Suchergebnisse

Despite South Africa having ratified several international and regional women's and children's rights treaties, and having one of the most admired constitutions in the world, the plight of women and children after 20 years of democracy remains, in many respects, dire—especially in rural communities. South Africa is a deeply conservative and patriarchal society, with high levels of violence in general and gender-based violence in particular. It has failed to create sufficient employment opportunities and to sustainably address intergenerational poverty, the latter of which impacts most severely rural women and children. HIV/AIDS has wreaked its most adverse effects on women and children. This context is exacerbated by breakdowns in the health, education, justice, and security sectors; the relative inaccessibility of services (such as health care, schooling, and housing); and the frequently poor quality of services when they are available.

Historically, neural tube defects (NTD) in Australia affected around 1 in every 1000 births; 42% higher for Aboriginal births. Following firm evidence of the protective effect of periconceptional folate, health promotion activities encouraged increased folate intake through diet and supplements and limited voluntary food fortification. A 30% reduction in NTD was observed in non-Aboriginal but not Aboriginal infants, widening the disparity between Aboriginal and non-Aboriginal rates. Mandatory flour fortification with folic acid in 2009, led to further reductions in overall NTD, and greater reduction among Aboriginal infants, such that rates in Aboriginal and non-Aboriginal infants were similar by 2010–2014. Elimination of this disparity will make a small but important contribution to the Australian government's Closing the Gap initiative to reduce disadvantage among Aboriginal people. Long-term, complete, high-quality surveillance data on NTD have been of great value in monitoring trends in and evaluation of public health interventions for NTD in Australia.

IntroductionCongenital heart defects (CHD) are diagnosed up to age 6 in 8-12/1,000 births annually in Western Australia. Recent improvements in management of infants with CHDs has significantly increased survival; approximately 85\% of infants with CHDs live beyond childhood. However, children with CHDs may have increased risk of life-long intellectual disabilities.
Objectives and ApproachWe conducted a study of 20,997 children to determine risk of intellectual disability (ID). All singleton, live born infants with CHDs born 1983-2010 were identified from the Western Australian Register for Developmental Anomalies, a statewide birth defects registry (n=6,968). Infants without CHDs born 1983-2010 were randomly selected from birth records (n=14,029). All data were linked to the Western Australia Midwives Notification System to obtain maternal and infant information. Children with ID were identified by linkage to the statewide Intellectual Disability Exploring Answers database. Risk ratios (RR) and 95% confidence intervals (CI) were calculated from multivariable logistic regression analyses.
ResultsOf 20,997 children, 965 (4.6%) had an ID; 1.3% of children without CHDs and 11.2% of children with CHDs had an ID (P<0.001). 0.2% of children without CHDs and 0.4% of children with CHDs had autism. Three percent of children with CHDs had a known biomedical cause for ID (excluding trisomy 21) and 4.4% of children with CHDs had trisomy 21. Children with CHDs had 9 times the risk of ID compared to children without CHDs (RR=9.30; 95% CI: 7.91, 10.94). Children with CHDs almost had a twofold increased risk of autism compared to children without CHDs (RR=1.78; 95% CI: 1.07, 2.95). The greatest risk of ID among children with CHDs was associated with trisomy 21 (RR=166.0; 95% CI: 78.5, 350.8).
Conclusion/ImplicationsChildren with CHDs have higher risk of ID than children without CHDs. Although the greatest risk for ID was for trisomy 21, children with CHDs still had increased risk of ID from other causes and all causes overall. Future research should elucidate the underlying etiology of ID in these children.

ABSTRACTObjectivesPrevious research has identified that heavy maternal alcohol use impacts on a child's health and development including poor cognitive and educational outcomes. However, very few studies have used objective measures of heavy alcohol-use and standardised school-based measures. Further, the magnitude of the effect of heavy maternal alcohol use on the educational outcomes of children in Australia is unknown. The primary aim of the project was to examine the association between in-utero and childhood exposure to maternal alcohol use disorder, which provides a proxy for heavy alcohol use, and children's educational outcomes.
ApproachThis Western Australian population cohort study made use of linked administrative data to compare the educational outcomes of a cohort of exposed children born between 1989 and 2007 whose mother had an alcohol related diagnosis recorded on health datasets, with children whose mother did not have a diagnosis. The exposed cohort of mothers was frequency matched on maternal age within Indigenous status, and year of child's birth with a comparison cohort of mothers without an alcohol-related diagnosis. Records were linked with education records up to 2011, which included the results of standardised state and national testing for children (ages 8-14), and school attendance data (ages 6-18). Mixed multivariate models were used to examine the relationship between exposure, and timing of exposure in relation to pregnancy, and the risk of failure to meet educational benchmarks for reading, writing, spelling, numeracy and school attendance. Separate analyses were run for Indigenous and non-Indigenous children.
ResultsA higher proportion of both Indigenous and non-Indigenous exposed children failed to reach minimum standards for all domains of testing compared to those in the unexposed cohort. The risk of failure in the exposed cohort remained significant with adjustment for a set of known confounders and there was no consistent relationship between timing of exposure and academic performance.
ConclusionThis project provides a unique view of how maternal alcohol use disorders affect a child's educational outcomes. The use of linked administrative data overcomes the use of retrospective recall of past behaviour, and self-reports of drinking patterns which may be considered socially unacceptable. Results of this project indicate that children whose mothers have an alcohol use disorder are academically at risk. These results suggest that routine monitoring of maternal alcohol use, early identification of at-risk children and intervention at both the school and family level may assist vulnerable children to reach academic benchmarks.

ABSTRACT
ObjectivesTo examine the risk of abuse and neglect for children with different types of disabilities taking into account other existing adversities, including socioeconomic disadvantage, parental mental health issues, etc.
ApproachPopulation based record linkage study of all children born between 1990-2010 utilising the Western Australian Register of Developmental Anomalies, the Intellectual Disabilities Exploring Answers database, Health data and Child Protection data.
ResultsAfter taking into account existing adversities intellectual disability was associated with the highest risk of a child maltreatment allegation and entering out-of-home care. Further results include risk by level of intellectual disability and causes of disability.
ConclusionDifferent disabilities are associated with differing risk of child maltreatment and child protection involvement. Groups that are considered at higher risk require services to identify and address the support needs of this group and determine how prevention and early intervention can lower the risk for child abuse and neglect in this vulnerable group.

AbstractLittle is known about the significance of cultural differences to how caregivers receive a diagnosis of neurodevelopmental disability. As part of a Fetal Alcohol Spectrum Disorder prevalence study among sentenced, detained youth, our qualitative study explored the experiences of diagnostic assessment among detained young people and their caregivers. We present findings from the perspectives of caregivers. In conversation with the sociology of diagnosis literature, we present vignettes of three Aboriginal and two non‐Aboriginal caregivers' experiences of the diagnostic assessment process. We found that Aboriginal caregivers conceptualised their children's diagnosis and ongoing management in the context of their family networks and community. In contrast, non‐Aboriginal caregivers focused on how the diagnosis would affect their child and interactions with various institutions including healthcare systems and schools. Caregivers' engagement with diagnostic reports and resources also followed cultural lines. Reflections on intergenerational drinking were voiced by Aboriginal caregivers, who expressed shame at receiving diagnosis. These findings advance our appreciation of cultural difference in receiving a diagnosis, the examination of which is in its nascent stages. We also suggest ways to mitigate harm from a stigmatising diagnosis and soften the well‐established effects of medical dominance over the process of defining a person's capacity and status.

Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by exposure to alcohol in utero. It has pervasive, lifelong impacts and is recognised as a major public health concern in many countries where alcohol is used. The FASD Research Australia Centre of Research Excellence (CRE) was funded by the National Health and Medical Research Council to generate and translate evidence to address prevention, diagnosis, and management of FASD in Australia. The current paper describes the approach to policy and practice impact taken by our CRE, including our stakeholder engagement processes and the key principles that underlie our approach. We provide examples of policy and practice influence in FASD prevention, diagnosis and management that have been achieved over the past five years and discuss challenges that are routinely faced in the translation of our work.

IntroductionFetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcoholexposure (PAE). FASD research is a rapidly growing field that crosses multiple disciplines. To ensureresearch is relevant and meaningful for people living with FASD, their families, and the broader publicthere is a need to engage community members in setting priorities for research.
ObjectivesOur primary objective was to formally identify the views of people living with FASD, their par-ents/caregivers, service providers, and the general community on the research priorities for FASDand alcohol use in pregnancy in Australia. Our secondary objective was to provide an overview ofcurrent research in the highest priority areas identified.
MethodsThe approach for this study involved two community surveys and a consensus workshop, followed bya rapid literature review. Survey responses (n = 146) were collected and grouped using qualitativethematic analysis. The themes identified were then ranked in a second survey (n = 45). The 22highest ranked themes were considered in a workshop with 21 community members, and consensuson the top ten priority areas was sought. The priority areas were grouped into conceptually similartopics and rapid literature reviews were undertaken on each.
ResultsA diverse range of priorities was identified within key areas of prevention, diagnosis, and therapy. Onrequest from participants, separate priority lists were developed by Aboriginal and non-Aboriginalparticipants.
ConclusionsThere is need for a national network of researchers to take forward the research commenced by theCentre of Research Excellence, FASD Research Australia, in addressing community priorities.