Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia

BMC Pediatrics

Research Article

David Harley¹  Philippa J. Dossetor²  Alexandra L. C. Martiniuk³  June Oscar⁴  Maureen Carter⁵  Rochelle Watkins⁶  Heather E. Jeffery⁷  Elizabeth J. Elliott⁸  James P. Fitzpatrick⁹ 

[1] Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, 97/2 Edinburgh Ave, 2601, Canberra, ACT, Australia;National Centre for Epidemiology and Population Health, Australian National University, Building 62, Corner of Eggleston and Mills Roads, 0200, Canberra, ACT, Australia;Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, 97/2 Edinburgh Ave, 2601, Canberra, ACT, Australia;University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia;Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia;Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;The George Institute for Global Health, PO Box M201, Missenden Rd, 2050, Sydney, Australia;Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia;Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Australia;School of Arts and Science, University of Notre Dame, Broome, Australia;Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia;Population Sciences Division, Telethon Kids Institute, The University of Western Australia, Perth, Australia;RPA Newborn Care, Royal Prince Alfred Hospital, Sydney, NSW, Australia;Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia;University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia;Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia;The Sydney Children’s Hospital Network (Westmead), Westmead, Australia;University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia;Population Sciences Division, Telethon Kids Institute, The University of Western Australia, Perth, Australia;

关键词: Hospitals, pediatric;    Pediatrics;    Health services, indigenous;    Australia;    Child;    Rural health services;    Oceanic ancestry group;    Rural and remote;   

DOI  :  10.1186/s12887-017-0947-0

 received in 2016-09-08, accepted in 2017-11-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWe analysed hospital admissions of a predominantly Aboriginal cohort of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life.MethodsAll children born between January 1, 2002 and December 31, 2003 and living in the Fitzroy Valley in 2009–2010 were eligible to participate in the Lililwan Project. Of 134 eligible children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in 2011 and comprised our cohort. Lifetime (0–7 years) hospital admission data were available and included the dates, and reasons for admission, and comorbidities. Conditions were coded using ICD-10-AM discharge codes.ResultsOf the 127 children, 95.3% were Indigenous and 52.8% male. There were 314 admissions for 424 conditions in 89 (70.0%) of 127 children. The 89 children admitted had a median of five admissions (range 1–12). Hospitalization rates were similar for both genders (p = 0.4). Of the admissions, 108 (38.6%) were for 56 infants aged <12 months (median = 2.5, range = 1–8). Twelve of these admissions were in neonates (aged 0–28 days).Primary reasons for admission (0–7 years) were infections of the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract (11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory tract infections (18.1%), failure to thrive (13.6%), and anaemia (12.7%), were common.In infancy, primary cause for admission were infections of the lower respiratory tract (40.8%), gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper respiratory tract infections (33.3%), failure to thrive (18.5%) and anaemia (18.5%).ConclusionIn the Fitzroy Valley 70.0% of children were hospitalised at least once before age 7 years and over one third of admissions were in infants. Infections were the most common reason for admission in all age groups but comorbidities were common and may contribute to need for admission. Many hospitalizations were feasibly preventable. High admission rates reflect disadvantage, remote location and limited access to primary healthcare and outpatient services. Ongoing public health prevention initiatives including breast feeding, vaccination, healthy diet, hygiene and housing improvements are crucial, as is training of Aboriginal Health Workers to increase services in remote communities.

【 授权许可】

CC BY   
© The Author(s). 2017