report

Improving Aboriginal Children’s Ear Health

Audit finding – WA Health’s data does not give a clear picture of Aboriginal children’s ear health

OM affects Aboriginal children at a higher rate than non-Aboriginal children

Although there is no conclusive and comprehensive data, the weight of research shows that OM is a significant issue for Aboriginal children. It shows that OM appears at a younger age, is more common and more likely to result in hearing loss in Aboriginal children than in non-Aboriginal children. High rates of OM were first recognised in WA by the Deputy Commissioner Public Health in 1957.

Aboriginal children have some of the highest rates in the world of CSOM, a severe form of OM that is a major cause of hearing loss. A 2004 WHO paper reported the issue for Australian Aboriginal children was ‘a massive public health problem’ (Figure 3). In contrast, it noted that the overall Australian rate was amongst the lowest worldwide.

Prevalence of CSOM Nation / population group
Highest (>4%) – urgent attention needed to deal with a massive public health problem Tanzania, India, Solomon Islands, Guam, Aboriginal Australians, Greenland
High (2-4%) – avoidable burden of disease must be addressed Nigeria, Angola, Mozambique, Republic of Korea, Thailand, Philippines, Malaysia, Vietnam, Micronesia, China, Eskimos
Low (1-2%) Brazil, Kenya
Lowest (<1%) Gambia, Saudi Arabia, Israel, Australia, United Kingdom, Denmark, Finland, Native Americans

Source: WHO: Chronic suppurative otitis media; Burden of illness and management options

Figure 3: CSOM prevalence

A 2004 Telethon Kids Institute (TKI) survey[1] of parents and care-givers of Aboriginal children found that high rates of Aboriginal children reported runny ears or recurrent ear infections. When ears are runny, OM is severe and the eardrum has been perforated. Results varied by region, but 10-25% of Aboriginal children (0-17 years of age) experienced runny ears or recurring ear infections.

Another TKI research project regularly examined 100 Aboriginal and 180 non-Aboriginal children from birth to the age of 2 in the Goldfields. This study found that the rates of OM in Aboriginal children were more than double that of non-Aboriginal children (55% of 184 examinations in Aboriginal children compared to 26% of 392 examinations in non-Aboriginal) (Figure 4).  

Aboriginal children in WA have higher rates of presentation at hospital for OM than non-Aboriginal children. Commonwealth data from 2004 to 2015 showed that Aboriginal children in WA were hospitalised more often than both non-Aboriginal and Aboriginal children from the rest of Australia. Another TKI study[2] of children born in WA between 1996 and 2012 found Aboriginal children 10 times more likely to present at hospital with OM.

We reviewed regional hospital data and found that Aboriginal children presented at emergency departments with OM more often than non-Aboriginal children. Of 1,157 OM presentations from 2012 to 2017, 72% were Aboriginal, supporting these findings.

A study[3] of Aboriginal children in Perth from 1998 to 2004 found high rates of OM. The study found hearing loss evident in 40.9% of the children aged between 4 and 7 years – right at the beginning of formal education.

WA Health does not have a clear view of how bad the problem is or if initiatives are successful

Although entities collect case by case information on children’s ear health, they do not collate it to provide a more complete picture of incidence and severity. They also cannot access primary health records of diagnosis. As a result, WA Health does not know exactly how many Aboriginal children are diagnosed with OM, how often they are diagnosed or where it is most prevalent.

Because entities don’t have a robust baseline, it is very difficult for them to demonstrate what kind of treatments, programs and services work best to reduce the burden of ear disease for Aboriginal children in WA communities. Nor can they identify where the problems are greatest so they cannot efficiently target initiatives and funding where they are likely to have most impact on ear health outcomes for Aboriginal children.  

The many entities, organisations and medical practices involved in identifying, diagnosing and treating OM in Aboriginal children across WA collect their own specific data. However due to privacy concerns, they do not share patient information, even at a de-identified and aggregated level. There isn’t one entity responsible for collecting, evaluating and reporting the data. Because the data is not shared, no one knows how bad the situation is for Aboriginal children at a whole of state level at any specific point in time, and there is no baseline to measure performance.

While WACHS and CAHS collect some data, they do not use data or information to track children’s journeys through the system or their ear health outcomes. For example, they record instances of health checks through the Universal checks and the EACHS program but do not link this data with hospital or ear, nose and throat (ENT) specialist records. They cannot use the data to identify patterns in OM or test the success of regional programs. Whether a child with suspected OM actually gets that problem resolved or treated is not known or routinely analysed.

 

[1] Zubrick, S., Silburn, S., Lawrence, D. et al. (2005). The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People. Curtin University of Technology and Telethon Institute for Child Health

[2] Westphal, D., Lehmann, D., Richmond, P., Lanningan, F., Williams, S., Moore, H. Epidemiology of Otitis Media hospitalisations in Western Australia: a retrospective population cohort study (1996-2012). Telethon Kids Institute, National Centre for Epidemiology and Population Health, Australian National University, School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children

[3] Williams, C., Coates, H., Pascoe, E., Axford, Y., Nannup, I. (2009) Middle ear disease in Aboriginal children in Perth: analysis of hearing screening data 1998-2004, MJA Volume 190 Number 10

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