non-Indigenous Children Research Articles

Oral health disparities among Brazilian self-identified indigenous individuals

This article aimed to use epidemiological constructs to describe and analyze the oral health burdens among self-identified indigenous individuals in Brazil and to compare the findings with the oral health status within the non-indigenous population. The study utilized secondary data from the Oral health Brazil database (SB Brasil 2003) to address the null hypothesis that there were no oral health differences between self-identified indigenous and non-indigenous individuals in Brazil. Indigenous individuals had 3.17 (95% C.I.:2.44--4.13) greater odds of never having visited a dentist’s office than non-indigenous individuals. Indigenous persons had 1.55 (95% C.I.:1.20--2.00) greater odds of having periodontal problems than non-indigenous persons. Indigenous children had 1.71 (95% C.I.:1.37--2.14) higher odds of having a decayed, missing, and filled teeth score different from zero than non-indigenous children. Finally, indigenous persons were found to have 1.24 (95% C.I.:1.07--1.45) greater odds of not being a caries free individual than a non-indigenous person. The results lend credence to the suspicions that in Brazil there are unequal and unfair differences in oral health status and access to dental care between self-identified indigenous individuals and their respective national counterpart.

Teaching geometrics to young learners using computer-based simulation: the interaction effect of guidance, in relation to representation and manipulation, with socio-cultural background

ABSTRACT Computer simulations have become widely available to support geometric learning; however, the type and amount of guidance, as well as the freedom to engage in self-directed learning that should be allowed for children from differential socio-cultural backgrounds, have not yet been clarified. On the basis of the cognitive theory of multimedia learning and cognitive load theory, we varied guidance – in relation to representation and manipulation – between two levels (high and low) to form four conditions. We investigated 152 fifth-grade students with various socio-cultural backgrounds (80 were non-indigenous and 72 were indigenous) to explore the interaction effects of guidance on their learning of area-related concepts using a computer simulation–based environment. The results indicated that the learning performance of children from various socio-cultural backgrounds interacts with four experimental conditions at different guidance levels. More specifically, the indigenous children outperformed the non-indigenous children in highly directed learning environment, but the non-indigenous children outperformed the indigenous children in learning environments that entailed a high degree of exploration. Children from different socio-cultural backgrounds also exhibited various patterns of germane cognitive load. Finally, we discussed future study directions based on cognitive and socio-cultural perspectives for simulation-based learning environments.

Nutritional status of children in rural areas of the Komi Republic and Khanty-Mansi Autonomous Okrug - Yugra by anthropometric data

A characteristic feature of the "global obesity epidemic" in recent decades is the rapid spread of overweight among the rural population. However, there is a lack of objective data on how this process is unfolding in the northern and Arctic regions of the Russian Federation. The aim of the work was to analyze the prevalence of malnutrition and rates of overweight and obesity in children living in Khanty-Mansi Autonomous Okrug - Yugra (KhMAO) and the Komi Republic (KR). Material and methods. We conducted a study of the nutritional status of rural children in the northern regions of the Russian Federation in 2018-2019. The subjects of the study were children aged 3-17 years of KhMAO, ethnic Khanty, Mansi and of various non-indigenous descent in small remote settlements (n=302) and 956 children in the administrative center of the northern district, a town-type residency. We also examined 7-17-year-old children (n=628) in large settlements of the KR, over 90% of them were ethnic Komi. For each individual, body mass index values (BMI) were calculated. The nutritional status was assessed by comparing the individual BMI with the age and sex specific standards set by the Ministry of Health of the Russian Federation (2017). Results and discussion. 74.4% of children aged 3-6 in KhMAO, and 70% of the 7-17-year-old children of KR and KhMAO meet the standards for their age-sex groups; 6.1% of children aged 3-17 are underweight and 19.5% are overweight. Among the 7-17-year-olds, the ratio of the underweight and overweight (including obese) differs significantly in the settlement dwellers of the KR from that in the living in small settlements of KhMAO (p=0.004), as well as in the group of town residents of KhMAO (p=0.017). The children of the KR have slightly higher percentage of the overweight and obese (26.6 vs 25.7 and 24.8% in the town and settlements of KhMAO, respectively), but significantly lower percentage of those who are underweight (1.9 vs 5.0 and 6.8%). The proportion of obese schoolchildren in small remote settlements of KhMAO is higher than that in the large settlements of KhMAO and in large settlements of the KR (13.1, 7.7 and 9.2%, respectively). Conclusion. There were no differences found between ethnic groups, however the role of social and anthropological factors in the formation of the nutritional status differences between the indigenous and non-indigenous children in Western Siberia calls for further investigation.

Hearing loss prevalence and hearing health among school-aged children in the Canadian Arctic

Objective Hearing loss is an important health concern in Canada’s Arctic. The objective of this research was to provide information on the prevalence of childhood hearing loss in Nunavut. Design This cross-sectional study involved comprehensive audiologic assessments of school-aged children in six communities to determine overall and community-specific prevalence of hearing loss. Data were collected about hearing aid use and factors affecting use through a parent questionnaire. Study sample Assessments were completed for 644 children in kindergarten to grade 6. Results 124 (19.3%) children had hearing loss of ≥ 30 dB HL at one or more frequencies in at least one ear (93.5% conductive loss). Applying a Canadian prevalence study definition, 148 (23.5%) children had hearing loss. Tympanic membrane perforations were present in 36.8% (n = 28) of children with unilateral and 45.8% (n = 22) with bilateral loss. Conclusions The prevalence of hearing loss in Canada’s North was almost three times that reported for non-indigenous children. One in five school-aged children was found to have hearing loss that is likely to affect classroom learning and social/emotional development. A hearing health strategy tailored to this population is critically needed.

Maternal alcohol use disorder hurts most offspring: Australian study

Most children whose mothers have alcohol use disorder (AUD) experience adverse effects — not just a vulnerable subgroup — according to new research published in Pediatrics last month. The study looked at multiple outcomes, including birth, child protection, justice contact and academic outcomes for indigenous and nonindigenous children (the study was conducted in Australia). The adverse effects were higher in the indigenous children. For the study, all women with a birth recorded from 1983 to 2007 and their offspring were included. Fifty‐five percent of the exposed nonindigenous children and 84% of the indigenous children whose mothers had AUD experienced a negative outcome. The odds of experiencing a negative outcome were highest for those children whose mothers were diagnosed while pregnant; however, this was a small number overall. The researchers concluded that universal prevention strategies are needed to reduce harmful alcohol use and to support at‐risk women and children. O'Leary C, Lawrence D, Hafekost K, et al: Maternal alcohol‐use disorder and child outcomes. Pediatrics. 2020 Feb 24. pii: e20191574. doi: 10.1542/peds.2019‐1574. [Epub ahead of print]

Maternal Alcohol-Use Disorder and Child Outcomes.

Investigate the relationship between maternal alcohol-use disorder and multiple biological and social child outcomes, including birth outcomes, child protection, justice contact, and academic outcomes for both Indigenous and non-Indigenous children. Women with a birth recorded on the Western Australian Midwives Notification System (1983-2007) and their offspring were in scope. The exposed cohort were mothers with an alcohol-related diagnosis (International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision) recorded in an administrative data set and their offspring (non-Indigenous: n = 13 969; Indigenous: n = 9635). The exposed cohort was frequency matched with mothers with no record of an alcohol-related diagnosis and their offspring (comparison cohort; non-Indigenous: n = 40 302; Indigenous: n = 20 533). Over half of exposed non-Indigenous children (55%) and 84% of exposed Indigenous children experienced ≥1 negative outcome. The likelihood of any negative outcome was significantly higher for the exposed than the comparison cohort (non-Indigenous: odds ratio [OR] = 2.67 [95% confidence interval (CI) = 2.56-2.78]; Indigenous: OR = 2.67 [95% CI = 2.50-2.85]). The odds were greatest for children whose mothers received a diagnosis during pregnancy (non-Indigenous: OR = 4.65 [95% CI = 3.87-5.59]; Indigenous: OR = 5.18 [95% CI = 4.10-6.55]); however, numbers were small. The effects of maternal alcohol-use disorder are experienced by the majority of exposed children rather than a vulnerable subgroup of this population. These findings highlight the need for universal prevention strategies to reduce harmful alcohol use and targeted interventions to support at-risk women and children.

Briefly Noted

Most children whose mothers have alcohol use disorder (AUD) experience adverse effects — not just a vulnerable subgroup — according to new research published in Pediatrics last month. The study looked at multiple outcomes, including birth, child protection, justice contact and academic outcomes for indigenous and nonindigenous children (the study was conducted in Australia). The adverse effects were higher in the indigenous children. For the study, all women with a birth recorded from 1983 to 2007 and their offspring were included. Fifty‐five percent of the exposed nonindigenous children and 84% of the indigenous children whose mothers had AUD experienced a negative outcome. The odds of experiencing a negative outcome were highest for those children whose mothers were diagnosed while pregnant; however, this was a small number overall. The researchers concluded that universal prevention strategies are needed to reduce harmful alcohol use and to support at‐risk women and children. For the study, go to https://pediatrics.aappublications.org/content/early/2020/02/20/peds.2019‐1574.

Culturally Appropriate Outreach Specialist Respiratory Medical Care Improves the Lung Function of Children in Regional and Remote Queensland

Indigenous Respiratory Outreach Care (IROC) is a culturally appropriate specialist respiratory service established to deliver multidisciplinary respiratory care to regional and remote Queensland communities. Our objective was to evaluate the impact of an outreach specialist respiratory service on the spirometry of children attending IROC clinics, particularly Indigenous children with asthma and bronchiectasis. Retrospective single-arm cohort study of 189 children who performed spirometry at twelve sites across regional and remote Queensland between October 2010 and December 2017. Each child's baseline spirometry was compared to their best spirometry at follow-up visit occurring within (1) 12months of their most recent visit with at least 12months of specialist care and; (2) each year of their first 3years of care. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) z-scores improved significantly across the whole group from baseline to follow-up (change in z-scores (Δz) of FEV1 = 0.38, 95% CI 0.22, 0.53; ΔzFVC = 0.36, 95% CI 0.21, 0.51). In subgroup analyses, lung function significantly improved in Indigenous children (n = 141, ΔzFEV1 = 0.37, 95% CI 0.17, 0.57; ΔzFVC = 0.36, 95% CI 0.17, 0.55) including those with asthma (n = 117, ΔzFEV1 = 0.41, 95% CI 0.19, 0.64; ΔzFVC = 0.46, 95% CI 0.24, 0.68) and bronchiectasis (n = 38, ΔzFEV1 = 0.33, 95% CI 0.07, 0.59; ΔzFVC = 0.26, 95% CI - 0.03, 0.53). Significant improvements in FEV1 and FVC were observed within the first and second year of follow-up for Indigenous children, but not for non-Indigenous children. The IROC model of care in regional and remote settings leads to significant lung function improvement in Indigenous children with asthma and bronchiectasis.

Australian vaccine preventable disease epidemiological review series: invasive Haemophilus influenzae type b disease, 2000–2017

Invasive Haemophilus influenzae type b (Hib) disease is rare in Australia following vaccine introduction in 1993. Two deaths in vaccinated children in 2017, and the Hib booster dose moving from age 12 months to 18 months in 2018, prompted this review. Hib Case Surveillance Scheme 2000-2017 data were used to calculate incidence, incidence rate ratios (IRR) and vaccine failure (VF) trends. We used denominators from the Australian Immunisation Register to calculate incidence in immunised and unimmunised children. All-age national invasive Hib disease incidence halved from 0.13 per 100,000 population in 2000 to 0.06 in 2017. Of 345 cases notified in 2000-2017, 153 were born post-2000, with 51 (33%) Aboriginal and Torres Strait Islander (Indigenous), and compared with non-Indigenous children IRR was 8.34 (95% CI: 5.83-11.79), with no evidence of decrease. Overall case fatality rate was 12.4% (19/153); 6 cases had underlying medical conditions. The overall incidence of invasive Hib disease was over 8 times higher (16.6 per 100,000) in children with no recorded doses than in children with ≥1 vaccine dose (1.9 per 100,000). VF criteria were met in 65/145 (45%) cases aged >8 weeks, of whom 7 (11%) were immunocompromised and 6 (9%) died, with no evidence of VF increase over time. Overall, invasive Hib disease incidence declined by 55% from 2000 to 2017, but marked disparity persists between Indigenous and non-Indigenous children. Following moving the fourth dose from 12 to 18 months in 2018, monitoring of 3-dose VFs will be important, especially in Indigenous children.

Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000

AbstractOur study estimates the effects of exposure to a family planning program which promoted surgical contraception for the first time in Peru on women's use of birth control methods and their children's health. While a broad program, the Programa de Salud Reproductiva y Planificación Familiar forced many indigenous women to undergo sterilization. We compare provinces affected by the program earlier with provinces affected later, before and after the policy. Overall, the results indicate that women in treated areas were more likely to use both temporary and permanent contraceptive methods and their children were less likely to die within their first year of life, partly due to longer breastfeeding. However, we observe heterogeneity by ethnicity. In treated provinces, nonindigenous children benefited from the policy regardless of their mothers’ choice of contraceptive method, while there were few positive impacts for indigenous children whose mothers underwent sterilization. This suggests that coercive or aggressively implemented family planning programs may not confer health benefits on children.

Clinical response to antibiotics in indigenous versus non-indigenous children under 5 years old with community-acquired pneumonia in Otavalo, Ecuador.

INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo’s Kichwa population may have contributed to the observed clinical response to CAP treatment.

Response of Salivary Microbiota to Caries Preventive Treatment in Aboriginal and Torres Strait Islander Children

ABSTRACT A once-annual caries preventive (Intervention) treatment was offered to Aboriginal and Torres Strait Islander schoolchildren—a population with disproportionately poorer oral health than non-Indigenous Australian children—in the Northern Peninsula Area (NPA) of Far North Queensland (FNQ), which significantly improved their oral health. Here, we examine the salivary microbiota of these children (mean age = 10 ± 2.96 years; n = 103), reconstructing the bacterial community composition with high-throughput sequencing of the V4 region of bacterial 16S rRNA gene. Microbial communities of children who received the Intervention had lower taxonomic diversity than those who did not receive treatment (Shannon, p < 0.05). Moreover, the Intervention resulted in further decreased microbial diversity in children with active carious lesions existing at the time of saliva collection. Microbial species associated with caries were detected; Lactobacillus salivarius, Lactobacillus reuteri, Lactobacillus gasseri, Prevotella multisaccharivorax, Parascardovia denticolens, and Mitsuokella HMT 131 were significantly increased (p < 0.05) in children with severe caries, especially in children who did not receive the Intervention. These insights into microbial associations and community differences prompt future considerations to the mechanisms behind caries-preventive therapy induced change; important for understanding the long-term implications of like treatment to improve oral health disparities within Australia. Trial registration: ANZCTR, ACTRN12615000693527. Registered 3 July 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368750&isReview=true

Converging and Diverging Points of Indigenous Education and Formal Education Systems in Nepal: A Case of Tharu Community

This study was carried out to explore the converging and diverging points of indigenous education and formal education systems of Nepal. The entire research process of the study was guided by the interpretive-constructivist paradigm followed by a case study design. Tharu teachers and students were chosen as a sample by using a purposive sampling method and then in-depth interviews, focus group discussion, and document analysis was used as the main methods of garnering intensive information regarding the similarities and differences of indigenous education and formal education systems primarily in reference to Tharu community. Study results reveal that both formal and indigenous education systems have their own educational goals, curriculum, teachers, and both of them impart particular knowledge and skills to the learners by using certain instructional techniques. Nevertheless, both education systems are not identical to each other in terms of learning environment, skills-focused, nature of learning, type of teachers, the medium of instruction, and assessment devices. As a result, Tharu children show poor academic performance within the formal education system as compared to non-indigenous children. Coherence between formal curricular contents and indigenous knowledge should be made to provide relevant and effective educational services to indigenous children within formal educational institutions for the purpose of improving their living standards in the future through quality education.

Role of maternal age at birth in child development among Indigenous and non-Indigenous Australian children in their first school year: a population-based cohort study

Indigenous Australian children are twice as likely to score poorly on developmental outcomes at age 5 years than their non-Indigenous peers. Indigenous children are also more likely to be born to younger mothers. We aimed to quantify the relationship between maternal age at childbirth and early childhood development outcomes in Indigenous and non-Indigenous children. In this population-based, retrospective cohort study, we used data from the Australian Early Development Census (AEDC) that were probabilistically linked by the New South Wales (NSW) Centre for Health Record Linkage to several NSW administrative datasets, including the Perinatal Data Collection, the Register of Births, Deaths and Marriages (for birth registrations), the Admitted Patient Data Collection, and public school enrolment records, as part of the Seeding Success study. The resulting data resource comprises a cohort of 166 278 children born in NSW whose first year of school was reported in a 2009 or 2012 AEDC record (which were the years of AEDC data available at the time of data linkage). The primary outcome was the aggregate outcome of developmental vulnerability (scores in the bottom decile, according to the 2009 benchmark, on one or more of the five AEDC domains, which include physical, social, emotional, language and cognitive, and communication development). This outcome was measured in singleton children without special needs recorded on the AEDC, in those with available developmental data. As a secondary outcome analysis, we also repeated the main analyses on the outcome of developmental vulnerability on the individual domains. We estimated the absolute risk of developmental vulnerability by maternal age in Indigenous and non-Indigenous populations, and we also estimated the risk difference and relative risk between Indigenous and non-Indigenous children by use of modified Poisson regression. Of 166 278 children in the cohort, 107 666 (64·8%) children were enrolled in a public school in NSW in 2009 or 2012, of whom 7994 (7·4%) children were Indigenous (ie, they, or either parent, were recorded as Aboriginal or Torres Strait Islander on one or more birth records) and 99 672 (92·6%) children were not Indigenous. After exclusions, the final study population included 99 530 children (7206 [7·2%] Indigenous and 92 324 [92·8%] non-Indigenous). Of those for whom developmental outcome data were available, 2581 (35·9%) of 7180 Indigenous children and 18 071 (19·7%) of 91 835 non-Indigenous children were developmentally vulnerable on one domain or more. The risk of developmental vulnerability decreased with maternal ages between 15 and 39 years, but the decrease in risk with maternal age was significantly steeper in non-Indigenous than Indigenous children. Developmental vulnerability is most common in Indigenous and non-Indigenous children born to young mothers; however, Indigenous children have an increased risk of this outcome across most of the maternal age range. Policies that improve the socioeconomic circumstances of Indigenous children and families could promote better developmental outcomes among Indigenous children. Culturally appropriate support for Indigenous children, including those born to young mothers and disadvantaged families, could also reduce early childhood developmental inequalities. The Australian National Health and Medical Research Council, Manitoba Centre for Health Policy.

The ORVAC trial protocol: a phase IV, double-blind, randomised, placebo-controlled clinical trial of a third scheduled dose of Rotarix rotavirus vaccine in Australian Indigenous infants to improve protection against gastroenteritis

IntroductionRotavirus vaccines were introduced into the Australian National Immunisation Program in 2007. Despite this, Northern Territory Indigenous children continue to be hospitalised with rotavirus at a rate more than 20...

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children.

Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.

Annual Immunisation Coverage Report 2016.

This tenth annual immunisation coverage report shows data for the calendar year 2016 derived from the Australian Immunisation Register (AIR) and the National Human Papillomavirus (HPV) Vaccination Program Register. After a decade of being largely stable at around 90%, 'fully immunised' coverage at the 12-month assessment age increased in 2016 to reach 93.7% for the age assessment quarterly data point in December 2016, similar to the 93.4% for the age assessment quarterly data point in December 2016 for 60 months of age. Implementation of the 'No Jab No Pay' policy may have contributed to these increases. While 'fully immunised' coverage at the 24-month age assessment milestone decreased marginally from 90.8%, in December 2015, to 89.6% for the age assessment quarterly data point in December 2016, this was likely due to the assessment algorithm being amended in December 2016 to include four doses of DTPa vaccine instead of three, following reintroduction of the 18-month booster dose. Among Indigenous children, the gap in coverage assessed at 12 months of age decreased fourfold, from 6.7 percentage points in March 2013 to only 1.7 percentage points lower than non-Indigenous children in December 2016. Since late 2012, 'fully immunised' coverage among Indigenous children at 60 months of age has been higher than for non-Indigenous children. Vaccine coverage for the nationally funded seasonal influenza vaccine program for Indigenous children aged 6 months to <5 years, which commenced in 2015, remained suboptimal nationally in 2016 at 11.6%. Changes in MMR coverage in adolescents were evaluated for the first time. Of the 411,157 ten- to nineteen-year-olds who were not recorded as receiving a second dose of MMR vaccine by 31 December 2015, 43,103 (10.5%) of them had received it by the end of 2016. Many of these catch-up doses are likely to have been administered as a result of the introduction on 1 January 2016 of the Australian Government's 'No Jab No Pay' policy. In 2016, 78.6% of girls aged 15 years had three documented doses of HPV vaccine (jurisdictional range 67.8-82.9%), whereas 72.9% of boys (up from 67.1 % in 2015) had received three doses.

Antibioticoterapia em crianças indígenas e não indígenas desnutridas

Introdução: A prevalência da desnutrição infantil vem diminuindo em todo o mundo, mas ainda acomete milhões de crianças, especialmente indígenas. Devido ao elevado número de doenças infecciosas associadas à desnutrição, a antibioticoterapia faz parte da terapêutica recomendada. Objetivo: Observar os casos de desnutrição entre crianças indígenas e não indígenas hospitalizadas e a terapêutica empregada durante o tratamento. Métodos: Estudo de coorte retrospectivo, farmacoepidemiológico, realizado com informações extraídas de prontuários arquivados do período de janeiro de 2012 a dezembro de 2014 de um hospital público. Resultados: Participaram 166 crianças, sendo o número de crianças indígenas aproximadamente seis vezes maior do que não indígenas. Houve maior prevalência entre lactentes e crianças com idade inferior a um ano apresentaram mais chances de serem internadas por desnutrição. Os diagnósticos de desnutrição mais vistos foram os inespecíficos, com uma proporção significativa de óbitos relacionados ao diagnóstico E43. As infecções mais comuns foram do sistema digestório e respiratório. Crianças indígenas tiveram quase cinco vezes mais chances de apresentarem infecção respiratória. A maior proporção recebeu até três antibióticos, havendo crianças que receberam mais que sete antibióticos diferentes durante o período de internação. Conclusão: A população infantil deve ser acompanhada por meio de inquéritos que possam subsidiar políticas de saúde que atendam suas necessidades. É necessária a capacitação dos profissionais envolvidos no cuidado da criança desnutrida, recursos materiais e financeiros, a fim diminuir o número de diagnósticos inespecíficos e evitar o uso indiscriminado de antibióticos, sendo imprescindível uma política de controle efetiva no uso da politerapia antimicrobiana.

Story-telling abilities of young Indigenous and non-Indigenous Australian children across three protocols

Purpose: Little is documented about the story-telling skills of Indigenous Australian children. Therefore, this study explores the complexity of stories produced by Indigenous and non-Indigenous Australian children in their first year of school.Method: An observational design allowed comparison across cultural groups and story protocols. Three stories were elicited from 49 Indigenous and non-Indigenous children aged 4;10 to 6;5. Stories were analysed using the Index of Narrative Complexity (INC) to generate scores for each story element. Story elements were further categorised and evaluated for level of use across participants. Story protocol and cultural group effects were explored using ANOVA.Result: Participant stories featured high use of characters, initiating events, attempts, and consequences; and little use of internal plans, formulaic markers, causal adverbial markers and evaluations. Story complexity scores did not differ between the Indigenous and non-Indigenous children, but significant differences were evident among the three, story protocols.Conclusion: Findings suggest that story elicitation protocols and analysis methods used in this study may be appropriate for use with both Indigenous and non-Indigenous children from urban contexts. However, caution is needed when making diagnostic decisions based on story complexity without well-developed, culturally appropriate protocols and normative data.

The Abecedarian Approach in a Low-Resource Urban Neighborhood in Canada: An Impact Evaluation in a Child Care Setting

Despite the best efforts, persistent educational gaps remain between Indigenous and non-Indigenous children when they begin school. This evaluation explores the impact of the Abecedarian Approach for early education on the language development of First Nations and non-First Nations children, living in a low-resource, urban neighborhood in Canada. A treatment group received the Abecedarian Approach in a child care center, supplemented by home visiting, and comprised 20 families with 41 children of whom 51% were First Nations. The control group comprised 27 families with 39 children of whom 46% were First Nations. The analyses presented explore child language outcomes at the end of the second year of participation and take account of child and family characteristics, as well as the baseline language scores. Results indicate that children in the treatment group had stronger language outcomes than the control group. While First Nations children in the treatment group had lower levels of language development than non-First Nations children, at baseline, both groups progressed at about the same rate. While the findings do not guarantee that achievement gaps would close during the school years, improved language development in the years before school is likely to be associated with better achievement during school.