Abstract
In this report the New Zealand Child and Youth Epidemiology Service (NZCYES) provides data and information to contribute to the effective planning and funding of services to improve, promote and protect the health and wellbeing of New Zealand children in their earliest years. The indicators of child health and wellbeing reported in this report begin in the prenatal period and extend to around five years of age. Indicators to be reported in 2018 and 2019 will extend further along the life course, to around age 14 years and age 24 years respectively. Indicator data for this report were extracted in 2017 from a range of routinely collected datasets. For each indicator the report provides an analysis of the most recent data available at the time of writing, followed by evidence for good practice derived from current policies, guidelines and the evidence-based literature. Where possible, the evidence for good practice includes discussion of equity issues relevant to each indicator, to inform service planning and delivery.
The 2017 report begins with the very earliest days in a child’s development, the prenatal period. Early enrolment with a lead maternity carer or district health board (DHB) primary maternity service, maternal smoking and maternal weight are sentinel indicators of the health and wellbeing of women who are pregnant.
The next section presents birth outcome data including gestation at birth and birthweight, as well as data about fetal deaths (also known as stillbirths). Birth outcome data can also be used to help quantify the need for care for babies born prematurely or with low birthweight. Birth outcomes are associated with a number of factors, including access to high quality antenatal care (which can help to reduce rates of preterm birth, low birthweight, and stillbirth and also to identify when a newborn baby may require additional services).
The mortality rate for children aged under five years is a high-level indicator of child health and wellbeing within a population. The 2017 report presents data on all deaths of under-five-year-olds, on deaths of infants in the first year of life, including sudden unexpected death in infancy (SUDI), and deaths of 1–4 year olds.
Immunisation and Well Child/Tamariki Ora (WCTO) services provide a foundation for child health and wellbeing. The next three sections of the report present data on breastfeeding, immunisation coverage, and child weight.
Hospitalisations for ambulatory care-sensitive conditions (ASCH) may provide an indication, at a community level, of accessibility of primary care services. However, ACSH rates are also influenced by other factors at a local level, including overall social determinants of health, and must be interpreted in the light of each DHB’s specific circumstances. The final section of this report provides data from the community oral health service on oral health of five-year-olds in the community, with further data on hospitalisations of under-five-year-olds for dental conditions.
Two review topics were selected by DHBs for inclusion in this report: Making health easier: Reducing inequalities in child health through addressing low health literacy (by Dr Judith Adams) and Factors that influence inequity of oral health in New Zealand and what we can we do about them (by Deanna M Beckett and Alison M Meldrum, from the University of Otago Dental School). These two sections of the report can inform strategies to promote health and wellbeing for all children. Health services can provide information in a way that supports parents to build their knowledge and skills to keep their children well and safe. Healthy public policy and supportive environments are key components to promote good oral health for all children from their earliest years.
The report appendices provide detail that may be helpful when interpreting information presented in the report. They include detailed descriptions of the methods used to develop evidence for good practice, and the statistical methods used in the data analyses, descriptions of the data sources used for various indicators reported, explanation about classification of ethnicity and social and material deprivation in the report, and a list of the clinical codes relevant to each indicator.
In summary, the 2017 report on health and wellbeing of under-five-year-olds presents data and interpretation on a set of relevant indicators extracted from national health datasets. The data used were the most recent available at the time of writing, and provide a snapshot of achievements and challenges in these areas. This report cannot address questions that require outpatient data, as these are not yet available at a national level. Systems that can provide a fuller picture of outpatient and primary health care data are important to inform child health service planning at national and DHB level.