Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life

Abstract

Objective: To describe the epidemiology of acute lower respiratory infection (ALRI) and bronchiectasis in Northern Territory Indigenous infants hospitalised in the first year of life. Design: A historical cohort study constructed from the NT Hospital Discharge Dataset and the NT Immunisation Register. Participants and setting: All NT resident Indigenous infants, born 1 January 1999 to 31 December 2004, admitted to NT public hospitals and followed up to 12 months of age. Main outcome measures: Incidence of ALRI and bronchiectasis (ICD‐10‐AM codes) and radiologically confirmed pneumonia (World Health Organization protocol). Results: Data on 9295 infants, 8498 child‐years of observation and 15 948 hospitalised episodes of care were analysed. ALRI incidence was 426.7 episodes per 1000 child‐years (95% CI, 416.2–437.2). Incidence rates were two times higher (relative risk, 2.12; 95% CI, 1.98–2.27) for infants in Central Australia compared with those in the Top End. The median age at first admission for an ALRI was 4.6 months (interquartile range, 2.6–7.3). Bronchiolitis accounted for most of the disease burden, with a rate of 227 per 1000 child‐years. The incidence of first diagnosis of bronchiectasis was 1.18 per 1000 child‐years (95% CI, 0.60–2.16). One or more key comorbidities were present in 1445 of the 3227 (44.8%) episodes of care for ALRI. Conclusions: Rates of ALRI and bronchiectasis in NT Indigenous infants are excessive, with early onset, frequent repeat episodes, and a high prevalence of comorbidities. These high rates of disease demand urgent attention.

Mailed versus frozen transport of nasal swabs for surveillance of respiratory bacteria in remote Indigenous communities in Australia

“…The rates of acute and chronic infections of the upper and lower respiratory tract in Indigenous children in remote communities in Australia are amongst the highest reported worldwide [1,2]. Furthermore, repeated infections in childhood are thought to contribute to the high rates of chronic lung disease in both adolescents and adults in these communities [3].…”

Antibiotics for bronchiectasis exacerbations in children: rationale and study protocol for a randomised placebo-controlled trial

“…In our recently completed multicentre study of children newly referred for chronic cough and managed in accordance to a standardised protocol [7], 31 (9%) of the 346 children had bronchiectasis proven on radiology [8]. In the Northern Territory in Australia, the incidence of bronchiectasis in the first year of life is 118 in 100,000 [9]. The estimated prevalence of bronchiectasis is 1,470 per 100,000 in Central Australian Indigenous children aged below 15 years [10] and 1,600 per 100,000 in Alaskan Native children [11].…”

Upper airway viruses and bacteria in urban Aboriginal and Torres Strait Islander children in Brisbane, Australia: a cross-sectional study

“…In a study of upper airway viruses and bacteria in Central Australian Aboriginal children hospitalised for pneumonia [8], a population with high rates of hospitalised lower ARI [15] and nasal colonisation [16], the overall prevalence of any organism was 94.5%, with 34.5% positive for both viruses and bacteria. The prevalences of S. pneumoniae , M. catarrhalis and NTHi were 64%, 70.3% and 76.5% respectively [8].…”