Growth and Nutrition Report

NT Annual Report 2016

Healthy Under 5 Kids Program

Final Release

Introduction

The Healthy Under 5 Kids program is the well-child health schedule for remote Indigenouschildren covered by the government health service of the Northern Territory (NT) aged 0-5years. This report provides information about the physical growth and nutrition of childrenin remote areas. The purpose of this report is to monitor indicators of health and wellbeingof the most vulnerable members of our society, children, so health service providers andpolicy makers can ensure that the right programs and policies are being put in place toaddress health needs from a population perspective.

The report utilises data from all NT health service providers, including non-governmentorganisations who have agreed to be part of the program. Currently the following serviceproviders take part in this program:

• Katherine West Health Board• Sunrise Health Service• Northern Territory Department of Health Primary Health Centres

Top End Health Service

Adelaide River

Alyangula

Angurugu

Batchelor

Belyuen

Binjari

Borroloola

Gapuwiyak

Gunbalanya

Jabiru

Maningrida

Milikapiti

Milingimbi

Milyakburra

Minjilang

Nauiyu

Nganmarriyanga

Numbulwar

Peppimenarti

Pine Creek

Pirlangimpi

Ramingining

Robinson River

Central Australia Health Service

Ali Curung

Alpurrurulam

Atitjere

Canteen Creek

Elliott

Engawala

Finke

Haasts Bluff

Hermannsburg

Imanpa

Kaltukatjara

Kings Canyon

Laramba

Mount Liebig

Nturiya

Nyirripi

Orrtipa-Thurra

Papunya

Tara

Titjikala

Wallace Rockhole

Willowra

Wilora

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Data for all children are collated and analysed using the World Health Organisation(WHO) 2006 growth references (using this reference, data is analysed to measureunderweight: whether children are less than the average weight range for children theirage; stunting: whether children are less than the average length or height range forchildren their age; wasting: whether children are less than the average range of weight fortheir length or height). The analysis is carried out using statistical averages to allow apopulation level assessment.For individual children, growth assessment is done by plotting weight and height over timeon their growth chart. Individual needs can then be actioned by the health professional.

Report Title: Healthy Under 5 Kids Program Growth and Nutrition NT Annual Report2016 v1.0.1

Compiled by: Data Management and Sysem Reporting Branch, Department of Health,Northern Territory

Data Source: Healthy Under 5 Kids Data Collection Program

Universe Sources: GAAWARE WHO

Last Refreshed: Tuesday, 28 March 2017

Young children in remote areas of the NT have been found to have high levels of irondeficiency anaemia which is measured by haemoglobin (Hb) values. The anaemia (Hb)cut-off criterion used in this report is the endorsed Central Australian Rural PractitionersAssociation (CARPA) Standard Treatment Manual, 6th Edition 2014.

Important note for readers of this reportThis report supersedes any previous reports. Over time, data corrections, improved dataprocessing and calculation methods are implemented that may result in changed valuesand trends for earlier years’ data. These variations are highlighted where appropriate.

Top End Health Service

Umbakumba

Wadeye

Warruwi

Woodycupaldiya

Wurrumiyanga

Yirrkala

Central Australia Health Service

Wutunugurra

Yuelamu

Yuendumu

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DoH HU5K Privacy Statement

The Northern Territory Department of Health (DoH) manages the HU5K under protocolsfor data privacy and release. These protocols provide NT HU5K participating servicesassurance that their data will be protected from unauthorised use and provided understrict and consistent protocols that include:

The NT Information Act 2002.

The Commonwealth Privacy Act 2006 and associated Information Privacy Principles.

The Human Research Ethics Committee of the Northern Territory Department of Healthand the Menzies School of Health Research (that is constituted in accordance with theNHMRC Act 1992 (Cth).

The National Statement on Ethical Conduct in Research Involving Humans (1999).

Policies and procedures establish the rules for issues such as:

(a) Information gathering and receipt (b) Information storage and retention (c) Information transmission (d) Information retrieval and use within DoH (e) Information release and disclosure outside DoH

NT HU5K data is any data sourced from health service organisations operated by bothnon-government and government organisations.

All access to NT HU5K data will be controlled under the DoH Data Access Protocol (May2015) that includes methods for community consultation for the release and use of data.

For further information, please contact the Child & Youth Health Stragety Unit on (08)8985 8130.

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HU5K MetadataChildren's DemographicsPatientInformation RecallSystem (PIRS)

This is the remote health service provider's (both DoH and Aboriginal CommunityControlled Health Organisations) system. The child's demographic and health data areextracted from these PIRS and used to inform this report. Health service provider PIRSinclude both Primary Care Information System (PCIS) and Communicare.

Resident childrenwithinthe NT

Residency of a child is determined by the health service provider. A child is considered aresident of the NT if the child is identified as a resident by the participating health serviceprovider and recorded as such within the health service PIRS.

Resident childrenwithinthe SurveyDistrict

A child is considered a resident of the survey district when the district that the child isidentified as a resident of within the PIRS matches the district in which the HU5K surveycollection took place.

HU5K GrowthAge

The growth age calculations used in this report reflect the WHO Growth Age calculation(2006).

If a resident child has received a HU5K check then their age in months is calculated thefollowing way:

date of HU5K check - date of birth rounded down to the nearest decimal place (i.e. a child who is 59.5 months will be 59 months)

If a resident child has not received a HU5K check then their age in months is calculatedthe following way:

HU5K survey start date - date of birth rounded down to the nearest decimal place (i.e. a child who is 59.2 months will be 59 months)

Survey District This is the NT District in which the HU5K survey data were collected.

Resident District This is the NT district that the child is identified as a resident of within the health serviceproviders PIRS.

Survey Results for Growth Charts

Survey Period Refers to the HU5K Survey Period commencing from 15 October to 16 April eachfinancial year.

Z ScoresA z-score is a statistical figure derived by comparing client length/height and/or weightmeasurements with averages based on sex, age, length/height and weight. A child musthave a valid measurement in order to calculate a z score. This report calculates z-scoresagainst the WHO growth reference table for length/height and/or weight averages.

WHO GrowthStandards

HU5K's growth status values are calculated against the WHO Child Growth Standards2006. http://www.who.int/childgrowth/standards/technical_report/en/index.html

WHO Stunted

Analysis of the child's length/height for age status. Length is measured in children under2 years of age whereas height is measured for children aged 2 years and older. Forsimplicity, throughout this report, height will be used to refer to both height and lengthmeasurements. A child's most recent height measurement in the reporting period is usedin the calculations. For children < 60 months (WHO Growth Age), if WHO HAZ (height forage z-score) < -2 (meaning that they are more than 2 standard deviations below themedian of the reference population for height for age, then the child is identified asstunted.

WHOUnderweight

Analysis of the child’s weight for age status. A child's most recent weight measurement inthe reporting period is used in the calculations. For children < 60 months (WHO GrowthAge) if WHO WAZ (weight for age z-score) < -2 (meaning that they are more than 2standard deviations below the median of the reference population for weight for age,then the child is identified as underweight.

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WHO Wasted

Analysis of the child’s weight for length/height status. A child's most recent recording ofheight and weight being measured is used in the calculations. For children < 60 months(WHO Growth Age), if WHO WHZ (weight for height z-score) < -2 (meaning that they aremore than 2 standard deviations below the median of the reference population for weightfor height, then the child is identified as wasted. Please note that the figures presented for wasting in this report are the best estimate ofwasting based on the data available. The heights and weights used in the calculationsreported here were not necessarily measured on the same day and consequently may beinaccurate.

2014 CARPA 6thEdition guidelinesfor AnaemiaStatus

Analysis of the child’s haemoglobin reading (g/L). This is not a derived measure. If thehaemoglobin reading is < 105g/L for a child between 6 and 12 months or < 110g/L for achild between 12 and 60 months, the child is identified as anaemic.

Stunted, underweight and wasted are extreme categories using set cut-offs and do not take into accountchildren who may be growth faltering but have not yet reached these extremes of stunted, wasted, orunderweight.

Inclusions / Exclusions

Age exclusionsChildren aged 60 months and older according to the growth age calculations, at thebeginning of the data collection period, 15 October, will be excluded from all lists, reportsand population counts.

Deceasedexclusion

Once a child is notified as being deceased, the child will be excluded from all lists,reports and population counts from the survey of notice onwards.

Small numberexclusion If population < 20, children then a community will not to be reported on.

NormalDistribution

In a population with normal distribution, approximately 3% of children who have normalstature would appear to be stunted, underweight or wasted.

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Number of resident children measured for atleast one of height , weight or Haemoglobin 3,343

Number of resident children aged 0-59 months 3,937

Coverage (Resident children measured /number of resident children) 85%

Healthy Under 5 Kids 2016 summary results for all children withinremote Northern Territory

Population coverage for participating HU5K health service providers within theNT

Characteristic Resident childrenwith characteristic

Total residentchildren measured

% resident childrenmeasured withcharacteristic

Coverage (Residentchildren

measured / Numberof residentchildren) *

Stunted 392 2,812 14% 71%

Underweight 168 3,312 5% 84%

Wasted 95 2,786 3% 71%

Anaemic ** 518 2,601 20% 72%

Summary Results

* Numbers in red indicate that coverage is less than 80%

** Children are not tested for anaemia until they are 6 months of age. Therefore the denominator for thiscalculation is the number of resident children aged between 6 and 59 months of age - 3,605.

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Percentage of measured resident children less than 5 years of age who areUNDERWEIGHT by survey period 2012 - 2016

WHO Growth Chart results forUnderweight 2012 2013 2014 2015 2016

Number of resident children measuredfor weight 3,557 3,505 3,543 3,458 3,312

Number of resident children identified asunderweight 266 215 241 193 168

% of measured resident childrenidentified as underweight 7% 6% 7% 6% 5%

Number of resident children 4,400 4,244 4,234 3,850 3,937

Coverage (Resident children measured /number of resident children) * 81% 83% 84% 90% 84%

Weight for Age StatusWeight for age is an indicator of the growth of a child. A child whose Weight-for-Age Z-score (WAZ) is less than -2.0 is called underweight. An underweight child is one who isgrowing poorly, whose weight is too low for his or her age. A child may be underweightbecause of illness or inadequate diet.

* Numbers in red indicate that coverage is less than 80%

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Age (Months) 00-05 06-11 12-17 18-23 24-35 36-47 48-59 Total

Number of resident childrenmeasured for weight 306 349 361 353 563 617 763 3,312

Number of resident childrenidentified as underweight 29 13 15 14 22 42 33 168

% of measured residentchildren identified asunderweight

9% 4% 4% 4% 4% 7% 4% 5%

Number of resident children 332 381 388 387 663 735 1051 3,937

Coverage (Resident childrenmeasured / number of residentchildren) *

92% 92% 93% 91% 85% 84% 73% 84%

Percentage of measured children less than 5 years of age who areUNDERWEIGHT by age group for survey period 2016

Underweight by Age Group

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who areUNDERWEIGHT by survey period and age group 2012 - 2016

WHO Growth Chart results forunderweight 2012 2013 2014 2015 2016

< 12 months

Measured for weight 767 735 697 722 655

Identified as underweight 87 39 46 40 42

% of measured children underweight 11% 5% 7% 6% 6%

Resident children 889 838 785 778 713

Coverage (Measured / Resident) * 86% 88% 89% 93% 92%

1 to < 3 years

Measured for weight 1,461 1,388 1,407 1,314 1,277

Identified as underweight 99 83 96 67 51

% of measured children underweight 7% 6% 7% 5% 4%

Resident children 1,799 1,656 1,651 1,425 1,438

Coverage (Measured / Resident) * 81% 84% 85% 92% 89%

3 to < 5 years

Measured for weight 1,329 1,382 1,439 1,422 1,380

Identified as underweight 80 93 99 86 75

% of measured children underweight 6% 7% 7% 6% 5%

Resident children 1,712 1,750 1,798 1,647 1,786

Coverage (Measured / Resident) * 78% 79% 80% 86% 77%

Underweight Trend by Age Group

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who areUNDERWEIGHT by district for survey period 2016

WHO Growth Chart results forunderweight

AliceSpringsRemote

Barkly DarwinRural

EastArnhem Katherine Total

Number of resident childrenmeasured for weight 602 223 1,338 479 670 3,312

Number of children identified asunderweight 14 4 82 38 30 168

% of measured resident childrenidentified as underweight 2% 2% 6% 8% 4% 5%

Number of resident children 661 269 1,525 680 802 3,937

Coverage (Resident childrenmeasured / Number of residentchildren) *

91% 83% 88% 70% 84% 84%

Underweight by District

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured resident children less than 5 years of age who areSTUNTED by survey period 2012 - 2016

WHO Growth Chart results forStunting 2012 2013 2014 2015 2016

Number of resident children measuredfor height 2,667 2,496 2,508 2,934 2,812

Number of resident children identified asstunted 370 424 424 444 392

% of measured resident childrenidentified as stunted 14% 17% 17% 15% 14%

Number of resident children 4,400 4,244 4,234 3,850 3,937

Coverage (Resident children measured /number of resident children) * 61% 59% 59% 76% 71%

Height for Age StatusHeight-for-age is an indicator of the growth of a child. A child whose Height for Age Z-score (HAZ) is less than -2 is called stunted. A stunted child is one who is growing poorlyover time, whose height is too low for his or her age. A child may be stunted because ofillness or inadequate diet.

* Numbers in red indicate that coverage is less than 80%

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Age (Months) 00-05 06-11 12-17 18-23 24-35 36-47 48-59 Total

Number of resident childrenmeasured for stunting 292 314 323 304 465 522 592 2,812

Number of resident childrenidentified as stunted 76 68 62 46 51 55 34 392

% of measured residentchildren identified as stunted 26% 22% 19% 15% 11% 11% 6% 14%

Number of resident children 332 381 388 387 663 735 1051 3,937

Coverage (Resident childrenmeasured / number of residentchildren) *

88% 82% 83% 79% 70% 71% 56% 71%

Stunted by Age GroupPercentage of resident children less than 5 years of age measured who areidentified as STUNTED by age group for survey period 2016

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who are STUNTEDby survey period and age group 2012 - 2016

WHO Growth Chart results forstunting 2012 2013 2014 2015 2016

< 12 months

Measured for stunting 683 445 459 676 606

Identified as stunted 101 84 59 147 144

% of measured children stunted 15% 19% 13% 22% 24%

Resident children 889 838 785 778 713

Coverage (Measured / Resident) * 77% 53% 58% 87% 85%

1 to < 3 years

Measured for stunting 1,024 1,027 1,043 1,094 1,092

Identified as stunted 172 244 249 186 159

% of measured children stunted 17% 24% 24% 17% 15%

Resident children 1,799 1,656 1,651 1,425 1,438

Coverage (Measured / Resident) * 57% 62% 63% 77% 76%

3 to < 5 years

Measured for stunting 960 1,024 1,006 1,164 1,114

Identified as stunted 97 96 116 111 89

% of measured children stunted 10% 9% 12% 10% 8%

Resident children 1,712 1,750 1,798 1,647 1,786

Coverage (Measured / Resident) * 56% 59% 56% 71% 62%

Stunted Trend by Age Group

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who are STUNTEDby district for survey period 2016

WHO Growth Chart results forstunting

AliceSpringsRemote

Barkly DarwinRural

EastArnhem Katherine Total

Number of resident childrenmeasured for stunting 487 186 1,102 434 603 2,812

Number of children identified asstunted 73 21 175 56 67 392

% of measured resident childrenidentified as stunted 15% 11% 16% 13% 11% 14%

Number of resident children 661 269 1,525 680 802 3,937

Coverage (Resident childrenmeasured / Number of residentchildren) *

74% 69% 72% 64% 75% 71%

Stunted by District

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured resident children less than 5 years of age who areWASTED by survey period 2009 - 2013

WHO Growth Chart results forWasting 2012 2013 2014 2015 2016

Number of resident children measuredfor wasting 2,644 2,485 2,506 2,919 2,786

Number of resident children identified aswasted 138 112 123 134 95

% of measured resident childrenidentified as wasted 5% 5% 5% 5% 3%

Number of resident children 4,400 4,244 4,234 3,850 3,937

Coverage (Resident children measured /number of resident children) * 60% 59% 59% 76% 71%

Weight for Height StatusWeight for Height is an indicator of the growth performance of a child. A child whoseweight for height z-score (WHZ) is less than -2.0 is called wasted. A wasted child is onewho is growing poorly, usually in a short period of time, whose weight is too low for his orher height. A child may be wasted because of acute illness or inadequate diet.

* Numbers in red indicate that coverage is less than 80%

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Age (Months) 00-05 06-11 12-17 18-23 24-35 36-47 48-59 Total

Number of resident childrenmeasured for wasting 277 313 323 304 462 521 586 2,786

Number of resident childrenidentified as wasted 12 7 7 9 12 22 26 95

% of measured resident childrenidentified as wasted 4% 2% 2% 3% 3% 4% 4% 3%

Number of resident children 332 381 388 387 663 735 1051 3,937

Coverage (Resident childrenmeasured / number of residentchildren) *

83% 82% 83% 79% 70% 71% 56% 71%

Wasted by Age GroupPercentage of measured children less than 5 years of age who are WASTED byage group for survey period 2016

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who are WASTED bysurvey period and age group 2012 - 2016

WHO Growth Chart results forwasting 2012 2013 2014 2015 2016

< 12 months

Measured for wasting 667 443 457 665 590

Identified as wasted 39 22 30 34 19

% of measured children wasted 6% 5% 7% 5% 3%

Resident children 889 838 785 778 713

Coverage (Measured / Resident) * 75% 53% 58% 85% 83%

1 to < 3 years

Measured for wasting 1,022 1,024 1,043 1,092 1,089

Identified as wasted 51 45 32 40 28

% of measured children wasted 5% 4% 3% 4% 3%

Resident children 1,799 1,656 1,651 1,425 1,438

Coverage (Measured / Resident) * 57% 62% 63% 77% 76%

3 to < 5 years

Measured for wasting 955 1,018 1,006 1,162 1,107

Identified as wasted 48 45 61 60 48

% of measured children wasted 5% 4% 6% 5% 4%

Resident children 1,712 1,750 1,798 1,647 1,786

Coverage (Measured / Resident) * 56% 58% 56% 71% 62%

Wasted Trend by Age Group

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children less than 5 years of age who are WASTED bydistrict for survey period 2016

WHO Growth Chart results forWasting

AliceSpringsRemote

Barkly DarwinRural

EastArnhem Katherine Total

Number of resident childrenmeasured for wasting 484 185 1,092 430 595 2,786

Number of children identified aswasted 6 4 38 24 23 95

% of measured resident childrenidentified as wasted 1% 2% 3% 6% 4% 3%

Number of resident children 661 269 1,525 680 802 3,937

Coverage (Resident childrenmeasured / Number of residentchildren) *

73% 69% 72% 63% 74% 71%

Wasted by District

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured resident children aged 6 months to 5 years of agewho are ANAEMIC by survey period 2012 - 2016

Anaemia 2012 2013 2014 2015 2016

Number of resident children measuredfor anaemia 2,752 2,712 2,633 2,760 2,601

Number of resident children identified asanaemic 667 592 566 468 518

% of measured resident childrenidentified as anaemic 24% 22% 21% 17% 20%

Number of resident children 3,938 3,800 3,818 3,467 3,605

Coverage (Resident children measured /number of resident children) * 70% 71% 69% 80% 72%

Anaemia StatusThe diagnosis of anaemia is specified in CARPA 6th Edition 2014, page 119. A childwhose haemoglobin level is less than 105 g/L (for 6-11 months old) or less than 110 g/L(for 1-4 years old) is anaemic and requires treatment.

* Numbers in red indicate that coverage is less than 80%

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Age (Months) 06-11 12-17 18-23 24-35 36-47 48-59 Total

Number of resident childrenmeasured for anaemia 307 327 322 495 542 608 2,601

Number of resident childrenidentified as anaemia 86 119 72 68 89 84 518

% of measured resident childrenidentified as anaemic 28% 36% 22% 14% 16% 14% 20%

Number of resident children 381 388 387 663 735 1,051 3,605

Coverage (Resident childrenmeasured / number of residentchildren) *

81% 84% 83% 75% 74% 58% 72%

Anaemia By Age GroupPercentage of measured children aged 6 months to 5 years of age who areANAEMIC by age group for survey period 2016

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children aged 6 months to 5 years of age who areANAEMIC by survey period and age group 2012 - 2016

Anaemia 2012 2013 2014 2015 2016

< 12 months

Measured for anaemia 346 291 268 314 307

Identified as anaemic 127 96 84 71 86

% measured children anaemic 37% 33% 31% 23% 28%

Resident children 427 394 369 395 381

Coverage (Measured / Resident) * 81% 74% 73% 79% 81%

1 to < 3 years

Measured for anaemia 1,283 1,233 1,174 1,204 1,144

Identified as anaemic 363 330 276 261 259

% measured children anaemic 28% 27% 24% 22% 23%

Resident children 1,799 1,656 1,651 1,425 1,438

Coverage (Measured / Resident) * 71% 74% 71% 84% 80%

3 to < 5 years

Measured for anaemia 1,123 1,188 1,191 1,242 1,150

Identified as anaemic 177 166 206 136 173

% measured children anaemic 16% 14% 17% 11% 15%

Resident children 1,712 1,750 1,798 1,647 1,786

Coverage (Measured / Resident) * 66% 68% 66% 75% 64%

Anaemia Trend by Age Group

* Numbers in red indicate that coverage is less than 80%

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Percentage of measured children aged 6 months to 5 years of age who areANAEMIC by district for Survey Period 2016

AnaemiaAlice

SpringsRemote

Barkly DarwinRural

EastArnhem Katherine Total

Number of resident childrenmeasured for anaemia 459 173 1,021 374 574 2,601

Number of children identified asanaemic 99 42 189 57 131 518

% of measured resident childrenidentified as anaemic 22% 24% 19% 15% 23% 20%

Number of resident children 615 247 1,405 624 714 3,605

Coverage (Resident childrenmeasured / Number of residentchildren) *

75% 70% 73% 60% 80% 72%

Anaemia by District

* Numbers in red indicate that coverage is less than 80%

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2016 Tracking - StuntingChildren who were reported to be STUNTED in 2015 were tracked in 2016 and identifiedto be:

2016 Tracking - Underweight

Children who were reported to be UNDERWEIGHT in 2015 were tracked in 2016 andidentified to be:

No longerunderweight

Stillunderweight Not Measured 5+ Total

Number of Children 63 66 42 6 177

% 36% 37% 24% 3% 100%

No longer stunted Still stunted Not Measured 5+ Total

Number of Children 206 105 95 5 411

% 50% 26% 23% 1% 100%

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2016 Tracking - WastingChildren who were reported to be WASTED in 2015 were tracked in 2016 and identified tobe:

2016 Tracking - AnaemiaChildren who were reported to be ANAEMIC in 2015 were tracked in 2016 and identifiedto be:

No longer Wasted Still wasted Not Measured 5+ Total

Number of Children 52 14 42 4 112

% 46% 13% 38% 4% 100%

No longerAnaemic Still anaemic Not Measured 5+ Total

Number of Children 222 57 84 42 405

% 55% 14% 21% 10% 100%

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