ABSTRACT
AIM: To determine the influence of perinatal and childhood exposures on lung function in a cohort of Australian Aboriginal children. METHODS: This was a cross-sectional study of 547 Northern Territory Aboriginal children, aged 8-14 years, belonging to a birth cohort. Assessment included physical examination and spirometry as well as retrospective review of centralised hospital records. The effect of select perinatal and childhood exposures on lung function outcomes (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and forced expiratory flow between 25 and 75 s (FEF25-75)) adjusted for age, sex, height and other measures of size was examined using multiple regression. RESULTS: Non-urban residence (FEV1 -5% (95% confidence interval, CI 0.91-0.99), FVC -9% (95% CI 0.87-0.95)), current cough (FEV1 -6% (95% CI 0.91-0.97), FVC -4% (95% CI 0.93-0.97), FEF25-75 -8% (95% CI 0.86-0.98)) and hospitalisations for respiratory disease (FEV1 -10% (95% CI 0.86-0.95), FEF25-75 -12% (95% CI 0.70-0.87)) all had significant negative effects on adjusted lung function measures. Children with a non-Aboriginal ancestor had significantly better lung function. No perinatal exposure other than neonatal lung disease had any significant effect on adjusted lung function. CONCLUSIONS: For Northern Territory Aboriginal children factors related to the childhood environment are more important than perinatal factors in determining childhood lung function.
Subject(s)
Lung/physiology , Native Hawaiian or Other Pacific Islander , Adolescent , Child , Cross-Sectional Studies , Female , Humans , Male , Medical Audit , Northern Territory , Physical Examination , Retrospective Studies , Risk Factors , SpirometryABSTRACT
OBJECTIVES: To describe the characteristics and short-term outcomes of children with malnutrition admitted to Dili National Hospital (DNH), East Timor. METHODS: A prospective observational survey using caretaker interviews and medical record review was conducted on the paediatric ward at DNH for 12 months from March 2002. Patients were children aged 2 months to 12 years, admitted with moderate to severe malnutrition as either a primary or secondary diagnosis. RESULTS: Malnutrition was present in 31.8% (280/880) of paediatric admissions during the study period. Sixty-one per cent of the malnutrition cases were severe malnutrition (weight-for-height below -3 Z-scores and/or oedema) and 53.7% were both wasted and stunted. The hospital case-fatality rate was 12.9% (36/280). Immunization coverage was low, with 39% of cases never immunized and 29% incompletely immunized according to the national immunization schedule. CONCLUSIONS: There is a high rate of malnutrition among paediatric inpatients at DNH, consistent with results of anthropometric surveys in the newly independent East Timor. Despite the introduction of a standardized protocol following WHO guidelines and associated training on the management of severe malnutrition, the hospital case-fatality rate for severe malnutrition was still high (12.9%).
Subject(s)
Child Nutrition Disorders/epidemiology , Hospitals, Public , Anthropometry , Child , Child Nutrition Disorders/diagnosis , Child Nutrition Disorders/therapy , Child Welfare , Child, Preschool , Comorbidity , Family Characteristics , Female , Health Care Surveys , Humans , Infant , Male , Medical Audit , Prospective Studies , Timor-Leste/epidemiology , Treatment OutcomeABSTRACT
OBJECTIVES: To describe the prevalence of markers of growth, chronic and infectious disease in peripubertal Aboriginal children living in the Darwin Health Region in the "Top End" of the Northern Territory, and to compare prevalence between children living in urban and remote areas. DESIGN: Cross-sectional survey nested in a prospective birth cohort. SUBJECTS: 482 children living in the region who were recruited at birth (Jan 1987 to Mar 1990) and were followed up between 1998 and 2001, when aged 8-14 years. MAIN OUTCOME MEASURES: Selected parameters of growth and nutrition, infectious disease and potential markers of chronic adult disease were compared between children living at follow-up in suburban situations in Darwin-Palmerston (urban) and those living in rural communities with an Aboriginal council (remote). RESULTS: Remote children were shorter than urban children (mean height, 141.7 v 146.3 cm; P < 0.001), lighter (median weight, 30.3 v 37.1 kg; P < 0.001) and had lower body mass index (median, 15.3 v 17.9 kg/m(2); P < 0.001) and haemoglobin level (mean, 125.1 v 130.9 g/L; P < 0.001). Some potential markers of adult chronic disease were higher in urban than remote children: systolic blood pressure (mean, 109.6 v 106.2 mmHg; P = 0.004), and levels of total cholesterol (4.3 v 4.0 mmol/L; P < 0.001), high-density lipoprotein cholesterol (mean, 1.4 v 1.2 mmol/L; P < 0.001) and insulin (median, 7 v 4 mU/L; P = 0.007). Diastolic blood pressure, levels of red cell folate, serum glucose and low-density lipoprotein cholesterol, and urinary albumin-creatinine ratio did not differ by location. The prevalence of visible infections was also higher in remote than urban children (P < 0.05). CONCLUSION: As some markers of health differ between peripubertal Aboriginal children living in urban areas and those in remote areas, results of surveys in remote areas cannot be generalised to urban Aboriginal populations.
