Health Service Use and Needs of Aboriginal Children in the Remote Fitzroy Valley, WA

Abstract

Despite a focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges to provision of health services in very remote communities.The Fitzroy Valley is home to 4500 people, the majority (81%) Aboriginal from five language groups. In 2009, Indigenous leaders initiated a research partnership to conduct The Lililwan Project to address community priorities linked to Fetal Alcohol Spectrum Disorders (FASD) and prenatal alcohol exposure (PAE).

Chapter One provides a Thesis introduction and context amidst the broader scope of the Lililwan Project. We aim to identify service gaps and inform future policy and planning for the Fitzroy Valley and similar remote Australian communities.

This Thesis aimed to conduct a literature review to assess availability, access, and use of health services by children in remote Australia. Chapter Two encompasses a strategic search and review of 92 grey and peer-reviewed documents. This chapter highlights the paucity of information around remote dwelling children's access to and health service utilisation across Australia. It highlights difficulties in delivering services in these remote locations. These findings show knowledge gaps of which we aimed to fill in subsequent chapters.

Chapter Three aimed to document existing paediatric services in the Fitzroy Valley. Semi-structured interviews were performed with clinicians/service managers from 17 key service providers. Qualitative analyses occurred throughout. We identified that service delivery is impacted by inadequacies in staffing, infrastructure, funding complexities, service coordination, large geographic areas and extreme environment. There is a critical shortage of Aboriginal Health Workers (AHW) and a dearth of comprehensive preventative and primary health care. This work will inform future health service planning and staffing strategies.

In Chapter Four we review lifetime (0-7 years) admissions to hospital for the Lililwan cohort. 70% of children had at least one admission (total 314 admissions, median 5, range 1-12). Infants (N=56) accounted for 38.6% of admissions. Primary admission reasons were infections including: lower respiratory; gastrointestinal; upper respiratory. Comorbidities were common. Many hospitalisations were feasibly preventable. The high rates may reflect disadvantage and limited access to outpatient and preventative health services.

Chapter Five aimed to review emergency department (ED) presentations to the Fitzroy Crossing Hospital (between 2007-11) for the Lililwan cohort. There were 1058 presentations over 5-years. Most children (81%) had at least one presentation (median 9.0, range 1-50). Common presentations were for screening/follow-up/social reasons, injury, diseases of the ear, skin, respiratory tract. Children with prenatal alcohol exposure (PAE) presented at higher rates. Socio-economic factors were associated. Many presentations were potentially preventable. There is a need for culturally appropriate public health preventative strategies and improved access to primary health services. Chapter Six provides a summary of the principal findings of this Thesis, describes the implications, proposes directions for future research and presents recommendations. In conclusion, this Thesis provides the first population-based cohort study of predominantly Aboriginal children with PAE and FASD. The findings provide new information regarding children's access to and utilisation of health services in remote Australian communities. This demonstrates the significant challenges that children with complex chronic and acute health needs in remote Australia face. This has significant implications for informing future health services and workforce planning in remote Australia. Future work in this area is key to ensure the health and wellbeing needs of this particularly vulnerable group of children are met. Show more