title: Evaluation of an Australian indigenous housing programme: community level impact on crowding, infrastructure function and hygiene.
abstract: OBJECTIVE
  Housing programmes in indigenous Australian communities have focused largely on achieving good standards of infrastructure function. The impact of this approach was assessed on three potentially important housing-related influences on child health at the community level: (1) crowding, (2) the functional state of the house infrastructure and (3) the hygienic condition of the houses.
  
  
  METHODS
  A before-and-after study, including house infrastructure surveys and structured interviews with the main householder, was conducted in all homes of young children in 10 remote Australian indigenous communities.
  
  
  RESULTS
  Compared with baseline, follow-up surveys showed (1) a small non-significant decrease in the mean number of people per bedroom in the house on the night before the survey (3.4, 95% CI 3.1 to 3.6 at baseline vs 3.2, 95% CI 2.9 to 3.4 at follow-up; natural logarithm transformed t test, t=1.3, p=0.102); (2) a marginally significant overall improvement in infrastructure function scores (Kruskal-Wallis test, χ(2)=3.9, p=0.047); and (3) no clear overall improvement in hygiene (Kruskal-Wallis test, χ(2)=0.3, p=0.605).
  
  
  CONCLUSIONS
  Housing programmes of this scale that focus on the provision of infrastructure alone appear unlikely to lead to more hygienic general living environments, at least in this study context. A broader ecological approach to housing programmes delivered in these communities is needed if potential health benefits are to be maximised. This ecological approach would require a balanced programme of improving access to health hardware, hygiene promotion and creating a broader enabling environment in communities.
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Northern Territory, Australia. ross.bailie@menzies.edu.au
authors.forename: Ross S
authors.initials: RS
authors.lastname: Bailie
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: McDonald
authors.forename: Matthew
authors.initials: M
authors.lastname: Stevens
authors.forename: Steven
authors.initials: S
authors.lastname: Guthridge
authors.forename: David R
authors.initials: DR
authors.lastname: Brewster
mesh_terms: D001315:Australia; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003625:Data Collection; D004777:Environment; D005260:Female; D006291:Health Policy; D006798:Housing / Q000592:standards*; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011156:Population Density; D016730:Program Development; D015397:Program Evaluation; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D013997:Time Factors
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