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

Detection and whole genome sequence analysis of an enterovirus 68 cluster

Background

Enteroviruses are a common cause of human disease and are associated with a wide range of clinical manifestations. Enterovirus 68 is rarely detected yet was reported in many countries in 2010. Here enterovirus 68 was identified for the first time in New Zealand in 2010 and was detected in a further fourteen specimens over a six month period.

Objectives

To genetically characterise enterovirus 68 specimens identified in New Zealand in 2010.

Study design

The genome sequence of a New Zealand representative enterovirus 68 isolate was obtained. Ten clinical specimens were analysed by sequencing the VP1 region of the enterovirus 68 genome.

Results

Based on sequence analysis of the VP1 region and the full genome of one representative isolate, the New Zealand enterovirus 68 isolates clustered with contemporary enterovirus 68 viruses and do not show any clear distinguishing genetic diversity when compared to other strains. All fifteen specimens showed high similarity with enterovirus 68 by VP1 sequencing. The majority of New Zealand patients suffered from bronchiolitis, were less than two years of age and were of Pacific Island or Maori descent.

Conclusions

We document the rare occurrence of an enterovirus 68 cluster in New Zealand in 2010. These viruses shared similarity with other clusters of enterovirus 68 that occurred globally in 2010. A greater awareness in enterovirus 68 infection may help detect this virus with increased frequency and enable us to better understand the role this strain plays in disease and the reasons behind this global emergence in 2010.

Aboriginal cultural awareness training: policy v. accountability - failure in reality

Despite 42 years progress since the 1967 referendum enabling laws to be made covering Aboriginal Australians their poor health status remains and is extensively documented. This paper presents results of a study into Cultural Awareness Training (CAT) in New South Wales and specifically South West Sydney Area Health Service (SWSAHS) with the aim of improving long-term health gains. The evidence demonstrates poor definition and coordination of CAT with a lack of clear policy direction and accountability for improving cultural awareness at government level. In SWSAHS staff attendance at training is poor and training is fragmented across the Area. The paper proposes actions to improve Aboriginal cultural awareness for health professionals including incorporating Aboriginal CAT into broader based Cross Cultural Training (CCT).

Infection is the major component of the disease burden in aboriginal and non-aboriginal Australian children: a population-based study

BACKGROUND

Infection accounts for the majority of pediatric mortality and morbidity in developing countries, but there are limited data on the infectious diseases burden in children from developed countries. We investigated reasons for hospitalization before age 2 years in a birth cohort of Western Australian Aboriginal and non-Aboriginal children.

METHODS

Data on live births between January 1990 and December 2000, and corresponding deaths and hospitalizations in the first 2 years of life, were obtained through linked population-based data.

RESULTS

Almost half the cohort of 270,068 children were hospitalized at least once. Aboriginal children had significantly higher admission rates (2196 vs. 779 per 1000 live births), stayed longer and were more likely to die in hospital than non-Aboriginal children. Infections (mainly respiratory and gastrointestinal) were the most common reason for hospitalization, accounting for 34% of all admissions, with higher rates in Aboriginal (1114 per 1000 live births) than non-Aboriginal children (242 per 1000) (P < 0.001). Over time, admission rates for infections declined in Aboriginal children but increased in non-Aboriginal children. Aboriginal children were admitted 14 times more often for pneumonia than non-Aboriginal children.

CONCLUSIONS

Infections are the leading cause of hospitalization in children under 2 years of age. The continuing heavy burden of serious infections, borne disproportionately by Aboriginal children, needs to be alleviated. Public health interventions such as the development and universal implementation of vaccines for respiratory syncytial virus, rotavirus and influenza are needed, while adequate funding must be committed to Indigenous health services and training.

The effect of locational disadvantage on hospital utilisation and outcomes in Western Australia

This study analyses the effect of location of residence on hospital utilisation and outcomes using geocoded hospital morbidity and mortality data for the Western Australian population from 1994 to 1999. Compared to highly accessible areas, the overall hospital admission rate ratio was 2.27 (95% CI 2.19-2.36) for those in moderately accessible areas and 2.35 (95% CI 2.23-2.47) for those in remote areas. The corresponding ratios for total length of stay were 1.19 (95% CI 1.17-1.20) and 1.25 (95% CI 1.23-1.27) and the hazard ratios for risk of readmission at 30 days were 1.06 (95% CI 1.04-1.07) and 1.17 (95% CI 1.15-1.19). This study represents an important advance in describing the effects of remoteness on health service utilisation and outcomes.

The vaccination status of aboriginal and Torres Strait Island children in far north Queensland

A survey was undertaken to ascertain the vaccination status of all 773 Aboriginal and Torres Strait Island children who were born and remained in Far North Queensland during the 1993-94 financial year. Only 42% had received all 15 vaccines scheduled in the first two years of life by their second birthday. More who resided in remote communities were fully vaccinated (64%) by then than those who lived in rural towns (32%) or an urban setting (21%) (p < 0.01). The 445 children who were not fully vaccinated required a median of three vaccines to have been fully vaccinated by the second birthday. Of these, 146 (33%) required only one vaccine, nearly 60% of whom would have been fully vaccinated if they had had the fourth (18-month) dose of diphtheria-tetanus-pertussis (DTP) vaccine. Of the 445, 143 (32%) required five or more vaccines to have been fully vaccinated. Only 26% and 36% of the children received all the vaccines scheduled at six and 12 months of age, respectively, on the same day. However, the eventual uptakes of the three vaccines scheduled at six months of age were very similar (approximately 80%) and simultaneous vaccination with the two vaccines scheduled at 12 months of age would have made a very limited (approximately 4 percentage points) impact on the overall percentage of fully vaccinated children. Considerably more than simple and apparently logical strategies will be required to ensure that Indigenous children in Far North Queensland are adequately vaccinated. A systematic approach, with a careful understanding of the barriers to routine vaccination and a means of prospectively tracking the vaccination status of each child, will be needed if state and national vaccination goals are to be met.

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.

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.

Persistent growth faltering among aboriginal infants and young children in north-west Australia: a retrospective study from 1969 to 1993

The objective was to examine long-term changes in the growth of Aboriginal infants and young children in the Kimberley region in the far north-west of Australia from 1969 to 1993. A retrospective analysis of anthropometric data (weight and length) routinely collected on 0-5-year-old children in 5-year cohorts from 1969 to 1993 was carried out. From 1974-78 to 1989-93 there has been a significant increase in mean birthweight (ANOVA p < 0.05). The percentage of low birthweight infants (< 2500 g) declined from 14% in 1979-83 to 10% in 1989-93 (p < 0.001). There were no consistent improvements in the growth patterns of infants from birth to 60 months. All cohorts displayed pronounced growth faltering in weight-for-age and height-for-age from 6 to 12 months of age and fell significantly below both the NCHS reference values and mean values for healthy breastfed infants. In conclusion, reductions in Aboriginal infant mortality and infectious disease rates over the past 20 years have not been accompanied by improved growth. The persistence of child malnutrition in these communities may warrant a shift in attention from disease treatment and prevention to a better understanding of nutritional influences, particularly weaning practices, during infancy and early childhood.