New Zealand Children Research Articles

Pacific Island children: The use of maps in helping better understand children's lives

Children's voices have been little heard in the Pacific research. The United Nations Convention on the Rights of the Child 1989 asserts the child's right to have a say on matters that affect them and for their views to be considered. There has been massive growth in technologically assisted participative research; however, we argue the value of hand drawn maps should not be underestimated in the rush to engage with more advanced techniques. We present data from 267 neighbourhood maps drawn by children in Fiji, Kiribati, Samoa and New Zealand. To better understand the social construction of knowledge in children's everyday lives, we propose two models to conceptualise the complexity of their world, a social connection and a spatial connection model. These models reveal how Pacific Island children negotiate different levels of social connection from home, family, and community through to transnational kinship relations. People, specifically family, provide the geographic basis on which their spatial encounters are overlaid. Irrespective of country or rural/urban/atoll setting, it is social space that is the strongest connector for children as displayed in their maps. Application of our models can be used to reveal how knowledge is socially constructed in Pacific children's everyday lives.

Language learning environments for Arabic-speaking children in New Zealand: Family demographics and children’s Arabic language exposure

ABSTRACT The language-learning environments of children growing up bilingual are highly variable. For speech and language therapists (SLTs), understanding the features of these environments can enhance the quality of services. In New Zealand (NZ), the language learning environments for children in Arabic-speaking families are largely unresearched. Participants from 85 Arabic-speaking families living in NZ completed an online survey (with each participant representing one family). The survey collected information about some of the factors which are known to affect children’s bilingual language development. Analysis focused on education levels, parents’ language proficiencies, years in NZ, and language exposure. The Arabic-speaking population in this survey provided a high proficiency Arabic language-learning environment for their children. They had higher than average education levels and reported greater proficiency in Arabic than English. English proficiency in the parents was associated with education levels and length of time in NZ. Exposure to Arabic was predominantly within the home context. The consistent use of Arabic at home combined with a lack of formal teaching of Arabic literacy suggests that these children will be able to speak Arabic but may exhibit limited ability to read and write in Arabic. This information on a sample of Arabic families in NZ may be useful for service and educational planning purposes. SLTs are advised to investigate the individual linguistic environments of children growing up bilingual in Arabic and English in NZ as part of their practice.

Health outcomes of children in state care in Aotearoa New Zealand.

This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all-cause hospitalisation and mortality. This was a national retrospective cohort study using linked administrative data from the Integrated Data Infrastructure. Data were obtained for all 0-17 year-olds living in NZ on 31 December 2013. In-care status was ascertained at this point. Outcomes of all-cause hospitalisation and all-cause mortality were assessed between 1 January 2014 and 31 December 2018. Adjusted models incorporated age, sex, ethnicity, level of socioeconomic deprivation and rural/urban status. There were 4650 in-care children and 1 009 377 not-in-care children in NZ on 31 December 2013. Of those in care, 54% were male, 42% lived in the most deprived areas and 63% identified as Māori. Adjusted models showed that in-care children were 1.32 (95% CI 1.27-1.38) times more likely to be hospitalised than not-in-care children and 3.64 (95% CI 2.47-5.40) times more likely to die. This cohort study highlights that the care and protection system prior to 2018 was not preventing children in its care from experiencing severe adverse outcomes. Overseas research has previously been relied on when making practice and policy decisions around child care and protection in NZ, so this research will provide valuable insight into best practice in an NZ context.

Rising Incidence of Inflammatory Bowel Disease in South Asian Children in New Zealand-A Retrospective Population-Based Study.

High rates of inflammatory bowel disease (IBD) are reported in children of South Asian (SA) descent in some western countries. This population-based study describes the incidence and clinical course of IBD in SA children compared to non-South Asian (NSA) children in New Zealand (NZ). Children (≤15 years) with new-onset IBD presenting to a centralized tertiary referral center in Auckland, NZ from 2010 to 2020 were identified. Disease phenotype, clinical characteristics, response to exclusive enteral nutrition, clinical remission rates at 3 and 12 months, biologic use, corticosteroid exposure, and disease complications were compared by ethnicity; IBD incidence was calculated. There were 127 (26 SA; 101 NSA) children with Crohn disease, 41 (10 SA; 31 NSA) with ulcerative colitis, and 10 (3 SA; 7 NSA) with IBD-unclassified. IBD incidence in SA and NSA children was 14.1 per 100,000 and 4.3 per 100,000 respectively ( P < 0.001). IBD incidence increased by 5.6% per year ( P = 0.022), due to a greater rise in incidence in SA (SA 16.8% per year, P = 0.015; NSA 4.5% per year, P = 0.317). At presentation, SA children had worse biochemical parameters, severe colitis, and vitamin D deficiency. SA children had lower rates of remission following exclusive enteral nutrition (28.5% vs 65.0%, P < 0.001) or biologic induction (35.7% vs 70.8%, P = 0.020), at 3-month (35.3% vs 69.8%, P < 0.001) and 12-month follow-up (29.4% vs 55.0%, P = 0.005). No significant differences were found in disease location or corticosteroid burden. Increasing incidence of IBD was disproportionately represented by SA children with more severe disease and lower remission rates following exclusive enteral nutrition or biologic therapy.

Indications and prescribing patterns of antiseizure medications in children in New Zealand.

To determine indications and prescribing patterns for antiseizure medications (ASMs) in children by age, sex, and socioeconomic status. This retrospective study searched the New Zealand database of ASM prescriptions dispensed to individuals aged 18 years or under during 2015 in three regions of New Zealand (48% paediatric population). Medical records were reviewed by a paediatric neurologist for indication. ASMs were grouped into old or new (1993 onwards). In total, 2594 children (0 to 18 years, mean age 11 years 2 months, median 12 years; 51% male) were dispensed 3557 ASMs for seizures (76%), pain (6%), headache (5%), mental health (3%), and movement disorders (2%). After 10 years of age, lamotrigine was more likely and valproate less likely to be prescribed in females than males. No sex difference was observed for valproate prescriptions for non-seizure indications. Topiramate prescriptions increased in adolescent females. Prescriptions for non-seizure indications increased from 7% in children aged 6 years or under to 31% in 16- to 18-year-olds. The proportion of children receiving a new ASM compared to an old ASM was greater in children from higher than lower socioeconomic areas. Our results highlight a need for focused ASM teratogenicity messaging to clinicians prescribing ASMs for non-seizure indications. In addition, to improve equity of epilepsy care, it is critical for health policies to consider socioeconomic factors that impact on ASM prescribing.

Point Prevalence of Complementary or Alternative Medicine Use among Children Attending a Tertiary Care Hospital.

Complementary or alternative medicine (CAM) describes products/practices outside conventional medical care. CAM may be used to support or replace conventional/prescribed therapies. The aim of this study was to determine patterns of CAM use among children attending a tertiary care hospital in New Zealand (NZ) and measure parental opinion about CAM. Prospective survey-based study among children and their parents attending inpatient and outpatient clinical areas. Surveys collected demographic and health variables, current CAM use, and parental opinions on CAM. Of the 236 children participating: 41% female, mean age 6.8 years (SD5), 76 (32%) with a chronic illness. CAM was used by 132 (56%) children, the most common being: oral supplements, body manipulation methods, or holistic practices. CAM use was associated with lower child health rating (p = 0.001), Māori ethnicity (p = 0.03), parent education level (p = 0.002), and family member CAM use (p &lt; 0.001). Opinion survey results revealed CAM use was most strongly related to doctors recommending CAM, information on CAM, and CAM cost. There was a 31% CAM disclosure rate to the child's medical team. This study highlights cultural differences in CAM use not previously reported among children in NZ. Parental opinion regarding CAM influences use for their child and disclosure rates.

Nutrient-Level Evaluation of Meals Provided on the Government-Funded School Lunch Program in New Zealand

Approximately 1 in 6 children in New Zealand are living in households facing poverty and 14% of the population is food insecure. The Ka Ora, Ka Ako|Healthy School Lunches program aims to reduce food insecurity by providing access to a nutritious lunch every school day. This study analyzed the nutritional content of Ka Ora, Ka Ako meals and compared them to national and international standards. Meals were selected at random from approved menus. The suppliers covered by the 302 meals analyzed provide 161,699 students with a lunch (74.9% of students on the program). The meals were analyzed using Foodworks 10 nutrient analysis software. The nutrient content was compared against the New Zealand/Australia Nutrient Reference Values (NRVs) and to nutrient-level standards for international school lunch programs. A total of 77.5% of nutrients analyzed exceeded 30% of the recommended daily intakes. Protein, vitamin A and folate met the NRV targets and a majority of the international standards (55/57). Energy, calcium, and iron were low compared to NRVs and international standards (meeting 2/76 standards). Carbohydrates were low compared to international standards. The findings have been used to inform the development of revised nutrition standards for the program, which will be released in 2022.

Prevalence of nutrition risk and associated risk factors among New Zealand pre-school children.

To determine the prevalence of nutrition risk using the validated, Nutrition Screening Tool for Every Pre-schooler (NutriSTEP) among pre-school children in New Zealand (NZ) and to identify socio-demographic factors associated with nutrition risk. Parents/caregivers of NZ pre-school children (aged 2-5 years) completed an online survey including NutriSTEP, both parent and child height and weight, as well as socio-demographic characteristics. The 17-item NutriSTEP responses were scored between 0 and 4; where item scores ≥2 indicate risk, and the maximum score is 68. Participants were stratified into low-risk (score ≤ 20) and moderate to high-risk (score > 20) groups. Strength of associations between nutrition risk and socio-demographic characteristics were explored using binary regression analysis. Of 505 pre-school children, 96 (19%) were at moderate to high risk (median interquartile range NutriSTEP score 24 [22-26]) and 409 (81%) were at low risk (score 13 [10-16]). Pre-school children at highest risk were non-NZ European (P=0.002), with solo parents (P=0.002), from households with incomes ≤$50 000 (P ≤ 0.021) and with non-university educated parents (P ≤ 0.0001). More than 30% of pre-schoolers were at high risk for inadequate consumption of fruit, vegetables, grains, milk products, meat and meat alternatives, as well as exposure to screens during meals and overuse of supplements. A fifth of NZ pre-school children were at moderate to high nutrition risk and may not have met the nutrition guidelines. Economic and ethnic disparities were apparent. Using NutriSTEP may assist to identify NZ pre-school children at highest nutrition risk who may benefit from appropriate nutrition support.

The long-term outcome of New Zealand Maori and Pacific Island children diagnosed with childhood onset lupus nephritis.

To determine the long-term outcome of Maori and Pacific Island children diagnosed with childhood onset lupus nephritis. A chart review was conducted of children diagnosed with biopsy proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Baseline and follow-up kidney histology, adherence and response to therapy including partial or full renal remission, refractory disease, end-stage kidney disease (ESKD) and mortality were determined. In a New Zealand cohort of 42 with childhood onset lupus nephritis, Maori and Pacific Island children were significantly more likely to develop class 4 lupus nephritis (RR (95% CI), 11.3 (3.84-49.9), p < 0.0001), demonstrate medication nonadherence (RR (95% CI) 12.4 (3.48-85.7), p < 0.0001) and experience end stage kidney disease (RR (95% CI) 15.7 (2.97-389.3), p = 0.0003) and mortality (RR (95% CI) 11.1 (1.91-280.1), p = 0.005) compared to non-Maori and Pacific Island children. In addition, Maori children with childhood onset lupus nephritis developed chronic histological changes significantly more rapidly than Pacific or Asian children (p = 0.038). Lupus nephritis is more common among Maori and Pacific Island children in New Zealand associated with a significant incidence of end stage kidney disease and mortality, with some Maori children developing rapid histologic disease progression.

E-cigarette use patterns, brand preference and knowledge about vaping among teenagers (13-16 years) and parents of children attending Christchurch Hospital.

Parents attending hospital with children in New Zealand are routinely asked about tobacco use, but information about vaping is lacking. We assessed e-cigarette use, brand preferences, and knowledge during paediatric outpatient attendance at Christchurch Hospital. We undertook an anonymous online survey of teenagers and parents attending paediatric outpatient clinic in December 2021 to February 2022. The sample (n=95) were 16% Māori and 8.4% currently smoked (4.8% teenagers, 11.3% parents). We used descriptive and contingency table analysis. Ever vaping was reported in 33.3% of teenagers and 30.8% of parents, and current use in 7.1% vs 15.1%, respectively. Most teenagers selected "curiosity/just wanted to try them" as their reason for vaping, whereas parents selected vaping to quit or reduce/avoid smoking. More teenagers than parents used nicotine-containing e-cigarettes (100% vs 86.7%) and more parents vaped indoors (in home or car) when other people were present. The most important reasons for choosing particular e-cigarette brands among teenagers were price and flavours, with fruit flavours preferred. No teenagers obtained their e-cigarettes from vape shops versus 40% of parents. The primary source of information about vaping for teenagers and parents was friends/peers. Vaping was common among teenagers and parents; teenagers vaped for curiosity and flavours and obtained vape products from sources other than vape shops.

The Nature of Disadvantage. Faced by Children in New Zealand: implications for policy and service provision

This article summarises key findings from three recent New Zealand research projects looking at how disadvantage due to a lack of resources and increased ‘toxic stress’ in the household impacts on child wellbeing and development in early childhood. About one in ten children experience substantial disadvantage relating to a lack of resources during early childhood, and for many children this lack of resources is persistent. This disadvantage is inequitably distributed across the population and is associated with worse outcomes later in childhood. The challenge for policy is to find a way to provide support that is flexible and values the choices family and whānau make to look after their children in the early years of life.

The epidemiology of aseptic meningitis in New Zealand children from 1991 to 2020.

Aseptic meningitis, including culture negative and viral meningitis, contributes a significant health-care burden, including unnecessary antibiotic use and hospitalisation to treat possible bacterial meningitis. This study analysed aseptic meningitis hospitalisations in New Zealand (NZ) children over 29 years. In this population-based study, aseptic meningitis hospitalisations in NZ children <15 years old were analysed from 1991 to 2020. Incident rate ratios were calculated using Poisson regression models. Variations in hospitalisations by age, year, sex, ethnicity, geographical region and socio-economic deprivation were analysed. There were 5142 paediatric aseptic meningitis hospitalisations from 1991 to 2020. Most were unspecified viral meningitis (64%), followed by enterovirus (29%). Hospitalisation rates varied annually with a median of 18.4/100 000 children including a peak in 2001 of 56.4/100 000 (51.7-61.6). From 2002 to 2019, rates increased by 8.4%/year (7.2-9.5%) in infants <90 days old but decreased in all other age groups. In 2020, a reduction in hospitalisations to 9.6/100 000 (7.9-11.8) occurred, and in infants <90 days old were 0.37 times expected. Hospitalisations were 1.50 times (1.49-1.68) higher in males than females; higher in children of Māori (P< 0.001) and Pacific (P< 0.001) versus European ethnicity; and higher for children living in the most (2.44 times, (2.16-2.75)) versus least deprived households; and in northern versus southern NZ. Aseptic meningitis hospitalisations increased in young infants during 29 years of surveillance, apart from 2020 when admissions reduced during the COVID-19 pandemic. In contrast, hospitalisations decreased in children aged >1year. Further investigation into reasons for higher admissions by ethnic group, geographical location and increased deprivation are required.

Nourishing Hawke’s Bay: He wairua tō te kai – food security, health behaviours and wellbeing in children in regional New Zealand

ABSTRACT Our current food system is failing to deliver on equitable health outcomes, wellbeing and food security and the Hawke’s Bay region of New Zealand has high inequities and one the highest levels of childhood obesity nationally. This articlereports baseline quantitative data from 2087 students (aged 9 or 13) from 41 primary and secondary schools, including schools participating in the Ka Ora, Ka Ako Healthy School Lunch programme. Students answered an online survey covering food security, general wellbeing (WHO-5), eating behaviours and physical activity and were measured/weighed for body size. 16.8% of students experienced food insufficiency in the home and 31.3% of 13-yr-olds did not eat breakfast. Overall, only 12.9% met the national vegetable intake guidelines and 39.6% met fruit intake guidelines. Students in high advantage schools (decile 8–10) were twice as likely to meet the vegetable intake guidelines. 47.1% of 13-year old girls were at risk of reduced wellbeing. 54.6% of students had a healthy weight and 44.5% experienced overweight or obesity; in low advantage (decile 1–3) schools 64.4% experienced overweight or obesity. The data form a baseline for an evaluation of multiple public health initiatives underway in Hawke’s Bay to improve food environments and nutritional wellbeing.

Moe Kura: a longitudinal study of mother and child sleep and well-being in Aotearoa New Zealand

ABSTRACT Moe Kura is a longitudinal study focused on the role of sleep in the health and well-being of mothers and children in Aotearoa New Zealand (NZ). The leadership, design and conduct of the study is informed by Kaupapa Māori research principles and is positioned within a broader rights-based approach to health, recognising that inequities in health must be identified and understood to improve the health of wāhine Māori and tamariki. In late pregnancy 418 Māori women and 768 non-Māori women were recruited and data collected at four waves (35–37 weeks gestation, 4–6 weeks postpartum, 11–13 weeks postpartum and when the Moe Kura child was 3–4 years of age) with linkage to birth records and national administrative datasets and associated qualitative research. Findings demonstrate substantial inequities in sleep health, infant and maternal health, and maternal employment between Māori and non-Māori, along with the important role of sleep in perinatal health and maternal mental health outcomes. The research philosophy that underpins the study, the primary focus on women, and the detailed measurement of sleep during the childbearing years has provided new and important findings that contribute to intervention development and health policy for women and children in NZ.

Impact of COVID-19 on appendicitis presentations in children in Australia and New Zealand.

BackgroundIn contrast to many countries, the prevalence of COVID‐19 in Australia and New Zealand has been low. We hypothesised, however, that a potential secondary effect of the COVID‐19 pandemic would be delayed presentation of paediatric appendicitis, with resultant higher rates of complicated appendicitis. This study was an initiative of the Australian and New Zealand Surgery in Children Registrars' Association for Trials collaborative, a trainee‐led research group based in Australia and New Zealand.MethodsA binational multicentre, retrospective review was undertaken of paediatric patients with appendicitis early in the COVID‐19 pandemic (20 March–30 April 2020), compared with previous years (2018, 2019). Primary outcomes were the duration of symptoms prior to presentation and the severity of disease.ResultsA total of 400 patients from six centres were included. Duration of symptoms prior to presentation, sepsis at presentation, complicated disease and presence of complications did not differ significantly between time periods. Duration of intravenous antibiotic treatment and overall antibiotic treatment were both significantly shorter during 2020 (2.4 days versus 3.5 in 2018 and 3.0 in 2019 [P = 0.0038] and 3.7 days versus 5.2 in 2018 and 4.6 in 2019 [P = 0.04], respectively). Management approach did not differ, with the majority of patients managed operatively.ConclusionsWe did not demonstrate any difference in duration of symptoms prior to presentation or other markers of disease severity early in the pandemic. Duration of antibiotic treatment was shorter during this period compared with previous years. Management of children with appendicitis, both simple and complicated, did not appear to change as a result of COVID‐19.

Statistical analysis plan for Better Evidence for Selecting Transplant Fluids (BEST-Fluids): a randomised controlled trial of the effect of intravenous fluid therapy with balanced crystalloid versus saline on the incidence of delayed graft function in deceased donor kidney transplantation

BackgroundDelayed graft function, or the requirement for dialysis due to poor kidney function, is a frequent complication of deceased donor kidney transplantation that is associated with inferior outcomes. Intravenous fluids with a high chloride content, such as isotonic sodium chloride (0.9% saline), are widely used in transplantation but may increase the risk of poor kidney function. The primary objective of the BEST-Fluids trial is to compare the effect of a balanced low-chloride crystalloid, Plasma-Lyte 148 (Plasmalyte), versus 0.9% saline on the incidence of DGF in deceased donor kidney transplant recipients. This article describes the statistical analysis plan for the trial.Methods and designBEST-Fluids is an investigator-initiated, pragmatic, registry-based, multi-centre, double-blind, randomised controlled trial. Eight hundred patients (adults and children) in Australia and New Zealand with end-stage kidney disease admitted for a deceased donor kidney transplant were randomised to intravenous fluid therapy with Plasmalyte or 0.9% saline in a 1:1 ratio using minimization. The primary outcome is delayed graft function (dialysis within seven days post-transplant), which will be modelled using a log-binomial generalised linear mixed model with fixed effects for treatment group, minimization variables, and ischaemic time and a random intercept for study centre. Secondary outcomes including early kidney transplant function (a ranked composite of dialysis duration and the rate of graft function recovery), treatment for hyperkalaemia, and graft survival and will be analysed using a similar modelling approach appropriate for the type of outcome.DiscussionBEST-Fluids will determine whether Plasmalyte reduces the incidence of DGF and has a beneficial effect on early kidney transplant outcomes relative to 0.9% saline and will inform clinical guidelines on intravenous fluids for deceased donor kidney transplantation. The statistical analysis plan describes the analyses to be undertaken and specified before completion of follow-up and locking the trial databases.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12617000358347. Prospectively registered on 8 March 2017ClinicalTrials.gov identifier NCT03829488. Registered on 4 February 2019

Who meets national early childhood sleep guidelines in Aotearoa New Zealand? A cross-sectional and longitudinal analysis.

To investigate the proportion of children in Aotearoa New Zealand (NZ) who do or do not meet sleep duration and sleep quality guidelines at 24 and 45 months of age and associated sociodemographic factors. Participants were children (n = 6490) from the Growing Up in New Zealand longitudinal study of child development with sleep data available at 24 and/or 45 months of age (48.2% girls, 51.8% boys; 22.4% Māori [the Indigenous people of NZ], 12.9% Pacific, 13.4% Asian, 45.2% European/Other). Relationships between sociodemographic factors and maternally reported child sleep duration (across 24 hours) and night wakings were investigated cross-sectionally and longitudinally. Estimates of children in NZ meeting sleep guidelines were calculated using a range of analytical techniques including Bayesian linear regression, negative binomial multiple regression, and growth curve models. In NZ, 29.8% and 19.5% of children were estimated to have a high probability of not meeting sleep duration guidelines and 15.4% and 8.3% were estimated to have a high probability of not meeting night waking guidelines at 24 and 45 months respectively, after controlling for multiple sociodemographic variables. Factors associated cross-sectionally with children's sleep included ethnicity, socioeconomic deprivation, material standard of living, rurality, and heavy traffic, and longitudinal sleep trajectories differed by gender, ethnicity, and socioeconomic deprivation. A considerable proportion of young children in NZ have a high probability of not meeting sleep guidelines but this declines across the ages of 24 and 45 months. Sleep health inequities exist as early as 24 months of age in NZ.

Prospective longitudinal study investigating predictors of childhood injuries from Growing Up in New Zealand cohort: study protocol

BackgroundInjury is one of the leading causes of mortality and morbidity worldwide and yet preventable and predictable. In New Zealand (NZ), unintentional injury is the leading cause of emergency department...

Regression Equations for Weight Estimation in Paediatric Resuscitation.

Weight estimation is critical in paediatric resuscitation, as stopping to weigh a child could influence their survival. Weight estimation methods used in New Zealand (NZ) are not accurate for the population, increasing the complexity of prescribing medication and selecting equipment. Develop regression equations (RE) to predict the weight of NZ children based on height, sex, age and ethnicity to be deployed in a mobile application (Weight Estimation Without Waiting). The RE was derived from retrospective regression modelling of a large existing dataset. Data were presented using descriptive statistics and calculation of means, limits of agreement and the proportion of weight estimates within a percentage of actual weight. The RE developed in this study outperformed existing age-based weight estimation methods while providing a method to ensure that weight estimation techniques evolve with NZ children.

Comparison of group A streptococcal titres in healthy children and those with pharyngitis and skin infections

ObjectivesRates of acute rheumatic fever, a sequelae of group A Streptococcal (GAS) infection, remain unacceptably high in Indigenous Māori and Pacific children in New Zealand. This prospective study aimed to describe GAS antibody titres in healthy children (5–14 years) by ethnicity, and to determine how paired titres vary with GAS culture positive and negative pharyngitis, and GAS skin infections. MethodsAnalysis included 887 children (32% Māori, 36% Pacific, 33% European/Other) from Auckland, New Zealand. Cases comprise 772 children who had a sore throat or skin infection, which resulted in a swab taken for culture. Healthy controls were asymptomatic (N = 154) and matched by age, ethnicity and region. All participants had a serum sample, with a second sample collected from cases only. Sera were analysed for anti-streptolysin O (ASO) and anti-DNase-B (ADB) antibodies. ResultsHealthy Māori and Pacific children had higher GAS antibody titres than healthy European/Other children. Children with GAS-positive sore throat had the highest mean ASO titres and children with GAS-positive skin infection had the highest mean ADB titres. When a two-fold increase or an upper limit of normal cut-off (ASO 450 IU/ml, ADB 400 U/ml) was applied to titres from children with GAS-positive sore throat, 62.1% were classified as having serologically confirmed GAS pharyngitis and 37.9% had GAS detected without serological response. ConclusionsElevated ASO titres were associated with GAS pharyngitis and elevated ADB titres were associated with GAS skin infections in New Zealand children. Higher ASO/ADB titres in healthy Māori and Pacific children could indicate a greater prior exposure to GAS infections.