non-Indigenous Children Research Articles

An evaluation of the racial equity of the actuarial Family risk assessment instrument used in Queensland, Australia

BackgroundRisk assessment instruments used in child protection to guide intervention decisions should be equitable. To be considered equitable, two criteria are necessary: instruments should avoid discriminatory logic and display comparative validity for children of different races. Empirical evidence about the equity of risk assessment instruments is limited. Objective: To investigate the racial equity of a widely used risk assessment instrument, the Structured Decision Making Family Risk Assessment (FRA). Participants and setting: Administrative data were obtained for all children subject to investigation in Queensland, Australia in 2018, for whom an FRA was completed (n = 17,851). MethodsRelationships between FRA items, race, and recurrence (subsequent investigation within 12 months) were explored using crosstabulations and Cox Proportional Hazards. Accuracy of FRA recommendations and practitioner decisions were compared using sensitivity and specificity for Indigenous and non-Indigenous children. ResultsMost FRA items predicted race better than recurrence. Differences in recurrence by race were only partially explained by FRA items. The FRA produced high rates of false positives for Indigenous children (incorrectly classifying 48.9% of children who did not recur compared to 31.7% for non-Indigenous children) and high rates of false negatives for non-Indigenous children (incorrectly classifying 59% of children who did recur compared to 39% for Indigenous children). Practitioner discretion did not mitigate inequitable FRA recommendations. ConclusionsThe FRA failed both criteria of equity, discriminating indirectly by relying heavily on factors correlated with race, and demonstrating less accuracy for Indigenous children. High rates of false positives for Indigenous children exacerbate Indigenous overrepresentation in child protection.

Kidney transplantation access and outcomes for Aboriginal and Torres Strait Islander children and young adults, 1963-2020: an ANZDATA registry study.

To assess differences between Aboriginal and Torres Strait Islander and non-Indigenous Australian children and young adults in access to and outcomes of kidney transplantation. A cohort study based on prospectively collected data; analysis of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data. Children and young adults aged 0-24 years who commenced kidney replacement therapy in Australia during 1963-2020. Proportions of children and young adults who received kidney transplants within five years of commencing dialysis; 5- and 10-year death-censored graft survival; and 5- and 10-year survival of children and young adults who received kidney transplants or who remained on dialysis. During 1963-2020, 3736 children and young adults received kidney replacement therapy in Australia: 213 (5.8%) Aboriginal and Torres Strait Islander and 3523 (94.2%) non-Indigenous children and young adults. During follow-up (median, eight years; interquartile range [IQR], 2.6-15 years), 2762 children and young adults received kidney transplants: 93 Aboriginal and Torres Strait Islander (43.7% of those receiving kidney replacement therapy) and 2669 non-Indigenous children and young adults (75.8%). Smaller proportions of Aboriginal and Torres Strait Islander than of non-Indigenous children and young adults received transplants within five years of commencing dialysis (99, 46% v 2924, 83.0%), received living donor transplants (19, 20% v 1170, 43.9%), or underwent pre-emptive transplantation (one, 1.1% v 363, 13.6%). Five-year graft survival for Aboriginal and Torres Strait Islander recipients was similar to non-Indigenous recipients (61% v 75%; adjusted hazard ratio [aHR], 1.43; 95% confidence interval [CI], 0.02-2.05), but 10-year graft survival was lower (35% v 61%; aHR, 1.69; 95% CI, 1.25-2.28). Five- and 10-year survival after kidney transplantation was similar for Aboriginal and Torres Strait Islander and non-Indigenous people. Among those who remained on dialysis, 10-year survival was poorer for Aboriginal and Torres Strait Islander than non-Indigenous children and young adults (aHR, 1.50; 95% CI, 1.08-2.10). Five-year graft and recipient survival were excellent for Aboriginal and Torres Strait Islander children and young adults who received kidney transplants; however, a lower proportion received transplants within five years of dialysis initiation, than non-Indigenous children and young adults. Improving transplant access within five years of dialysis commencement should be a priority.

“How About Being Trustworthy Rather Than Asking Families to Trust?”: A Prerequisite for Child Protection Authorities Partnering with Indigenous Communities

Australia’s Indigenous children are 12 times more likely than non-Indigenous children to be in out-of-home care, a rate that has been increasing. Since 2009, government policies have committed to keeping children safe in families through support, early intervention, and Indigenous self-determination. Action has not matched policy. Quantitative and qualitative survey data from third parties (n = 29 Indigenous and n = 358 non-Indigenous) are analysed with a view to understanding expectations and visions for reform. Third parties expressed distrust and resistance toward child protection authorities. Indigenous third parties more so. Achieving reform objectives depends on child protection authorities initiating relational repair with third parties through addressing ritualism, implementing policy and investing in genuine partnering. Indigenous third parties, in addition, identified institutional racism and cultural disrespect as obstacles to reform.

Childhood Cancer Incidence and Survival in South Australia and the Northern Territory, 1990-2017, with Emphasis on Indigenous Peoples.

Reports of a rise in childhood cancer incidence in Australia and globally prompted the investigation of cancer incidence and survival in South Australia (SA) and the Northern Territory (NT) over a 28-year period, with emphasis on Indigenous peoples. This cross-sectional analysis of two prospective longitudinal databases, the SA and NT Cancer Registries (1990-2017), included all reported cases of childhood cancers. Poisson regression provided estimates of incidence rate ratios and survival was modelled using Cox proportional hazard models for children aged <5 and ≥5 years. A total of 895 patients across SA (N = 753) and the NT (N = 142) were ascertained. Overall and in the NT, childhood cancer incidence was higher in males compared with females (IRR 1.19 [1.04-1.35] and 1.43 [1.02-2.01], respectively). Lymphocytic leukemia was the most reported cancer type across all locations. With reference to the 1990-1999 era (181.67/100,000), cancer incidence remained unchanged across subsequent eras in the combined cohort (SA and NT) (2000-2009: 190.55/100,000; 1.06 [0.91-1.25]; 2010-2017: 210.00/100,000; 1.15 [0.98-1.35]); similar outcomes were reflected in SA and NT cohorts. Cancer incidence amongst non-Indigenous children significantly decreased from the 1990-1999 era (278.32/100,000) to the 2000-2009 era (162.92/100,000; 0.58 [0.35-0.97]). Amongst 39 Indigenous children in the NT, incidence rates remained unchanged across eras (p > 0.05). With reference to the 1990-1999 era, overall survival improved in subsequent eras in SA (2000-2009: HR 0.53 [0.38-0.73]; 2010-2017: 0.44 [0.28-0.68]); however, remained unchanged in the NT (2000-2009: 0.78 [0.40-1.51]; 2010-2017: 0.50 [0.24-1.05]). In the NT, overall survival of Indigenous patients was significantly lower compared with the non-Indigenous cohort (3.42 [1.92-6.10]). While the survival of Indigenous children with cancer significantly improved in the last two eras (p < 0.05), compared to the 1990-1999 era, no change was noted amongst non-Indigenous children in the NT (p > 0.05). The incidence of childhood cancers has remained unchanged over 28-years in SA and the NT. Encouragingly, improved survival rates over time were observed in SA and amongst Indigenous children of the NT. Nevertheless, survival rates in Indigenous children remain lower than non-Indigenous children.

Establishing a telehealth model addressing paediatric sleep health in remote and rural Northern Territory Australia: Overcoming the distance barrier.

This study examined the outcomes of a telehealth model for sleep health assessment among Indigenous and non-Indigenous children residing in remote and regional communities at the Top End Northern Territory (NT) of Australia. Video telehealth consultation, that included clinical history and relevant physical findings assessed virtually with an interstate paediatric sleep physician was conducted remotely. Polysomnography (PSG) and therapeutic interventions were carried out locally at Darwin, NT. The study participants were children referred between 2015 and 2020. Of the total 812 children referred for sleep assessment, 699 underwent a diagnostic PSG. The majority of patients were female (63%), non-Indigenous (81%) and resided in outer regional areas (88%). Indigenous children were significantly older and resided in remote or very remote locations (22% vs. 10%). Referral patterns differed according to locality and Indigenous status - (non-Indigenous via private (53%), Indigenous via public system (35%)). Receipt of referrals to initial consultation was a median of 16 days and 4 weeks from consult to PSG. Remote children had slightly longer time delay between the referral and initial consult (32 vs. 15 days). Fifty one percent were diagnosed to have OSA, 27% underwent adenotonsillectomy and 2% were prescribed with CPAP therapy. This study has demonstrated that a telehealth model can be an effective way in overcoming logistical barriers and in providing sleep health services to children in remote and regional Australia. Further innovative efforts are needed to improve the service model and expand the reach for vulnerable children in very remote communities.

A health inequality analysis of childhood asthma prevalence in urban Australia

Long-standing health inequalities in Australian society that were exposed by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic were described as "fault lines" in a recent call to action by a consortium of philanthropic organizations. With asthma a major contributor to childhood disease burden, studies of its spatial epidemiology can provide valuable insights into the emergence of health inequalities early in life. The aims of this study were to characterize the spatial variation of asthma prevalence among children living within Australia's 4 largest cities and quantify the relative contributions of climatic and environmental factors, outdoor air pollution, and socioeconomic status in determining this variation. A Bayesian model with spatial smoothing was developed to regress ecologic health status data from the 2021 Australian Census against groups of explanatory covariates intended to represent mechanistic pathways. The prevalence of asthma in children aged 5 to 14 years averages 7.9%, 8.2%, 8.5%, and 7.6% in Sydney, Melbourne, Brisbane, and Perth, respectively. This small inter-city variation contrasts against marked intracity variation at the small-area level, which ranges from 6% to 12% between the least and most affected locations in each. Statistical variance decomposition on a subsample of Australian-born, nonindigenous children attributes 66% of the intracity spatial variation to the assembled covariates. Of these covariates, climatic and environmental factors contribute 30%, outdoor air pollution contributes 19%, and areal socioeconomic status contributes the remaining 51%. Geographic health inequalities in the prevalence of childhood asthma within Australia's largest cities reflect a complex interplay of factors, among which socioeconomic status is a principal determinant.

Prevalence and determinants of insufficient vitamin D status in young Canadian Inuit children from Nunavik.

Background: Vitamin D deficiency has reached pandemic levels affecting over one billion people worldwide. However, limited data is available on the prevalence and determinants of vitamin D status of Canadian Indigenous children and no study has been reported in Inuit children from Nunavik. Aim: Therefore, using data collected between 2006 and 2010, we aimed to investigate the prevalence and main determinants of insufficient serum 25-hydroxyvitamin D (s25(OH)D) concentrations in Inuit children attending childcare centres in Nunavik. Methods: This study included 245 Inuit children aged 11 to 54 months. s25(OH)D concentrations were measured by radioimmunoassay. Dietary intakes were assessed using 24-hour recalls. Usual dietary intakes were estimated using the National Cancer Institute method. We used a multiple imputation technique to replace missing values when performing regression analysis. Results: Our findings revealed that 64.5% of children had a s25(OH)D concentration < 75 nmol/L, while 78.1% did not meet the estimated average requirement (EAR) for vitamin D. Vitamin D intake and fluid milk consumption were positively associated with s25(OH)D concentrations, while negative associations were observed with children' energy intake, non-alcoholic beverage consumption, body weight, breastfeeding duration and, biological/adoptive/foster parents' educational level. Conclusion: Vitamin D inadequacy was highly prevalent and closely aligned with levels observed over the years in non-Indigenous children. Breastfed children who do not receive vitamin D supplementation, overweight and obese children, and children with inadequate milk consumption were at high risk of vitamin D insufficiency. Eating vitamin D rich foods such as fluid milk and seafood along with vitamin D supplementation when needed are recommended.

Child care participation among Indigenous children in Canada

The release of a Canadian Indigenous Early Learning and Child Care Framework highlights the importance of recent, Indigenous-specific information to describe the landscape of child care among Indigenous children in Canada; however, there has been a gap in identity-specific, national data on child care for Indigenous children. The purpose of the current study was to address data gaps on participation in child care for First Nations children living off reserve, Métis, and Inuit children. Furthermore, two years of data are examined which provide information on child care use both prior to and during the first year of the COVID-19 pandemic. In 2019, First Nations children living off reserve (49%) and Inuit children (42E %)1 were significantly less likely to participate in child care compared with non-Indigenous children (60%), although Métis children (60%) were equally likely to participate in child care compared with non-Indigenous children. Only First Nations children living off reserve (40%) were significantly less likely than non-Indigenous children (53%) to participate in child care in 2020. In terms of the type of child care used, Inuit children were more likely to be in a daycare centre (70%) compared with non-Indigenous children (52%) in 2019, although Inuit children’s participation in a daycare centre dropped to 46E% in 2020. This is likely due to public health restrictions which closed many child care centres during the pandemic, as over one-third of child care in the territories is centre-based. The findings provide important information about patterns of child care use for Indigenous children both before and during the pandemic.

Ações Coordenadas na Brincadeira Livre de Crianças em Encontros Interétnicos

Abstract: This study aimed to investigate coordinated actions built between Mbya-Guarani and non-indigenous children during free play activities. 21 Mbya-Guarani and 61 non-indigenous children participated in two “Encounters for Play,” a project constructed by the Indigenous Network and Mbya-Guarani communities. We recorded children’s social interactions during the free playtimes, selected the first and last 10 minutes of each encounter: (1) Performed scans every 30s registering children who were playing together; (2) Applied Social Network Analysis to explore children’s association pattern on each encounter; (3) Performed a focal continuous transcription of each child present in the interethnic clusters using an ethogram. Our results show free play was effective in promoting coordinated actions between children up to eight years old, in mixed age clusters. The “Encounters for Play” activities demonstrated the ability to mitigate the avoidance of ethnic groups in children, displaying potential as an educational intervention.

Associations between maternal stressful life events and child health outcomes in indigenous and non-indigenous groups in New Zealand

ABSTRACT Exposure to stressful life events (SLE) around the time of pregnancy is associated with adverse health outcomes for mothers and children. Previous New Zealand research found Indigenous Māori women are more likely to be exposed to SLE than non-Māori, and are exposed to a higher number of SLE. The consequences of this for ethnic inequities in child health outcomes are unknown. This paper examines the relationship between patterns of maternal SLE exposure with child health and development outcomes at age 3 years, for Indigenous and non-Indigenous children. We found most children had a stressful early life environment at least sometimes, but more than a quarter of Māori children had a mother experiencing multiple SLE on all occasions measured. We found a clear association between maternal experiences of SLE and disordered child sleep and development concerns. While not able to fully assess the contribution of maternal SLE to ethnic inequities in child health outcomes, we did clearly demonstrate that more Māori children have mothers exposed to multiple SLE, and that these maternal SLE are associated with poorer child outcomes. The impacts of chronic SLE exposure need to be better understood, especially given the large ethnic disparity in chronic SLE exposure.

How Can We Find Out What Indigenous Children and Their Families Need to Manage Weight? Lessons from Formative Nutrition Intervention Research with First Australians.

In Australia, Indigenous children have rates of overweight and obesity 1.5 times those of non-Indigenous children. Culturally safe and effective nutrition interventions are needed for this group. This paper aims to describe a Community-based Participatory Action Research (CPAR) approach to designing formative nutrition intervention research with First Australian children and their families and to reflect on the challenges arising from this process. After obtaining ethical approvals, a Steering Committee (SC), including nine Aboriginal and Torres Strait Islander people experienced in delivering or receiving health care, was established as a project governance body to develop culturally safe project materials and methods. The Indigenous research method of yarning circles was chosen by the SC for the community consultation, and the First Australian SC members were trained to collect the data. They liaised with community organizations to recruit yarning circle participants. Individual interviews conducted by an Aboriginal research assistant replaced yarning circles due to the COVID-19 pandemic lockdowns. While the CPAR approach to formative research was successful, the pandemic and other factors tripled the study duration. To authentically, ethically and safely engage First Australians in research, researchers need to decolonize their methodological approach, and funding bodies need to allow adequate time and resources for the process.

Early Childhood Caries Intervention in Aboriginal Australian Children: A Cross-in Randomized Trial.

Early childhood caries (ECC) is the strongest predictor of dental caries in adulthood. Indigenous children have higher levels of ECC compared with non-Indigenous children. The study aimed to estimate the efficacy of an ECC intervention among Aboriginal Australian children. Baby Teeth Talk was an outcome assessor-blinded, closed-cohort cross-in randomized controlled trial conducted in South Australia, Australia. We randomly allocated 448 women pregnant with an Aboriginal child to either an immediate (II) or delayed (DI) intervention group between January 2011 and May 2012. The immediate intervention comprised (1) provision of dental care to mothers during pregnancy; (2) application of fluoride varnish to teeth of children at ages 6, 12; and 18 mo; (3) motivational interviewing delivered in conjunction; and (4) anticipatory guidance. Mothers/children in the DI group received the same intervention commencing when the child was 24 mo of age. The outcomes were assessed by the number of decayed, missing, and filled teeth (dmft) in children aged 24, 36, and 60 mo. Regression-based approaches with generalized linear mixed effect (log-Poisson) model characterized the mean dmft to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs). A total of 223 participants were randomly allocated to the II group and 225 to the DI group. Three hundred sixty-five children (178 II, 187 DI) received at least 1 dental clinical examination at 24, 36, and 60 mo of follow-up. The mean dmft was lower in the II group (0.48, 1.32, and 2.06) than in the DI group (0.82, 1.90, and 3.29) at each time point, respectively. The direct ECC intervention effect was to prevent/decrease dental decay experience (dmft) occurrence by 84% (RR = 1.84, 95% CI: 1.20-2.48) after adjusting for all covariates. Our analysis indicated that the time-varied ECC intervention had immediate and longer-term effects on the prevention of ECC among Indigenous Australian children. The study aimed to estimate the efficacy of an early childhood caries (ECC) intervention among Aboriginal Australian children. The findings indicated that the culturally appropriate ECC intervention is effective for the preventive of ECC and can be used by clinicians, educators, and policy makers when planning an ECC intervention, so as to prevent and reduce ECC and meet identified oral health needs across the Australian population, which is important for preventive dental care.

Optical Coherence Tomography-Derived Measurements of the Optic Nerve Head Structure of Aboriginal and Torres Strait Islander Children.

This study demonstrated significant differences in optic nerve head characteristics in Aboriginal and Torres Strait Islander children compared with non-Indigenous children, which has implications for glaucoma risk and diagnosis in Aboriginal and Torres Strait Islander populations. The purpose of this study was to examine the optic nerve head (ONH) characteristics of visually normal Aboriginal and Torres Strait Islander children and non-Indigenous Australian children. Spectral domain optical coherence tomography imaging was performed on the right eye of 95 Aboriginal and Torres Strait Islander children and 149 non-Indigenous Australian children (5-18 years). Horizontal and vertical line scans, centered on the ONH, were analyzed to determine the dimensions of the ONH (Bruch membrane opening diameter), optic cup diameter, Bruch membrane opening minimum rim width, and the peripapillary retinal nerve fiber layer thickness. The vertical but not horizontal Bruch membrane opening diameter of Aboriginal and Torres Strait Islander children was significantly larger than non-Indigenous children (mean difference: 0.09mm, P = 0.001). The horizontal (mean difference: 0.12mm, P = 0.003) and vertical cup diameter (mean difference: 0.16mm, P < 0.001) were also significantly larger in Aboriginal and Torres Strait Islander children, as were the horizontal and vertical cup-to-disc ratios (both P < 0.01). Aboriginal and Torres Strait Islander children also had a significantly thinner Bruch membrane opening minimum rim width in the superior, nasal, and temporal meridians (all P < 0.001). Peripapillary retinal nerve fiber layer thickness did not differ between groups. Differences exist in the ONH structure between Aboriginal and Torres Strait Islander children and non-Indigenous children, which may have implications for the detection and monitoring of ocular disease in this population and highlights the need to extend this research to the adult population.

Revitalization of First Nations languages: a Queensland perspective

First Nations languages can play a significant role in ensuring connection to land, culture, Songlines, kinship, history, and stories. Ongoing language attrition for First Nations peoples of Australia has been due to colonization and past adverse government policies, which rendered First Nations languages a threat to the expansion of the colony. Through processes of dislocation from country and punishment for speaking language, many First Nations peoples began to lose their languages and were forcefully compelled to speak the English language on missions and reserves. Promoting First Nations languages in early educational contexts can instill a sense of cultural identity and connectedness to schooling for First Nations children, helping to ensure that languages are passed on to future generations. In many parts of Australia, First Nations languages are being revitalized and are being taught to both First Nations children and non-Indigenous children in early learning centers and in classrooms. This paper draws upon existing literature, briefly examining the removal of First Nations languages in Queensland from a historical perspective. The authors consider three essential elements required to work with First Nations communities when revitalizing First Nations languages and implementing a successful language program into schools: co-design, authentic delivery, and cultural inclusivity. We demonstrate how these elements have been used in the revitalization of First Nations languages in two Queensland schools. Finally, the importance of using an Indigenous centered approach to maintain languages at a local level is posited as a critical step in creating culturally inclusive environments for First Nations children in mainstream school settings.

Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia.

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

Movement Lawyering and theCaring SocietyLitigation

AbstractIn 2016, the Canadian Human Rights Tribunal issued a landmark ruling in First Nations Child and Family Caring Society of Canada v. Canada finding that the government of Canada was racially and ethnically discriminating against First Nations children and their families in its funding and delivery of child welfare services to them. This ruling did not result from an isolated legal case; it was the result of litigation that was part of a broader social campaign with active supporters from all over the world. The litigation was driven by, and supported, a dynamic movement for sovereignty for First Nations Peoples around child welfare. This article examines the Caring Society case through the lens of movement lawyering—using the law to bring about transformative social change.Section 2 examines movement lawyering as an approach to lawyering. Movement lawyering involves a range of practices, advocacy and mobilizing that seek to dismantle architectures of subordination. Section 3 provides an overview of the Caring Society litigation and the social campaign within which the case was litigated. The I am a Witness campaign, a dynamic education and grassroots social campaign that engaged Indigenous and non-Indigenous children and sought to make the litigation accessible to the public, is examined in detail. Section 4 analyses Caring Society as a study of movement lawyering. It examines how three elements of movement lawyering; integrated advocacy; accountability to social movements; and willingness to address the root causes of structural oppression were at play in the litigation and related campaigns.In conclusion, the authors contend that Caring Society and the I am a Witness campaign constitute a successful example of movement lawyering as they properly recognize litigation, and the role of lawyers, as one piece of the mosaic of efforts needed to advance transformative social change.

SMS reminders increase on-time vaccination in Aboriginal and Torres Strait Islander infants.

Timely immunisation is important to protect children from communicable diseases. However, immunisation uptake in Aboriginal and Torres Strait Islander children under the age of two years is often lower than in non-Indigenous children. This contributes to the gap in health outcomes between Aboriginal and Torres Strait Islander children and non-Indigenous children. We have tested the effectiveness of short message service (SMS) reminders in improving timeliness of childhood immunisation in Aboriginal and Torres Strait Islander infants in regional Queensland, Australia. Reminders were sent to parents of Aboriginal and Torres Strait Islander children, at five immunisation age milestones: six weeks, four months, six months, 12 months, and 18 months. There was a significant improvement in the proportion of children vaccinated on-time (within 30 days of the due date), compared to an earlier age cohort, at all milestones except 12 months. The absolute risk difference (ARD) of on-time vaccination between the two cohorts ranged between 4.7% (95% confidence interval [95% CI]: 1.1-8.2%, at six weeks) and 12.9% (95% CI: 7.4-18.5%, at six months). The likelihood of on-time vaccination (rate ratio, RR) in the intervention group compared to the control group ranged from 1.05 (95% CI: 1.01-1.10, at six weeks) to 1.31 (95% CI: 1.14-1.50, at 18 months). SMS reminders were associated with an improvement in immunisation timeliness in Aboriginal and Torres Strait Islander infants at all age milestones measured except 12 months.

SMS reminders increase on-time vaccination in Aboriginal and Torres Strait Islander infants.

Timely immunisation is important to protect children from communicable diseases. However, immunisation uptake in Aboriginal and Torres Strait Islander children under the age of two years is often lower than in non-Indigenous children. This contributes to the gap in health outcomes between Aboriginal and Torres Strait Islander children and non-Indigenous children. We have tested the effectiveness of short message service (SMS) reminders in improving timeliness of childhood immunisation in Aboriginal and Torres Strait Islander infants in regional Queensland, Australia. Reminders were sent to parents of Aboriginal and Torres Strait Islander children, at five immunisation age milestones: six weeks, four months, six months, 12 months, and 18 months. There was a significant improvement in the proportion of children vaccinated on-time (within 30 days of the due date), compared to an earlier age cohort, at all milestones except 12 months. The absolute risk difference (ARD) of on-time vaccination between the two cohorts ranged between 4.7% (95% confidence interval [95% CI]: 1.1-8.2%, at six weeks) and 12.9% (95% CI: 7.4-18.5%, at six months). The likelihood of on-time vaccination (rate ratio, RR) in the intervention group compared to the control group ranged from 1.05 (95% CI: 1.01-1.10, at six weeks) to 1.31 (95% CI: 1.14-1.50, at 18 months). SMS reminders were associated with an improvement in immunisation timeliness in Aboriginal and Torres Strait Islander infants at all age milestones measured except 12 months.

Health services for aboriginal and Torres Strait Islander children in remote Australia: A scoping review.

In Australia, there is a significant gap between health outcomes in Indigenous and non-Indigenous children, which may relate to inequity in health service provision, particularly in remote areas. The aim was to conduct a scoping review to identify publications in the academic and grey literature and describe 1) Existing health services for Indigenous children in remote Australia and service use, 2) Workforce challenges in remote settings, 3) Characteristics of an effective health service, and 4) Models of care and solutions. Electronic databases of medical/health literature were searched (Jan 1990 to May 2021). Grey literature was identified through investigation of websites, including of local, state and national health departments. Identified papers (n = 1775) were screened and duplicates removed. Information was extracted and summarised from 116 papers that met review inclusion criteria (70 from electronic medical databases and 45 from the grey literature). This review identified that existing services struggle to meet demand. Barriers to effective child health service delivery in remote Australia include availability of trained staff, limited services, and difficult access. Aboriginal and Community Controlled Health Organisations are effective and should receive increased support including increased training and remuneration for Aboriginal Health Workers. Continuous quality assessment of existing and future programs will improve quality; as will measures that reflect aboriginal ways of knowing and being, that go beyond traditional Key Performance Indicators. Best practice models for service delivery have community leadership and collaboration. Increased resources with a focus on primary prevention and health promotion are essential.

Changes to acute-care hospitalizations among Indigenous children and youth: Results from the 2006 and 2011 Canadian Census Health and Environment Cohorts.

This study described the differences in the hospitalization rates of First Nations children and youth living on and off reserve, Inuit children and youth living in Inuit Nunangat (excluding Nunavik), and Métis children and youth, relative to non-Indigenous children and youth and examined rate changes across 2006 and 2011. The 2006 and the 2011 Canadian Census Health and Environment Cohorts provided five years of hospital records that Statistics Canada linked to peoples' self-reported Indigenous identity as recorded on the census. Causes of hospitalizations were based on the most responsible diagnosis coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada, aggregated by chapter code. Age-standardized hospitalization rates (ASHRs) were calculated per 100,000 population. Rate ratios (RRs) were reported for each Indigenous group relative to non-Indigenous children and youth. For the 2006 and the 2011 cohorts, ASHRs were generally higher among Indigenous children and youth than among non-Indigenous children and youth. For some health conditions, hospitalization patterns also varied across the two time periods within the given Indigenous groups. Among children, leading elevated RRs occurred for diseases of the respiratory system, the digestive system and injuries. Elevated mental health-related RRs were observed among all Indigenous groups for both cohort years of youth. Significant increases in mental health-related ASHRs were observed in 2011 compared with 2006 among all youth groups, except for Inuit youth living in Inuit Nunangat, possibly due in part to data limitations. Among Indigenous youth, elevated RRs were observed for pregnancy, childbirth and the puerperium, and for injuries. For all youth (except Inuit), childbirth-related ASHRs decreased in 2011 compared with 2006. Findings align with previously observed hospitalization disparities between Indigenous and non-Indigenous children and youth. These data enabled the tracking of changes over time to partly address national information gaps about population health outcomes for children and youth, namely hospitalization.