Māori Health Review Issue 46

This qualitative research paper presents the views of medical students early in their clinical training and their clinical teachers with respect to Māori health teaching and learning. The 276 students and 135 clinical teachers were asked to respond to a set of questions about the teaching and assessment of Hauora Māori (Māori health). The content analysis determined that the majority of students question the quality of Hauora Māori teaching and assessment. It also indicated that many clinical teachers felt underprepared to teach this aspect of the curriculum. The study authors discovered a range of views, often polarised, and a degree of resistance to Māori health teaching and learning.

These researchers analysed admission rates to any New Zealand hospital from August 2001 through July 2011 for all lower respiratory infection (LRI) including pneumonia for children aged <2 years resident in Counties Manukau District Health Board (CMDHB), to determine the impact of the pneumococcal conjugate vaccine 7 valent (PCV7), introduced in June 2008. There was a gradual decline over time in rates of pneumonia admissions (incidence risk ratio [IRR] for a change of 1 year 0.96; p<0.0001) and of an additional step down in rates of pneumonia admissions after vaccine introduction (IRR pre- to post-PCV 1.51; p<0.0001). There was evidence of a significant decline in pneumonia admissions post-PCV introduction for Pacific children (IRR 1.70; p<0.0001) and other ethnicities (IRR 1.93; p=0.003), but not for Māori children (IRR 1.05; p=0.76). No such evidence of a general change over time or change from pre- to post-vaccine introduction could be demonstrated for bronchiolitis. Māori and Pacific children are at increased risk of admission with LRI compared to European children (relative risk [RR] 4.6 and 5.0, respectively) as are those living in Decile 9 or 10 regions compared with those from other deciles (RR 1.43).

Data were retrospectively analysed from 106 blind and 64 low-vision Māori children (<16 years) enrolled with the Blind and Low Vision Education Network New Zealand (BLENNZ). The leading causes of blindness in Māori children are cerebral visual impairment (41.0%), optic nerve atrophy (19.0%) and optic nerve hypoplasia (13.0%). Avoidable causes of blindness for Māori children amounts to 28.5% of Māori childhood blindness; non-accidental injury (NAI) is the leading cause of blindness in Māori children.

Recent research and policy around sudden unexpected death in infancy (SUDI) have highlighted the importance of SUDI prevention strategies focusing on safe sleep messages, particularly among Māori, who feature prominently in SUDI rates (e.g., between 2002 and 2009 the Māori death rate from suffocation in the place of sleep was 8.22 times the European rate). This paper reviews Māori-initiated innovations for safer infant sleep environments. The development of the wahakura (a flax bassinet modelled on a traditional Māori infant sleeping item) in Gisborne in 2006 proved highly acceptable with Māori and also effective as an infant health promotion vehicle. Since then, the making of wahakura has been promoted by the Māori SIDS Prevention Programme (now known as Whakawhetu) and regional wahakura projects have been developed in Northland, Auckland and the Waikato. The less expensive pēpi-pod portable beds are also proving to be highly acceptable, with an evaluation of their use among primarily Māori and Pacific families reporting that many mothers appreciated being able to confidently have their baby close by, in or on the parental bed. Research is currently being undertaken to provide robust evidence for the safety of these infant sleeping devices, as is the exploration of similar alternatives. The paper’s authors suggest that utilising and adapting indigenous infant sleeping methods may also prove appropriate in other countries where SIDS/SUDI persists in indigenous and other marginalised communities.

Interviews were conducted at 3 months post-injury with 2856 New Zealand residents aged 18–64 years enrolled in the Prospective Outcomes of Injury Study (POIS); all study participants had experienced ≥1 injuries between June 2007 and May 2009. This investigation examined the prevalence of health and social outcomes pre- and 3 months post-injury, and the association between New Injury Severity Scores (NISS) and 3-month outcomes, for the 566 participants who reported Māori ethnicity. High levels of adverse outcomes were observed 3 months post-injury: 49% reported problems with mobility; 56% reported trouble performing usual activities; 70% were experiencing pain or discomfort; and 45% were experiencing a moderate level of psychological distress. The prevalence of some adverse outcomes increased with increasing NISS but a high level of problems were still experienced by those classified as having a ‘minor’ injury. Nonetheless, 71% were satisfied with life and 81% were satisfied with global social relationships at 3 months, and 74% considered themselves to have good to excellent overall health.

This paper describes pre-injury and injury-related predictors of life satisfaction 3 months after injury for 563 of the 566 Māori participants in the POIS. The Te Whare Tapa Whā model of overall health and well-being was used to help inform the selection of post-injury life satisfaction predictor variables. Ninety-three percent of participants reported satisfaction with life pre-injury; 71% were satisfied with life at 3 months post-injury. In multivariate analysis for life satisfaction 3 months after injury, participants with an injury severity NISS >6 were less likely to be satisfied with life 3 months after injury compared with those with injury severities of NISS 1–3 (RR 0.80). In addition, those who were not satisfied with pre-injury social relationships or had poor general self-efficacy pre-injury were less likely to be satisfied with life 3 months after injury.

This paper describes the development of evidence-based protocols for the recognition and treatment of skin sepsis in nurse (RN)-led school clinics in South Auckland, including provision of antibiotics under delegated standing orders. An algorithm for diagnosis of skin infections was adapted from Steer et al. (Bull World Health Organ. 2009;87:173-9). The targeted skin infections include impetigo, cellulitis, scabies and infected eczema. The algorithim recommends fusidic acid ointment as first-line treatment for localised impetigo and twice-daily oral cephalexin for extensive impetigo and cellulitis, for palatability and simplicity of dosing. In the first 15 weeks of a pilot study, 56 school students diagnosed with one or more skin infections were treated under standing orders.

Outcomes are reported from the 5 New Zealand centres that participated in Phase One (1993) and Phase Three (2001–2003) of the International Study of Asthma and Allergies in Childhood (ISAAC). The first phase found a high prevalence of symptoms of eczema in New Zealand and Phase Three sought to determine whether the prevalence of eczema was changing over time, whether prevalence differs by ethnicity, and to clarify the risk factors for eczema. Whereas there was little change in prevalence over time for the children (6–7-year-olds), eczema decreased in prevalence among the adolescents (13–14-year-olds). Prevalence was higher among Māori and even higher among Pacific participants than among European children. In both age groups, current eczema symptoms were positively associated with truck traffic in the street of residence and with current paracetamol consumption, while for children only, a positive association was seen between current eczema and antibiotics or paracetamol in the 1st year of life. Residence in New Zealand for <5 years, consumption of milk, seafood and eggs, and presence of a dog in the home, were all inversely associated with current eczema.

Using data from the national pharmaceutical claims database, these researchers identified 80,514 children aged <15 years dispensed >2 asthma medicines, in this investigation into the recommended treatment and outcomes for asthma in all New Zealand children by age, sex, and ethnic group. A total of 16.0% of children were dispensed asthma medicines, 9.2% were dispensed medicine >2 times, 3.6% were hospitalised at least once for asthma and 98.9% of admissions were acute. Māori (OR 1.46) and Pacific children (OR 2.38) were less likely to have their treatment escalated to a higher step than other children. At all steps of treatment, Māori and Pacific children were more likely to be using oral steroids to control asthma exacerbations and in all age groups, Māori children (5.1%; OR 1.88) and Pacific children (5.6%; OR 2.05) were more likely to be hospitalised for asthma than children of other ethnicities (2.8%).