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A literature review of overweight and obesity prevention and management programmes for Australian Aboriginal and Torres Strait Islander children 5-17 years to inform a co-design weight management intervention in an urban Aboriginal community. Systematic searching of PubMed, Science Direct, Lowitja LitSearch and hand-searching of references, government and Aboriginal websites. Programmes were categorised as including nutrition and food literacy, cooking skills, health education and cultural components. Quality was assessed against the CREATE QAT Tool. Eight programmes, including two evaluations and six programme descriptions, were identified. Interventions ranged in duration from 1 day to 10 weeks involving nutrition education, health information, cooking skills, exercise and cultural content. There were no significant reductions in weight outcomes, although there were reported positive health changes to the children including a reduction in waist circumference and an increase in exercise levels. Insights for future research include effective co-design with community and the delivery of flexible content through an Aboriginal-led, multifaceted programme. There is limited evidence for the prevention and management of weight in Aboriginal children with overweight and obesity. Future research efforts should include more time-intensive, multifaceted, community-run programmes that are supported by medical, advocacy and evaluation expertise from health services., (© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aim: There is limited information on the health status of urban Australian Aboriginal children and young people attending community-based child health services. Such information is vital to plan appropriate services. The objective of the study is to describe the health status and service use of children and young people presenting to an urban Aboriginal Community Paediatric Service in Sydney, Australia., Methods: Cross-sectional analysis of routinely collected data extracted from electronic medical records and the Australian Immunisation Register for urban Aboriginal children and young people aged 0-18 years who visited the service between January 2013 and December 2017., Results: A total of 273 Aboriginal children and young people had 609 occasions of service. Almost all (97.35%) were fully immunised. Forty-six percent of occasions of service noted >3 diagnoses; 55% of the consultations were for mental health and behavioural disorders. The most frequent diagnoses were speech and language delay, attention deficit hyperactivity disorder and school difficulty. Psychosocial concerns were noted in 61.2% of occasions of service, and 19.4% of children had a history of prematurity. Eighty-five percent of consultations had an onward referral to additional services. The most common referrals were for audiology, ear-nose and throat specialists and speech therapy. There were low numbers of referrals to mental health services relative to the high number of mental health diagnoses., Conclusion: It is essential that we address the mental, developmental and psychosocial needs of Aboriginal children and young people who attend urban Community Child Health services. Integrated service models should be developed in partnership with Aboriginal community to do this., (© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: The aim of this study was to measure young people's health status and explore associations between health status and belonging to one or more socio-culturally marginalised group., Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12-24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures., Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions ( p = 0.001), a greater likelihood of high psychological distress ( p = 0.001) and of illness or injury related absence from school or work ( p < 0.05)., Conclusions: increasing marginalisation is associated with decreasing health status. Using an intersectional lens can to be a useful way to understand disadvantage for young people belonging to multiple marginalised groups.

Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children's hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children's Hospitals Network (SCHN) over five years (2011-2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of significance were: Circulatory disorders (Odds Ratio (OR) 17.16, p < 0.001), neoplasm/blood/immune disorders (OR 2.77, p < 0.001), emergency admissions (OR 1.94, p < 0.001), aboriginality (OR 1.73, p = 0.005) and longer length of stay (OR 1.012; p < 0.001). Conclusions: Our data show that Aboriginal children are almost twice as likely to die than non-Aboriginal children. In particular, excess deaths in Aboriginal children are most commonly from outer regional and remote areas and children aged under 2 years with perinatal or circulatory conditions.

Objectives: To investigate differences in demographic and clinical characteristics of Aboriginal and non-Aboriginal children aged 0-4 years hospitalised for unintentional poisoning in New South Wales (NSW), Australia., Design and Setting: Retrospective whole-of-population cohort analysis of linked hospital and mortality data for 2000-2014., Participants: All children (Aboriginal and non-Aboriginal) under the age of 5 years who were born in a hospital in NSW from 2000 to 2009., Outcomes: The primary outcome was hospitalisation for unintentional poisoning. Logistic regression was used to estimate odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children. Poisoning agents and clinical outcomes were compared by Aboriginality., Results: The cohort included 767 119 children, including 28 528 (3.7%) Aboriginal children. Aboriginal children had approximately three times higher rates of hospitalised poisoning (1.34%) compared with non-Aboriginal children (0.41%). Poisoning incidence peaked at 2-3 years of age. Male sex, socioeconomic disadvantage and geographical remoteness were associated with higher odds of poisoning hospitalisation for Aboriginal and non-Aboriginal children, but associations with disadvantage and remoteness were statistically significant only for non-Aboriginal children. Most (83%) poisonings were caused by pharmaceutical agents. Few Aboriginal and non-Aboriginal children had repeat admissions for poisoning; most had a length of stay of 1 day or less. Only 8% of poisoning admissions involved contact with a social worker., Conclusion: Commonly used medications in the general population contribute to poisonings among both Aboriginal and non-Aboriginal preschool-aged children. This study highlights a need to develop culturally safe poisoning prevention strategies and policies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To determine the cultural competency training, knowledge and attitudes of health professionals about Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health-care delivery., Methods: Survey of medical (n = 200), nursing (n = 200) and other health professionals (n = 210) working in two tertiary paediatric hospitals in December 2013. The main outcome measures were training in Aboriginal health-care delivery, knowledge of Aboriginal health and services, attitudes to identification of Aboriginal patients and suggested ways to improve health-care delivery to Aboriginal patients., Results: We received responses from 286 of 572 (50.0%) staff with valid emails: 75 medical, 88 nursing and 123 other health professionals. A minority reported receiving specific Aboriginal health training (126/286, 44.8%) and Aboriginal cultural competency training (106/286, 37.1%). Medical staff were less likely than others to report Aboriginal health-care training (P = 0.01), cultural competency training (P < 0.001) and that their training equipped them to manage Aboriginal patients (P = 0.04). Few medical staff reported a good/very good knowledge of the services provided by the Aboriginal Community Controlled Health Services (20.0%), the Federal Government Closing the Gap initiative (14.7%) or the Royal Australasian College of Physicians' Reconciliation Action Plan (8.0%). Only 62 of 286 (21.7%) staff agreed that they usually asked patients/parents whether they identified as Aboriginal. Although 256 of 286 (89.5%) agreed that Aboriginal staff were an important resource, only 125 of 286 (43.7%) had referred Aboriginal patients to one., Conclusion: The opportunities we have identified to improve health-care delivery to Aboriginal patients include: increasing Aboriginal cultural competency training, correct identification of Aboriginal patients, referring Aboriginal patients to Aboriginal health-care services and increased awareness of Aboriginal Community Controlled Health Services., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Aims: To describe the engagement of a cohort of urban Aboriginal families with an Early Childhood Health Service, and to assess any association of engagement with the service with screening by the Edinburgh Post-Natal Depression Scale (EPDS), full breastfeeding rates and post-natal smoking status., Methods: Routine electronic medical record data collected by a Child and Family Health Nurse between 2011 and 2014 was analysed retrospectively. Associations between use of the service and acceptance of EPDS, breastfeeding rates and post-natal smoking status were determined using binary and multinomial multiple logistic regression analyses., Results: There were 424 Aboriginal babies and 215 mothers included in the study. Each occasion of service increased the odds of accepting screening with the EPDS (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.00-1.03, P = 0.04) and complete breastfeeding (OR 1.11, CI 1.01-1.23, P = 0.04), but not of quitting smoking (OR 0.99, CI 0.96-1.02, P = 0.34). Despite accounting for engagement with the service, overall uptake of the EPDS remained low; of 267 offers for EPDS screening, only 115 were accepted (43%)., Conclusion: The service was accessed in increasing numbers during the study period. Mothers who utilised the service more frequently were more likely to accept EPDS screening and exclusively breastfeed; however, acceptance of EPDS screening remained low overall. Further research is recommended to investigate the low acceptance of EPDS in this Aboriginal population and whether those results are transferable to other communities., (© 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children., Methods: This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, and private health insurance/patient status. Area-level covariates included remoteness of residence and area socioeconomic disadvantage., Results: There were 365 386 potentially avoidable hospitalizations observed over the study period, most commonly for respiratory and infectious conditions; Aboriginal children were admitted more frequently for all conditions. Avoidable hospitalization rates were 90.1/1000 person-years (95 % CI, 88.9-91.4) in Aboriginal children and 44.9/1000 person-years (44.8-45.1) in non-Aboriginal children (age and sex adjusted rate ratio = 1.7 (1.7-1.7)). Rate differences and rate ratios declined with age from 94/1000 person-years and 1.9, respectively, for children aged <2 years to 5/1000 person-years and 1.8, respectively, for ages 12- < 14 years. Findings were similar for the subset of ambulatory care sensitive hospitalizations, but in contrast, non-avoidable hospitalization rates were almost identical in Aboriginal (10.1/1000 person-years, (9.6-10.5)) and non-Aboriginal children (9.6/1000 person-years (9.6-9.7))., Conclusions: We observed substantial inequalities in avoidable hospitalizations between Aboriginal and non-Aboriginal children regardless of where they lived, particularly among young children. Policy measures that reduce inequities in the circumstances in which children grow and develop, and improved access to early intervention in primary care, have potential to narrow this gap.

Objectives The aims of the present study were to: (1) describe the health status and health indicators for urban Aboriginal children (age 0-16 years) in south-east Sydney; and (2) evaluate the quality of routinely collected clinical data and its usefulness in monitoring local progress of health outcomes. Methods Aboriginal maternal and child health routine data, from multiple databases, for individuals accessing maternal and child health services between January 2007 and December 2012 were examined and compared with state and national health indicators. Results Reductions in maternal smoking, premature delivery and low birthweight delivery rates were achieved in some years, but no consistent trends emerged. Paediatric services had increased referrals each year. The most frequent diagnoses were nutritional problems, language delay or disorder and developmental delay or learning difficulties. Twenty per cent of children had a chronic medical condition requiring long-term follow-up. Aboriginal children were more likely to be discharged from hospital against medical advice than non-Aboriginal children. Routinely collected data did not include some information essential to monitor determinants of health and health outcomes. Conclusions Aboriginal children living in this urban setting had high levels of need. Routinely recorded data were suboptimal for monitoring local health status and needed to reflect national and state health indicators. Routinely collected data can identify service gaps and guide service development. What is known about this topic? Despite improvements in some areas, there continue to be significant gaps in maternal and child health outcomes between Aboriginal and non-Aboriginal Australians. These are poorly documented at a local service level. What does this paper add? Intensive, local services offered to Aboriginal women and children can result in rapid service engagement. Health service data routinely collected by local services can be used to demonstrate reductions in antenatal risk factors in pregnant Aboriginal women, even within the short time frame of 6 years. However, improvements in child health outcomes may require longer time frames. In this urban setting, the most frequent diagnoses in Aboriginal children attending the service were nutritional problems, language delay or disorder and developmental delay or learning difficulties. What are the implications for practitioners? Key information regarding determinants of health should be routinely monitored at a local level to understand local rates and health needs in addition to evaluating and quantifying the effectiveness of service delivery or health promotion activities.

Objectives: To evaluate an urban art-based community health program (Ngala Nanga Mai; We Dream) that seeks to improve health, education, empowerment and connectedness of Aboriginal parents by describing paediatric health service attendance, maternal educational engagement, participant growth and empowerment, and worker and participant experiences., Methods: Mixed methods were used. Qualitative data was collected through interviews and focus groups. Demographics, health service use and child health status were extracted from clinical records. Psycho-social empowerment and wellbeing was measured using the Growth and Empowerment Measure (GEM). A Critical Effectiveness Factor framework that measures factors necessary for success, effectiveness and sustainability was used to assess program quality., Results: Between 2009 and 2012, 92 Aboriginal parents participated. A total of 93.5% of regular participants engaged their children at least once with paediatric health services and 27.1% undertook further education. Empowerment scores significantly improved, despite little change in psychological distress. The program operationalised all 10 Critical Effectiveness Factors for youth wellbeing., Conclusions: Ngala Nanga Mai creates an environment of social connectedness, strengthened parenting, maternal and child wellbeing and empowerment. It supports increased utilisation of health, education and support services, and early detection of treatable child health issues., Implications: Improving the health of Aboriginal children requires new strategies and learning from innovative programs. Solid baseline data, long-term follow-up data and meaningful health outcome data are critical to improving services and health outcomes at the program level. Ultimately, long-term commitment to adequate resourcing is needed in order to deliver broader improvement of child health outcomes., (© 2015 The Authors.)

Aim: This study describes the presentations made to the Sydney Children's Hospital (SCH) Emergency Department (ED) by local Aboriginal and Torres Strait Islander (Aboriginal) children with particular reference to children who present frequently or whose presentation was preventable., Methods: Data from the SCH ED Information System were extracted for all presentations made by children who identified as Aboriginal, aged between 0-15 years, who presented between 2005-2008. Presentations were coded according to the presenting problem, diagnosis, outcome, and whether the presentations were potentially preventable. Preventable presentations include those presentations considered to be avoidable and those that could have been managed by a local primary care or community service., Results: There were 1252 presentations to the SCH ED by 453 Aboriginal children aged 0-15 years. More than 50% of children presented more than once. Seventy-nine children presented more than five times. Nearly 45% of presentations were coded as potentially preventable., Conclusions: A significant proportion of ED presentations were potentially preventable with the use of culturally appropriate and accessible local community and primary health care services and better referral pathways back to these services. Community engagement is required to raise awareness of common presentations and to look at strategies to prevent common problems both occurring and presenting to the ED. This will enhance the health of urban Aboriginal children., (© 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)