Rural Indigenous Children Research Articles

Perfil nutricional de crianças indígenas menores de cinco anos de idade no Alto Rio Solimões, Amazonas, Brasil (2013)

Abstract Objectives: to characterize the nutritional status of indigenous children underfive years of age living in rural communities in the Upper Solimões River region, inhabited by seven ethnic groups, based on data of december 2013. Methods: weight and height data extracted from SISVAN-I (Indigenous Food and Nutritional Surveillance System) forms filled in 2013 for 7,520 children (86.0% of the estimated children in this age group). The indices height-for-age (H/A), weight-for-age (W/A), weight-for-height(W/H), and body mass index-for-age (BMI/A) were calculated. Growth reference curves proposed by the World Health Organization were used to calculate z-scores. Results: the height-for-age (H/A) index presented the lowest mean z-score values, reaching -1.95 among children between 36 and 60 months. Mean z-score values for the weight-for-age (W/A) index also remained below zero. Mean z-score values for the indices weight-for-height (W/H) and body mass index-for-age (BMI/A) remained slightly above zero, reaching a maximum value of 0.5. Of all children, 45.7% presented low H/A, 9.6% presented low W/A, 4.5% presented low W/H, and 10.7% presented overweight based on BMI/A. Conclusion: our analysis show that in 2013 poor nutritional status persisted as an important health issue among these rural indigenous children.

High prevalence of chronic malnutrition in indigenous children under 5 years of age in Chimborazo-Ecuador: multicausal analysis of its determinants

BackgroundDespite the multiple initiatives implemented to reduce stunting in Ecuador, it continues to be a public health problem with a significant prevalence. One of the most affected groups is the rural indigenous population. This study aimed to analyze the prevalence of chronic malnutrition in indigenous children under 5 years of age and its association with health determinants, focusing on one of the territories with the highest prevalence of stunting.MethodsA cross-sectional study in 1,204 Kichwa indigenous children under the age of five, residing in rural areas of the counties with the highest presence of indigenous in the province of Chimborazo-Ecuador. A questionnaire on health determinants was applied and anthropometric measurements were taken on the child and the mother. Stunting was determined by the height-for-age z-score of less than 2 standard deviations, according to the World Health Organization´s parameters. Data were analyzed using bivariate and multivariate Poisson regression.Results51.6% (n = 646) of the children are stunted. Height-for-age z-scores were significantly better for girls, children under 12 months, families without overcrowding, and families with higher family income. The variables that were significantly and independently associated with stunting were: overcrowding (PR 1.20, 95% CI 1–1.44), the mother required that the father give her money to buy medicine (PR 1.33, 95% CI 1.04–1.71), the father did not give her money to support herself in the last 12 months (1.58, 95% CI 1.15–2.17), mother’s height less than 150 cm (PR 1.42, 95% CI 1.19–1.69) and the child was very small at birth (PR 1.75, 95% CI 1.22–2.5).ConclusionOne out of every two rural indigenous children included in this study is stunted. The high prevalence of stunting in the indigenous and rural population is multicausal, and requires an intersectoral and multidisciplinary approach. This study identified three fundamental elements on which public policy could focus: (a) reduce overcrowding conditions, improving economic income in the rural sector (for example, through the strengthening of agriculture), (b) provide prenatal care and comprehensive postnatal care, and (c) promote strategies aimed at strengthening the empowerment of women.

Ethnic inequalities and trends in stunting prevalence among Guatemalan children: an analysis using national health surveys 1995\u20132014

BackgroundGuatemala has the highest prevalence of stunting among under-five children in Latin America. We aimed to compare indigenous and non-indigenous under-five child populations in relation to stunting, as well as to explore the intersectionality of ethnicity by wealth and by place of residence. We also studied how the ethnic inequalities changed over time, using five ENSMI surveys from 1995 to 2014.MethodsFive national health surveys carried out between 1995 and 2014 were analysed. World Health Organization (WHO) 2006 growth standards were used to calculate stunting prevalence. Self-reported ethnicity was classified as indigenous or nonindigenous. Wealth was measured through an asset-based index, and households were classified into quintiles (for analyses of the whole populations) or tertiles (for analyses of intersectionality with ethnicity). Area of residence was recorded as urban or rural, according to country definition.ResultsOverall stunting prevalence declined by 9.8 percentage points (95% CI −16.4 to − 3.3) from 1995 to 2014. The slope index for absolute inequalities in stunting - which corresponds to the difference in prevalence between the wealthiest and poorest households - ranged from − 52.9 to − 60.4 percentage points, with no significant change over time. Children in rural areas were consistently more stunted than those in urban areas, but rural indigenous children were significantly worse than any other group. Indigenous children in the poorest tertile of family wealth consistently presented the highest stunting prevalence, compared to all other groups. Time trends in stunting were assessed through the average annual absolute change (AAAC). The fastest decline was observed among indigenous children from the middle wealth tertile (AAAC = − 1.21 percentage points per year (pp/y); 95% CI − 1.45 to − 0.96) followed by nonindigenous children also from the middle tertile (AAAC = − 0.80 pp./y; 95% CI − 0.99 to − 0.60). Stunting prevalence in the two poorest tertiles of indigenous children in 2015 was similar to what nonindigenous children presented in 1995, 20 years earlier. In the wealthiest tertile, indigenous children were far worse off than nonindigenous children 20 years earlier.ConclusionsIn terms of stunting prevalence, poor and rural indigenous children are twenty years behind nonindigenous children with similar characteristics.

Contemplating remote presence technology for culturally safe health care for rural indigenous children

Indigenous children living in rural and remote Canada have limited access to paediatric specialty services. As such, they experience a high rate of medical transport out of their home communities. The Truth and Reconciliation Commission’s calls to action has prioritized access to health care that is culturally safe and community directed. Remote presence robotic technology—a novel form of telemedicine—seeks to overcome the barriers of distance and time to improve health care access. The robot allows for direct patient visualization, examination, and communication with local health care providers and family members. This intervention may reduce unnecessary paediatric transfers, and enhance culturally safe care in the child’s home community through timely access to paediatric subspecialty care.

Screening for kidney disease in Indigenous Canadian children: The FINISHED screen, triage and treat program.

Indigenous populations are disproportionately affected by kidney failure at younger ages than other ethnic groups in Canada. As symptoms do not occur until disease is advanced, early kidney disease risk is often unrecognized. We sought to evaluate the yield of community-based screening for early risk factors for kidney disease in youth from rural Indigenous communities in Canada. The FINISHED project screened 11 rural First Nations communities in Manitoba, Canada after community and school engagement. The results for the 10- to 17-year olds are reported here. Body mass index (BMI), blood pressure, estimated glomerular filtration rate (eGFR), hemoglobin A1c's (HbA1c) and urine albumin-to-creatinine ratios (ACR) were assessed. All children were triaged and referred to either primary or tertiary care, depending on risk. A total of 353 were screened (estimated 22.4% of population). The median age was 12 years (IQR 10 to 13), 55% were female and 55% were overweight or obese. Overall, 21.8% of children had at least one abnormality. Hypertension was identified in 5.4% and 11.9% had prehypertension. None of the children had an eGFR < 60 ml/min/1.73 m2 however 10.5% had an ACR > 3 mg/mmol and 6.2% had an eGFR < 90 ml/min/1.73 m2 suggestive of early kidney disease. Diabetes was identified in 1.4%, and 1.4% had HbA1c's between 6.1% and 6.49%. Risk factors for chronic kidney disease are highly prevalent in rural Indigenous children. More research is required to confirm the persistence of these findings, and to evaluate the efficacy of screening children to prevent or delay progression to kidney failure.

I’ve got a feeling: Urban and rural indigenous children’s beliefs about early life mentality

This cross-cultural investigation explored children’s reasoning about their mental capacities during the earliest period of human physical existence—the prenatal period. For comparison, children’s reasoning about the observable period of infancy was also examined. A total of 283 5- to 12-year-olds from two distinct cultures (urban Ecuador and rural indigenous Shuar) participated. Across cultures, children distinguished the fetal period from infancy, attributing fewer capacities to fetuses. However, for both the infancy and fetal periods, children from both cultures privileged the functioning of emotions and desires over epistemic states (i.e., abilities for thought and memory). Children’s justifications to questions about fetal mentality revealed that although epistemic states were generally regarded as requiring physical maturation to function, emotions and desires were seen as functioning as a de facto result of prenatal existence and in response to the prospect of future birth and being part of a social group. These results show that from early in development, children across cultures possess nuanced beliefs about the presence and functioning of mental capacities. Findings converge with recent results to suggest that there is an early arising bias to view emotions and desires as the essential inviolable core of human mentality. The current findings have implications for understanding the role that emerging cognitive biases play in shaping conceptions of human mentality across different cultures. They also speak to the cognitive foundations of moral beliefs about fetal rights.

Disparities in dental insurance coverage among hospitalised Western Australian children

We sought to understand disparities in dental insurance coverage among hospitalised Western Australian children and associated factors. This study analysed the data obtained for 43,937 child patients under the age of 15years hospitalised for an oral-health related condition, as determined by principal diagnosis (ICD-10AM). Primary place of residency, age, gender, Indigenous status and socioeconomic status were also analysed. Of our sample, 47.3% reported lack of dental insurance coverage. Non-Indigenous children were more likely to have dental insurance than Indigenous children. When insurance status was considered, Indigenous children were less likely to be hospitalised for dental treatment. Rural children were more likely to be uninsured than urban children. Lack of health insurance coverage was strongly associated with children living in very remote areas. These disparities were exacerbated among rural indigenous children. Disparities in dental insurance coverage and dental care are also evident by socioeconomic status. Better understanding of disparities in access to care among children, socioeconomic divide in oral health insurance coverage and subsequent development of intervention programmes, will be critical to improving Australian children's oral health.

Accuracy of pre-recorded video images for the assessment of rural indigenous children with ear, nose and throat conditions

We compared the accuracy of ear, nose and throat (ENT) assessments made by a specialist in the conventional face-to-face (FTF) manner with assessments made using pre-recorded information, i.e. history and video recording of the ears, nose, face and throat. 58 patients, mainly of indigenous background, agreed to participate in the study (median age 6 years, interquartile range 4–8). They were assessed FTF by a specialist and then at least two months later were assessed by the same specialist on the basis of video clips and history recorded by a research nurse. A consensus panel of otolaryngologists compared the diagnosis and management from the original face-to-face appointment and the review of the pre-recorded material. Of the 58 assessments, the diagnosis was the same in 47 cases (81 %). Where differences in opinion occurred, four were considered to be related to the quality of baseline history and seven were thought to be related to the examination. Decisions related to clinical management (including treatment) were identical in 44 cases (76%). Where differences were identified, six were related to quality of history and seven associated with the examination. When intra-observer agreement was measured, there were variations in up to 10% of cases which may explain some of the discrepancies in the cases reviewed. The study confirms that pre-recorded video images are useful for the assessment of common ENT conditions. It also demonstrates the potential of a telemedicine application for the early detection and monitoring of indigenous children at high risk of developing chronic diseases that cause hearing loss.

The Role of Location in Indigenous and Non‐Indigenous Child Oral Health

To examine the role of location in Indigenous and non-indigenous child oral health in three Australian states and territories. The association of Indigenous status and residential location with caries prevalence, severity and unmet treatment need was examined. Data were collected as part of a national monitoring survey of 4-14-year-old children enrolled in school dental services in New South Wales, South Australia and the Northern Territory, Australia. Of the 326,099 children examined, 10,473 (3.2%) were Indigenous. Fewer 4-10-year-old rural Indigenous children were caries-free in the deciduous dentition than their non-indigenous counterparts and rural Indigenous children had almost twice the mean number of decayed, missing and filled teeth (dmft) of rural non-indigenous children. The % d/dmft was higher among rural Indigenous children than rural nonIndigenous children. Fewer 6-14-year-old rural Indigenous children were caries-free in the permanent dentition than their non-indigenous counterparts and rural Indigenous children had almost twice the mean DMFT of rural non-Indigenous children. The % D/DMFT was higher in rural Indigenous than rural non-indigenous children. Living in a rural location was the strongest indicator of caries prevalence, severity and unmet treatment need in the deciduous dentition of Indigenous 4-10-year-olds while being socially disadvantaged was the strongest indicator of poor oral health outcomes among older Indigenous and all non-Indigenous children. Living in a rural location exhibited the strongest association with poor oral health outcomes for young Indigenous children but was also associated with poorer oral health among older Indigenous and non-Indigenous children.

Asthma in the Australian Indigenous population: a review of the evidence

In 2001 national health survey data, Indigenous Australians reported asthma as the second most commonly experienced health condition. This systematic review was undertaken to determine the current evidence concerning asthma in the Aboriginal and Torres Strait Islander population. The review was conducted according to Australian National Health and Medical Research Council guidelines. Relevant databases and Internet sites were searched with selection criteria inclusive of all study designs, outcome measures and interventions that investigated asthma in Australian Indigenous participants. Studies of Level 4 evidence were graded using the READER critical appraisal tool, in the absence of an instrument validated and specifically designed for the Indigenous Australian context. A total of 10 descriptive studies published in scientific journals were found, which were largely cross-sectional prevalence studies with rural and remote populations and retrospective reviews of hospitalisation data. There are no published scientific papers on the prevalence of asthma in Indigenous individuals dwelling in metropolitan areas. Other papers included a review, an editorial, and a number of abstracts and letters. Three national health surveys published by the Australian Bureau of Statistics were included. Inconsistency of results regarding the prevalence of asthma was common among studies. Asthma prevalence in rural children has been described as low as 0.5% and as high as 39.4%, and in rural adults in one study as 3.3%. In remote communities, asthma prevalence has been described as 15.8% for children, and for adults between 7% and 26%. National health survey data in the last 10 years has described overall prevalence of asthma in the Indigenous population in the range 15.3%-19%. Hospitalisation data for children with asthma in the Northern Territory showed that rural Indigenous children were admitted significantly less than urban non-Indigenous children, while a Western Australian study found that admissions for asthma were 3.1 times higher in Indigenous than non-Indigenous children, and rates were higher in non-metropolitan compared with metropolitan areas. A single descriptive study of an asthma management strategy utilised with good attendance rates on a remote Torres Strait Island has been published. It is unclear whether the divergence in research findings reflects a difference in prevalence of asthma across demographic regions and among different states and territories, or results from the lack of standardisation of epidemiological research methods used. Previous research efforts concerning asthma in the Australian Indigenous population are insufficient, although there has been an increasing number of studies published during the past decade. All studies undertaken reside at a low level on the hierarchy of evidence scale. There remains no consensus of scientific opinion around the prevalence and aetiology of asthma in Aboriginal and Torres Strait Islander individuals. Particularly lacking are quality studies on asthma management interventions. Extensive consultation with Indigenous communities is indicated in order to determine priorities for asthma research. Following this, well-funded studies of a high methodological quality and culturally appropriate design investigating asthma in the Indigenous population should be undertaken.

Niveles de colesterol, C-LDL y C-HDL en niños de la etnia pehuenche (rurales): Comparación con sus pares de Concepción (urbanos), Chile

Serum cholesterol and lipoprotein levels in rural children of the pehuenche etnia and in a mixed urban children population Cholesterol, high and low density lipoprotein cholesterol (HDL-C and LDL-C) and triglyceride serum concentrations were measured in 100 school children aged 6 to 1 5 years 'rorn a rural indigenous community (pehuenches) from the andean sector o^ the Bio-Bio r>ver basin and compared with those from a random sample in 1 00 ethnically mixed school children of the same age range from urban schools at Concepcibn, in the lower Bio-Bio basin, Chile. Results {mean, p) were, for boys urban/rural, cholesterol 153/123 (p ; triglycerides 73.2/81.6 (ns) mg/dl. Among girls serum cholesterol levels were 150-5/124 (p < 0.05); HDL-C 47.6/39.5 (p < 0.05); LDL-C 81.5/66.3 (p < 0.05); triglycerides 91.9/80.6 (p < 0.05) mg/dl. Physical activity was intense among rural children in contrast to urban children. Rural indigenous children had-significantly lower serum levels of cholesterol and LDL-cholesterol that urban children of the same age.

Como veo, cuento. Imágenes artísticas y narrativas en niños indígenas rurales de Amealco, Querétaro. Una aproximación metodológica y epistemológica

El tema de este trabajo es la producción escolar de narrativas artísticas multimodales en niños indígenas rurales de Santiago Mexquititlán, en el municipio de Amealco, Querétaro, y presenta los procesos y resultados de una investigación cualitativa sobre la utilización de la educación y la creación artística con niños de un pueblo originario hñähñu. Los objetivos fueron motivar y generar en los alumnos diferentes tipos de narrativas visuales, verbales y corporales que afiancen la interacción con su medio y la construcción de la subjetividad, así como reivindicar su origen identitario indígena y favorecer la expresión oral. Con fundamentos teórico-metodológicos y artefactos verbales, visuales y escénicos, sustentados en el giro narrativo, la etnografía educativa, la investigación basada en las artes y el reconstruccionismo social, se exponen y analizan varias actividades artísticas realizadas con niños de tercero y cuarto de una escuela indígena. Los hallazgos, basados en evaluaciones de los alumnos y de la investigadora, condujeron a concluir que la motivación y generación de las narrativas multimodales basadas en las artes, propiciaron en ellos diferentes estímulos y procesos lúdicos, cognitivos y socioafectivos relevantes con repercusiones muy positivas en su desarrollo integral e identitario, y en su concientización y compromiso activo con su entorno.