Maternal and environmental factors associated with infections and undernutrition in young Australian aboriginal children

Gastroenteritis and environmental health among Aboriginal infants and children in Western Australia

OBJECTIVE

To retrospectively examine rates of hospitalization of infants and children in Western Australia for gastroenteritis from 1994 through 2000.

METHODOLOGY

Analysis of hospital separations data from the Hospital Morbidity Data System of the Department of Health, Western Australia.

RESULTS

Rates of hospitalization of Aboriginal infants and children for gastroenteritis from 1994 to 2000 in Western Australia were approximately seven times higher than for their non-Aboriginal peers. This was despite some decline in Aboriginal hospitalization rates over the study period. This may have been due to a simultaneous decline in hospital admissions of non-Aboriginal infants and children. Rates of hospitalization of Aboriginal infants and children were much higher in non-metropolitan rather than in metropolitan regions. There was a remarkable fall in the deaths of Aboriginal infants and children from gastroenteritis between 1970 and 2000. There were no deaths recorded in Western Australian hospitals from this disease from 1990 to 2000.

Birth to age 7 growth of children prenatally exposed to drugs: a prospective cohort study

Prenatal exposure to cocaine, alcohol, and cigarettes has been linked to decreased birth weight and length. Unclear, however, is whether growth deficits persist into childhood. Women who were pregnant, African-American, not HIV-positive, and who delivered singleton infants were extensively screened throughout pregnancy for cocaine, alcohol, cigarette, and other illicit drug use. Of the approximately 1100 eligible subjects, 665 families were located at a 7-year postbirth follow-up and 540 participated. After appropriate control for potential confounders and prenatal exposures, prenatal exposure to cocaine, alcohol, and cigarettes each independently predicted birth weight and length. At age 7, prenatal cocaine exposure was significantly related to height deficits after accounting for other prenatal exposures and significant confounders. Children at age 7 exposed to cocaine in utero were up to 1 in. shorter and twice as likely to fall below the 10th percentile in height as the control children after accounting for other significant confounders including other prenatal exposures. Maternal age moderated the relation between prenatal exposures and child growth. Children born to women over 30 and exposed to cocaine were up to 2 in. shorter and four times more likely to have clinically significant height deficits at age 7. Children of older women and exposed to moderate-to-high levels of alcohol prenatally were up to 14 lb lighter and five times more likely to fall below the 10th percentile in weight. Similar growth restriction was not associated with prenatal exposures for children born to younger mothers. These outcomes add to the growing body of literature detailing long-term effects of prenatal drug exposure, suggesting differential effects for cocaine and alcohol, and indicating that maternal age may moderate these effects. Mechanisms for growth restriction and failure of catch-up under conditions of prenatal exposures are presented, suggesting further study of these developmental outcomes.

Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children

Before permanent European colonization 2 centuries ago, Australian Aborigines were preagriculturalist hunter-gatherers who had adapted extraordinarily well to life in a variety of habitats ranging from tropical forests, coastal and riverine environments, savannah woodlands, and grasslands to harsh, hot, and very arid deserts. Colonization had serious negative effects on Aboriginal society, well-being, and health, so much so that Aborigines are now the unhealthiest subgroup in Australian society. The change from active and lean hunter-gatherers to a more sedentary group of people whose diet is now predominantly Westernized has had, and continues to have, serious effects on their health, particularly in relation to cardiovascular disease and type 2 diabetes mellitus, which are highly prevalent among Aborigines. The contemporary diets of Australian Aborigines are energy rich and contain high amounts of fat, refined carbohydrates, and salt; they are also poor in fiber and certain nutrients, including folate, retinol, and vitamin E and other vitamins. Risks of development of cardiovascular disease and type 2 diabetes in this population probably develop during late childhood and adolescence. This indicates a need for greater emphasis on health promotion and disease prevention than at present and a need to plan these in culturally sensitive, secure, and appropriate ways. Most information about Aboriginal diets is anecdotal or semiquantitative. More effort needs to be invested in studies that more clearly and precisely define dietary patterns in Aboriginal people, especially children, and how these patterns influence their growth, nutritional status, and health, prospectively.

Differences in growth among remote and town-dwelling aboriginal children in the Kimberley region of Western Australia

This paper documents the growth of Aboriginal children in remote communities and gazetted towns of the Kimberley region in the far north of Western Australia over the past 20 years. The study's specific aim was to compare the height and weight growth of children in different environments from birth to five years of age. From 1979 to 1983, children living in towns were significantly taller and heavier than their counterparts in remote communities. From 1984 to 1988 and thereafter, there were no significant differences in the growth patterns of children in towns and remote communities. Overall, weight-for-age and height-for-age of children in remote communities has improved since the 1970s relative to their town-dwelling counterparts. These changes in growth shed light on the quality of the social and physical environment over the past 20 years and may assist with the development of future programs for child health.

Australian Aboriginal child health

There have been substantial improvements in the health of Australian Aboriginal children over the past 2 decades. These include lower infant and toddler mortality rates and a significant decline in rates of hospitalization for conditions such as gastro-enteritis and lower respiratory tract infection. In addition, the degree of illness among these children on presentation is now generally much less severe than previously. There is evidence also of some improvement in birthweight, growth and nutritional status over the past 20 years. Incidence rates of infections among Aboriginal children, however, are still much higher than among their non-Aboriginal counterparts and much of this is due to unsatisfactory standards of living and community and personal hygiene. This is aggravated by widespread inadequate infrastructures for providing better housing, water supplies, solid and liquid waste disposal and the provision of regular, clean and nutritious food supplies in Aboriginal communities. These issues and more effective and culturally acceptable methods of disease prevention and health promotion are now being accorded high priority. But serious concerns remain about early Aboriginal "lifestyles" that may have important implications for health and mortality patterns among Aborigines during young to middle-age adult life. These include proneness to non-insulin-dependent diabetes mellitus, hypertension, cardiovascular disease, particularly ischaemic heart disease, and stroke which are likely to have their origins in childhood. The recent increase in rates of motor vehicle accidents, sometimes fatal, homicide and suicide, and the increasing rate of tobacco smoking and the use of addictive drugs, including the sniffing of petrol, glue and other volatile substances, is cause for serious concern for the future health and well-being of Aboriginal youth and their families.

Substance misuse in Aboriginal Australians

Australia's Aborigines lived in isolation from the rest of humanity as successful hunter-gatherers for tens of thousands of years. That isolation ended abruptly with British colonization in the late 18th century and was followed by a traumatic 200 years for Aborigines who are now seriously disadvantaged, socio-economically and in terms of their health standards. It has often been assumed that the Aborigines had no access to psychotropic substances before permanent European contact but several pieces of evidence dispute this view. The history of Aboriginal contact with and usage of intoxicating substances, including alcohol, is extremely complex and affected by a maze of restrictive government policies. These interact with a wide range of other Federal and State policies which have changed rapidly since the late 1960s when Aborigines were first granted the franchise; access to unrestricted drinking followed soon afterwards. Today Aborigines suffer disproportionately to other Australians from the physical and social consequences of excess alcohol consumption, tobacco usage, petrol and other solvent sniffing, usage of marijuana, amphetamines, cocaine and heroin, as well as other drugs. The Aboriginal population is dispersed in cities, towns, fringe settlements, rural and remote areas over this vast continent and there are different patterns of drug usage from place to place. This review attempts to synthesize some of this information in order to give an overview to the history, background, current status of substance misuse by Aborigines as well as some strategies being used to try to overcome this serious problem.

Environmental health conditions in remote and rural aboriginal communities in western Australia

During 1994-1995 environmental health conditions of about 13,760 persons in 155 remote and rural Aboriginal communities in 20 local shires in Western Australia (WA) were surveyed. A semiquantitative questionnaire sought data about the communities and their services, including water supplies, power, sanitation and disposal of solid and liquid waste; a separate section dealt with conditions of individual dwellings. Data were recorded by experienced local workers. Thirty-five communities considered to have the worst conditions were evaluated on-site by a team of senior personnel in mid-1995. Environmental health problems were prevalent and often serious: over one-third of the communities had water supply or sanitation problems and 70 per cent had housing problems, with overcrowding and substandard housing being commonplace. Thirty-six per cent had difficulties with waste water disposal, 37 per cent had no rubbish disposal, and in others, the methods of disposal were often inadequate; pests were problems in 44 per cent of communities and the hygiene and maintenance of communal toilets was unacceptable in 25 per cent. Seventy-two per cent had no on-site environmental health worker and 44 per cent had no on-site or visiting medical, nursing or health worker personnel. An action plan was developed and the highest-priority communities were targeted in a program of major works (for example, housing, drainage and sewerage) and minor works, which have been commenced. The remote-area environmental health workers' program is being expanded. Increased intersectoral collaboration and enhanced community involvement in decision making have occurred as a result of this work.

Hospitalization of infants for infections in Western Australia, 1980-91

Rates of hospitalization of Aboriginal infants in Western Australia from 1980 through 1991 for infections were much higher than for other infants and were consistently higher in rural areas than in metropolitan areas. There were substantial declines in rates of hospital admissions and bed occupancy of rural Aboriginal infants for respiratory and gastrointestinal infections during the study period; changes in rates for other infections were less marked and less consistent. Despite recent improvements, Aboriginal infants are hospitalized much more frequently and for longer than other infants because of these diseases. Hospitalization rates reflect many factors including disease incidence and severity but also are affected by isolation, climatic and physical conditions, and access to medical and nursing care. Preventive health programmes need to be maintained and intensified in order to improve health standards of young Aborigines and to lessen their need for hospital care.

Diarrhoea in Australian Aborigines

Infectious diarrhoea has been recognised as a serious public health problem for Aboriginal Australians, particularly infants and young children, for more than two decades. These diseases are caused by bacterial, viral and parasitic infections which are spread mainly by the faecal-oral route and which must be interrupted if prevention is to be effective. This paper reviews published reports on this subject and interventions which have been used elsewhere to reduce the incidence of infectious diarrhoea. These reports have important implications for Aboriginal health but interventions and strategies to overcome this problem must recognise the unique circumstances of Aboriginal people in Australia.