Rural Aboriginal Children Research Articles

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

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

A systematic review of clinical research addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children.

The objective of this review was to systemically identify and summarize all the clinically relevant evidence available from studies addressing the prevalence, aetiology, diagnosis, prognosis and therapy of otitis media in Australian Aboriginal children. Electronic searching of Medline, the Australian Medical Index and the Aboriginal and Torres Strait Islander Health Bibliographic Index was performed. This was supplemented by hand searching the Menzies School of Health Research otitis media collection, the Aboriginal and Torres Strait Islander Health Information Bulletin and Aboriginal Health: an annotated bibliography. Data were extracted and placed in a series of evidence tables relevant to clinical practice. There were 59 studies that met the inclusion criteria. The majority were surveys, and only 19 addressed diagnosis, prognosis or therapy. Severe otitis media in rural Aboriginal children does not occur in isolation but as part of a spectrum of chronic bacterial infections of the respiratory tract. Although the aspects of poverty that result in this condition remain to be clarified, exposure to other young children with chronic nasal discharge is likely to be important. Whilst there is a considerable amount of literature on otitis media in Australian Aboriginal children, the number of studies most relevant to improving health outcomes is small. A systematic approach to disease surveillance, diagnosis, and application of medical interventions is required urgently. Future medical research should be concerned with the evaluation of interventions and the generalisabilty of studies from different populations.

Evaluation of a child health program to prevent and treat anaemia in Arnhemland.

Iron deficiency anaemia is a common condition in rural Aboriginal children. Poor nutrition and helminth infections are the common causes of this morbidity. This study aims to evaluate the impact of annual single dose mebendazole 300-500 mg (albendazole unavailable) in preventing anaemia and the impact of iron and mebendazole in treating anaemia in a population of remote Aboriginal children in Arnhemland.

Malnutrition among rural aboriginal children in the Top End of the Northern Territory.

To calculate the minimum prevalence of malnutrition among rural Aboriginal children under two years of age in the Top End of the Northern Territory (NT) using World Health Organization (WHO) criteria. We calculated weight-for-height and height-for-age Z-scores (WHO-endorsed references) for all children under two years who were admitted to hospital with diarrhoeal disease between May 1990 and April 1991. Weights recorded 48 hours after admission were used to allow for acute dehydration. Malnutrition was defined in terms of "wasting" and "stunting" when weight-for-height and height-for-age were more than two standard deviations below the median of the WHO reference population. The denominator population was calculated from NT Department of Health and Australian Bureau of Statistics data. From an average population of no more than 480 children under two years, 34% were admitted to hospital at least once with diarrhoeal disease in the 12 months; 59% were malnourished (wasting alone, 36%; stunting alone, 10%; both, 13%). In the study period an estimated minimum of 20% of all Aboriginal children in the Top End were malnourished (wasted, 12%; stunted, 3%; both, 5%). The 20% prevalence of malnutrition is many times higher than would be expected statistically, and higher than in many underdeveloped countries. International relief agencies regard a prevalence of wasting in children of more than 8% as a nutritional emergency. We urge that programs to alleviate the poor socioeconomic conditions, and mechanisms for early detection and intervention in childhood malnutrition, be offered to Aboriginal communities.

Malnutrition among rural Aboriginal children in the Top End of the Northern Territory

Malnutrition among rural Aboriginal children in the Top End of the Northern Territory

Bacterial colonization of the nasopharynx predicts very early onset and persistence of otitis media in Australian Aboriginal infants

Otitis media (OM) develops in the first months of life and persists throughout childhood in many rural Aboriginal children. We have followed Aboriginal and non-Aboriginal infants from birth to determine the relationship of the early onset of OM to nasopharyngeal colonization with respiratory pathogens. Aboriginal infants were colonized with multiple species of respiratory bacteria (Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae) at a rate of 5% per day and the timing of colonization predicted the onset of persistent OM in individual Aboriginal infants. Non-Aboriginal infants became colonized by M. catarrhalis alone at the slower rate of 1% per day and experienced transient episodes of OM in the absence of colonization. We attribute early bacterial colonization in most Aboriginal infants to high rates of cross-infection due to overcrowding, poor hygiene and high rates of bacterial carriage. Early age of infection and the multiplicity of bacterial types may contribute to prolonged carriage and to eustachian tube damage leading to persistent OM. Thus Aboriginal infants are "otitis-prone" and might qualify for prophylactic antibiotics.

Should aboriginals in the "top end" of the Northern Territory be vaccinated against hepatitis A?

To determine the level of immunity to hepatitis A virus infection in rural Australian Aboriginal populations in the "Top End" of the Northern Territory. A total of 344 sera, for which details of donors' age, sex and domicile were available, were collected and tested for hepatitis A total antibody in a delinked seroprevalence study. Overall, 337/344 samples (97.97%) tested positive for hepatitis A total antibodies--18/20 samples (90%) in the 1-5 year age group; 85/88 (96.6%) in the 6-10 year age group; 98/98 (100%) in the 11-15 year age group; 32/33 (97.0%) in the 16-20 year age group and 104/105 (99%) in the older than 20 year age group. Hepatitis A is hyperendemic in the rural Aboriginal communities studied and the virus is acquired predominantly in the first five years of life. Symptomatic hepatitis A infection is uncommon in this population. We suggest that hepatitis A vaccination for rural Aboriginal children is not indicated as it would not reduce clinical disease rates and may produce a cohort whose immunity could decrease over the following 10 years. Although vaccination is appropriate for non-immune individuals working in remote communities, emphasis must be placed on the inequities in health infrastructure and education underlying the high transmission rates in Aboriginal children.

Development of sex-role stereotyping in rural aboriginal children.

42 rural aboriginal children and 96 suburban white children aged between 32 and 74 mo. were individually tested for stereotyping of sex role using a toy-preference technique. Significant effects of age and racial group upon level of stereotyping were obtained. These indicated that older children in both groups were more rigidly stereotyped and that the aboriginal group was less stereotyped than the white group. This was conceptualised as indicating a developmental lag of approximately 15 mo. Possible reasons for this lag, and the additional restriction of sex-role stereotyping upon aboriginal development, were discussed.

Listening: An Experimental Study

A listening program geared to the interests of rural Aboriginal children was prepared and sent out to two Year S classes in the north-west of New South Wales. The class, with 19 Aboriginals and 4 whites showed measurable gains in listening comprehension at the end of the program. The Experimental Class with one Aboriginal girl and 10 white children did not show improvements in listening until the Aboriginally oriented listening program was terminated. The significance of these results, particularly for minority groups in a classroom, are discussed.