Clinic Attendances during the First 12 Months of Life for Aboriginal Children in Five Remote Communities of Northern Australia

Abstract

BackgroundThe vast majority (>75%) of Aboriginal people in the Northern Territory (NT) live in remote or very remote locations. Children in these communities have high attendance rates at local Primary Health Care (PHC) centres but there is a paucity of studies documenting the reason and frequency of attendance. Such data can be used to help guide public health policy and practice.Methods and FindingsClinic presentations during the first year of life were reviewed for 320 children born from 1 January 2001–31 December 2006. Data collected included reason for infectious presentation, antibiotic prescription and referral to hospital. The median number of presentations per child in the first year of life was 21 (IQR 15–29) with multiple reasons for presentation. The most prominent infectious presentations per child during the first year of life were upper respiratory tract infections (median 6, IQR 3–10 ); diarrhoea (median 3, IQR 1–5); ear disease (median 3, IQR 1–5); lower respiratory tract infection (median 3, IQR 2–5); scabies (median 3, IQR 1–5); and skin sores (median 3, IQR 2–5).ConclusionsInfectious diseases of childhood are strongly linked with poverty, poor living conditions and overcrowding. The data reported in our study were collected through manual review, however many remote communities now have established electronic health record systems, use the Key Performance Indicator System and are engaged in CQI (continuous quality improvement) processes. Building on these recent initiatives, there is an opportunity to incorporate routine monitoring of a range of infectious conditions (we suggest diarrhoea, LRTI, scabies and skin sores) using both the age at first presentation and the median number of presentations per child during the first year of life as potential indicators of progress in addressing health inequities in remote communities.

High burden of infectious disease and antibiotic use in early life in Australian Aboriginal communities

“…For infants and young children whose carers provided consent, all clinic attendance records from birth up to 4.75 years of age for children born from January 2001 to December 2005 were retrospectively audited. Analyses of three separate but overlapping cohorts have been published by Kearns et al, 10 McMeniman et al 11 and Clucas et al 12 The communities, ages of participants and duration of follow‐up differed between these cohorts (Table ). Ethics approval to access the datasets was granted by the Human Research Ethics Committee of the Northern Territory Department of Health and Families and the Menzies School of Health Research (Approval number 2015–2516).…”

“…when skin sore prevalence is equal to 0%). While the antibiotic used was not specified in any study, route of administration was recorded in two of the three studies 10,11 …”

“…To this end, we have revisited pivotal historical studies undertaken by the Menzies School of Health Research and community partners during the 2000s. Although individual datasets have previously been described, 10–12 they have not been analysed in aggregate. In this study, which is part of a larger program of related research, we use pooled data collected with a consistent methodology to describe the childhood burden of infectious disease presenting to primary care, with a particular focus on skin infections.…”

The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo

“…Participation in the skin sore trial was permitted every 90 days, as skin sores recur and many children present for treatment of sores several times a year. 13 It was also postulated that the treatment effects of the regimens trialed would have no ongoing efficacy after the brief intervention (for oral antibiotics) and up to a maximum of 1 month (for intramuscular antibiotics). Of the screened participants, 508 children were randomized to participate over 663 enrollments.…”

“…12 Where tropical climates prevail, children with scabies are 2-7 times more likely to have impetigo than children without scabies. 13 Untreated scabies infestations may become secondarily infected, and result in serious invasive bacterial infections. 2,14,15 In addition, once scabies lesions become infected with S. pyogenes, the host is at risk of the immunological consequences of S. pyogenes infection including post-streptococcal glomerulonephritis and probably, acute rheumatic fever (ARF).…”