Dossetor Philippa J, Martiniuk Alexandra L C, Fitzpatrick James P, Oscar June, Carter Maureen, Watkins Rochelle, Elliott Elizabeth J, Jeffery Heather E, Harley David
Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, 97/2 Edinburgh Ave, Canberra, ACT, 2601, Australia.
University of Sydney, Discipline of Paediatrics and Child Health, Sydney Medical School, Sydney, Australia.
BMC Pediatr. 2017 Nov 22;17(1):195. doi: 10.1186/s12887-017-0947-0.
We analysed hospital admissions of a predominantly Aboriginal cohort of children in the remote Fitzroy Valley in Western Australia during the first 7 years of life.
All children born between January 1, 2002 and December 31, 2003 and living in the Fitzroy Valley in 2009-2010 were eligible to participate in the Lililwan Project. Of 134 eligible children, 127 (95%) completed Stage 1 (interviews of caregivers and medical record review) in 2011 and comprised our cohort. Lifetime (0-7 years) hospital admission data were available and included the dates, and reasons for admission, and comorbidities. Conditions were coded using ICD-10-AM discharge codes.
Of the 127 children, 95.3% were Indigenous and 52.8% male. There were 314 admissions for 424 conditions in 89 (70.0%) of 127 children. The 89 children admitted had a median of five admissions (range 1-12). Hospitalization rates were similar for both genders (p = 0.4). Of the admissions, 108 (38.6%) were for 56 infants aged <12 months (median = 2.5, range = 1-8). Twelve of these admissions were in neonates (aged 0-28 days). Primary reasons for admission (0-7 years) were infections of the lower respiratory tract (27.4%), gastrointestinal system (22.7%), and upper respiratory tract (11.4%), injury (7.0%), and failure to thrive (5.4%). Comorbidities, particularly upper respiratory tract infections (18.1%), failure to thrive (13.6%), and anaemia (12.7%), were common. In infancy, primary cause for admission were infections of the lower respiratory tract (40.8%), gastrointestinal (25.9%) and upper respiratory tract (9.3%). Comorbidities included upper respiratory tract infections (33.3%), failure to thrive (18.5%) and anaemia (18.5%).
In the Fitzroy Valley 70.0% of children were hospitalised at least once before age 7 years and over one third of admissions were in infants. Infections were the most common reason for admission in all age groups but comorbidities were common and may contribute to need for admission. Many hospitalizations were feasibly preventable. High admission rates reflect disadvantage, remote location and limited access to primary healthcare and outpatient services. Ongoing public health prevention initiatives including breast feeding, vaccination, healthy diet, hygiene and housing improvements are crucial, as is training of Aboriginal Health Workers to increase services in remote communities.
我们分析了西澳大利亚偏远菲茨罗伊山谷中以原住民为主的儿童队列在其生命的前7年中的住院情况。
所有在2002年1月1日至2003年12月31日之间出生且在2009 - 2010年居住在菲茨罗伊山谷的儿童均有资格参与Lililwan项目。在134名符合条件的儿童中，127名（95%）于2011年完成了第一阶段（对照顾者的访谈和病历审查），并组成了我们的队列。可获取终生（0 - 7岁）住院数据，包括住院日期、住院原因和合并症。疾病情况使用ICD - 10 - AM出院编码进行分类。
127名儿童中，95.3%为原住民，52.8%为男性。127名儿童中有89名（70.0%）因424种疾病住院314次。89名住院儿童的住院次数中位数为5次（范围1 - 12次）。男女住院率相似（p = 0.4）。在这些住院病例中，108次（38.6%）是56名年龄小于12个月婴儿的住院（中位数 = 2.5，范围 = 1 - 8次）。其中12次住院是新生儿（0 - 28天）。（0 - 7岁）住院的主要原因是下呼吸道感染（27.4%）、胃肠系统疾病（22.7%）、上呼吸道感染（11.4%）、损伤（7.0%）和发育不良（5.4%）。合并症很常见，尤其是上呼吸道感染（18.1%）、发育不良（13.6%）和贫血（12.7%）。在婴儿期，住院的主要原因是下呼吸道感染（40.8%）、胃肠疾病（25.9%）和上呼吸道感染（9.3%）。合并症包括上呼吸道感染（33.3%）、发育不良（18.5%）和贫血（18.5%）。
在菲茨罗伊山谷，70.0%的儿童在7岁前至少住院一次，超过三分之一的住院病例是婴儿。感染是所有年龄组住院的最常见原因，但合并症也很常见，可能导致住院需求。许多住院情况在可行的情况下是可以预防的。高住院率反映了不利条件、地理位置偏远以及获得初级医疗保健和门诊服务的机会有限。持续开展包括母乳喂养、疫苗接种、健康饮食、卫生和住房改善等公共卫生预防举措至关重要，培训原住民卫生工作者以增加偏远社区的服务也同样重要。
