ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 39-2012

Maori Health Review
Maori Health Review

Medical assessment for child sexual abuse: A post-code lottery?

Authors: Everitt R et al

Summary: These researchers determined that 804 medical assessments for child and adolescent sexual abuse (children aged 0 to 16) were performed over 12 months (July 1 2006 to June 30 2007) throughout NZ. CYF received 73,326 notifications; 46,776 required further action (investigation). Child protective services regarded 1207 cases as substantiated, and 1434 claims for mental injury were lodged. CYF was involved in 628 of the 804 cases seen for medical assessment. In the matched Auckland cohort, CYF substantiated 162 of the 317 cases of sexual abuse in Auckland that year. However, CYF substantiated 418 cases of sexual abuse in Auckland that year. Therefore, only 162/418 (38%) were medically assessed. A doctor with expertise in the assessment of sexual abuse was available in most areas, but service structure varied widely. The availability of nurse or social work support was poor. The proportion of children and adolescents receiving a medical assessment, and the quality of service structure, was directly related to regional population.

Comment: Surely this is an area that requires 1. A national, standardised approach and 2. Timely, appropriate and specialised care. Hopefully, this is something that the Children’s Commissioner will address or an issue that Owen Glenn’s donation will tackle.

Reference: J Paediatr Child Health. 2012;48(5):389-94.


The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study

Authors: Mills C et al

Summary: Findings are reported from a preliminary analysis of the cost of health inequities between Māori and non-Māori children in New Zealand. The estimate of the health sector costs of child health inequities between Māori and non-Māori suggests a cost saving to the health sector of $24,737,408 per annum. However, significant societal costs were identified: over $NZ62 million per year in a conservative “base case” scenario estimate, with alternative costing methods identifying even larger costs of nearly $NZ200 million per annum. The total cost estimate was found to be highly sensitive to the costing method used, the discount rate and Value of Statistical Life applied: the cost of potentially avoidable deaths of Māori children was a large proportion of the total costs.

Comment: Although described by the authors as a scoping study, the preliminary findings are astounding. Not only have they shown preferential spending by ethnicity in Aotearoa, but they have also highlighted the fact that traditional methods and measures may underestimate the problem.

Reference: BMC Public Health. 2012;12(1):384.


The practice of surrogacy in New Zealand

Authors: Anderson L et al

Summary: The New Zealand Human Assisted Reproductive Technology Act 2004 (HART Act) prohibits commercial surrogacy but does allow for altruistic clinic-assisted surrogacy. Couples wishing to attempt altruistic surrogacy must apply for approval to a statutorily appointed ethics committee. These researchers reviewed the outcomes of surrogacy applications since the HART Act was established and the uptake of surrogacy by Māori. Of 104 applications for surrogacy between 2005 and 2010, 4 (3.8%) were declined. By July 2011, of 100 approved, there were 26 (26%) live births; 52 (52%) were discontinued, and 22 (22%) were ongoing. Māori are much less likely to utilise surrogacy. Of the 104 original applications, 9 (8.6%) Māori women were willing to act as a surrogate, and 2 (1.9%) were intended mothers. Seven (6.7%) Māori were partners of a surrogate, with 2 (1.9%) intending mothers having Māori partners

Comment: I thought this was an interesting paper as I see the adverts calling for potential surrogates and always wonder about the people behind them. Importantly, the study reviewed applications to HART and did not look at non- HART surrogacy. This may be more difficult to estimate and examine.

Reference: Aust N Z J Obstet Gynaecol. 2012;52(3):253-7.


The incidence, clinical features, and treatment of type 2 diabetes in children <15 yr in a population-based cohort from Auckland, New Zealand, 1995–2007

Authors: Jefferies C et al

Summary: Data were retrospectively analysed from 52 patients with type 2 diabetes mellitus (T2DM) from a population-based treatment referral cohort, from 1 January 1995 to 31 December 2007. Over this time, the annual incidence of new cases of T2DM in children 9% in both groups.

Comment: Major messages here to those working in primary care about type 2 DM in under 15-year-olds – the incidence has increased five-fold in the past decade; children are symptomatic but diagnosis is late; and it is poorly managed. Appropriate investigation is required in suspect cases or we may need to consider some form of screening programme.

Reference: Pediatr Diabetes. 2012 May 31. doi: 10.1111/j.1399-5448.2012.00851.x. [Epub ahead of print]


Maori Health Review

Geographic, ethnic and socioeconomic factors influencing access to implantable cardioverter defibrillators (ICDs) in New Zealand

Authors: Wilson D et al

Summary: All new implanted cardioverter defibrillator (ICD) recipients in 2010 were assessed according to home DHB, ethnicity and socioeconomic status using the NZDep index. A total of 352 new ICDs were implanted nationwide during 2010, yielding an overall implantation rate of 80.6/million. There was substantial variance in implant rates across the 20 DHBs with the highest implant rate observed in Tairawhiti at 192.3/million, and the lowest at 22/million in the Nelson region. Implant rate also varied significantly by ethnicity, with Māori ethnicity at an implant rate of 114/million, European patients at 83/million, Pacific Island patients at 47/million and Asian patients at an implant rate of 32/million. Socioeconomic decile had no significant effect upon number of implants.

Comment: I’ve included this paper to highlight the fact that ‘not all things are equal’. So when the authors suggest that people living in Tairawhiti and Māori have higher implant rates than others, I’d argue that there is greater need for implants in these two populations. In fact, Māori are twice as likely to die from CVD than NZ Europeans, and therefore Māori should be receiving ICDs at twice the rates of NZ Europeans. Instead, the rates are only 1.4 times higher; therefore Māori are missing out!

Reference: Heart Lung Circ. 2012 May 15. [Epub ahead of print]


A decade of tobacco control efforts in New Zealand (1996–2006): Impacts on inequalities in census-derived smoking prevalence

Authors: Salmond C et al

Summary: Between 1996 and 2006, a range of tobacco control activities were implemented in New Zealand. Data from the 1996 and 2006 national censuses were compared in this investigation, which examined the relationships between smoking prevalence and age, sex, socioeconomic position, and ethnicity. Throughout the decade, there was no change in the strong relationship between small-area socioeconomic deprivation and smoking prevalence. Smoking prevalence continued to be associated with Māori ethnicity independently of small-area socioeconomic deprivation. Smoking prevalence reduced modestly between 1996 and 2006 but increased in some age/sex/ethnic/deprivation groups.

Comment: Studies like this are required to be able to show whether tobacco control is working, and whether strategies are effective for all/equitably. Given the recent changes in policy, including further increases in tobacco tax, more recent data is required.

Reference: Nicotine Tob Res. 2012;14(6):664-73.