Aboriginal Children In Australia Research Articles

Body distribution of impetigo and association with host and pathogen factors

Background Impetigo or skin sores are estimated to affect >162 million people worldwide. Detailed descriptions of the anatomical location of skin sores are lacking. Methods We used prospectively collected data from a randomised control trial of treatments for impetigo in Aboriginal children in Australia. We generated heat-map distributions of skin sores on the human body from 56 predefined anatomical locations and stratified skin sore distribution by sex, age, causative pathogen and co-infection with scabies, tinea and head lice. We compared the distribution of sores between males and females, between sores with only Streptococcus pyogenes and sores with only Staphylococcus aureus; and across age groups with a Fisher’s exact test. Results There were 663 episodes of impetigo infections among 508 children enrolled in the trial. For all 663 episodes, the lower limbs were the most affected body sites followed by the distal upper limbs, face and scalp. On the anterior surface of the body, the pre-tibial region was the most affected while on the posterior surface, the dorsum of the hands and calves predominated. There was no observable difference between males and females in distribution of sores. Children up to 3 years of age were more likely to have sores on the upper posterior lower limbs and scalp than older age groups, with the distribution of sores differing across age groups (p = 3 × 10−5). Sores from which only Staphylococcus aureus was cultured differed in distribution to those with only Streptococcus pyogenes cultured (p = 3 × 10−4) and were more commonly found on the upper posterior lower limbs. Conclusions Skin sores were predominantly found on exposed regions of the lower leg and distal upper limbs. The distribution of sores varied by age group and pathogen. These results highlight key areas of the body for clinicians to pay attention to when examining children for skin sores.

A network psychometric validation of the Children Oral Health-Related Quality of Life (COHQoL) questionnaire among Aboriginal and/or Torres Strait Islander children.

In Australia, research evidence has shown that Aboriginal and/or Torres Strait Islander children experience a higher burden of oral health diseases compared to other non-Indigenous children. The impact of oral health diseases on children’s functional and psychosocial outcomes led to the development of several instruments to evaluate child oral health-related quality of life (COHQoL), such as the Parental-Caregiver Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS). However, the psychometric properties of these instruments have been evaluated only in Western cultures and have not been investigated for Aboriginal children in Australia. The current study aimed to examine the psychometric properties of the short-forms P-CPQ and FIS for Aboriginal and/or Torres Strait Islander children aged 2–3 years. Data were collected from the South Australian Aboriginal Birth Cohort (SAABC), including 270 Aboriginal children aged 2–3 years. Network psychometric models were used to investigate dimensionality, item redundancy, structural consistency and item stability, model fit, internal consistency reliability and criterion validity. We propose an instrument named Aboriginal Children’s Oral Health-Related Quality of Life Questionnaire (A-COHQoL). Our findings indicated that, after the exclusion of four problematic items, the A-COHQoL showed a three-dimensional structure (“Parent/Family Activities”, “COHQoL” and “Family Conflict”) with good model fit and reliability. The A-COHQoL is a psychometrically robust and sensitive instrument that is readily available for Aboriginal and/or Torres Strait Islander children aged 2–3 years in Australia and can be adapted in the future for Indigenous child groups in other countries.

Unintended consequences of welfare reform: Evidence from birthweight of Aboriginal children in Australia

In 2007, Australia introduced its most radical welfare reform in recent history, targeting Aboriginal communities with the aim of protecting children from harm. The ‘income management’ policy forced Aboriginal welfare recipients to spend at least half of their government transfers on essentials (e.g. food, housing), and less on non-essentials (e.g. alcohol, tobacco). By exploiting its staggered rollout, we estimate the impact of in utero exposure to the policy rollout on birthweight. We find that exposure to the income management policy reduced average birthweight robustly by 85 g and increased the risk of low birth weight by 3 percentage points. This finding is not explained by behavioral change (fertility, maternal risk behavior, access to care), or survival probabilities of at-risk fetuses. More likely, a lack of policy implementation planning and infrastructure led to acute income insecurity and stress during the rollout period, exacerbating the existing health inequalities it sought to address.

The Developmental and Educational Impact of Hearing Impairment in Aboriginal Children Living in Remote Australia – A Data Linkage Study

IntroductionHigh prevalence of otitis media (OM) and hearing impairment (HI) in Aboriginal children in Australia’s Northern Territory (NT) is well documented. HI may be associated with poorer outcomes in early childhood development, school attendance and academic achievement. However, these associations have not been investigated in this population.
 Objectives and ApproachRetrospective cohort studies were conducted to investigate the association between HI and three education-related outcomes in Aboriginal children living in remote NT communities. The explanatory variable for all studies was audiometrically determined hearing levels. The outcome measures were Australian Early Development Census (AEDC) results, representing developmental outcomes at around age 5 years; Year 1 school attendance rates; and, National Assessment Program – Literacy and Numeracy (NAPLAN) results for Year 3 for academic achievement. Relevant confounding variables from available linked datasets were controlled for in the statistical analyses.
 ResultsCompared with normal hearing children, after adjustment for selected confounding factors, children with HI had higher risk for being developmentally vulnerable in two or more of the five AEDC domains (adjusted odds ratio 1.69); lower AEDC domain score sum (-1.60~-2.40); scoring lower in Numeracy (by 15.2 points), Writing (by 13.4-15.6 points) and Spelling (by 5.0 points) domains of NAPLAN; and having lower attendance rates (attending 4.0-5.6 fewer days in Year 1). Severer HI categories generally yielded greater effect sizes. Notably, across the studies, some confounding variables included in the analysis yielded substantially greater effect sizes.
 Conclusion / ImplicationsOM-related HI has a negative impact on early childhood development, Year 1 school attendance and academic achievement in Year 3 in Aboriginal children living in remote NT communities. To improve the developmental and educational outcomes it is important to detect HI at an early age and provide effective educational support, in addition to clinical and audiometric management.

Oral health status, behaviours, food and beverage consumption of aboriginal children in Australia.

Dental decay is prevalent among Australian Aboriginal children, yet little is known about their oral health-related behaviours. This study explored the oral health status, behaviours, food and beverage consumption of Aboriginal school children aged 7-9years in Sydney, Australia. Parents who were part of an existing longitudinal birth cohort ("Gudaga") were surveyed when their child was between 7 and 9years. Children (n=110) also received oral health screening by a trained nurse. A number of children (62%-91%) had at least one visible oral health problem across the 2 years. Around two thirds (62%-67%) of parents rated their child's oral health as excellent/very good and less than half the children (32%-45%) had received dental check-ups. Most children (79%-90%) brushed their teeth and drank water (97%) but more than half (57%-70%) also drank sugar sweetened beverages daily. Parents are instilling good oral health behaviours, however, the oral health screening suggests children are experiencing oral health issues of which parents may be unaware. Parents also seem to be unaware of beverage consumption practices that can increase the risk of childhood decay. SO WHAT?: The findings highlight the need for greater oral health awareness among Aboriginal families on how to recognise early symptoms dental decay and risk factors like sugar sweetened beverages among school going children. This suggests that existing health promotion strategies may not be reaching many Aboriginal families in the urban areas and more culturally appropriate programs may be needed.

The social determinants of otitis media in Aboriginal children in Australia: are we addressing the primary causes? A systematic content review

BackgroundAboriginal and Torres Strait Islander children experience some of the highest rates of otitis media in the world. Key risk factors for otitis media in Aboriginal children in Australia are largely social and environmental factors such as overcrowded housing, poverty and limited access to services. Despite this, little is known about how to address these risk factors. A scoping content review was performed to determine the relationship between social determinants of health and otitis media in Aboriginal and Torres Strait Islander children as described by peer-reviewed and grey literature.MethodSearch terms were established for location, population and health condition. The search terms were used to conduct a literature search using six health research databases. Following the exclusion process, articles were scoped, analysed and categorised using scoping parameters and a social determinants of health framework.ResultsHousing-related issues were the most frequently reported determinants for otitis media (56%). Two articles (4%) directly investigated the impact of social determinants of health on rates of otitis media within Aboriginal and Torres Strait Islander children. The majority of the literature (68%) highlights social determinants as playing a key role in the high rates of otitis media seen in Aboriginal populations in Australia. There were no intervention studies targeting social determinants as a means to reduce otitis media rates among Aboriginal and Torres Strait Islander children.ConclusionsThis review identifies a disconnect between otitis media drivers and the focus of public health interventions within Aboriginal and Torres Strait Islander populations. Despite consensus that social determinants play a key role in the high rates of otitis media in Aboriginal and Torres Strait Islander children, the majority of intervention studies within the literature are focussed on biomedical approaches such as research on vaccines and antibiotics. This review highlights the need for otitis media intervention studies to shift away from a purely biomedical model and toward investigating the underlying social determinants of health. By shifting interventions upstream, otitis media rates may decrease within Aboriginal and Torres Strait Islander children, as focus is shifted away from a treatment-focussed model and toward a more preventative model.

Re-examining Australia’s hidden genocide: the removal of Aboriginal children in Australia as an act of cultural genocide

The 1997 Bringing Them Home Inquiry (BTHI) sparked a significant shift in public understanding of the Stolen Generations. While substantial evidence incriminated the Australian government with acts of genocide, the allegations were subdued by the division around the circumstances in which Aboriginal children were removed. This essay analyses political discourse before and after the BTHI, while offering a contemporary understanding of genocide.

Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years.

Undernutrition contributes to five million deaths of children under five each year. Furthermore, throughout the life cycle, undernutrition contributes to increased risk of infection, poor cognitive functioning, chronic disease, and mortality. It is thus important for decision-makers to have evidence about the effectiveness of nutrition interventions for young children.

Food Supplementation for Improving the Physical and Psychosocial Health of Socio‐economically Disadvantaged Children Aged Three Months to Five Years: A Systematic Review

Food Supplementation for Improving the Physical and Psychosocial Health of Socio‐economically Disadvantaged Children Aged Three Months to Five Years: A Systematic Review

High folate levels in Aboriginal children after subsidised fruit and vegetables and mandatory folic acid fortification.

To evaluate the impact of a fruit and vegetable (F&V) subsidy program for disadvantaged Aboriginal children in Australia, implemented alongside the introduction of mandatory folic acid fortification of bread-making flour. A before-and-after evaluation was undertaken of a F&V subsidy program at three Aboriginal community-controlled health services in New South Wales. The program provided a weekly box of subsidised F&V linked to preventive health services and nutrition promotion for families. In this analysis, red blood cell (RBC) folate was assessed together with self-reported dietary intake at baseline and 12 months later in a cohort of 125 children (aged 0-17 years). No children had low RBC folate at baseline or at follow-up; however, 33 children (26%) exceeded the reference range of RBC folate at baseline and 38 children (30%) exceeded the reference range at follow-up. Mean RBC folate levels increased substantially in children at follow-up (mean RBC folate z-score increased +0.55 (95%CI 0.36-0.74). Change in F&V intake (p=0.196) and mean bread intake (p=0.676) were not statistically significant predictors for change in RBC folate levels. RBC folate levels increased among these disadvantaged Aboriginal children following mandatory folic acid fortification and participation in a subsidised F&V program. Even before mandatory folic acid fortification, none of these children had low RBC folate. The effect on health of mandatory fortification of foods with folate is not clear, hence, ongoing population-based monitoring of folate levels to assess the impact of mandatory folic acid fortification is important.

Child disability services in Bangladesh: Scherzer et al. reply

SIR–We welcome the supportive comments of McConachie and Salt about our review, which concludes that there is a great need for incorporating early evaluation and intervention programs into routine pediatric care. However, it should be kept in mind that a major focus of this paper is the need for continuous surveillance by practitioners at all levels whenever there is clinical contact, with early referral for further and more detailed evaluation, parental education and support, and early intervention as circumstances permit. The problem often encountered in lowand middle-income countries is that too often practitioners have little or no training in child development, or indeed any awareness of potential developmental problems that should be addressed in addition to the concern presented by the parent. Our focus, therefore, is on the need for training of all staff to enable regular developmental surveillance, and the supplemental use of a simple reminder, a chronological age check-off sheet, such as was trialled in Cambodia. The Rapid Neurodevelopmental Assessment (RNDA) for Bangladeshi children validated by Khan et al. is an outstanding step forward, and is among other emerging tools in lowand middle-income countries such as the caregiver developmental reports in Kenya, the Malawi Developmental Assessment Tool (MDAT), and the Brigance developmental assessment tool for Aboriginal children in Australia. However, like the RNDA, these tools require specially trained staff, and can best perform at a secondary level by providing detailed evaluation for children referred through regular surveillance by practitioners. Such screening instruments do need to be further developed and validated; however, they do not take the place of training for regular developmental surveillance and the possible use of a supplemental reminder mechanism to ensure that all practitioners on every level think developmentally and refer early.

A review of dental caries in Australian Aboriginal children: the health inequalities perspective

The purpose of this study was to: (1) describe caries prevalence and experience among Aboriginal children; and (2) investigate the disparity in dental caries between Aboriginal and non-Aboriginal Australian children. As background, dental caries is a widespread disease within Aboriginal communities and it has a particularly severe impact on children. In recognition of the extent and severity of this disease, its impact on childhood nutrition, socialisation and schooling, the control of dental caries has been identified as a key indicator in the reduction of disadvantage among Aboriginal communities. Medline was the primary database used in the literature search. Other databases included: PubMed, Web of Science and Google Scholar. Australian National and State departments of health websites were also searched for relevant documents. Articles were included in the review if they reported information on either caries prevalence rates or experience scores or both, for Aboriginal children in Australia. Articles were excluded if the study sample was special needs children, and/or caries statistics were reported only for children over 12 years. Caries prevalence among 6-year-olds in rural non-fluoridated Western Australia in 1963 was 27%, and in 2004 was 85% among 6-year-olds in rural non-fluoridated Queensland. There was a corresponding increase in caries experience scores in this period from 2.07 in 1963 to 6.37 in 2004. National estimates for 2000-2003 reported a caries prevalence of 72% and caries experience (dmft: decayed, missing and filled primary teeth) of 3.68 for 6-year-old Aboriginal Australian children. For 12-year-olds the national estimates were a caries prevalence of 45% and experience (DMFT, Decayed, Missing and Filled Permanent Teeth) of 1.25 (SE=0.07). The magnitude of disparity (relative difference) in 6-year-old caries experience between Aboriginal and non-Aboriginal children was relatively consistent over the period 1983-2007, with Aboriginal children having an approximately two-fold higher caries experience score. The 2000-2003 national estimates for caries experience showed that Aboriginal 6-year-olds had a dmft score that was 2.38 times higher than non-Aboriginal children (3.68 vs 1.54). For the 12-year-olds, the magnitude of disparity was not as marked, though the direction was similar. Both caries prevalence and experience are higher in the primary dentition. In rural Queensland and the Northern Territory there are high caries rates for both 6- and 12-year-olds. Rural Aboriginal children are generally at a disadvantage compared with their urban counterparts. The magnitude of disparity in caries rates appears to be relatively unchanged over time but there is indication that it may be increasing. This raises the issue of health inequity and the need to fund practical, culturally appropriate and sustainable preventive programs. It also indicates the urgent need for more research on the determinants of oral health inequalities.

Cultural Effects on the Mental Number Line

This special issue is the result of a workshop on the cultural effects on the mental number line held in York (U.K.) in July 2009. The workshop was funded by the Experimental Psychology Society (www.eps.ac.uk) and the European Society for Cognitive Psychology (www.escop.eu), and we thank both organisations for sponsoring the event. The aims of the workshop were to bring together experimental psychologists who study effects of cultural variables on numerical cognition, to facilitate insights into the development and flexibility of numerical cognition by comparing across cultures, and to provide an up-to-date cross-disciplinary overview of research into cultural aspects of numerical cognition that encompasses behavioural, observational, Internet-based, and neuroscientific methods. This special issue gives a lively and accurate representation of the breadth and depth of the workshop contributions. Humans are intrinsically driven to represent numerosity in many ways. The “mental number line” in our title is a metaphor for number representations that are not linguistically mediated but spatial in nature. The most common spatial representation of numbers in Western societies is a left-to-right arrangement for numbers of increasing magnitude (such as on rulers). While this is not the only spatial representation of numbers (think of thermometers, hands, clocks, ...), it seems to have a profound effect on our numerical cognition. This has led to the discovery of the SNARC effect and to the relative neglect of other spatial mappings. Several articles in this special issue illustrate the variety of interactions that emerge between number representations and cultural preferences over the time course of our enculturation (see Figure 1). Finger counting, for example, is ontogenetically one of the first methods used to represent numerosity. Lindemann, Alipour, and Fischer show cultural differences in finger counting that persist well into adulthood. The question about what causes those differences is at the heart of this special issue. Evidence for two potential causes is presented: Cultural differences might be driven by the direction of reading or by differences in the existence, structure, or use of number words. Bender and Beller investigate the variability in linguistic structures used in Polynesian and Micronesian languages by documenting the development of those numeration systems and suggest how this development might have influenced spatial representations. Data by Helmreich et al. juxtaposing Germanand Italianspeaking children show that the structure of the numeration system used in a particular language can indeed influence the accuracy of spatial-numerical mappings. And it does not only affect spatial representations: Krinzinger et al., comparing children speaking French, German, or Flemish, show clearly that the consistency of the numeration system has an effect on children’s ease of acquisition of number words and number transcoding. Furthermore, Butterworth et al. show that in a culture that has no number words children use spatial strategies very effectively to solve numerical tasks. They investigated number processing in aboriginal children in Australia and also report the curious lack of finger counting in this population.

A Regional Initiative to Reduce Skin Infections amongst Aboriginal Children Living in Remote Communities of the Northern Territory, Australia

BackgroundLinked to extreme rates of chronic heart and kidney disease, pyoderma is endemic amongst Aboriginal children in Australia's Northern Territory (NT). Many of those with pyoderma will also have scabies. We report the results of a community-based collaboration within the East Arnhem Region, which aimed to reduce the prevalence of both skin infections in Aboriginal children.Methodology/Principal FindingsCommencing September 2004, we conducted an ecological study that included active surveillance for skin infections amongst children aged <15 years in five remote East Arnhem communities over a three year period. Screening was undertaken by trained local community workers, usually accompanied by another project team member, using a standard data collection form. Skin infections were diagnosed clinically with the aid of a pictorial flip chart developed for the purpose. Topical 5% permethrin was provided for age-eligible children and all household contacts whenever scabies was diagnosed, whilst those with pyoderma were referred to the clinic for treatment in accordance with current guidelines. In addition, annual mass scabies treatment (5% permethrin cream) was offered to all community residents in accordance with current guidelines but was not directly observed. Pyoderma and scabies prevalence per month was determined from 6038 skin assessments conducted on 2329 children. Pyoderma prevalence dropped from 46.7% at baseline to a median of 32.4% (IQR 28.9%–41.0%) during the follow-up period – an absolute reduction of 14.7% (IQR 4.7%–16.8%). Compared to the first 18 months of observation, there was an absolute reduction in pyoderma prevalence of 18 cases per 100 children (95%CI −21.0, −16.1, p≤0.001) over the last 18 months. Treatment uptake increased over the same period (absolute difference 13.4%, 95%CI 3.3, 23.6). While scabies prevalence was unchanged, the prevalence of infected scabies (that is with superimposed pyoderma) decreased from 3.7% (95%CI 2.4, 4.9) to 1.5% (95%CI 0.7, 2.2), a relative reduction of 59%.ConclusionAlthough pyoderma prevalence remained unacceptably high, there was a substantial reduction overall with improvements in treatment uptake a critical factor. More acceptable alternatives, such as cotrimoxazole for pyoderma and ivermectin as a community-wide scabicide, warrant further investigation in these settings. We are encouraged by progress made through this work, where local action was led by local community members and primary health care providers with external training and support.Trial RegistrationClinicalTrials.gov NCT00884728

After the apology: Why are so many First Nations children still in foster care?

Although the undesirable child outcomes arising from the chronic over-representation of First Nations children and young people in child welfare care have been broadly acknowledged in Canada, research on this critical issue is just emerging. This paper summarizes the North American literature on ethnic over-representation and structural risks to inform future research directions in First Nations child welfare. Comparisons to the situation of Aboriginal children in Australia are also discussed.

Biopolitiques et Empire britannique

At the end of the 1990s, Australia’s imperial past and legacy resurfaced through two investigations, into the forced migration of British children after the Second World War and into the kidnappings of Aboriginal children in Australia itself — which often led to the institutionalisation of both groups. These movements are here analysed as late examples of the biopolitics of the imperial State and of the private institutions to which some of its powers were delegated. At the other end of the ‘transaction’, the Australian State, as the extension of the British State and the beneficiary of these policies, was equally involved. Admittedly, these policies did not have the same influence on the two groups of children nor on the group they came from. Yet they had comparable effects on individuals and analysing the forced redistribution of population in the long term is essential to the understanding of imperial legacies.

The question of genocide and Indigenous child removal: the colonial Australian context

Most academic debate about the stolen generations of Aboriginal children in Australia's past has focused on the twentieth century, when government agents directed official attention to the removal of Aboriginal children from their family groups. This article focuses on the earlier colonial period in Australia, from 1788 to 1901, when generations of Aboriginal children were forcibly removed from their Aboriginal family groups. Aboriginal children were popularly considered to be more “controllable” or susceptible to assimilation than Aboriginal adults. Consequently, by the late nineteenth century, government officials in various Australian colonies encouraged the removal of Aboriginal children from their families and their retraining in manual labour. This idea of containing an “Indigenous threat” by removing and retraining Aboriginal children clearly guided the “Stolen Generation” policies of the nineteenth and twentieth centuries. This paper examines the unity of colonial Australian discourse about Aboriginal child removal and makes some observations about the scale of Indigenous child removal in the colonial era. It argues that the use of a conceptual framework centred around genocidal discourse provides the most effective way of understanding the motivations behind Indigenous child removals in Australia's past.

Models of Policy Development in Aboriginal Education: Issues and Discourse

The education of Aboriginal children in Australia has been extensively examined and reviewed. Missing from this investigative activity, however, is the attempt to critically conceptualise the current approaches to the delivery of education for this highly disadvantaged group. There are two main aims behind this paper. Firstly, it devises a framework of seven discrete models of Aboriginal education to guide policy and practice. Secondly, the paper investigates the extent to which the official discourse reflects an understanding of these models. Finally, some thought is given to implications for government flowing from an understanding of the models, especially in the areas of improving policy development and official review.

Beyond apologies: The Stolen Generations and the Churches

The complicity of state and church in the removal and placement of Aboriginal children in Australia has been well documented. Since the investigation by the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families, a number of churches have apologised for their participation in these practices. Alongside the apologies, churches have engaged in activities of reconciliation. This paper documents a research project, commissioned by the Minajalku Aboriginal Corporation, to explore the role of churches and church agencies in Victoria.

Conjugate pneumococcal vaccines for Aboriginal children in Australia

Research indicates a high burden of pneumococcal disease and great potential benefits of conjugate vaccines in Indigenous Australian children, who should have high priority for delivery of these vaccines. Incidence of invasive pneumococcal disease in Indigenous people in central Australia is the highest reported in the world (2053 per 100,000 persons per year in those aged under two years). Acute respiratory infection is a major cause of morbidity in Indigenous children in rural and remote areas. Early pneumococcal colonisation of the nasopharynx and high rates of carriage are seen in Indigenous children, and are probably related to their high rates of ear disease. Current seven-valent conjugate vaccines are likely to cover about two-thirds of invasive isolates in Indigenous Australian children; 11-valent vaccines will cover a higher proportion. Questions remain about the best vaccine carrier protein and the likely impact of vaccine on ear disease, pneumococcal carriage and antibiotic resistance.