Estimating the number of New Zealand children with a physical disability

Aims:   To estimate the number of New Zealand children who have a physical disability, and to describe this group in relation to sex, age, ethnic group and severity.
Methods:   We used data collected by Statistics New Zealand's Household Disability Survey 2001. Within the estimated 90 000 children aged 0–14 years with a disability as described in Disability Counts 2001, we identified a subgroup using information on the use of equipment suggestive of mobility disability, the numbers estimated to be in receipt of or in need of physiotherapy and/or occupational therapy, and the small number needing ramps or similar modifications.
Results:   An estimated 14 500 children had a physical disability. This equates to an estimated 1.7% of the New Zealand population of children aged 0–14 years. Fifty-seven per cent were boys. An estimated 9600 were New Zealand-European, 3800 Maori and 600 Samoan. Approximately half were of moderate severity as defined by Statistics New Zealand. An estimated 9500 had a multiple disability.
Conclusions:   The rate is somewhat higher than in studies from countries where only locomotor disability is described, but similar to rates where other types of disability such as dexterity disability are included. This may reflect the fact that within our group are children who in other countries would have been described as having a dexterity or a self-help disability. It would be useful if future New Zealand data collection could attempt to separate these subgroups in order to allow better forward planning of health, education and family support services.     

Rotavirus hospitalisation in New Zealand children under 3 years of age

OBJECTIVE: To describe the epidemiology of severe rotavirus gastroenteritis and to estimate the hospitalisation rates of this illness in New Zealand children under 3 years of age. METHODS: Children under 3 years of age with acute diarrhoea admitted to 1 of 8 study hospitals between 1 May 1998 and 30 April 2000 were surveyed. Their socio-demographic, treatment and length-of-stay data were recorded and stool samples tested by a rotavirus-specific enzyme-linked immunoassay. National hospital discharge data for infectious diarrhoea (International Classification of Diseases, ninth revision, 003-009) were reviewed, allowing population-based estimates for rotavirus-related hospitalisation in New Zealand. RESULTS: Of 2019 enrolled children, 1138 (56.4%) provided stools for testing, and of these 485 (42.6%) tested rotavirus positive. Rotavirus detection varied significantly by age (26.8% for 0 to 5 months, 42.5% for 6 to 11 months and 52.1% for children aged 12 to 35 months; P < 0.001), and by season (51.2% in winter/spring vs. 24.5% in summer/autumn; P < 0.001). While those infected with rotavirus were more likely to be dehydrated (50.6% vs. 37.4%; P < 0.001), their median hospital stay was similar (1.0 vs. 2.0 days; P = 0.09) to other children with acute gastroenteritis. The estimated national hospitalisation rate for rotavirus diarrhoea in children under 3 years, standardised for age and season, was 634 (95% CI 597, 672) per 100,000. In New Zealand, rotaviruses result in 1 in 52 children being hospitalised by 3 years of age. CONCLUSIONS: Rotavirus diarrhoea is an important, potentially vaccine-preventable cause of hospitalisation in New Zealand children, especially during winter and spring seasons.     

Effect of combined maternal and infant vitamin D supplementation on vitamin D status of exclusively breastfed infants

Severe vitamin D deficiency in mothers and their breastfed infants is a significant health problem in the Middle East. Supplementation of the breastfed infant alone with the recommended dose of vitamin D may be insufficient in high‐risk population. We investigated the effect of combined maternal and infant vitamin D supplementation on vitamin D status of the breastfed infant. We examined also the effect of supplementation on vitamin D antirachitic activity of breast milk in a subset of mothers. Healthy breastfeeding mothers (n = 90) were randomly assigned to 2000 IU daily (group 1) or 60 000 IU monthly (group 2) of vitamin D₂, and all their infants (n = 92) received 400 IU daily of vitamin D₂ for 3 months. Most infants had vitamin D deficiency – 25‐hydroxyvitamin D [25(OH)D] ≤ 37.5 nmol L^?1– at study entry. Serum 25(OH)D concentrations at 3 months increased significantly from baseline in infants of mothers in group 1 (13.9 ± 8.6 vs. 49.6 ± 18.5 nmol L^?1, P < 0.0001) and group 2 (13.7 ± 12.1 vs. 44.6 ± 15.0 nmol L^?1, P < 0.0001). Maternal and infant serum 25(OH)D concentrations correlated positively at baseline (r = 0.36, P = 0.01) and 3 months (r = 0.46, P = 0.002). Milk antirachitic activity increased from undetectable (<20 IU L^?1) to a median of 50.9 IU L^?1. In conclusion, combined maternal and infant vitamin D supplementation was associated with a threefold increase in infants’ serum 25(OH)D concentrations and a 64% reduction in the prevalence of vitamin D deficiency without causing hypervitaminosis D.     

Frequency of vitamin D insufficiency in healthy children between 1 and 16 years of age in Turkey

Background: The aim of this study was to establish the frequencies of vitamin D deficiency and insufficiency among healthy children aged 1–16 years and also to determine the factors affecting the levels of vitamin D in Turkey. Methods: A total of 849 healthy individuals whose ages ranged from 1 to 16 years were included in the study. Serum 25(OH)D, calcium, phosphorous and alkaline phosphatase l levels were measured at the end of the winter period. The approximate daily calcium intake was calculated by using a 1‐week diet history. Results: We determined that the prevalence of vitamin D deficiency (<20 ng/mL) was 8% and that of vitamin D insufficiency (20–29 ng/mL) was 25.5% in the population investigated. The average daily intake of calcium was especially low in the >8‐year‐old age group (<1300 mg/day). Conclusion: Vitamin D insufficiency was found to be very common in the population investigated. The daily calcium intake was below the adequate levels especially in school children. Vitamin D supplementation after the first year of life could be beneficial especially for school children and adolescents. The government must develop public policies for the fortification of milk, milk products, and fruit juices with vitamin D.     

Survival by ethnicity for children diagnosed with cancer in New Zealand during 1990-1993

AIM: This study aimed to assess survival by ethnicity for all New Zealand children (0-14 years) diagnosed with cancer during 1990-1993 and second, to determine the accuracy of the children's routinely collected ethnicity information. METHODS: Four hundred and nine children were followed up using two largely independent sources. We compared survival using the Cox model. RESULTS: Maori and Pacific Island children had the same survival as non-Maori/non-Pacific children for 'all cancers combined' (hazard ratios (HR): 0.98; 95% confidence interval (CI): 0.64-1.50 and 1.01; 95% CI: 0.53-1.89 respectively) and acute lymphoblastic leukaemia (HR: 1.09; 95% CI: 0.45-2.62 and 0.99; 95% CI: 0.24-4.16, respectively). The ethnicity data stored within the National Health Index and the New Zealand Cancer Registry showed reasonably close agreement with ethnicity data provided by the children's mothers at interview (Kappa statistics: 0.82 and 0.81 respectively) while the Mortality Collection showed only moderate agreement (Kappa statistic: 0.63). CONCLUSION: The point estimates in this study provide no evidence of ethnic disparities in survival from childhood cancer in New Zealand. However, even in this national study there were small numbers of Maori and Pacific children leading to wide confidence intervals. We therefore recommend cautious interpretation.     

Global summary of maternal and newborn vitamin D status – a systematic review

Pregnant women and newborns are at increased risk of vitamin D deficiency. Our objective was to create a global summary of maternal and newborn vitamin D status. We completed a systematic review (1959–2014) and meta‐analysis of studies reporting serum 25‐hydroxyvitamin D [25(OH)D] concentration in maternal and newborn populations. The 95 identified studies were unevenly distributed by World Health Organization (WHO) region: Americas (24), European (33), Eastern Mediterranean (13), South‐East Asian (7), Western Pacific (16) and African (2). Average maternal 25(OH)D concentrations (nmol L^?1) by region were 47–65 (Americas), 15–72 (European), 13–60 (Eastern Mediterranean), 20–52 (South‐East Asian), 42–72 (Western Pacific) and 92 (African). Average newborn 25(OH)D concentrations (nmol L^?1) were 35–77 (Americas), 20–50 (European), 5–50 (Eastern Mediterranean), 20–22 (South‐East Asian), 32–67 (Western Pacific) and 27–35 (African). The prevalences of 25(OH)D <50 and <25 nmol L^?1 by WHO region in pregnant women were: Americas (64%, 9%), European (57%, 23%), Eastern Mediterranean (46%, 79%), South‐East Asian (87%, not available) and Western Pacific (83%, 13%). Among newborns these values were: Americas (30%, 14%), European (73%, 39%), Eastern Mediterranean (60%, not available), South‐East Asian (96%, 45%) and Western Pacific (54%, 14%). By global region, average 25(OH)D concentration varies threefold in pregnant women and newborns, and prevalence of 25(OH)D <25 nmol L^?1 varies eightfold in pregnant women and threefold in newborns. Maternal and newborn 25(OH)D concentrations are highly correlated. Addressing vitamin D deficiency in pregnant women and newborns should be a global priority. To protect children from the adverse effects of vitamin D deficiency requires appropriate interventions during both pregnancy and childhood.     

Population prevalence and risk factors for iron deficiency in Auckland, New Zealand

AIM: Previous prevalence estimates of iron deficiency (ID) in young New Zealand children are inaccurate because of sampling bias and imprecise definition of ID. The aim of this study was to estimate the prevalence of ID in children aged 6-23 months and the factors associated with ID. METHODS: An ethnically stratified sample identified from random residential address start points. Children resident in Auckland, New Zealand were enrolled from 1999 to 2002. Children with elevated C-reactive protein (>4 mg/L) were excluded. Iron status was determined in 324 (78%) of 416 enrolled children. Analyses adjusted for clustering and weighted for ethnic stratification. ID defined as abnormal values for two or more of serum ferritin (<10 microg/L), iron saturation (<10%) and mean cell volume (<73 fl). RESULTS: ID was present in 14% (95% confidence interval (CI) 9-17%). ID prevalence varied with ethnicity (Maori 20%, Pacific 17%, other 27%, New Zealand European 7%, P = 0.005), but not with social deprivation. In a multivariate analysis that adjusted for low birthweight, there was an increased risk of ID associated with a body mass index >or= 18.5 kg/m(2) (RR = 4.34, 95% CI 1.08-10.67), and with receiving no infant or follow on formula (RR = 3.60, 95% CI 1.56-6.49). CONCLUSIONS: ID is prevalent in young New Zealand children. Variance in ID prevalence with ethnicity but not social deprivation implies that cultural practices influence iron status. Young children with more rapid growth are at increased risk of ID as are those receiving milk other than that specifically modified for them.     

Incidence of symptomatic vitamin D deficiency

A survey of West Midlands paediatricians in 2001 identified 24 cases of symptomatic vitamin D deficiency in children less than 5 years of age. The overall incidence was 7.5 per 100,000 children per year with notable differences in incidence per ethnic group.     

Dental caries and vitamin D status in children in Asia

Dental caries and vitamin D inadequacy are known to affect children worldwide. Vitamin D has a vital role in tooth formation. There is growing evidence linking suboptimal serum vitamin D level with dental caries in children. This paper reviews the literature on both the prevalence of dental caries and of vitamin D deficiency in children in four Asian regions, discusses their associated risk factors, and reviews the global evidence on the association between dental caries and vitamin D in children. Caries prevalence in children ranged from 40% to 97% in Eastern Asia, 38–73.7% in Southern Asia, and 26.5–74.7% in Western Asian countries. Moreover, a higher prevalence of vitamin D deficiency in Asian children was identified, even in countries in equatorial regions, ranging from 2.8% to 65.3% in Eastern Asia, 5–66.7% in Southern Asia, 4–45.5% in Western Asia and 38.1–78.7% in Central Asian countries. Obesity, age, female gender, higher latitude, season, darker skin pigmentation, sunlight protection behaviors, less sunlight exposure and low intake of food containing vitamin D were important factors associated with lower serum vitamin D in Asia. Suboptimal vitamin D level in children may be a significant risk factor for dental caries, and requires further research to ascertain such an association in children in Asia, as well as to understand its exact influence on caries risk and development.     

Incidence of acute rheumatic fever in New Zealand children and youth

Aim: To estimate acute rheumatic fever (ARF) incidence rates for New Zealand children and youth by ethnicity, socioeconomic deprivation and region. Methods: National hospital admissions with a principal diagnosis of ARF (ICD9_AM 390‐392; ICD10‐AM I00‐I02) were obtained from routine statistics and stratified by age, ethnicity, socioeconomic deprivation index (NZDep2006) and District Health Board (DHB). Results: The mean incidence rate for ARF in 2000–2009 peaked at 9 to 12 years of age. Incidence rates for children 5 to 14 years of age for Māori were 40.2 (95% confidence interval 36.8, 43.8), Pacific 81.2 (73.4, 89.6), non‐Māori/Pacific 2.1 (1.6, 2.6) and all children 17.2 (16.1, 18.3) per 100 000. Māori and Pacific incidence rates increased by 79% and 73% in 1993–2009, while non‐Māori/Pacific rates declined by 71%. Overall rates increased by 59%. In 2000–2009, Māori and Pacific children comprised 30% of children 5–14 years of age but accounted for 95% of new cases. Almost 90% of index cases of ARF were in the highest five deciles of socioeconomic deprivation and 70% were in the most deprived quintile. A child living in the most deprived decile has about one in 150 risk of being admitted to the hospital for ARF by 15 years of age. Ten DHBs containing 76% of the population 5 to 14 years of age accounted for 94% of index cases of ARF. Conclusions: ARF with its attendant rheumatic heart disease is an increasing public health issue for disadvantaged North Island communities with high concentrations of Māori and/or Pacific families.     

Vitamin D status of mothers and their neonates in Kuwait

BACKGROUND: There has been a resurgence of nutritional rickets in children in many developing countries and some of the developed countries. Children between 6 and 18 months old are commonly affected. In order to find out the association between vitamin D and rickets we studied the vitamin D status of the neonates and their mothers in Kuwait. METHODS: Two hundred and fourteen full-term pregnant mothers and their neonates were selected from two hospitals in Kuwait. All mothers had normal vaginal delivery. On the day of delivery 2.5 mL of maternal blood and 2.5 mL of cord blood samples were withdrawn. Serum 25-hydroxyvitamin D (25OHD) was determined in duplicate by radioimmunoassay using an Incstar kit. Quality control analyses were done using several between and within run experiments. RESULTS: A total of 128 mother-neonate pairs were selected from the Al-Adan hospital and 86 from the Maternity Hospital. The mean age and parity of the mothers were similar in both hospitals. The mean (+/- SD) 25OHD levels of the mothers and the neonates in the Adan hospital were 13.3 (6.5) ng/mL and 8.2 (6.5) ng/mL, respectively. The corresponding values in the Maternity Hospital were 17.6 (12.4) and 8.1 (7.3) ng/mL for the mothers and the neonate, respectively. Serum 25OHD of the mothers and their newborn infants were highly correlated (r = 0.790, P < 0.001). CONCLUSIONS: Results demonstrate that 40% of the mothers and 60% of the neonates are vitamin D deficient on the day of delivery. The vitamin D of the mothers and neonates are highly correlated (r = 0.790, P < 0.001).