ISSN ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 99 – 2022

Maori Health Review
Maori Health Review

Healer/patient views on the role of Rongoā Māori (traditional Māori healing) in healing the land

Authors: Mark G et al.

Summary: A qualitative study involving 49 practitioners and patients of Rongoā Māori across New Zealand has highlighted that when the land is well, the people are well. Themes identified from semi-structured interviews were: (1) land as an intrinsic part of identity; (2) land as a site and source of healing; (3) reciprocity of the healing relationship; and (4) the importance of kaitiakitanga/conservation to Rongoā Māori. Recommendations from the study were to: (1) reconnect with the land; (2) support Rongoā Māori healing; and (3) participate in the conservation and preservation of local land and waterways. The authors hope that as more is learnt about the connection between the land and Rongoā Māori, greater value will be placed on the need to conserve and preserve both the land and connections to it through traditional healing practices.

Comment: Wonderful and exciting to see such a range of Rongoā research and activity happening in Aotearoa right now. I’ve been privileged to be part of a team developing Ngati Hine’s strategy in this space, building on the work of Erena Wikaire’s PhD thesis. I hope to share these resources with readers soon!

Reference: Int J Environ Res Public Health. 2022;19:8547.


Efficacy of a 3% Kānuka oil cream for the treatment of moderate-to-severe eczema

Authors: Shortt N et al.

Summary: Kānuka oil may represent an effective and well tolerated treatment for moderate-to-severe eczema, according to a randomised controlled trial conducted in New Zealand. The trial involved 80 adults with self-reported moderate-to-severe eczema, assessed by Patient Orientated Eczema Measure (POEM), who received 3% Kānuka oil cream (n = 41) or a vehicle control (n = 39) topically, twice daily, for 6 weeks. The trial was undertaken in eleven research trained community pharmacies. The primary outcome was the difference between groups in POEM score at week 6 on intention-to-treat analysis. Mean POEM score improved from 18.4 at baseline to 6.8 at week 6 in the Kānuka oil group, and from 18.7 to 9.8 in the vehicle control group. The mean difference in POEM score between groups was -3.1 (95% CI -6.0, -0.2; p = 0.036). There were three treatment-related adverse events in the Kānuka oil group and two in the vehicle control group; no serious adverse events were reported.

Comment: Such a neat study in terms of its responsiveness to Māori. The team have partnered with a Māori-led organisation developing and distributing the Kānuka oil cream, Rongoā Māori and its contribution to wellbeing is valued, the research has focussed on a significant health issue for Māori (eczema) and 25% of recruited participants were Māori. An exemplar for future clinical trials in Aotearoa.

Reference: EClinicalMedicine. 2022;51:101561.


Trends in deprivation in hospitalisations of Indigenous children and young people in Aotearoa New Zealand

Authors: Oben G et al.

Summary: A review of discharge data has highlighted the persistence of deprivation inequities in hospitalisation for medical conditions among Māori compared with non-Māori non-Pacific (NMNP) taitamariki. Data were extracted from the National Minimum Dataset Hospitalisation for the period 2000 to 2019. Hospitalisation rates were consistently higher for Māori than for NMNP aged <25 years over the study period. Māori taitamariki residing in the most deprived (quintile 5) areas were more likely than NMNP to be hospitalised for a medical condition at each study time point. Despite a reduction in deprivation inequities over time, ethnic difference in hospitalisations persisted.

Comment: This paper provides a compelling argument for Te Aka Whai Ora, and its partnerships with key stakeholders, including Te Whatu Ora, to address health inequities for Māori, in addition to the drivers of inequity.

Reference: J Paediatr Child Health. 2022;58:1345-1351.


Adherence, sexual behavior and sexually transmitted infections in a New Zealand prospective PrEP cohort

Authors: Saxton PJW et al.

Summary: Structural interventions and delivery innovations are needed to ensure ethnic minority gay and bisexual men gain equal benefit from pre-exposure prophylaxis (PrEP) against HIV, according to a study undertaken in Auckland. The study investigated the experiences of 150 gay and bisexual men (including 50% non-European) on PrEP over a 12-month period. Participant retention at 12 months was 85.9% (75.6% among Māori/Pacific and 90.1% among non-Māori/Pacific). Missed pills increased over time and were higher among Māori/Pacific participants. PrEP breaks also increased over time, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had taken a PrEP break. The number of condomless receptive anal intercourse partners was stable over time. Sexually transmitted infections (STI) were common but chlamydia declined over the study period. The 12-month incidence of diagnosed infection was 8.7% for syphilis, 36.0% for gonorrhoea, 46.0% for chlamydia, 44.7% for rectal STI and 64.0% for any STI.

Comment: My experience with the PrEP clinicians, and the work they do with South Auckland gay and bisexual community needing PrEP, has been very positive. The fact that they were able to recruit people into this study, and retain more than 75% of them for 12 months, speaks to the respect held for them by this community. I like that the recommendations focussed on structural and delivery interventions too.

Reference: AIDS Behav. 2022;26:2723-2737.


Maori Health Review

Holistic antenatal education class interventions

Authors: Barrett NM et al.

Summary: A systematic review has highlighted the low consideration afforded to the antenatal health needs and aspirations of Indigenous people in New Zealand, Australia, Canada and the United States. A total of 17 primary research papers on antenatal education classes in these countries, published between 2008 and 2018, were identified from a search of 5 electronic databases. Only 2 studies identified Indigenous participants, and in those studies, Indigenous participants were underrepresented. It was therefore not possible to understand the antenatal experiences of Indigenous people. The study authors stated that targeted Indigenous interventions considering culture, language and wider aspects of holistic health must be prioritised to address the antenatal health inequities of Indigenous people.

Comment: Disappointing yet not surprising that only 2 of the 17 studies included Indigenous participants. The authors make other important points here - on the importance of quality ethnicity data, Indigenous knowledge and holistic approaches to wellbeing. I encourage readers, particularly students commencing systematic reviews, to look at the full article.

Reference: Arch Public Health. 2022;80:169.


Acute alcohol use and suicide deaths

Authors: Crossin R et al.

Summary: Acute alcohol use has been identified in approximately one quarter (26.6%) of suicides in New Zealand, with stronger associations in those of Māori and Pasifika ethnicity, and those aged <55 years. Data for all suicides in individuals aged ≥15 years were drawn from the National Coronial Information System between July 2007 and December 2020. Acute alcohol use was defined as a blood alcohol concentration >50 mg/100 ml. Compared with European individuals, Māori individuals (adjusted odds ratio 1.20, 95% CI 0.74-1.02) and Pacific individuals (adjusted odds ratio 1.46, 95% CI 1.1-2.00) were more likely to die by suicide involving acute alcohol use. Individuals aged 15-54 years had similar risks of suicide involving acute alcohol use, with a lower association in older age groups. There was no association between suicide involving acute alcohol use and gender. Acute alcohol use is a significant but modifiable risk factor for suicide in New Zealand, the study authors concluded.

Comment: If you haven’t already, please look at and consider supporting the ‘Reduce Alcohol Harm’ campaign. As its leaders highlight, this is an equity issue in Aotearoa and political leadership is required. You can find out more here: the-bill.

Reference: N Z Med J. 2022;135:65-78.