. School and clinic staff were trained in recognising and treating skin infections. Alongside identifying and treating skin infections, health promotion activities were developed in consultation with the nine Aboriginal communities involved in the trial to prevent skin infections. These included eight ‘Healthy Skin’ books in local languages, and a Hip-Hop video.
915 children were consented and 777 (85%) had skin checks performed on at least one of ten visits between May 2019, and Nov 2022. A decline in impetigo and scabies occurred across all clusters, with the greatest decline during the observational period prior to commencement of interventional activities.
Decreased impetigo prevalence during the observational period prior to commencement of Trial activities was sustained across the Trial, attributable to the trimodal skin health initiative. As the largest remote-based randomised control trial on healthy skin and rheumatic fever prevention in Australia, we will describe the importance of co-design, cultural engagement with local communities and opportunities to strengthen clinical trials through community involvement.