Clinic Attendances during the First 12 Months of Life for Aboriginal Children in Five Remote Communities of Northern Australia The ´re ` se Kearns 1 *, Danielle Clucas 2 , Christine Connors 3 , Bart J. Currie 1,3 , Jonathan R. Carapetis 4 , Ross M. Andrews 1 1 Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia, 2 Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia, 3 Preventable Chronic Conditions, Northern Territory Department of Health and Families, Darwin, Northern Territory, Australia, 4 Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western, Perth, Western Australia, Australia Abstract Background: The vast majority (.75%) of Aboriginal people in the Northern Territory (NT) live in remote or very remote locations. Children in these communities have high attendance rates at local Primary Health Care (PHC) centres but there is a paucity of studies documenting the reason and frequency of attendance. Such data can be used to help guide public health policy and practice. Methods and Findings: Clinic presentations during the first year of life were reviewed for 320 children born from 1 January 2001–31 December 2006. Data collected included reason for infectious presentation, antibiotic prescription and referral to hospital. The median number of presentations per child in the first year of life was 21 (IQR 15–29) with multiple reasons for presentation. The most prominent infectious presentations per child during the first year of life were upper respiratory tract infections (median 6, IQR 3–10 ); diarrhoea (median 3, IQR 1–5); ear disease (median 3, IQR 1–5); lower respiratory tract infection (median 3, IQR 2–5); scabies (median 3, IQR 1–5); and skin sores (median 3, IQR 2–5). Conclusions: Infectious diseases of childhood are strongly linked with poverty, poor living conditions and overcrowding. The data reported in our study were collected through manual review, however many remote communities now have established electronic health record systems, use the Key Performance Indicator System and are engaged in CQI (continuous quality improvement) processes. Building on these recent initiatives, there is an opportunity to incorporate routine monitoring of a range of infectious conditions (we suggest diarrhoea, LRTI, scabies and skin sores) using both the age at first presentation and the median number of presentations per child during the first year of life as potential indicators of progress in addressing health inequities in remote communities. Citation: Kearns T, Clucas D, Connors C, Currie BJ, Carapetis JR, et al. (2013) Clinic Attendances during the First 12 Months of Life for Aboriginal Children in Five Remote Communities of Northern Australia. PLoS ONE (3): e58231. doi:10.1371/journal.pone.0058231 Editor: Martyn Kirk, The Australian National University, Australia Received May 20, 2012; Accepted February 5, 2013; Published March 1, 2013 Copyright: ß 2013 Kearns et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by the Cooperative Research Council for Aboriginal Health (http://www.lowitja.org.au/), Rio Tinto Aboriginal Foundation (http://www.riotinto.com/), Ian Potter Foundation (http://www.ianpotter.org.au/), and the Australian Government Office of Aboriginal and Torres Strait Islander Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: therese.kearns@menzies.edu.au Introduction Disparities in disease burden and life expectancy for Aboriginal and Torres Strait Islander people in Australia are well documen- ted, even more so for those living in remote/very remote locations. [1] In the Northern Territory (NT), more than 75% of Aboriginal people live in remote or very remote locations. [1] Previously reported data from three remote communities highlighted very high clinic attendance rates and a previously unrecognized burden of skin infections commencing within the first few months of life. [2,3] We have now extended the study to include six birth cohorts (2001–2006) across five remote Aboriginal communities within the same region. We have focused our analyses using the presentations per child as the primary unit of measure and report clinic presentations for a range of infectious conditions. Methods We reviewed clinic presentations during the first year of life for children in five remote communities born from 1 January 2001 to 31 December 2006. The communities, located approximately 500–1000 km east of Darwin, were participating in the East Arnhem Regional Healthy Skin Project (EARHSP). [4] Children were recruited to the EARHSP by local researchers going house to house. Written informed consent was obtained from the parents/ guardian to screen their child for clinical signs of scabies and skin sores and to conduct an audit of their clinic presentations. Each community had a locally based Primary Health Care (PHC) centre, providing acute and chronic care as well as an after- hours emergency service. We estimated the total annual birth cohort for these five communities from 2001–2006 to be approximately 1500 (250 per year). For the purposes of this study, PLOS ONE | www.plosone.org 1 March 2013 | Volume 8 | Issue 3 | e58231 8