Low birthweight and mortality in Australian Aboriginal babies at the Royal Darwin Hospital: A 15 year study

Abstract A retrospective analysis was made of all births at the Royal Darwin Hospital from 1 January 1969 to 31 December 1983. The births were divided into weight categories and racial groups (Aboriginal and non-Aboriginal).
The study showed that there was a 23.2% incidence of low birthweight (LBW) babies (less than 2500 g) in Aboriginals compared with an incidence of 6.4% in non-Aboriginals. It was found that Aboriginals had a better chance of surviving the neonatal periods than non-Aboriginals of the same birthweight for all birthweights up to 2500 g. It is suggested that this occurred because most LBW Aboriginals were more mature than their birthweight would have suggested.
The perinatal and neonatal mortality, however, remains high in the Aboriginal babies and this can also be attributed to the high incidence of LBW babies in this group, and perhaps to the limited use of antenatal care by the Aboriginal mothers.     

Identification of Aboriginal infants at an urban hospital

AIM: This study explored the accuracy of identification of Aboriginal infants at an urban hospital. METHODS: Data on the Aboriginal status of all infants who were delivered at the hospital to mothers who resided in the surrounding Local Government Area during 2002 were extracted from the Obstetrics Data Package (ODP). These data were supplemented with local health worker knowledge about the Aboriginal status of infants and compared with NSW Birth Register data held by the Australian Bureau of Statistics. RESULTS: There were 1739 deliveries at the hospital to mothers from the Local Government Area. Our study showed that 71.4% (n = 90) of Aboriginal and 77.5% (n = 1649) of non-Aboriginal infants identified through ODP were included in the Birth Register. The proportion of Aboriginal infants identified through the ODP was 5.2% and the Birth Register was 5.6%. The 90 Aboriginal infants included 38 with an Aboriginal mother, 34 with an Aboriginal father, and 18 with two Aboriginal parents. CONCLUSIONS: This was the first use of these data to examine the accuracy of identification of Aboriginal infants born at this facility. The study highlighted the importance of systematically seeking information on the Aboriginal status of both parents by antenatal services; of providing opportunities for timely feedback on the data quality to maternity service providers; and ensuring that the data are used to inform development of culturally appropriate services. As a result of this study, services have implemented strategies to routinely identify infants with an Aboriginal father as well as those with an Aboriginal mother.     

Change in Aboriginal childhood morbidity and mortality in Bourke 1971–84

In the early 1970s, the Aboriginal community of Bourke attempted to improve its socioeconomic and health status through a number of community development activities. As a result, markers of nutrition in early childhood, housing conditions and access to health care all improved, in spite of a deterioration in employment opportunities and adult health. Coincidentally, most markers of the health of Aboriginal children in Bourke improved over the period 1971-84. In particular, Aboriginal child admissions due to gastroenteritis, eye and ear infections and accidents, and the community prevalence of trachoma, middle ear disease and pneumonia among Aboriginal children, decreased. Skin infections were an exception to this general picture, becoming more prevalent over the period.     

Sequelae of Haemophilus influenzae type b meningitis in Aboriginal and non-Aboriginal children under 5 years of age

Between 1984 and 1990, 257 cases of Haemophilus influenzae type b (Hib) meningitis occurred in children under five years of age in Western Australia. We obtained information on possible sequelae in 131 cases (all non-Aboriginal) by medical record review and parental interview, and in a further 116 cases (60 non-Aboriginal, 56 Aboriginal) by medical record review only; no follow-up information was available for ten children (nine non-Aboriginal, 1 Aboriginal). The incidence of Hib meningitis in children under five years of age was 26.3 per 100000 for non-Aboriginal and 152.2 per 100000 for Aboriginal children. The case fatality rate was 3.5% for non-Aboriginal children and 14.0% for Aboriginal children. Sequelae were recorded for 17.1% of non-Aboriginal and 22.4% of Aboriginal children who survived Hib meningitis. Surviving Aboriginal children experienced severe sequelae following Hib meningitis almost three times more frequently than surviving non-Aboriginal children (10.5%vs 3.6%), although mild and moderate sequelae were not more common in Aboriginal children. The information on incidence and severity of sequelae in this study was obtained by chart review and parental interview, and hence may be subject to error or bias, particularly for mild and moderate disabilities. Outcomes like death and severe sequelae, such as cerebral palsy and profound intellectual and physical disability, are less subject to bias. Of Aboriginal children who contracted Hib meningitis in Western Australia over the study period, 22.8% either died or had severe sequelae, while only 7.0% of non-Aboriginal children experienced these severe outcomes.     

Risk indicators for depressed mood in youth: Limited association with Aboriginal cultural status

INTRODUCTION

There have been too few studies on urban Aboriginal youth to permit inferences about depressed mood in this subgroup. The purpose of the present study was to determine whether Aboriginal cultural status is independently associated with moderate or severe depressed mood in youth after controlling for other covariates, including socioeconomic status.

METHODS

Every student between grades 5 and 8 in the city of Saskatoon, Saskatchewan, was asked to complete a questionnaire in February of 2007. Depressed mood was measured with a 12-question depression scale derivative of the 20-question Center for Epidemiologic Studies Depression Scale.

RESULTS

Four thousand ninety-three youth participated in the school health survey. For Aboriginal youth, the prevalence rate of moderate or severe depressed mood was 21.6% in comparison with 8.9% for Caucasian youth (rate ratio 2.43; 95% CI 1.92 to 3.08). Aboriginal cultural status was not associated with depressed mood after adjustment for other covariates in the final multivariate model (OR 1.132; 95% CI 0.682 to 1.881). Parental educational status and sex were confounders to the association between Aboriginal cultural status and depressed mood.

CONCLUSIONS

The recognition that Aboriginal cultural status is not independently associated with moderate or severe depressed mood in youth after full multivariate adjustment allows policy makers to acknowledge that mental health disparity prevention is possible because the determinants of health (ie, education) are modifiable (in comparison with Aboriginal cultural status).     

Social determinants of health and the future well-being of Aboriginal children in Canada

Aboriginal children’s well-being is vital to the health and success of our future nations. Addressing persistent and current Aboriginal health inequities requires considering both the contexts in which disparities exist and innovative and culturally appropriate means of rectifying those inequities. The present article contextualizes Aboriginal children’s health disparities, considers ‘determinants’ of health as opposed to biomedical explanations of ill health and concludes with ways to intervene in health inequities. Aboriginal children experience a greater burden of ill health compared with other children in Canada, and these health inequities have persisted for too long. A change that will impact individuals, communities and nations, a change that will last beyond seven generations, is required. Applying a social determinants of health framework to health inequities experienced by Aboriginal children can create that change.     

Management of children with otitis media: A survey of Australian Aboriginal Medical Service practitioners

Aim:   To determine whether Australian Aboriginal Medical Service (AMS) practitioners treat otitis media (OM) more aggressively in Aboriginal than non-Aboriginal children and the factors influencing their management decisions.
Methods:   A case vignette questionnaire was sent to all AMS practitioners working in December 2006. We compared responses based on the child's Aboriginal status using χ² analysis.
Results:   Questionnaires were returned from 63/87 (72%) of the AMSs by 131/238 (55%) eligible practitioners. Few practitioners (13%) reported using tympanometry or pneumatic otoscopy (9%) when examining children's ears. Practitioners were more likely to treat acute OM with antibiotics (92% vs. 49%, P < 0.01) and to treat with courses longer than 7 days (25% vs. 14%, P = 0.03) in Aboriginal than non-Aboriginal children. Most practitioners (60%) used oral antibiotics to treat chronic suppurative OM and OM with effusion in Aboriginal children (58%). Factors increasing the likelihood of antibiotic use included: the child being Aboriginal (67%), wet perforations (62%) and bulging eardrums (59%). No AMS or practitioner characteristics were significant predictors. Most practitioners (99%) were aware of Therapeutic Guidelines (Antibiotic). Only half (54%) were aware of the Australian Government guidelines for managing OM in Aboriginal and Torres Strait Islander populations and only 22% used them 'often' or 'always'.
Conclusions:   Australian AMS practitioners treat OM more aggressively in Aboriginal children, consistent with the Australian Government guidelines, despite half being unaware of them. Opportunities to improve management include increased use of pneumatic otoscopy and tympanometry, and decreased antibiotic usage for OM with effusion and chronic suppurative OM.     

Health issues for Aboriginal youth: Social and cultural factors associated with resilience

Abstract Research into Aboriginal health has tended to focus on the morbidity of babies and young children, or on the chronic illnesses of adults. Adolescent Aborigines are rarely the target of health research. While health services for Aboriginal people, even in remote areas, have improved enormously over the last few years with the provision of Aboriginal-controlled organizations, health services alone do not prevent the major causes of morbidity. In any case, young people, particularly adolescent boys, are poor users of these facilities. The major causes of adolescent Aboriginal morbidity and mortality are preventable: they have to do with ways of living, with the social, cultural and physical environments which surround adolescents. The paper draws on anthropological fieldwork which pays close attention to these issues. The paper examines the concept of 'adolescence' among Aboriginal groups, and explores the reasons for the resilience of some populations to a particular health problem, that of petrol sniffing among the young.     

Health research involving First Nations,Inuit and Métis children and their communities

Canadian and international guidelines address the ethical conduct of health research in general and the issues affecting Indigenous populations in particular. This statement summarizes, for clinicians and researchers, relevant ethical and practical considerations for health research involving Aboriginal children and youth. While not intended to duplicate findings arising from lengthy collaborative processes, it does highlight ‘wise practices’ that have successfully generated knowledge relevant to, respectful of and useful for Aboriginal children, youth and their communities. Further research on current health issues and inequities should lead to practical, effective and culturally relevant applications. Expanding our knowledge of ways to address the health disparities facing Canada’s Aboriginal children and youth can inform health policy and the provision of services. Community-based participatory research is proposed as a means to achieve this goal.     

Taste disorders in Australian Aboriginal and non-Aboriginal children

Aim: To assess the prevalence and type of taste disorders in Aboriginal and non‐Aboriginal children matched for age, gender and living in the same general and educational environment. Methods: Taste function was assessed in 432 Aboriginal (n = 166) and non‐Aboriginal (n = 266) children aged 8–12 years from six public schools in a rural township using a three‐choice taste identification test and a cross‐sectional design. Results: The prevalence of taste disorders was very high and significantly more common in Aboriginal (20/166; 12.0%) than in non‐Aboriginal (21/266; 7.9%) children. Forty‐one children had quality‐specific disorders, of whom 27 (65.9%) had sweet disorders. Children often had more than one quality disorder. Conclusion: The prevalence of taste disorders in children was high and exceeded the level (4%) designated by the World Health Organisation as requiring immediate action by health authorities. As the cause of the disorders is unknown, there is a need for a wider investigation of the causes and the consequences.     

Oral health care for children – a call for action

Oral health is a fundamental component of overall health. All children and youth should have access to preventive and treatment-based dental care. Canadian children continue to have a high rate of dental disease, and this burden of illness is disproportionately represented by children of lower socioeconomic status, those in Aboriginal communities and new immigrants. In Canada, the proportion of public funding for dental care has been decreasing. This financial pressure has most affected low-income families, who are also less likely to have dental insurance. Publicly funded provincial/territorial dental plans for Canadian children are limited and show significant variability in their coverage. There is sound evidence that preventive dental visits improve oral health and reduce later costs, and good evidence that fluoridation therapy decreases the rate of dental caries, particularly in high-risk populations. Paediatricians and family physicians play an important role in identifying children at high risk for dental disease and in advocating for more comprehensive and universal dental care for children.     

The health of a group of young Australians in a New South Wales juvenile justice detention centre: A pilot study

Objective: To consider the health profile of a sample of young, largely male Australians as assessed on their admission to a New South Wales Juvenile Justice Detention Centre.
Method: A retrospective analysis of primary care nurse health records for 100 sequential admissions.
Results: Of the 97 males and three females (mean age = 15.9 years), 30 were Aboriginal and 39 did not live with either parent at the time of admission. Respiratory illness, such as bronchitis and asthma were common. These diagnoses were overshadowed by histories of significant physical injury. The sample was at high risk of sexually transmitted disease. Forty-six per cent had prior contact with a mental health professional, 26% reported they had thought of suicide and 9% reported having attempted suicide. There was a high prevalence of substance abuse.
Conclusion: The health of these young Australians is at risk from every perspective. Improving the quality of their health assessments is an important issue for the clinicians who attend them as individuals and for policy makers who aim to reduce the considerable social and economic cost of juvenile crime. The discussion of these results from one centre has revealed opportunities to make such improvements. There is a need for a gathering of expertise to address the issue, preferably on a national basis.     

Upper respiratory tract bacterial carriage in Aboriginal and non-Aboriginal children in a semi-arid area of Western Australia

BACKGROUND: Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are associated with otitis media (OM). Indigenous children experience particularly high rates of OM. Few studies worldwide have described upper respiratory tract (URT) carriage in Indigenous and non-Indigenous children living in the same area. AIM: The aim of this study was to describe URT bacterial carriage in Aboriginal and non-Aboriginal children in the Kalgoorlie-Boulder area, Western Australia, as part of an investigation into causal pathways to OM. METHODS: Five hundred four and 1045 nasopharyngeal aspirates were collected from 100 Aboriginal and 180 non-Aboriginal children, respectively, followed from birth to age 2 years. Standard procedures were used to identify bacteria. RESULTS: Overall carriage rates of S. pneumoniae, M. catarrhalis and H. influenzae in Aboriginal children were 49%, 50% and 41%, respectively, and 25%, 25% and 11% in non-Aboriginal children. By age 2 months S. pneumoniae and M. catarrhalis had been isolated from 37% and 36% of Aboriginal children and from 11% and 12% of non-Aboriginal children, respectively. From age 3 months onward, carriage rates in Aboriginal children were 51% to 67% for S. pneumoniae and M. catarrhalis and 42% to 62% for H. influenzae; corresponding figures for non-Aboriginal children were 26% to 37% for S. pneumoniae and M. catarrhalis and 11% to 18% for H. influenzae. Non-Aboriginal children had higher carriage rates in winter than in summer, but season had little effect in Aboriginal children. Staphylococcus aureus carriage was highest under age 1 month (55% Aboriginal, 61% non-Aboriginal) and was always higher in non-Aboriginal than Aboriginal children. CONCLUSIONS: Interventions are needed to reduce high transmission and carriage rates, particularly in Aboriginal communities, to avoid the serious consequences of OM.     

Hospital admissions for infections of Aboriginal and non-Aboriginal infants and children in Western Australia, 1981-86

Abstract Rates of hospital admissions and bed usage for infections by Aborigines up to 15 years of age were much higher in Western Australia during 1981-86 than they were for the rest of the population. These rates for Aboriginal infants for gastroenteritis, for example, were 20-25 times and 40-50 times those for other infants. The rates mostly declined over the 6 years except for gastrointestinal and respiratory infections in Aboriginal infants and young children in rural and remote areas. Hospitalization rates reflect many factors which include disease incidence and severity but also distance, climate and access to medical and nursing care and their utilization. Preventative health programmes must be maintained to help improve the health of young Aborigines.     

A pediatrician and his mothers and infants

Pediatricians are in a unique place in society by being able not only to care for the health and well-being of mothers and which, are their clinical responsibility, but also by being able to act as advocates for those patients who are often among the most vulnerable of our population. This article illustrates some of these points by referring to Australian Aboriginals from the vast desert areas of Westerns Australia. In remote areas of Western Australia, Aboriginal infants have high rates of low birth weight, failure to thrive and undernutrition. They also have high rates of respiratory, gastrointestinal and other infections. Aboriginal infant mortality has improved significantly over recent years, but Aboriginal health and mortality rates are still much worse than those of non-Aboriginal children and tend to be worst in more remote parts of the state. Overall, Aboriginal infants less than one year in age were hospitalized 9.5 times more frequently than non-Aboriginal infants for respiratory diseases (such as pneumonia, acute bronchiolitis and asthma); diarrheal diseases and skin infections were other very important causes of hospitalization for Aboriginal infants. Another poorly understood aspect of Aboriginal health is their widespread proneness to urinary tract infections. This is very important now in Australian Aboriginals in whom end-stage renal failure is becoming very prevalent. Rapid social and lifesyle changes have been very important in the poor health status of Aboriginals. They are also subject to severe socio-economic discrimination, underemployment, limited education, overcrowding, social depression and severely depressed housing conditions, relative inaccessibility to adequate and nutritious foodstuffs, and limited access to clinical services. Aboriginal people are prone to obesity, hypertension, type-2 diabetes mellitus and cardiovascular diseases. Overuse of alcohol and tobacco smoking have also become important challenges, particularly among adolescents and young adults. For the past twenty years or so, special programs have been developed to help overcome some of these problems; these include immunization programs, an extensive child health care program, special childhood screening programs, and oral rehydration therapy to reduce the high rates of mortality and morbidity associated with diarrheal diseases. These improvements have been achieved despite a set of socio-economic circumstances that face Aboriginal infants and children who live with adverse social factors. This was termed "Down and Out in 1996" in an editorial in The New Scientist (27 January 1996). A strategy that Australian Aboriginals are using now is to increase their own role through Aboriginal-controlled health and medical services including child health programs.     

Small bowel intestinal permeability in Australian aboriginal children

OBJECTIVE: To show that the severity of diarrheal disease in Aboriginal children in tropical Australia is a consequence of underlying small intestinal mucosal damage. STUDY DESIGN: A prospective study of 338 Aboriginal admissions compared to 37 non-Aboriginal children, both diarrhea cases and controls. Intestinal permeability was measured by lactulose-rhamnose (L/R) ratios on a timed 90-minute blood test. RESULTS: For diarrheal admissions, significantly more Aboriginal (vs. non-Aboriginal children) had hypokalemia (70 vs. 10%), acidosis (65 vs. 29%), moderate to severe dehydration (52 vs. 19%) and a longer mean length of stay (mean 8.9 vs. 3.9 days). Mean L/R ratios (95% confidence intervals) in Aboriginal children (diarrhea vs. controls) were 16.5 (14.6-18.7) vs. 4.5 (3.8-5.3) compared to 7.7 (4.4-13.3) vs. 2.5 (1.8-3.4), respectively, in non-Aboriginals. Abnormal permeability ratios (> 5.6) consistent with tropical-environmental enteropathy syndrome were found in 36% (27/75) of Aboriginal controls compared to none of the non-Aboriginal controls. On multiple regression, the factors associated with high L/R ratios were diarrheal severity ( < 0.001), acidosis ( = 0.007) and hypokalemia ( = 0.04). CONCLUSIONS: An underlying tropical-environmental enteropathy contributes to the severity of acute gastroenteritis in Aboriginal children. Diarrheal complications, such as acidosis, hypokalemia, and osmotic diarrhea are associated with high L/R ratios, reflecting greater small intestinal mucosal damage.     

The medicalization of aboriginal children: a comparison of the lengths of hospital-stay of aboriginal and non-aboriginal children in Western Australia and the Northern Territory

This paper compares the lengths of hospital-stay of Aboriginal and non-Aboriginal children in Western Australia and the Northern Territory over the past few years. The comparison yields two trends: Aboriginal children stay longer in hospital than do non-Aboriginal children; within each racial group, children stay longer in hospital in the Northern Territory than in Western Australia. By-and-large, these trends continue irrespective of age, sex, diagnostic category, hospital and usual place of residence. It appears that factors in addition to high rates of infectious disease, severity of illness and remoteness of home address affect length of hospital stay. Two organizational factors are suggested: the latent, working logic of service institutions such as public hospitals and the tendency of government to institutionalize impoverished people. It is concluded however, that as health care becomes holistic and more the responsibility of Aboriginal people, there is every reason to predict a decrease in the lengths of hospital stay of Aboriginal children.     

Low birthweight and mortality in Australian Aboriginal babies at the Royal Darwin Hospital: a 15 year study

A retrospective analysis was made of all births at the Royal Darwin Hospital from 1 January 1969 to 31 December 1983. The births were divided into weight categories and racial groups (Aboriginal and non-Aboriginal). The study showed that there was a 23.2% incidence of low birthweight (LBW) babies (less than 2500 g) in Aboriginals compared with an incidence of 6.4% in non-Aboriginals. It was found that Aboriginals had a better chance of surviving the neonatal periods than non-Aboriginals of the same birthweight for all birthweights up to 2500 g. It is suggested that this occurred because most LBW Aboriginals were more mature than their birthweight would have suggested. The perinatal and neonatal mortality, however, remains high in the Aboriginal babies and this can also be attributed to the high incidence of LBW babies in this group, and perhaps to the limited use of antenatal care by the Aboriginal mothers.