Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia

Abstract

BackgroundWe analysed hospital admissions of a predominantly Aboriginal cohort of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life.MethodsAll children born between January 1, 2002 and December 31, 2003 and living in the Fitzroy Valley in 2009–2010 were eligible to participate in the Lililwan Project. Of 134 eligible children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in 2011 and comprised our cohort. Lifetime (0–7 years) hospital admission data were available and included the dates, and reasons for admission, and comorbidities. Conditions were coded using ICD-10-AM discharge codes.ResultsOf the 127 children, 95.3% were Indigenous and 52.8% male. There were 314 admissions for 424 conditions in 89 (70.0%) of 127 children. The 89 children admitted had a median of five admissions (range 1–12). Hospitalization rates were similar for both genders (p = 0.4). Of the admissions, 108 (38.6%) were for 56 infants aged <12 months (median = 2.5, range = 1–8). Twelve of these admissions were in neonates (aged 0–28 days).Primary reasons for admission (0–7 years) were infections of the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract (11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory tract infections (18.1%), failure to thrive (13.6%), and anaemia (12.7%), were common.In infancy, primary cause for admission were infections of the lower respiratory tract (40.8%), gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper respiratory tract infections (33.3%), failure to thrive (18.5%) and anaemia (18.5%).ConclusionIn the Fitzroy Valley 70.0% of children were hospitalised at least once before age 7 years and over one third of admissions were in infants. Infections were the most common reason for admission in all age groups but comorbidities were common and may contribute to need for admission. Many hospitalizations were feasibly preventable. High admission rates reflect disadvantage, remote location and limited access to primary healthcare and outpatient services. Ongoing public health prevention initiatives including breast feeding, vaccination, healthy diet, hygiene and housing improvements are crucial, as is training of Aboriginal Health Workers to increase services in remote communities.

Emergency department presentations by children in remote Australia: a population-based study

“…The cohort of 127 remote dwelling children born in 2002-3 have been previously described in detail [8]. In five years 2007-11 inclusive, there were 1058 presentations for 1743 conditions in 127 children.…”

“…Crossing, conducted following extensive community consultation, to determine the prevalence of FASD, other health problems and health service use [5,[11][12][13]. The identification and characterisation of the Lililwan cohort, definition of terms, culturally safe consent process utilising 'community navigators' and local languages, and results from the FASD prevalence study are detailed elsewhere [5,7,[11][12][13].…”

“…For the current study, Stage 4 (2013), we retrospectively handsearched electronic and hard copy health records for all 127 children within two separate hospital databases and patient files at Fitzroy Crossing Hospital. We documented ED presentations (from 2007-11), the focus of this paper; lifetime hospitalisations (age 0-7 years) [7] and existing health problems (2011). Demographic data and data on intra-uterine exposures, birth, health, family and home environment, and schooling were gathered via interviews with parents or carers using a standardised data collection form during Stage 1 [11].…”

“…The participation rate was high despite 45.7% of these children and families living in very remote communities of less than 1000 people [7]. Rates of FASD (19%) and its co-morbidities and hospital admissions were high in this cohort [8][9][10].…”

Hospital admissions in children with developmental disabilities from ethnic minority backgrounds

“…Indigenous mothers are often younger on average compared to other mothers, under-resourced, and have lived experiences of poverty, a reflection of continuous disadvantage in location, availability of, and limited access to primary health care. 20 While mothers from low-income countries are likely to have been disadvantaged early in their lives, they may continue to face social disadvantages in accessing primary health care with fewer supports, as well as language and knowledge barriers. 21 Moreover, children with intellectual disabilities with parents from low-income backgrounds may face additional risks; adults with intellectual disability are reported to have numerous organizational, social, and physical barriers in accessing adequate primary care.…”