Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage. Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9–91.4) in Aboriginal children and 44.9/1000 person-years (44.8–45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7–1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6–10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6–9.7)). Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap

Strengths of Australian Aboriginal cultural practices in family life and child rearing

This paper explores some of the characteristics of traditional Aboriginal and Torres Strait Islander cultural practices that contribute to effective family functioning, and how these practices can have positive effects on children and communities. The approach is to gather the views of Aboriginal families and compare these perspectives with supporting evidence drawn from the literature. The findings suggest that, provided the necessary social conditions are in place, culture can be a protective force for children, families and communities. Key Messages Aboriginal kinship relations reflect a complex and dynamic system that is not captured by existing non- Indigenous definitions of family. Emerging evidence supports some of the strengths of traditional Aboriginal culture in family functioning and raising children, yet conventional academic wisdom can be incompatible with traditional Aboriginal knowledge systems. The strengths of Aboriginal cultural traditions, as they apply to family life and raising children, revolve around four interrelated themes, including: –    Theme 1: A collective community focus on child rearing helps children—The values of interdependence, group cohesion and community loyalty are key features of Aboriginal family and community life, where raising children is considered to be a shared responsibility of all community members. –    Theme 2: Children need the freedom to explore and experience the world—Aboriginal communities offer their children every opportunity to explore the world around them, to help them develop the necessary skills to successfully negotiate their pathways to adulthood. –    Theme 3: Elderly family members are important to family functioning—The elderly are highly respected for their contributions to family life in Aboriginal communities, particularly in helping children to understand the practical aspects of life and society. –    Theme 4: Spirituality helps families cope with challenges—Families and communities who engage in spiritual practices benefit from a greater sense of identity, and individuals are more likely to connect with, support and help protect one another

The well-being of carers of older Aboriginal people living in the Kimberley region of remote Western Australia: Empowerment, depression, and carer burden

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider

Why the caged bird sings: issues with the Royal Commission into Institutional Responses to Child Sexual Abuse

In 2013, the Aboriginal Legal Service of Western Australia (Inc) (‘ALSWA’) received funding from the Federal Government to support the activities of the Royal Commission into Institutional Responses to Child Sexual Abuse (‘RCIIRCSA’). Since its inception, ALSWA has been a strong advocate for recognition of, and reparation for, the various state practices of forced removal of Aboriginal children into institutional care, which took place until the 1970s and came to be known as the Stolen Generations. Given the state policies in relation to the Stolen Generations, and the continued disproportionate number of Aboriginal children in out-of-home care, it is a logical inference that Aboriginal people are disproportionately affected by institutional child sexual abuse. However, for a number of reasons, which will be discussed in this article, ALSWA is concerned that the extent of institutional child sexual abuse against Aboriginal children will be under-reported to the Commission

Enhancing the implementation of the Aboriginal and Torres Strait Islander Child Placement Principle: policy and practice considerations

Overview The Aboriginal and Torres Strait Islander Child Placement Principle ("the Principle") was developed in recognition of the devastating effects of forced separation of Indigenous children from families, communities and culture. The Principle exists in legislation and policy in all Australian jurisdictions, and while its importance is recognised in many boards of inquiry and reviews into child protection and justice systems, there are significant concerns about the implementation of the Principle. Recent estimates suggest the Principle has been fully applied in as few as 13% of child protection cases involving Aboriginal and Torres Strait Islander children. The purpose of this paper is to explore the contemporary understanding of the Principle, and review the multiple and complex barriers at the policy and practice levels which are impeding its implementation. Promising approaches that might address these barriers are also examined. Key messages The Aboriginal and Torres Strait Islander Child Placement Principle was developed in response to the trauma experienced by individuals, families and communities from government policies that involved the widespread removal of Aboriginal and Torres Strait Islander children. „ The fundamental goal of the Principle is to enhance and preserve Aboriginal and Torres Strait Islander children’s connection to family and community, and sense of identity and culture. „ The Principle is often conceptualised as the “placement hierarchy”, in which placement choices for Aboriginal and Torres Strait Islander children start with family and kin networks, then Indigenous non-related carers in the child’s community, then carers in another Aboriginal or Torres Strait Islander community. If no other suitable placement with Aboriginal and/or Torres Strait Islander carers can be sought, children are placed with non-Indigenous carers as a last resort, provided they are able to maintain the child’s connections to their family, community and cultural identity

Aboriginal Child Welfare

As the relationships between Canada’s Aboriginal peoples and the state undergo changes, the issue of Child Welfare is in the foreground; for it is around the well being, education and care of Aboriginal children that much of the painful historical relationship between First Nations and Canadian government has been played out. In this paper we consider the major issues in Canadian Aboriginal child welfare, drawing upon an extensive review and synthesis of current theory and research. Although there is an abundance of material available concerning Aboriginal child welfare, much of it exists outside mainstream academic child welfare literature. Some of the salient work on Aboriginal child welfare is contained in the justice literature and much is contained in evaluation reports, operational reviews, submissions to government bodies and in oral stories and testimony. Our goal has been to cull these sources in order to present a coherent understanding of Aboriginal child welfare issues that encompasses history, theoretical analysis, politics, visions, realities, education, evaluation and aspirations

No evidence for impaired humoral immunity to pneumococcal proteins in Australian Aboriginal children with otitis media

Background: The Australian Aboriginal population experiences disproportionately high rates of otitis media (OM). Streptococcus pneumoniae is one of the main pathogens responsible for OM and currently no vaccine offering cross strain protection exists. Vaccines consisting of conserved antigens to S. pneumoniae may reduce the burden of OM in high-risk populations; however no data exists examining naturally acquired antibody in Aboriginal children with OM. Methods: Serum and salivary IgA and IgG were measured against the S. pneumoniae antigens PspA1 and 2, CbpA and Ply in a cross sectional study of 183 children, including 36 non-Aboriginal healthy control children and 70 Aboriginal children and 77 non-Aboriginal children undergoing surgery for OM using a multiplex bead assay. Results: Significant differences were observed between the 3 groups for serum anti-PspA1 IgA, anti-CbpA and anti-Ply IgG and for all salivary antibodies assessed. Aboriginal children with a history of OM had significantly higher antibody titres than non-Aboriginal healthy children with no history of OM and non-Aboriginal children with a history of OM for several proteins in serum and saliva. Non-Aboriginal children with a history of OM had significantly higher salivary anti-PspA1 IgG than healthy children, while all other titres were comparable between the groups. Conclusions Conserved vaccine candidate proteins from S. pneumoniae induce serum and salivary antibody responses in Aboriginal and non-Aboriginal children with a history of OM. Aboriginal children do not have an impaired antibody response to the antigens measured from S. pneumoniae and they may represent vaccine candidates in Indigenous populations

Absent otoacoustic emissions predict otitis media in young Aboriginal children: A birth cohort study in Aboriginal and non-Aboriginal children in an arid zone of Western Australia

AbstractBackground: Otitis media (OM) is the most common paediatric illness for which antibiotics areprescribed. In Australian Aboriginal children OM is frequently asymptomatic and starts at a youngerage, is more common and more likely to result in hearing loss than in non-Aboriginal children.Absent transient evoked otoacoustic emissions (TEOAEs) may predict subsequent risk of OM.Methods: 100 Aboriginal and 180 non-Aboriginal children in a semi-arid zone of WesternAustralia were followed regularly from birth to age 2 years. Tympanometry was conducted atroutine field follow-up from age 3 months. Routine clinical examination by an ENT specialist wasto be done 3 times and hearing assessment by an audiologist twice. TEOAEs were measured at ages<1 and 1–2 months. Cox proportional hazards model was used to investigate the associationbetween absent TEOAEs and subsequent risk of OM.Results: At routine ENT specialist clinics, OM was detected in 55% of 184 examinations inAboriginal children and 26% of 392 examinations in non-Aboriginal children; peak prevalence was72% at age 5–9 months in Aboriginal children and 40% at 10–14 months in non-Aboriginal children.Moderate-severe hearing loss was present in 32% of 47 Aboriginal children and 7% of 120 non-Aboriginal children aged 12 months or more.TEOAE responses were present in 90% (46/51) of Aboriginal children and 99% (120/121) of non-Aboriginal children aged <1 month and in 62% (21/34) and 93% (108/116), respectively, inAboriginal and non-Aboriginal children at age 1–2 months. Aboriginal children who failed TEOAEat age 1–2 months were 2.6 times more likely to develop OM subsequently than those who passed.Overall prevalence of type B tympanograms at field follow-up was 50% (n = 78) in Aboriginalchildren and 20% (n = 95) in non-Aboriginal children

Diversity of Nontypeable Haemophilus influenzae Strains Colonizing Australian Aboriginal and Non-Aboriginal Children

Nontypeable Haemophilus influenzae (NTHI) strains are responsible for respiratory-related infections which cause a significant burden of disease in Australian children. We previously identified a disparity in NTHI culture-defined carriage rates between Aboriginal and non-Aboriginal children (42% versus 11%). The aim of this study was to use molecular techniques to accurately determine the true NTHI carriage rates (excluding other culture-identical Haemophilus spp.) and assess whether the NTHI strain diversity correlates with the disparity in NTHI carriage rates. NTHI isolates were cultured from 595 nasopharyngeal aspirates collected longitudinally from asymptomatic Aboriginal (n = 81) and non-Aboriginal (n = 76) children aged 0 to 2 years living in the Kalgoorlie-Boulder region, Western Australia. NTHI-specific 16S rRNA gene PCR and PCR ribotyping were conducted on these isolates. Confirmation of NTHI by 16S rRNA gene PCR corrected the NTHI carriage rates from 42% to 36% in Aboriginal children and from 11% to 9% in non-Aboriginal children. A total of 75 different NTHI ribotypes were identified, with 51% unique to Aboriginal children and 13% unique to non-Aboriginal children (P < 0.0001). The strain richness (proportion of different NTHI ribotypes) was similar for Aboriginal (19%, 65/346) and non-Aboriginal children (19%, 37/192) (P = 0.909). Persistent carriage of the same ribotype was rare in the two groups, but colonization with multiple NTHI strains was more common in Aboriginal children than in non-Aboriginal children. True NTHI carriage was less than that estimated by culture. The Aboriginal children were more likely to carry unique and multiple NTHI strains, which may contribute to the chronicity of NTHI colonization and subsequent diseas

Optimising the learning of gifted aboriginal students

[Abstract]: According to the United Nations Educational, Scientific and Cultural Organisation's (2000) 'Education for All' goals, all students are entitled to opportunities to fulfil their potential. This implies that appropriate programs need to be in place for all children, especially gifted Aboriginal students. Accordingly, this means that all educational institutions in Australia have an obligation to provide involvement and commitment opportunities for all gifted and talented Aboriginal students in meeting their basic learning needs. This goal is not being achieved within Australia. Gifted and talented Aboriginal students have been identified as the most educationally disadvantaged group in the Australian education system (Sydney Morning Herald, 2004). Education for Aboriginal learners varies throughout the states of Australia. While New South Wales has provided excellent modelling of accommodating for inclusion of gifted Aboriginal students, in Queensland the lower representation of Indigenous students in gifted programs suggests inappropriate facilitation. This discussion paper compares and contrasts New South Wales and Queensland gifted Indigenous educational policy, exploring the issues of appropriate identification and programs for gifted Aboriginal students, Aboriginal learning styles and the role of the classroom teacher in accommodating these students