New Zealand Child and Youth Epidemiology Service collectionhttp://hdl.handle.net/10523/61072024-03-09T05:54:13Z2024-03-09T05:54:13ZHospitalisations for epilepsy and status epilepticus – the tip of the iceberg?Tustin, KarenKeenan, NgaireSadleir, LynetteNolan, MelindaMcAnally, HelenaAdams, JudithWicken, AndrewDuncanson, Mavishttp://hdl.handle.net/10523/165802024-03-08T14:18:09Z2024-02-15T00:49:02ZHospitalisations for epilepsy and status epilepticus – the tip of the iceberg?
2023-11-08
Tustin, Karen; Keenan, Ngaire; Sadleir, Lynette; Nolan, Melinda; McAnally, Helena; Adams, Judith; Wicken, Andrew; Duncanson, Mavis
Background: Epilepsy is the most common serious neurological condition in children and adolescents and affects 3–5 in every 1,000. Although most health care for epilepsy is delivered in outpatient settings, data on hospitalisations for epilepsy can provide an epidemiological background to the burden of epilepsy within a population.
Methods: We used data from the National Minimum Dataset (NMDS) to examine rates of hospitalisation for epilepsy and status epilepticus in 0–24-year-olds from 2000 to 2022. We performed a series of time-trend analyses by age group, prioritised ethnicity, and socio-economic deprivation.
Results: Rates of children and young people hospitalised with a diagnosis of epilepsy or status epilepticus have increased overall from 2000 to 2022. Rates of hospitalisation were highest for 0–4-year-olds, for whom there was a particularly large increase in rates after 2020. This trend was not due to an increase in hospitalisation events for individual children; the same patterns were evident for unique individuals. There were disparities for Māori, who were hospitalised at greater rates than were children of other ethnicities, particularly among 15–24-year-olds. Rates of hospitalisation have been consistently highest for children and young people living in the most deprived areas. Recently, however, this deprivation gradient has reduced (although it is still present).
Conclusion: Consistent with other research in Aotearoa, the higher hospitalisation rates for epilepsy and status epilepticus experienced by Māori and those living within high deprivation areas may reflect inadequate access to routine epilepsy care and, hence, suboptimal seizure control. These hospitalisation data will only reflect the tip of the iceberg; this narrow clinical window does not paint the full picture of paediatric epilepsy in Aotearoa. Our findings highlight the importance of a systems-level approach to improve outcomes for all tamariki and taitamariki with epilepsy.
2024-02-15T00:49:02ZPaediatricians in Aotearoa contribute to rare disease surveillanceDuncanson, MavisWheeler, BenjaminMcIntyre, PeterBates, Rachelhttp://hdl.handle.net/10523/164742024-03-08T14:18:47Z2023-12-15T02:08:11ZPaediatricians in Aotearoa contribute to rare disease surveillance
2023
Duncanson, Mavis; Wheeler, Benjamin; McIntyre, Peter; Bates, Rachel
Background: Monthly surveys provide an opportunity for paediatricians in Aotearoa to contribute to international and national surveillance of rare childhood conditions. This is linked to active surveillance of acute flaccid paralysis (AFP) undertaken for Manatū Hauora and reported to the Western Pacific Region (WPR) Office of the World Health Organization (WHO).
Methods:
• Review and analysis of the NZPSU database to describe the contribution of paediatricians to this project in 2022/23, identify conditions under surveillance and review recent research findings
• Audit of AFP surveillance against hospital discharge diagnoses and World Health Organization standards
Results: Each month from July 2022 to June 2023 around 200 paediatricians responded to an online survey reporting children in their care with acute flaccid paralysis or other rare childhood diseases.The overall response rate was 74%.
In 2022 responding paediatricians reported 20 cases of acute flaccid paralysis, 4 infants with HIV positive birthing parent, 22 infants with birthing parent with positive syphilis serology, 8 adverse drug reactions in childhood, 46 children aged under 15 years who presented with self-harm and were seen by a paediatrician, and 22 cases of severe acute hepatitis. From March 2022 there were reports of 52 children with COVID-19 who required ICU level care or who had a multi-inflammatory condition. There were no reports of congenital rubella. Principal investigators for each condition obtained further clinical information and used this to inform policy and practice. Achievements include third trimester testing for syphilis and ongoing research to address self-harm in the paediatric population.
Audit against hospital discharge data identified a further 5 cases with AFP. The AFP rate of 2.6 cases per 100,000 0–14-year olds was considerably higher than the expected rate of 1 case per 100,000. Two timely stool samples were provided for only 44% of AFP cases in 2022.
Conclusion: Paediatricians are key players in routine active surveillance that contributes to understanding of poliomyelitis in the WPR and enhances understanding of rare childhood diseases in Aotearoa.
2023-12-15T02:08:11ZUpdate from Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa (NZCYES)Duncanson, Mavishttp://hdl.handle.net/10523/164732024-02-15T15:53:00Z2023-12-15T02:04:48ZUpdate from Te Ratonga Mātai Tahumaero Taitamariki o Aotearoa (NZCYES)
2023
Duncanson, Mavis
2023-12-15T02:04:48ZSnapshots of child and youth population healthDuncanson, Mavishttp://hdl.handle.net/10523/164712024-02-26T14:52:57Z2023-12-15T01:27:02ZSnapshots of child and youth population health
2023
Duncanson, Mavis
This keynote address will present series of snapshots that reflect some of the work undertaken by the three child population health research groups within the Department of Women's and Children's Health at the Dunedin School of Medicine within the University of Otago. The New Zealand Paediatric Surveillance Unit has an important role in certifying polio-free status on behalf of Manatū Hauora, and providing a platform to investigate other rare childhood conditions. The New Zealand Child and Youth Epidemiology Service was established in partnership with The Paediatric Society of New Zealand Te Kāhui Mātai Arotamariki o Aotearoa and former district health boards, with support of the Ministry of Health and now Te Whatu Ora. The Mortality Review Data Group has a statutory data role to drive improved quality and safety in child health through the Health Quality and Safety Commission, reporting on child and youth mortality and on perinatal and maternal mortality in Aotearoa.
2023-12-15T01:27:02ZRate of new-onset diabetic ketoacidosis increasing in Aotearoa New Zealand 2014–2022Adams, JudithWheeler, BenjaminJefferies, CraigTustin, KarenWicken, AndrewMcAnally, HelenaDuncanson, Mavishttp://hdl.handle.net/10523/163862024-01-24T00:58:30Z2023-11-20T23:23:51ZRate of new-onset diabetic ketoacidosis increasing in Aotearoa New Zealand 2014–2022
2023-11-09
Adams, Judith; Wheeler, Benjamin; Jefferies, Craig; Tustin, Karen; Wicken, Andrew; McAnally, Helena; Duncanson, Mavis
Background: Increases in incidence rates for type 1 diabetes have been observed internationally in association with the COVID-19 pandemic.1 2 Children with type 1 diabetes have been noted to present with more severe symptoms during the pandemic than before it.2 During the 2020 nationwide lockdown paediatricians reported cases of diabetic ketoacidosis that may have resulted from delay in seeking medical care.3 The proportion of new-onset diabetes hospitalisations with DKA at Starship was stable prior to 2013.4
Methods: Administrative data on first hospitalisations with type 1 diabetes in children aged under 15 years in Aotearoa from 2014–2022 were analysed. The proportion of these first hospitalisations with diabetic ketoacidosis was calculated using the DKA subcode. The proportions of first hospitalisations with DKA were compared for the six years before the COVID-19 pandemic (2014–2019) and the years 2021–2022 after widespread community transmission of COVID-19 first occurred in Aotearoa.
Results: From 2014–2022 there were 2,165 first hospitalisations for diabetes of children aged under 15 years, of which 773 (36%) were coded as DKA. The proportion of first hospitalisations for diabetes with a DKA subcode increased from 33.3% in 2014–2019 to 43.3% in 2021–2022 (p < .01). An increase in the proportion of first hospitalisations presenting with DKA was seen in all New Zealand Index of Deprivation (NZDep) quintiles. Regression analysis indicated that only discharge year was a significant predictor of DKA status (p = .02) and there was no independent effect of deprivation.
Conclusion: The proportion of children presenting with DKA at their first hospitalisation for type 1 diabetes increased in Aotearoa following widespread community transmission of COVID-19. Reasons for this are unclear. There are important implications for health service planning with a need to ensure adequate resources for intensive acute care and ongoing management.
2023-11-20T23:23:51ZHospitalisations for inflammatory bowel disease in New Zealand children and young peopleAdams, JudithMcAnally, HelenaTustin, KarenWicken, AndrewDuncanson, Mavishttp://hdl.handle.net/10523/163852024-01-24T00:58:31Z2023-11-20T23:17:44ZHospitalisations for inflammatory bowel disease in New Zealand children and young people
2023-10-09
Adams, Judith; McAnally, Helena; Tustin, Karen; Wicken, Andrew; Duncanson, Mavis
Inflammatory bowel disease (IBD, ulcerative colitis and Crohn’s disease) has peak incidence in the 15–25 years age group. The incidence of paediatric inflammatory bowel disease is increasing, both in Aotearoa and worldwide. There is no cure for inflammatory bowel disease. Treatment aims to induce remission through controlling intestinal inflammation and then to maintain remission to promote nutrition and growth and prevent disease complications. Children and young people with IBD may need hospitalisation for colonoscopy and endoscopy under general anaesthesia (to confirm the diagnosis and to assess response to therapy), for treatment of disease flares, and for surgery.
2023-11-20T23:17:44ZChildren and young people with chronic health conditions in Aotearoa (2022)Duncanson, MavisAdams, JudithTustin, Karenvan Asten, HedwigRoy, MelyssaOben, GlendaMcAnally, HelenaWicken, Andrewhttp://hdl.handle.net/10523/162882024-02-04T21:47:22Z2023-11-03T02:56:08ZChildren and young people with chronic health conditions in Aotearoa (2022)
2023
Duncanson, Mavis; Adams, Judith; Tustin, Karen; van Asten, Hedwig; Roy, Melyssa; Oben, Glenda; McAnally, Helena; Wicken, Andrew
This report from the New Zealand Child and Youth Epidemiology Service (NZCYES) aims to present data and information to assist in commissioning services that can contribute to improved health and wellbeing of children and young people in each locality.
This 2022 report focuses on children and young people with long-term health conditions. Some of these conditions are present at birth, and others develop during childhood and adolescence. Once diagnosed, the conditions may be ongoing, long term, or recurrent. Children with these conditions usually require lifelong health care, and may experience limitations in day-to-day activities and interrupted education. In addition, management of the conditions can impact on whānau wellbeing. Adolescence usually signals the need for children with long-term conditions to transition into adult health services. This is a key aspect of health service commissioning and delivery in which data are needed to monitor positive and beneficial transitions that promote equity and wellbeing into adulthood.
The following indicators included in this report were identified in the indicator framework developed for the NZCYES through literature review and consultation with the child health workforce, and by ongoing discussion with child health service providers:
• Cystic fibrosis
• Diabetes
• Cerebral palsy
• Epilepsy
• Bronchiectasis (non-cystic fibrosis)
• Inflammatory bowel disease
Administrative data were extracted from National Collections, Surveys and Registers to provide an epidemiological background to the clinical context of day-to-day health care. Indicators were analysed to provide a descriptive account of mortality and of hospitalisation events, as well as data reflecting community prevalence where available. The former district health boards were in place through the time frame of this report, so reporting is still using these entities in analysis. It is important to note that the locality is the district health board in which the child or young person is usually resident. If a child is transferred to a larger centre for treatment, they will still be identified with their district of residence in this report.
Each indicator chapter begins with a description of the condition. The ‘data sources and methods’ boxes provide technical information about the specific indicator and data sources. Analysis presents information about deaths from the condition, and patterns of hospitalisation over time, and by demographic factors including age group, ethnicity, and social and material deprivation in the area where the child usually lives. The extent to which equity in health outcomes is being achieved, or not, is reflected in the rates of hospitalisation for different population groups of children. Each chapter concludes with an ‘evidence for good practice’ section which is a synthesis of national and international guidelines and an overview of recent research to inform service provision. There is a focus on equity and on achieving good outcomes for all children and young people.
The report appendices describe the processes used in compiling information for these reports, including the clinical codes relevant to each indicator, information about data sources and their limitations, classification of ethnicity and social and material deprivation, and statistical methods used in data analyses.
The NZCYES is very grateful to all those who have provided feedback on draft versions of each chapter. The comments and advice received have strengthened the report as a whole. Interpreting the implications and importance of the data in this report requires the participation of those actively involved in child health in each district. This report is provided in anticipation of it being used at a local level alongside clinical and professional knowledge and expertise.
A major limitation of this report is that it cannot address questions that require outpatient data, which are currently not available at a national level with diagnostic classifications. Developing systems that can provide a fuller picture of outpatient and primary health care data is an important priority for Te Whatu Ora and Te Aka Whai Ora to inform child health service planning at national and regional levels and to monitor the achievement of equity in child health outcomes.
In summary, the 2022 report from NZCYES presents data and interpretation on selected indicators of child and youth health status. The most recent data available at the time of writing were extracted in 2022 from a range of administrative datasets. It is provided with the intent of informing health service planning and delivery that acknowledges the burden of care associated with long-term health needs in childhood and adolescence, and promotes equitable health outcomes for these children and their whānau.
2023-11-03T02:56:08ZChildren and young people with chronic health conditions in Te Waipounamu (2022)Duncanson, MavisAdams, JudithTustin, Karenvan Asten, HedwigRoy, MelyssaOben, GlendaMcAnally, HelenaWicken, Andrewhttp://hdl.handle.net/10523/162792024-02-04T21:47:22Z2023-10-30T21:39:43ZChildren and young people with chronic health conditions in Te Waipounamu (2022)
2023
Duncanson, Mavis; Adams, Judith; Tustin, Karen; van Asten, Hedwig; Roy, Melyssa; Oben, Glenda; McAnally, Helena; Wicken, Andrew
This report from the New Zealand Child and Youth Epidemiology Service (NZCYES) aims to present data and information to assist in commissioning services that can contribute to improved health and wellbeing of children and young people in each locality.
This 2022 report focuses on children and young people with long-term health conditions. Some of these conditions are present at birth, and others develop during childhood and adolescence. Once diagnosed, the conditions may be ongoing, long term, or recurrent. Children with these conditions usually require lifelong health care, and may experience limitations in day-to-day activities and interrupted education. In addition, management of the conditions can impact on whānau wellbeing. Adolescence usually signals the need for children with long-term conditions to transition into adult health services. This is a key aspect of health service commissioning and delivery in which data are needed to monitor positive and beneficial transitions that promote equity and wellbeing into adulthood.
The following indicators included in this report were identified in the indicator framework developed for the NZCYES through literature review and consultation with the child health workforce, and by ongoing discussion with child health service providers:
• Cystic fibrosis
• Diabetes
• Cerebral palsy
• Epilepsy
• Bronchiectasis (non-cystic fibrosis)
• Inflammatory bowel disease
Administrative data were extracted from National Collections, Surveys and Registers to provide an epidemiological background to the clinical context of day-to-day health care. Indicators were analysed to provide a descriptive account of mortality and of hospitalisation events, as well as data reflecting community prevalence where available. The former district health boards were in place through the time frame of this report, so reporting is still using these entities in analysis. It is important to note that the locality is the district health board in which the child or young person is usually resident. If a child is transferred to a larger centre for treatment, they will still be identified with their district of residence in this report.
Each indicator chapter begins with a description of the condition. The ‘data sources and methods’ boxes provide technical information about the specific indicator and data sources. Analysis presents information about deaths from the condition, and patterns of hospitalisation over time, and by demographic factors including age group, ethnicity, and social and material deprivation in the area where the child usually lives. The extent to which equity in health outcomes is being achieved, or not, is reflected in the rates of hospitalisation for different population groups of children. Each chapter concludes with an ‘evidence for good practice’ section which is a synthesis of national and international guidelines and an overview of recent research to inform service provision. There is a focus on equity and on achieving good outcomes for all children and young people.
The report appendices describe the processes used in compiling information for these reports, including the clinical codes relevant to each indicator, information about data sources and their limitations, classification of ethnicity and social and material deprivation, and statistical methods used in data analyses.
The NZCYES is very grateful to all those who have provided feedback on draft versions of each chapter. The comments and advice received have strengthened the report as a whole. Interpreting the implications and importance of the data in this report requires the participation of those actively involved in child health in each district. This report is provided in anticipation of it being used at a local level alongside clinical and professional knowledge and expertise.
A major limitation of this report is that it cannot address questions that require outpatient data, which are currently not available at a national level with diagnostic classifications. Developing systems that can provide a fuller picture of outpatient and primary health care data is an important priority for Te Whatu Ora and Te Aka Whai Ora to inform child health service planning at national and regional levels and to monitor the achievement of equity in child health outcomes.
In summary, the 2022 report from NZCYES presents data and interpretation on selected indicators of child and youth health status. The most recent data available at the time of writing were extracted in 2022 from a range of administrative datasets. It is provided with the intent of informing health service planning and delivery that acknowledges the burden of care associated with long-term health needs in childhood and adolescence, and promotes equitable health outcomes for these children and their whānau.
2023-10-30T21:39:43Z