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HEALTHY CHILD DEVELOPMENT
Diet and nutrition
Poor diet and nutrition in the early years of life can affect childhood development, growth, functioning and health (Tomkins 2001). It is also a principal cause of many of the health conditions suffered by Aboriginal and Torres Strait Islander people. A diet high in carbohydrates and saturated fats, for example, is associated with high levels of obesity, Type 2 diabetes and renal disease, while consumption of fresh fruit and vegetables can be a protective factor against many of these diseases (NPHP 2001). Aboriginal and Torres Strait Islander families living in isolated areas, however, face particular challenges in providing their children with fresh, affordable food on a regular basis.
The National Health and Medical Research Council Dietary Guidelines recommend consuming a wide variety of nutritious foods, including a high intake of plant food such as fruit and vegetables, while also recommending moderating total fat and saturated fat intake (NHMRC 2003b). The daily food consumption guidelines for fruit and vegetable intake recommend:
The 2004-05 NATSIHS collected information on the dietary behaviour of Indigenous people aged 12 years and over, including the number of daily serves of fruit and vegetables usually eaten by those living in non-remote areas. Among Indigenous children aged 12-14 years in non-remote areas, 24% met the recommended daily fruit intake of three or more serves, and 59% met the recommended daily vegetable intake of three or more serves. Among teenagers aged 15-17 years, 20% met the daily fruit consumption guidelines and 61% met the daily vegetable consumption guidelines (table 6.9). There were no significant differences between the proportion of Indigenous and non-Indigenous children whose fruit and vegetable consumption met the recommended daily guidelines.
The Australian Childhood Immunisation Register (ACIR), managed by the Health Insurance Commission, holds information on childhood immunisation coverage. All children under seven years of age, enrolled in Medicare, are automatically included on the ACIR. Children who are not eligible to enrol in Medicare can be added to the ACIR when details of a vaccination are received from a doctor or immunisation provider. It should be noted that coverage estimates for Aboriginal and Torres Strait Islander children include only those who are identified as such and are registered on the ACIR. Children identified as Indigenous on the ACIR may not be representative of all Aboriginal and Torres Strait Islander children, and thus coverage estimates should be interpreted with caution.
Vaccination coverage rates for children aged one year, two years and six years at 31 December 2005 for New South Wales, Victoria, Western Australia, South Australia and the Northern Territory combined are shown in table 6.10. Aboriginal and Torres Strait Islander children had lower coverage compared with non-Indigenous children for all vaccines at 12 months of age (82% compared with 91%), while at two years of age the difference in vaccination coverage between Indigenous and non-Indigenous children was not as large (90% and 92% respectively). Immunisation rates at six years of age were similar for Indigenous and non-Indigenous children. This suggests that there may be a delay in the receipt of vaccines by Indigenous children, or in the transfer of data for Indigenous children to ACIR (AIHW 2007a).
The 2004-05 NATSIHS also provides information on the immunisation status of Indigenous children aged 0-6 years in non-remote areas of Australia. Among Indigenous children for whom immunisation records were available, 93% were fully immunised according to the recommended course of vaccinations at a specific age. In particular, 78% of Indigenous children in non-remote areas were fully immunised against diphtheria/tetanus, 74% against whooping cough, 82% against Hepatitis B, 78% against polio, 72% against Hib and 84% against measles, mumps and rubella (AIHW 2007a).
Selected environmental risk factors
Exposure to environmental tobacco smoke, commonly referred to as passive smoking, has been shown to be a significant cause of morbidity and mortality, and children are the most vulnerable to its effects. For babies, passive smoking is one of the significant risk factors for sudden infant death syndrome (AMA 1999). Exposure to second hand smoking also increases children's risk of ear infections and respiratory illnesses, such as asthma (Strachan & Cook 1997). Children living with parents and relatives who smoke indoors are particularly at risk.
In 2004-05, an estimated 119,000 Aboriginal and Torres Strait Islander children lived with a regular smoker. This represents two-thirds (66%) of all Indigenous children aged 0-14 years. In comparison, around one-third (35%) of non-Indigenous children aged 0-14 years lived with a regular smoker. Regular smokers may or may not smoke at home indoors. Some 28% of Aboriginal and Torres Strait Islander children were living in households with a regular smoker who smoked at home indoors, three times the comparable rate for non-Indigenous children (9%) (table 6.11).
Exposure to risky/high risk drinker(s)
According to the 2004-05 NATSIHS, an estimated 27,900 Indigenous children (15%) were living in a household in which there was at least one risky/high risk drinker, compared with 11% of non-Indigenous children aged 0-14 years. The proportion of Indigenous children exposed to risky/high risk drinking within their household ranged from 10% of those in very remote areas to 18% of those in inner regional areas (graph 6.12).
6.12 LIVING IN A HOUSEHOLD WITH RISKY/HIGH RISK DRINKER(a), Indigenous children aged 0-14 years - 2004-05
Health status of children
Long-term health conditions
The 2004-05 NATSIHS and 2004-05 NHS collected data on the prevalence of long-term health conditions among children 0-14 years of age, based on information provided by the person with main caring responsibility for the child. Similar proportions of Indigenous and non-Indigenous children had at least one long-term condition (44% compared with 42%) in 2004-05. The most common long-term health conditions reported for Indigenous children were respiratory diseases (19%), diseases of the ear (10%) and diseases of the eye (8%) (ABS 2006c).
While the same proportion of Indigenous and non-Indigenous children had respiratory disease(s) in 2004-05, Indigenous children were more likely than non-Indigenous children to have asthma (14% compared with 11%) and/or bronchitis (2% compared with 1%). Indigenous children were also more likely than non-Indigenous children to have ear/hearing problems, especially partial deafness (5% compared with 1%) and/or otitis media (4% compared with 2%) (table 6.13).
Burden of disease and injury
The burden of disease and injury among Indigenous Australians was assessed using Disability Adjusted Life Years (DALYS) - the sum of years of life lost due to premature death and years lived with disability (Vos et al 2007). In 2003 it was estimated that the burden of disease and injury for Indigenous Australians aged 0-14 years was 20,187 DALYS, representing 21% of the total burden of disease and injury for all Indigenous Australians (95,976 DALYS). The leading causes of this burden were neonatal (20%), mental disorders (19%), acute and chronic respiratory infections (18%) and congenital anomalies (12%).
Four major risk factors (tobacco, alcohol, illicit drugs and unsafe sex) attributed around 5% of the total burden of disease among Aboriginal and Torres Strait Islander children in this age group. Tobacco was by far the largest contributor to the disease burden in this age group due to the association between smoking during pregnancy and the increased risk of having a low birthweight baby (Vos et al 2007).
Hospitalisations of infants and children
Hospitalisations data provide a measure of a population's use of health services, but are not a direct measure of health status (see box 7.7 in Chapter 7). The quality of Indigenous identification in hospitalisations data varies across jurisdictions, with 2005-06 data presented for the six jurisdictions with adequate Indigenous identification - New South Wales, Victoria, Queensland, Western Australia, South Australia and the Northern Territory (see box 7.9 in Chapter 7).
In 2005-06, Aboriginal and Torres Strait Islander infants (aged less than one year) were hospitalised at a rate 1.4 times that of other Australian infants. Conditions originating in the perinatal period were the leading cause of hospitalisation of Indigenous infants, followed by diseases of the respiratory system and infectious and parasitic diseases. For skin diseases, diseases of the respiratory system and infectious and parasitic diseases, Indigenous infant hospitalisation rates were around three to four times the rates for other infants (table 6.14).
In 2005-06, Aboriginal and Torres Strait Islander children aged 1-14 years were hospitalised at a rate 1.3 times that of other children of the same age. Diseases of the respiratory system were the leading cause of hospitalisation among Indigenous children, followed by injury and poisoning and infectious and parasitic diseases. Aboriginal and Torres Strait Islander children were hospitalised for skin diseases at more than three times the rate of other Australian children, and were hospitalised for infectious and parasitic diseases at around twice the rate of other children (table 6.15).
Infant and child mortality
Identification of Indigenous Australians is incomplete in all states and territories however current mortality data are considered to have a sufficient level of coverage to enable statistics on Aboriginal and Torres Strait Islander mortality to be produced for four jurisdictions - Queensland, Western Australia, South Australia and the Northern Territory (see Chapter 9).
For analysis of trends over time in Indigenous and child mortality from 1991-2005, only three jurisdictions have a sufficient level of coverage to enable statistics on Aboriginal and Torres Strait Islander mortality to be produced - Western Australia, South Australia and the Northern Territory. Ideally, the trends data would compare rates for Indigenous and non-Indigenous infant and child mortality. The 'not stated' category for Indigenous status, however, was only included from 1998 onwards (before which, deaths with Indigenous status 'not stated' were included with non-Indigenous deaths). Indigenous mortality rates have therefore been compared with the mortality rates for 'other' Australians (i.e. deaths of both non-Indigenous people as well as those for whom Indigenous status was not stated).
Due to the incompleteness of Indigenous identification in mortality data, the number of deaths registered as Indigenous is an underestimate of the actual number of deaths that occur in the Indigenous population. Identification of Indigenous Australians may also differ between death registrations, birth registrations and the Census. Identification may also vary over time, and at different rates in states and territories. Therefore trends in infant and child mortality rates for Aboriginal and Torres Strait Islander children should be treated with caution.
Infant deaths are deaths of live-born babies who die before reaching their first birthday. For the period 2001-2005, the infant mortality rate for Aboriginal and Torres Strait Islander infants living in Queensland, Western Australia, South Australia and the Northern Territory combined was almost three times that of non-Indigenous infants (table 6.16). The leading causes of death for Indigenous infants were conditions originating in the perinatal period (mainly foetus and newborn babies affected by complications of placenta, cord and membrane, and foetus and newborn babies affected by maternal complications of pregnancy), symptoms, signs and ill-defined conditions (mainly sudden infant death syndrome), congenital malformations, respiratory diseases (mainly pneumonia), injury and poisoning (mainly accidental suffocation and strangulation in bed) and infectious and parasitic diseases (such as septicaemia, meningococcal infection and congenital syphilis).
Mortality rates for respiratory diseases and infectious and parasitic diseases were particularly high for Aboriginal and Torres Strait Islander infants. For these two conditions, mortality rates were 11 and 5 times the rates for non-Indigenous infants.
Trends in infant mortality
Infant mortality rates for Aboriginal and Torres Strait Islander infants decreased significantly in Western Australia, South Australia and the Northern Territory over the period 1991 to 2005. In Western Australia the infant mortality rate fell from 26 per 1,000 live births in 1991 to 12 per 1,000 live births in 2005, with corresponding decreases for South Australia (from 20 to 10 per 1,000 live births) and for the Northern Territory (from 25 to 16 per 1,000 live births). The mortality rate for other Australian infants also declined over this period, but to a lesser extent, so the difference between the two has decreased significantly (graphs 6.17, 6.18 and 6.19). Infant mortality rates in single years for each of these jurisdictions are presented in Chapter 9.
In the period 2001-2005, the mortality rate for Aboriginal and Torres Strait Islander children aged 1-14 years in Queensland, Western Australia, South Australia and the Northern Territory combined, was almost three times the mortality rate for non-Indigenous children in these jurisdictions (table 6.20).
External causes (such as transport accidents, assault and intentional self-harm) were the leading cause of death among Aboriginal and Torres Strait Islander children, and occurred at three times the rate for non-Indigenous children. Indigenous children died from infectious and parasitic diseases, diseases of the respiratory system and circulatory diseases at three to six times the rate of non-Indigenous children.
Trends in child mortality
Childhood mortality rates should be interpreted with caution due to the small number of deaths each year for Indigenous and other Australian children. The data indicate that the child mortality rate for Aboriginal and Torres Strait Islander children decreased significantly in the Northern Territory from 86 per 100,000 children in the period 1991-1993 to 52 per 100,000 children in the period 2003-2005. The child mortality rate for other Australian children decreased significantly in Western Australia and South Australia over this period - from 19 to 15 per 100,000 children in Western Australia - and from 19 to 13 per 100,000 children in South Australia (table 6.21).