child deaths prevention committee annual report …...nt child deaths review and prevention...

Northern Territory Child Deaths Review and Prevention Committee

Annual Report 2018-2019

Northern Territory Child Deaths Review and Prevention CommitteeThe NT Child Deaths Review and Prevention Committee respects the beliefs of Aboriginal and Torres Strait Islander people and advises there is information in this report regarding deceased Aboriginal and Torres Strait Islander children.

Postal NTOfficeoftheCoroner POBox1281DarwinNT0801

Telephone 0889997770

Facsimile 0889995128

E-mail [email protected]

Web www.justice.nt.gov.au

© NT Office of the Coroner, Northern Territory Government, 2019

Thisworkiscopyright,suchcopyrightbelongingtotheNorthernTerritoryofAustraliaandsubjecttoconditionsoftheCopyright Act 1968andtheNorthernTerritorycopyrightpolicy.

Theinformationinthisreportmaybefreelycopiedanddistributedfornon‑profitpurposessuchasstudy,research,servicesmanagementandpublicinformationsubjecttotheinclusionofanacknowledgementoftheChildDeathsReviewandPreventionCommittee,NorthernTerritoryasthesource.

ISSN 1837-3852

Printed by UniPrint

Suggested citation

CDRPC(2019).Annual Report 2018-2019, Northern Territory Child Deaths Review and Prevention Committee,OfficeoftheChildren’sCommissioner,Darwin

Thisreportisavailableinelectronicformatonthe Attorney‑GeneralandJusticewebsitelocatedatwww.justice.nt.gov.au

DrSaraWatsonConvenorNTChildDeathsReviewandPreventionCommittee31October2019

Child Deaths Review and Prevention Committee

Letter to Parliament

TheHonourableNatashaFylesMLAAttorney‑GeneralandMinisterforJusticeParliamentHouseMitchellStreetDARWINNT0800

DearMinister

IampleasedtoprovideyouwiththeAnnualReportoftheNorthernTerritoryChildDeathsReviewandPreventionCommitteefor2018‑2019,inaccordancewithsection213oftheCare and Protection of Children Act 2007.

Yourssincerely,

NORTHERN TERRITORY OF AUSTRALIA

NT Child Deaths Review and Prevention CommitteeAnnualReport2018‑19

ContentsList of tables .................................................................................................................................................................................. i

List of figures ................................................................................................................................................................................ ii

List of appendices ....................................................................................................................................................................... ii

Northern Territory Child Deaths Review and Prevention Committee ................................................................. iii

Glossary of terms ....................................................................................................................................................................... iv

Definitions ..................................................................................................................................................................................... v

Foreword ....................................................................................................................................................................................... 1

Executive summary .................................................................................................................................................................... 2

BackgroundandoverviewoftheCommitteeactivities.......................................................................................2

IssuesrelatingtochilddeathsdataintheNT..........................................................................................................2

ChilddeathsintheNT,2014‑2018.............................................................................................................................3

2018snapshot......................................................................................................................................................3

2014‑2018aggregatedsnapshot...................................................................................................................4

Issues reviewed by the Committee .......................................................................................................................................5

ReviewofthesentineleventbytheCommittee....................................................................................................5

Morbidobesity.....................................................................................................................................................5

InfantSUDI/SIDSdeathsbyyear,gender,Aboriginalstatus, usualresidenceandco‑sleepingstatus,NT,2014‑2018.....................................................................................6


Chapter 1 – Introduction ......................................................................................................................................................... 7

Introduction........................................................................................................................................................................7

FunctionsoftheCommittee.........................................................................................................................................7

TheChildDeathsRegister.............................................................................................................................................8

ActivitiesoftheCommittee..........................................................................................................................................8

Nationalrepresentationandengagement...................................................................................................8

Chapter 2 – Sources of Data – child deaths in the Northern Territory.....................................................................9

Sourcesofdataonchilddeaths...................................................................................................................................9

AustralianBureauofStatistics(ABS).............................................................................................................9

RegistryofBirths,DeathsandMarriages....................................................................................................9

TheNationalCoroner’sInformationSystem..............................................................................................9

OfficeoftheNTCoroner.............................................................................................................................. 10

Othersourcesofdata..................................................................................................................................... 10

Confidentialityofinformation.................................................................................................................................... 11

Codingcauseofdeath.................................................................................................................................................. 11

Calendaryearreporting............................................................................................................................................... 11

Chapter 3 – Child deaths in the Northern Territory..................................................................................................... 12

Childdeathsrates.......................................................................................................................................................... 12

Childdeathsin2018..................................................................................................................................................... 12

Childdeathsbyagegroup,NT,2018......................................................................................................... 12

Childdeathsbyagegroupandgender,NT,2018............................................................................................... 13

Childdeaths,2014‑2018............................................................................................................................................. 14


Childdeathsbyyear,genderandagegroup,NT,2014‑2018............................................................ 14

Childdeathsbyyear,Aboriginalstatusandagegroup,NT,2014‑2018......................................... 15

Childdeathsbyusualresidence,agegroup,genderandAboriginalstatus,NT,2014‑2018.... 16

Childdeathratesbyyear,NT,2014‑2018................................................................................................ 17

Childdeathratesbyagegroup,NT,2014‑2018.................................................................................... 18

Childdeathratesbyagegroupandgender,NT,2014‑2018............................................................ 18

InfantsDeaths,2014‑2018........................................................................................................................................ 19

InfantdeathsbygenderandAboriginalstatus,NT,2014‑2018........................................................ 19

Perinataldeathsbytype,Aboriginalstatusandyear,NT,2014‑2018............................................ 19

PostneonatalinfancybyAboriginalstatusandyear,NT,2014‑2018.............................................20

Deathsofchildrenwithafamilyinvolvementinchildprotectionservice2014‑2018...............20

CharacteristicsofchilddeathbyknowntoTFstatus,NT,2014‑2018.......................................... 21

Chapter 4 – Underlying causes of child deaths in the Northern Territory, 2014-2018 ................................... 22

UnderlyingcauseofdeathbyICD‑10chapterandyear,NT,2014‑2018...................................................22

UnderlyingcauseofdeathbyICD‑10chapter,genderandAboriginalstatus,NT,2014‑2018........... 24

UnderlyingcauseofdeathbyICD‑10chapterandgender, andchapterandAboriginalstatus,NT,2014‑2018.................................................................................. 25

UnderlyingcauseofdeathbyICD‑10chapterandusualresidence,NT,2014‑2018.............................. 27

UnderlyingcauseofdeathbyICD‑10chapterandagegroup,NT,2014‑2018........................................ 29

Appendices ................................................................................................................................................................................ 30

References ................................................................................................................................................................................. 34


i

List of tablesTable 1: NumberofchilddeathsbyagegroupandgenderandAboriginalstatus,NT,2018.......................... 11

Table 2: Childdeathsbyyear,genderandagegroup,NT,2014‑2018.................................................................... 12

Table 3: Childdeathsbyyear,Aboriginalstatusandagegroup,NT,2014‑2018................................................. 13

Table 4: Childdeathsbyusualresidence,agegroup,genderandAboriginalstatus,NT,2014‑2018............ 14

Table 5: Childdeathratesbyyear,NT,2014‑2018........................................................................................................ 15

Table 6: Childdeathratesbyagegroup,NT,2014‑2018............................................................................................ 16

Table 7: Childdeathratesbyagegroupandgender,NT,2014‑2018...................................................................... 16

Table 8: InfantdeathsbygenderandAboriginalstatus,NT,2014‑2018............................................................... 17

Table 9: Perinataldeathsbytype,Aboriginalstatusandyear,NT,2014‑2018.................................................... 17

Table 10: PostneonatalinfancybyAboriginalstatusandyear,NT,2014‑2018.................................................... 18

Table 11: CharacteristicsofchilddeathbyknowntoTFstatus,NT,2014‑2018.................................................. 19

Table 12: UnderlyingcauseofdeathbyICD‑10chapterandyear,NT,2014‑2018............................................. 21

Table 13: UnderlyingcauseofdeathbyICD‑10chapter,genderandAboriginalstatus,NT,2014‑2018......22

Table 14: UnderlyingcauseofdeathbyICD‑10chapterandusualresidence,NT,2014‑2018........................25

Table 15: UnderlyingcauseofdeathbyICD‑10chapterandagegroup,NT,2014‑2018.................................. 27

ii


List of figuresFigure 1: Numberofchilddeathsbyagegroup,NT,2018............................................................................................ 10

Figure 2: Childdeathratesbyyear,NT,2014‑2018........................................................................................................ 15

Figure 3: UnderlyingcauseofdeathbyICD‑10chapterandgender,NT,2014‑2018......................................... 23

Figure 4: UnderlyingcauseofdeathbyICD‑10chapterandAboriginalstatus,NT,2014‑2018...................... 24

Figure 5:UnderlyingcauseofdeathbyICD‑10chapterandusualresidence,NT,2014‑2018........................ 26

List of appendicesAppendix 1: TableofunderlyingcauseofchilddeathsbyICD‑10chapters,NT,2014‑2018........................... 28


iii

Northern Territory Child Deaths Review and Prevention CommitteeMembers as at 30 June 2019

Dr Sara Watson Convenor, NTChildDeathsReview andPreventionCommittee ActingChiefMedicalOfficerand SeniorDirectorofQualityandSafety DepartmentofHealth,NT

Ms Jeanette Kerr DeputyConvenor, NTChildDeathsReview andPreventionCommittee DeputyChiefExecutive, FamilyandRegionalServices TerritoryFamilies,NT

Mr Kelvin Currie DeputyCoroner, NTOfficeoftheCoroner Attorney‑GeneralandJustice,NT

Dr Marianne Tiemensma ForensicPathologist, ForensicPathologyUnit RoyalDarwinHospital DepartmentofHealth,NT

Ms Colleen Gwynne Children’sCommissioner Attorney‑General&Justice,NT

Commander David Proctor DomesticViolenceandPreventionCommand NTPolice,DarwinNT

Ms Priscilla Collins CEO, NorthAustralianAboriginalJusticeAgency(NAAJA) DarwinNT

Dr Kathryn Roberts ActingMedicalCo‑Director, DivisionofWomenChildrenandYouth RoyalDarwinHospital, DepartmentofHealth,NT

Associate Professor Robert Parker DirectorofPsychiatry, TopEndMentalHealthServices, DepartmentofHealth.NT

Mr Peter Pangquee PublicMember

Professor Gary Robinson Director, CentreforChildDevelopmentandEducation MenziesSchoolofHealthResearch AdvisortotheCommittee

Ms Maree Garrigan A/ExecutiveDirector, SchoolSupportServices DepartmentofEducation,NT

Committee Secretariat

Ms Alana Carter ResearchOfficer OfficeoftheCoroner Attorney‑GeneralandJustice,NT

iv


Glossary of terms

ABS AustralianBureauofStatistics

AGD DepartmentofAttorney–GeneralandJustice,NT

AIFS AustralianInstituteofFamilyStudies

ANZCDR&PG AustraliaandNewZealandChildDeathReviewandPreventionGroup

ASGC ABSAustralianStandardGeographicalClassification

BDM NorthernTerritoryOfficeoftheRegistrarofBirths,DeathsandMarriages

CDR ChildDeathRegister

CDRPC ChildDeathsReviewandPreventionCommittee

COD CauseofDeath

Committee ChildDeathsReviewandPreventionCommittee

Coroner OfficeoftheNTCoroner

DoH DepartmentofHealth,NT

ICD-10 AM InternationalStatisticalClassificationofDiseasesand RelatedHealthProblems,TenthRevision–AustralianModified

LGA NorthernTerritoryLocalGovernmentAreas

Menzies MenziesSchoolofHealthResearch

NCIS NationalCoronialInformationSystem

NSW NewSouthWales

NT NorthernTerritory

Qld Queensland

Register ChildDeathsRegister

SUDI SuddenUnexpectedDeathinInfancy

SIDS SuddenInfantDeathSyndrome

TF TerritoryFamilies

the Act Care and Protection of Children Act 2007

UCOD UnderlyingCauseofDeath

WHO WorldHealthOrganisation


v

Definitions

Aboriginal ThefollowingdefinitionisprovidedforthetermAboriginalinsection13oftheAct:

Aboriginal means: (a) a descendant of theAboriginal peoples of Australia; or (b) adescendantoftheIndigenousinhabitantsoftheTorresStraitIslands.

Throughout this report the term Aboriginalwill be used for people of either Aboriginal or Torres Strait Islander descent except wherespecific reference isbeingmade topublicationsthatuseotherterminology,forexample,theABSwhichoftenusesthetermIndigenous.

Cause of death (COD) Allthosediseases,morbidconditions,orinjurieswhich either resulted in or contributed todeathand thecircumstancesof theaccidentorviolencewhichproducedsuchinjuries.1

Child Section 13 of the Act defines child as (a) aperson aged seventeen years and under; or (b)apersonapparently lessthan18yearsofageifagecannotbeproved.

Child death Section 208 of the Act defines child death as(a) the death of a child who usually resided in theTerritory(whetherthedeathoccurredinthe Territory or not); or (b) a stillbirth as defined in the Births, Deaths and Marriages Registration Act 1996 thatoccurredintheTerritory.

1 WorldHealthOrganisation(2008),ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2 Instruction Manual, 33‑34.

2 Abeywardana,S.&Sullivan,E.A.(2008)Congenital anomalies in Australia 2002-2003. Birth anomalies series no. 3. Cat. No. PER 41. Sydney: Australian Institute

3 Laws,P.J.&Hilder,L.(2008).Australia’smothersandbabies2006.Perinatalstatisticsseriesno.22.Cat.NoPER46.Sydney:Australian Institute of Health and Welfare National Perinatal Statistics Unit.

4 lbid

Greater Darwin GreaterDarwinincorporatestheCityofDarwin,theCityofPalmerstonandtheLitchfieldShire.

Congenital malformations Congenital malformations, including deformitiesandchromosomalabnormalities,arephysicalandmentalconditionspresentatbirththatareeitherhereditaryorcausedbyenvironmentalfactors.

Infancy The infancy period extends from birth to12monthsofage.Aninfantdeathisthedeathofalivebornchildunder1yearofage.2

Neonatal The neonatal period extends from birth to28daysofage.Aneonataldeathisthedeathofalivebornbabywithin28daysofbirth3

Perinatal The Perinatal period extends from 20 weeksgestationto28daysfollowingbirth.Aperinataldeath is a fetal death (of at least 20 weeksgestation or at least 400 grams birthweight4)or a neonatal death (of a live baby within 28daysfrombirth).

vi


Post-neonatal The post‑neonatal period is the period from 28daysto1yearofage.

Rest of the NT Restof theNT incorporate thoseareasoutsidetheCityofDarwin, theCityofPalmerstonandtheLitchfieldShire.

Stillbirth (fetal death) Inaccordancewithsection4oftheBirths Deaths and Marriages Registration Act 1996, a stillbirthmeansthe birth of a still‑born child, which isdefinedasachildofatleast20weeksgestationorwith a body mass of at least 400 grams atbirth that exhibits no sign of respiration orheartbeat, orothersignoflife,afterbirth.5

Sudden infant deathsyndrome (SIDS) SIDS (Sudden infant death syndrome), is asubsetofSUDI,anddefinedasthesuddenandunexpected death of an infant <1 year of age,with the onset of the fatal episode apparentlyoccurringduringsleep,thatremainsunexplainedafter a thorough investigation, includingperformanceofa completeautopsyand reviewof the circumstances of death and the clinicalhistory.(SanDiego,2004definition).

5 lbid

6 opcit.

Sudden unexpected death in infancy (SUDI) SUDI (also described as Sudden UnexpectedInfant Death, SUID), is a term used for allunexpected infant deaths, whether theexplanation is immediate, determinable aftera thorough examination, or remains unknown.At one point all unexplained SUDI deathswerelabelledasSuddenInfantDeathSyndrome,SIDS.

Underlying cause of death (UCOD)(a) Thediseaseorinjurywhichinitiated

the train of morbid events leadingdirectlytodeath;or

(b) The circumstances of the accidentor violence, which produced thefatalinjury(WHO).6

InAustralia, the perinatal period commences atthe20thcompletedweekofgestationandends28completeddaysafterbirth.Perinataldeathsare a combination of stillbirths and neonataldeaths (as defined in theNTBirths, Deaths and Marriages Registration Act 1996).


1

ForewordThis is the eleventh Annual Report of the Northern Territory Child Deaths Review and PreventionCommittee.ThereportisbasedoninformationprovidedtotheCommitteeonthe38deathsofchildrenwhoseusualplaceof residence is theNTandof43stillbirths thatoccurredduring thecalendaryear2018. Thereportalsoprovidessummary informationon207childandinfantdeathsthatoccurred inthefive‑yearperiod2014‑2018.

ThisreportisthesecondtobeproducedbytheNTOfficeoftheCoronerwhonowhasresponsibilityfortheSecretariatoftheChildDeathsReviewandPreventionCommittee.

ThedeathofanychildisatragedyandthemembersoftheCommitteeextendtheirsincerecondolencesto the family, friends and communities of the children and young people cited in this report. Inhighlightingthecircumstancesrelatingtothesedeathsandbyconductingresearchbasedonidentifiedpatterns and trends, theCommittee’s objective is to effect change thatwill prevent and reduce childdeaths,accidentsanddiseasesintheNT.

Inaddition toprovidingananalysisof thechild and infantdeaths thatoccurredduring2018and thepreceding four years, this report provides information on injury related child deaths released by the NTChildDeathsReviewandPreventionCommitteeandtabledinParliament.

This year BrentWarren resigned as Deputy Convenor of the Committee. Other resignations werefrom Superintendent Kris Evans, Dr Charles Kilburn and Maree Garrigan as Committee members. All members made invaluable contributions and on behalf of the Committee I would like toexpress our sincere gratitude. We also welcomed the recent appointment of Jeanette Kerr andCommanderDavidProctoraswellastheappointmentofPaediatricianDrKathrynRoberts. BetweenthemtheybringextensiveknowledgeandexpertiseinNTPolice,TerritoryFamiliesandPaediatrics.

DrSaraWatson Convenor NTChildDeathsReviewandPreventionCommittee

31October2019

2


Executive Summary

Background and overview of the Committee activitiesThe Committee is established pursuant to Part 3.3 of the Care and Protection of Children Act 2007 (the Act). The purpose of the child deaths review process undertaken by the Committee is to assist in the prevention and reduction of child deaths in the Northern Territory. It achieves this through:

a) Maintainingadatabaseonchilddeaths;

b) Conductingresearchaboutchilddeaths,diseasesandaccidentsinvolvingchildrenand

c) Contributingtothedevelopmentofappropriatepolicytodealwithsuchdeaths,diseasesandaccidents.

TheCommittee’sspecificfunctionsaresetoutintheAct.

d) Actiononissuesarisingfromtheon‑goingqualityassuranceoftheChildDeathsRegister(theRegister);

Issues relating to child deaths data in the NTChapter 2 examines contextual factors and sources of data for the work of the Committee. This includes data obtained from national bodies such as the Australian Bureau of Statistics (ABS) and the National Coroners Information System (NCIS), which provide data on child deaths and demographics.

Theprimarysourceofdataonchilddeaths isobtainedfromtheOfficeoftheRegistrarofBirths,DeathsandMarriages (BDM)which also provides data on stillbirths in the NT. Other sources such asmedicalrecordsfromtheDepartmentofHealth(DoH)anddocumentsheldbytheOfficeoftheNTCoronerprovideadditionaldetailrelatingtoindividualdeaths.

Otherissuesincludethefollowing:

• AlthoughthisistheCommittee’s2018‑2019AnnualReport,thefocusisonchilddeathsforthecalendaryear2018withafurtheroverviewofcalendaryears2014‑2018.

• Presentationofdataisbasedontheactualyearofdeathratherthantheyearofregistrationofthedeathwhichisusedbyotheragencies(e.g.ABS);

• ICD‑10‑AMcodesareusedforclassifyingthecauseofdeathinlinewiththepracticeofmostothersimilarcommitteeswithinAustralia;

• Forallchilddeathsthat involvedareviewbytheNTCoroner,thedeliveryofcoronialfindingsfollowsathoroughcoronialinvestigationtodetermineacauseofdeathbeforeitisreportedtoBDM.Thismaytakemonths,possiblyyearstocompletetheseinvestigations,hencethedelayinreportingthesedeaths;

• TheneedtoobtainadditionaldatabeyondthatsuppliedbyBDM;

• TheneedtocanvasotherjurisdictionsincludingBDMregistriesinotherstatesandterritories,forinformationonthedeathsofNTchildrenthatoccurredinterstate.


3

Child deaths in the NT, 2014-2018Chapters 3 and 4 provide data on the deaths of children whose usual place of residence is the NT. The data for 2018 is current but it is important to view data aggregated over five years when determining trends or interpreting changes.

2018 snapshot

38 deaths of childrenwhoseusualplaceofresidenceisintheNT.

» 23(60.5%)weremale;15(39.5%)werefemale;

» 28(73.7%)wereAboriginal;10(26.3%)werenon‑Aboriginal

» 26(68.4%)werefromoutsidetheGreaterDarwinarea.

25(65.8%)ofthe38wereinfantdeaths;2(5.3%)were1to4yearsold,1(2.6%)was5to9yearolds,4(10.5%)were10‑14yearsoldand6(15.8%)were15‑17yearsold.

Of the 25 infant deaths, 11 (44%) were female and 14 (56%) were male; 19 (76%) were Aboriginal and6(24%)werenon‑Aboriginal.

Of the 25 infant deaths, 15 (60%) were neonatal (under 1month old) deaths, of which 11 (73.3%) wereAboriginaland4(26.7%)werenon‑Aboriginal.

In addition, 43 stillbirths were registered as having occurred in the NT. 17 (39.5%) were female and 23 (53.5%) were male and 3 (7%) wereunknown;19(44.2%)wereAboriginaland24(55.8%)werenon‑Aboriginal.

Therewere58perinatal (43stillbirths+15neonatal)deathsregistered intheNT:30(51.7%)wereAboriginaland28(48.3%)werenon‑Aboriginal.

43 stillbirths in 2018

38 deaths in 2018

4


2014-2018 aggregated snapshot

207 deaths of children whowereusuallyresidentintheNT:

» 96 (46.4%) were female, 110 (53.1%) were male and1(.5%)wasunknown;

» 145(70%)wereAboriginaland62(30%)werenon‑Aboriginal;and

» 134(64.7%)werefromoutsidetheurbanGreaterDarwinarea.

121(58.5%)wereinfants,23(11.1%)were1to4yearsold,9(4.3%)were5to9yearsold,21(10.1%)were10to14yearsoldand33(16%)were15to17yearsold.

Of the 121 infant deaths, 58 (48%) were females, 62 (51.2 %) were males and 1 (0.8 %) was unknown; 87(72%)wereAboriginaland34(28%)non‑Aboriginal.

Ofthe121infantdeaths87(72%)wereneonates,underonemonthofageofwhich62(71.3%)wereAboriginaland25(28.7%)werenon‑Aboriginal.

Inaddition,169stillbirthswereregisteredintheNT:83(49.1%)weremale,83(49.1%)werefemaleand3(1.8%)wereunknown;97(53%)werenon‑Aboriginaland72(47%)wereAboriginal.

Therewere256perinatal(169stillbirths+87neonatal)deathsregisteredintheNT134(52.3%)wereAboriginaland122(47.7%)werenon‑Aboriginal.

207 deaths over 2014 - 2018


5

Issues reviewed by the Committee

Review of sentinel event by the Committee

Morbid Obesity

Whilst theAnnualReport focuseson2018cases, theCommitteewishes tohighlightasentineleventcase discussed in2019. TheCommittee acknowledges theneed to respond to all deaths of children. The Committee makes a recommendation at this time in order to support opportunities to developpositivechangeinthisarea.

Theissueofobesitywashighlightedin2019duringacasereviewbytheCommittee.Thecaseinvolvedthedeathofachildinaremotecommunity,andobesitywasconsideredtobeacontributingfactorinthecauseofdeath.TheCommitteesoughtadvicefromexperts.

Expertadvice received is that there is increasingevidenceof intergenerational type2diabetes in theNT.Type2diabetesusedtobeaconditiononlyseeninadultsbutisnowbeingdiagnosedinyoungerages in NT Aboriginal children. There has been a 52% increase in type 2 diabetes in NT Aboriginalyouthaged15‑24yearsbetween2014and2018.Theobservedyoungerageofdiabetesonsetineachgeneration is likely because of the impact of pre‑existing type 2 diabetes in pregnancy on the child. Obesityandtype2diabetesarepreventable.Theymaybedelayedorpreventedwithimprovementsinpre‑conceptionhealth,healthinpregnancy,infantnutrition,healthyfoodandphysicalactivity.

TheCommitteeagreeswithexpertsthatactionisneededacrossmanyareasincludingimprovementsin:

• Health‑supportforhealthyfoodoptionsinshopsandstores;implementationofbodymassindexasakeyperformanceindicator;promotionofmentalhealthsupportservices;fosteringawarenessofobesityanditspreventionamongcommunities,consumersandclinicians.

• Housing‑overcrowding

• Education–healtheducationandpromotionwithinschools

• Sport,recreation–healthpromotioninyouthprogrammes

• Planning,infrastructure‑accesstosafe

Recommendation

TheCommittee recommends that theNTGovernment considers aTerritory‑wide actionplan toprevent andreduceobesityandtype2diabetes.TheplanwillneedtoincludeNTGovernment,non‑governmentorganisations,localgovernmentandcommunity‑controlledorganisationsinordertooptimisehealthylivesforchildren.

Theplanshouldcrossallageranges;becodesignedwithcommunities;includeaccesstoNT‑widefreedrinkingwaterandaimtoimproveaccesstohealthyfoodforcommunities.

6


Infant SUDI / SIDS deaths by year, gender, Aboriginal status, usual residence and co-sleeping status, NT, 2014-2018 SUDI(SuddenUnexpectedDeathinInfancy)isatermthatdescribesthesuddenandunexpecteddeathof an infant under the age of 12months, andmay be due to natural or unnatural causes, or remainunexplained.

SIDS(Suddeninfantdeathsyndrome),isasubsetofSUDI,anddefinedasthesuddenandunexpecteddeathofaninfant<1yearofage,withtheonsetofthefatalepisodeapparentlyoccurringduringsleep,thatremainsunexplainedafterathoroughinvestigation, includingperformanceofacompleteautopsyandreviewofthecircumstancesofdeathandtheclinicalhistory.(SanDiego,2004definition).

Between1January2014and31December2018,atotalof207deathsofchildrennormallyresidentintheNT,wereregisteredintheNT.

In the specific infant age group (under 1 year) therewere n=121, 58.5% deaths. Of the 121 infantdeaths, (n=34, 28.1%) were reportable deaths to the Coroner (Section 12(1) Coroners Act 1993). Of the34 reportabledeaths,23cases (67.6%) fall into thesubsetofSUDI (asper theabovedefinition). Atthetimeofthisreport,therewere5deathsfrom2018awaitingtheoutcomeofcoronialinvestigations.

In the years 2014 – 2018, the number of Aboriginal infant deaths classified as SUDI (n=17, 74%)was substantially greater than the proportion of non‑Aboriginal children (n=6, 26%) in the total NTpopulation. The number of co‑sleeping events (n=15, 65.2%) were noticeably higher than nonco‑sleeping events(n=8,34.8)withahighproportionoccurringoutsidethegreaterDarwinarea(n=14,60.9%).

TheCommitteewillworkwithagenciesin2019tounderstandthisissuebetterandidentifyhighriskpopulations.

Infant SUDI / SIDS deaths by year, gender, Aboriginal status, usual residence and co-sleeping status NT, 2014-2018

Infant Deaths under 1 year

Gender Aboriginal Status Region Co-sleeping Open cases

Male Female AboriginalNon-

AboriginalGreater Darwin

Rest of NT Yes No

2014 = 2 1 1 2 0 0 2 2 0 0

2015 = 9 4 5 7 2 3 6 6 3 0

2016 = 4 1 3 2 2 2 2 2 2 0

2017 = 3 1 2 3 0 1 2 2 1 0

2018 = 5 3 2 3 2 3 2 3 2 5

TOTAL 10 13 17 6 9 14 15 8 523 23 23 23

Source: NTChildDeathsRegister&NationalCoronialInformationSystem(NCIS)


7

Chapter 1 – Introduction

Introduction This is the Child Deaths Review and Prevention Committee’s (CDRPC or Committee) eleventh annual report. It provides information related to the deaths of 38 children under the age of 18 years whose usual place of residence is in the Northern Territory (NT) and 43 stillbirths registered in 2018. The report also includes information on child deaths and stillbirths from 2014 to 2018 for comparative and historical purposes.

Functions of the CommitteeTheCommittee’sfunctionare:

• toestablishandmaintaintheChildDeathsRegister.

• to conduct or sponsor research into child deaths, diseases and accidents involving children andotherrelatedmatters(suchaschildhoodmorbidityandmortality),whetheraloneorwithothers;

• tomakerecommendationsontheresearchintochilddeaths,diseasesandaccidents;

• tomonitortheimplementationoftherecommendations;

• toraisepublicawarenessinrelationto:

i. thedeathratesofchildren;

ii. thecausesandnatureofchilddeathsanddiseasesandaccidentsinvolvingchildren;

iii. thepreventionorreductionofchilddeaths,diseasesandaccidents;

• tocontributetoanynationaldatabaseonchilddeathsinAustralia;

• toenterintoanarrangementforsharingofinformationwithanyoneinAustraliawhohasfunctionssimilartothoseofthisCommittee;

At theendof eachfinancial year theCommittee is required toprepare a report about theoperationoftheCommitteeduringthatfinancialyear.ShouldtheCommitteeconductorsponsorresearchaboutissuesidentifiedasbeingrelevanttochilddeathsintheNT,theresultingreportmustalsobepresentedtotheMinister.TheMinisterisrequiredtotabletheCommittee’sAnnualReportandresearchreport/sintheLegislativeAssembly.

8


The Child Deaths RegisterUndertheCare and Protection of Children Act,thereisastatutoryobligationfortheCDRPCtoestablishandmaintain aChildDeathsRegister (theRegister). TheRegister contains information relating to the deaths ofchildrenandyoungpeopleundertheageof18yearswhoseusualplaceofresidenceistheNT.Section208oftheActdefinesachilddeathas:

a) the death of a childwho usually resided in the Territory (whether the death occurred in theTerritoryornot);or

b) a stillbirth as defined in the Births, Deaths and Marriages Registration Act that occurredintheTerritory.

TheRegistercontainsinformationrelatedtodateofbirth,dateofdeath,dateofregistration,age,gender,Aboriginal andTorres Strait Islander status, place of birth, place of death, usual place of residence andfamily details. Information is also gathered in relation to theunderlying causesof deaths andexternalfactorswhichmayhavecontributedtothedeath. Information intheRegister ispredominantlysourcedfrom data held by a number of NT government agencies, including the Department of the Attorney‑GeneralandJustice,DepartmentofHealth(DoH)andTerritoryFamilies(TF).Informationisalsoprovidedbygovernmentfundedhealthclinicsandprivatemedicalcentres.

InformationrelatingtothedeathsinterstateofchildrenwhoseusualplaceofresidenceistheNT,issourcedeitherfromchilddeathregistersofotherjurisdictionsortherespectivestateorterritoryBDM’s.Duetoanumberoflegislativeimpedimentspreventingsomejurisdictionssharingidentifiableinformationrelatingtochilddeaths,includingchildrenwhoseusualplaceofresidenceisintheNorthernTerritory,itisnotpossibletoreportonthesedeaths.

Activities of the CommitteeNational representation and engagement

The CDRPC has representation on the Australian and New Zealand Child Death Review andPreventionGroup(ANZCDR&PG),whichcomprisesrepresentativesfromalltheAustralianjurisdictions andNewZealand.

TheaimoftheANZCDR&PGistoidentify,addressandpotentiallydecreasethenumberofinfantandchildren deaths by sharing of information across jurisdictions andworking collaboratively to improvenationalandinternationalreporting.


9

Chapter 2 – Issues relating to child death data in the Northern Territory

Sources of data on child deathsAustralian Bureau of Statistics (ABS)

TheAustralianBureauofStatistics(ABS)publishesaseriesofreportsandtablesondeathsthatoccurinallAustralianjurisdictions.

ThereareanumberoflimitationswiththeABSdata,whichinclude:thetimelagbetweentherecordeddateofdeathwiththeNTBDMRegistryandthepublicationoftheABSreports,onlythemedicalcausesofdeatharerecordedandnottherelatedriskssuchasthesocialfactorsthatmayhavecontributedtothedeaths.TheABSchilddeathtablesdonotprovidedataforeachindividualyearofageso15,16and17yearsold,forexample,areincludedinthe15‑19agegrouping.

Registry of Births, Deaths and Marriages

TheDepartmentoftheAttorney‑GeneralandJustice’s(AGD)RegistryofBirths,DeathsandMarriagesprovides details of all child deaths occurring in the NT such as name, residence, date of birth, age, gender,AboriginalorTorresStraitIslanderstatus,dateandplaceofdeathandwhereavailablethecauseofdeath.

The Registry of Births, Deaths and Marriages also provides information relating to stillbirths in the NTincludingdateandplaceofbirth,gestationageandgestationweight.

The National Coroner’s Information System

The Committee obtains information such as Coronial Findings, Autopsy Reports, Toxicology Reports and Police Reports related to reportable deaths in the NT from the NationalCoroner’sInformationSystem(NCIS).

10


Office of the NT Coroner

TheOfficeoftheNTCoronerprovidesinformationtoNCISrelatedtodeathsofchildrendeemedtobereportableunderprovisionscontainedintheCoroners Act 1993.

Areportabledeathisdefinedasadeaththat:

• appearstohavebeenunexpected,unnaturalorviolent;

• appearstohaveresulted,directlyorindirectlyfromanaccidentorinjury;

• occurredduringananaestheticorasaresultofananaestheticandisnotduetonaturalcauses;

• occurredwhenapersonwasheldin,orimmediatelybeforedeath,washeldincareorcustody;

• wascausedorcontributedtobyinjuriessustainedwhilethepersonwasheldincustody;

• isofapersonwhoseidentityisunknown;

• andincertainothercircumstances.

Thedeathofachildthatisconsideredtohaveoccurredwhilstbeingincareorcustodyincludesthosecircumstances:

• wherethechildoryoungpersonisdeemedtobe‘incare’inaccordancewithprovisionscontained intheCare and Protection of Children Act 2007;or

• where the child or young person is an involuntary patient under theMental Health and Related Services Act 1998,whetherinhospitalortemporarilyremovedfromhospital;or

• iftheyoungperson’sdeathoccursinadetentioncentreapprovedundertheYouth Justice Act 2005.

Other sources of data

DoctorissueddeathcertificatesandotherrelevantinformationrequiredbytheCommitteeisprovidedbytheDepartmentofHealth(DoH)andotherhealthserviceproviders.


11

Confidentiality of informationThe Care and Protection of Children Act 2007 contains provisions that help ensure theconfidentiality of information obtained by the Committee in the exercising of its statutoryresponsibilities. It is anoffenceundertheActforapersontodisclose,oruseinformationobtainedaspartoftheperformanceoftheirfunctions.

TheActallowsforthedisclosureof informationforthepurposesofresearch;aspartofaninquiryorinvestigationconductedbyPoliceoraCoroner;toacourtortribunal,orwhereotherwiserequiredorauthorisedbylaw.

Coding cause of deathTheCommitteeusestheInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems,(ICD‑10whichwas developed by theWorldHealthOrganisation,WHO) to code theunderlying andmultiplecausesofdeath.TheICD‑10isdesignedtopromoteinternationalcompatibilityinthecollection,processing,classificationandpresentationofmorbidityandmortalitystatistics.ICD‑10‑AM(AustralianModified)9th EditionhasbeenmodifiedtoensurethattheclassificationiscurrentandappropriateforAustralianclinicalpracticewhilstensuringthatinternationalcompatibilityismaintained.

Calendar year reportingTheCommitteehaselectedtoreportonchilddeathsbasedonthecalendaryearasopposedtothefinancialyear.ThemajorityofotherAustralianjurisdictionsusethesamereportingperiod.

Age Group No

< 1 year 25

1‑4 years 2

5‑9 years 1

10‑14 years 4

15‑17 years 6

Total 38

12


Chapter 3 – Child deaths in the Northern Territory

This chapter provides statistical data related to child deaths in the calendar year 2018 and for the period 2014-2018. The data includes demographic details relating to age, gender, Aboriginal status and underlying causes of death and whether the child and/or a sibling is known to the child protection system. Updated data is used in the present report so there may be some variations in the data reported for previous years.

Child deaths ratesAchilddeathrateisameasurethatadjuststhenumberofdeathsfordifferenceinthepopulationsize.Childdeathratesarereportedasthenumberofdeathsper100,000populationofchildren.Bothchilddeath rates and infant death rates are standard units ofmeasurement. Rateswithin age groups arereported,asage‑groupspecificrates(numberofdeathsper100,000populations).

Child deaths in 2018Child deaths by age group, NT, 2018

Therewere38childdeathsregisteredin2018.Thehighestnumberofdeaths(n=25,65.8%)occurredduringinfancy,with(n=2,5.3%)deathsinthe1to4yearagegroup,(n=1,2.6%)inthe5to9yearsagegroup,(n=4,10.5%)10to14yearsand(n=6,15.8%)inthe15to17yearsagegroup.

Figure 1:Numberofchilddeathsbyagegroup,NT,2018

Source: NTChildDeathsRegister

15-17 years 15.8%

10-14 years 10.5%

5-9 years 2.6%

1-4 years5.3%

<1 year 65.8%

AgeGroup No

<1year 25

1‑4years 2

5‑9years 1

10‑14years 4

15‑17years 6

Total 38


13

Child deaths by age group and gender, NT, 2018Table 1: NumberofchilddeathsbyagegroupandgenderandAboriginalstatus,NT,2018

Age Group Female Male Total<1year 11 14 25

1‑4years 1 1 2

5‑9years 1 1

10‑14years 1 3 4

15‑17years 2 4 6

Total 15 23 38Aboriginal Status Total

Aboriginal 28

Non‑Aboriginal 10

Grand Total 38


14


Child deaths, 2014-2018Between1January2014and31December2018,atotalof207deathsofchildrennormallyresidentintheNTwereregisteredintheNT.

Child deaths by year, gender and age group, NT, 2014-2018

The majority of child deaths over the five year period occurred during infancy (n=121, 58.5%). Theagegroupwiththesecondlargestnumberofdeathswasthe15‑17yearsagegroup(n=33,16%),whilethe5‑9yearsagegrouphadthefewestnumberofdeaths(n=9,4.3%).Althoughtheyeardateshavechangedthesefiguresaresimilartolastyear’sfigures.

Malesmadeup51.6%ofallchildrenintheNTpopulation(ABS2018),andaccountedfor(n=110,53.1%)ofallchilddeathsovertheseyears.

Table 2:Childdeathsbyyear,genderandagegroup,NT,2014‑2018

Year and Gender < 1 year 1-4 years 5-9 years 10-14 years 15-17 years Total

2014 Female 11 1 0 3 3 Male 12 2 1 3 2 Subtotal 23 3 1 6 5 38

2015 Female 13 2 1 1 1 Male 12 4 2 0 1 Subtotal 25 6 3 1 2 37

2016 Female 15 2 0 0 5

Male 12 3 1 2 6

Subtotal 23 6 3 1 2 352017 Female 15 2 0 0 4

Male 12 3 1 2 6 Unknown 1 0 0 0 0

Subtotal 27 5 1 2 10 452018 Female 11 1 0 1 2

Male 14 1 1 3 4

Subtotal 25 2 1 4 6 38Total Female 58 10 2 9 17

Male 62 13 7 12 16

Male 1 0 0 0 0

Total 121 23 9 21 33 207

Source:NTChildDeathsRegisterandABS3101.0,June2018 Totalmaydifferfromlastyear’sreportduetolateregistrationsandinterstatedeaths


15

Child deaths by year, Aboriginal status and age group, NT, 2014-2018

Intheyears2014‑2018,thenumberofAboriginalchilddeathswassubstantiallygreaterthanthenumberofnon‑Aboriginalchildren. Therewasa totalof (n=145,70%)deathsofAboriginalchildren,which ismuchgreaterthantheproportionofnon‑Aboriginalchildren(n=62,30%)inthetotalNTpopulationfortheseagegroups.

Table 3: Childdeathsbyyear,Aboriginalstatusandagegroup,NT,2014‑2018

Year and Aboriginal Status < 1 year 1–4 years 5–9 years 10–14 years 15–17 years Total

2014 Aboriginal 16 5 2 4 6

Non‑Aboriginal 4 2 1 4 3

Subtotal 20 7 3 8 9 472015 Aboriginal 17 2 1 5 4








Subtotal 25 2 1 4 6 38Total Aboriginal 87 17 7 12 22


Total 121 23 9 21 33 207 Source: NTChildDeathsRegister Totalmaydifferfromlastyear’sreportduetolateregistrationsandinterstatedeaths

16


Child deaths by usual residence, age group and Aboriginal status, NT, 2014-2018

Usual residence refers to the child’s usual place of residence as recorded in the BDM register andreportedbytheparentsornextofkin.Forthepurposeofthisreport,usualresidencehasbeenclassifiedaseithergreaterDarwinortheRestoftheNT.

Inthefiveyearperiodfrom2014to2018,themajorityofchilddeaths(n=134,64.7%)occurredamongchildrenlivingoutsideGreaterDarwinregion.ThisdifferencewasdrivenbythelargernumberofdeathsofAboriginalchildren(n=121,58.5%)mostofwhomarelivingoutsidetheGreaterDarwinarea.

Table 4:Childdeathsbyusualresidence,agegroupandAboriginalstatus,NT,2014‑2018

Age Group Greater Darwin No. (%) Rest of NT No. (%)

<1year 43 59% 78 58%

1‑4years 7 9% 16 12%

5‑9years 5 7% 4 3%

10‑14years 8 11% 13 10%

15‑17years 10 14% 23 17%

Total Aboriginal Status 73 100% 134 100%Aboriginal 24 33% 121 90%

Non‑Aboriginal 49 67% 13 10%

Total 73 100% 134 100%


Totalmaydifferfromlastyear’sreportduetolateregistrationsandinterstatedeaths


17

Child death rates by year, NT, 2014-2018

Inthisreport,populationnumbersforthedenominatorarebasedonABSEstimatedResidentPopulationdata for single years – for children aged 0‑17 years in theNT (ABS Cat. 3101.0, 2018). Given therelativelysmallnumberofdeathseachyearintheNT,aggregatingdataacrossfiveyearsprovidesamorereliableindicatoroftheunderlyingrates.

Forthefiveyearperiodfrom2014‑2018,therewereatotalof207deathsofNTchildren.Theannualiseddeathrateforthisperiodwas66.1deathsper100,000children.TheannualratesarepresentedinTable5andFigure2.Apartfromahighratein2014therewasasuggestionthatannualNTdeathrateswerefalling,buthasrisenagainin2017.Itneedstoberememberedthattheremaybeadditionaldeathsinrecentyearsthathavenotyetbeenreported.

Table 5:Childdeathratesbyyear,NT,2014‑2018

Year Number of Deaths Rate #2014 47 75.3

2015 38 60.9

2016 37 59.0

2017 47 74.6

2018 38 60.5

Total 207 66.1

Figure 2: Childdeathratesbyyear,NT,2014‑2018

Child Death Rate #

2014 2015 2016 2017

59.0

2018

80

70

60

50

40

30

20

10

0

75.3

60.9

74.6

60.5

Source:NTChildDeathsRegisterand ABS3101.0,June2018 #per100.000children

Source:NTChildDeathsRegisterandABS3101.0,June2018 #per100.000children

18


Child death rates by age group, NT, 2014-2018

AnnualisedagegroupspecificdeathratesforthefiveyearperiodareshowninTable9.Theinfantdeathrateof616.2deathsper100,000children reflects the largenumberofdeaths,most in theneonatalperiod,thatoccurinthisagegroupandwerethemajorityofallNTchilddeaths.The15‑17yearsagegrouparethesecondhighestdeathrateat72.2deathsper100,000childrenandthelowestdeathrateisthe5to9yearsagegroupat9.9deathsper100,000children.

Table 6: Childdeathratesbyagegroup,NT,2014‑2018

Age Group Number of Deaths Rate #<1year 121 616.2

1‑4years 23 30.3

5‑9years 9 9.9

10‑14years 21 25.9

15‑17years 33 72.2

Total 207 66.1

Child death rates by age group and gender, NT, 2014-2018

Of the total of 207 deaths, (n=110, 53.1%) were male, (n=96, 46.4%) were female and (n=1, 0.5%)was unknown. The respective rates were 63.3 for females and 68.8 formales with an overall rate of 66.1 per 100,000 children. Across the 5 year period, the annualised infant death rate was609.5per100,000infantsforfemalesand612.7formales.

Table 7: Childdeathratesbyagegroupandgender,NT,2014‑2018

Age GroupFemale Male

Number of Deaths Rate # Number of Deaths Rate #

<1year 58 609.5 62 612.7

1‑4years 10 26.9 13 33.4

5‑9years 2 4.5 7 15

10‑14years 9 48.4 12 28.7

15‑17years 17 78.3 16 66.7

Total 96 63.3 110 68.1

Source:NTChildDeathsRegisterandABSCat3101.0,June2018 #per100.000children

Sometotalsmayvaryfromlastyear’sreportduetolateregistrationsandinterstatedeaths

Source:NTChildDeathsRegisterandABSCat3101.0,June2018 #per100.000children


19

Infants Deaths, 2014-2018Infant deaths by gender and Aboriginal status, NT, 2014-2018

Therewere121 infantdeathsbetween2014‑2018 in theNT. Aslightmajorityof thosewerefemale(n=63,52.5%)and(n=82,68.3%)wereAboriginalchildren.

Table 8: InfantdeathsbygenderandAboriginalstatus,NT,2014‑2018

Aboriginal Status Female Male Unknown Total

Aboriginal 41 45 1 87

Non‑Aboriginal 17 17 0 34

Total 58 62 1 121

Percentage 48% 51.2% 0.8% 100%Source:NTChildDeathsRegister

Perinatal deaths by type, Aboriginal status and year, NT, 2014-2018

Given that there is a substantially greater risk of death in the perinatal period, the Committee hasalwaysmonitored thisperiod. Perinataldeathsare thecombinationofneonataldeathsandstillbirths. Table 9 shows there are a total of (n=169, 66%) stillbirths and (n=87, 34%) neonatal deaths. ThepercentageofAboriginal (n=72,42.6%)andnon‑Aboriginal (n=97,57.4%)stillbirths isconsiderablydifferent. In theperiod2014‑2018 therewere87neonataldeaths. Themajorityofneonataldeaths(n=62,71.3%)wereAboriginalchildren.

Table 9: Perinataldeathsbytype,Aboriginalstatusandyear,NT,2014‑2018

Row Labels 2014 2015 2016 2017 2018 Total (%)

Aboriginal

Neonatal 14 11 15 11 11 62Stillbirth 11 15 15 12 19 72

Subtotal 25 26 30 23 30 134 (52.3%)

Non‑Aboriginal

Neonatal 4 4 2 11 4 25Stillbirth 18 20 15 20 24 97

Subtotal 22 24 17 31 28 122 (47.7%) Total 47 50 47 54 58 256 (100%)

Source:NTChildDeathsRegister

Individualtotalsmaydifferfromlastyear’sreportduetolateregistrationsandinterstatedeaths

20


Post neonatal infancy by Aboriginal status and year, NT, 2014-2018

Table 10 presents post‑neonatal infant deaths over the recent five year period by Aboriginal status. Of the total number of deaths in this age group, there is a majority that were Aboriginal children (n=25,73.5%).

Table 10: PostneonatalinfancybyAboriginalstatusandyear,NT,2014‑2018

Post Neonatal 2014 2015 2016 2017 2018 Total

Aboriginal 2 6 5 4 8 25

Non‑Aboriginal 0 2 3 2 2 9

Total 2 8 8 6 10 34


Deaths of children with a family involvement in child protection service 2014-2018

ChildreninvolvedwiththechildprotectionsystemareconsideredtobeaparticularlyvulnerableChildreninvolvedwiththechildprotectionsystemareconsideredtobeaparticularlyvulnerablesubgroupofthepopulation.Giventhattheriskisoftenassociatedwithfamilies,itisprudentthatchilddeathcommitteesconsiderthe ‘childprotection’historyofchildrenwhohavediedaswellasthatoftheirsiblings,asanindicatorofvulnerability.

Achild is considered tobe ‘known’ to thechildprotection system if an ‘action’hasbeen takenunderChapter2oftheCare and Protection of Children Act 2007 tosafeguardthewellbeingofthechild.This‘action’ by Territory Families can involve; receiving a child abuse notification, the assessing ofchild abusenotifications,childprotectioninvestigations,theundertakingofprotectiveassessments,theprovisionoffamilysupportservices,thetakingoutofstatutorychildprotectionorders,ortheplacementofachildintocare.

ThedeathofachildwhoisinthecareoftheChiefExecutiveOfficerofTerritoryFamiliesisrequiredbylawtobereferredtotheOfficeoftheNTCoronerforhim/hertomakeafindingonthechild’sdeath(DeathinCare).Inthepresentreportingperiod2014‑2018therehavebeen8deathsofchildrenwhowereknowntoTerritoryFamiliesandreferredtotheOfficeoftheNTCoroner.


21

Characteristics of child death by children and families known to TF status, NT, 2014-2018

Childrenknowntochildprotectionservicesmayoriginate fromfamiliescharacterisedbydysfunction,includingdomesticand familyviolence,alcohol,drugandvolatilesubstanceabuse,mental illness,andinvolvementwiththecriminaljusticesystem.

Of the 207 recorded child deaths in theNT in the reporting period 2014‑2018, (n=72, 34.8%)were‘known’ to Territory Families and (n=135, 65.2%) were ‘not known’ to Territory Families within the3yearspriortotheirdeath.Ofthe72deathsofchildrenknowntoTerritoryFamiliesthehighestnumberofinvolvementwasinthe<1yearrange(n=29,40.3%)andthelowestnumberofinvolvementwasinthe5‑9yearsrange(n=5,6.9%).

Ofthe72deathsofchildreninvolvedinthechildprotectionsystem,(n=61,83.3%)wereAboriginaland(n=11,16.7%)werenon‑Aboriginal.

Table 11: CharacteristicsofchilddeathbychildrenandfamiliesknowntoTFstatus,NT,2014‑2018

Child Characteristics Known to TF Number (%) Not known to TF Number (%)

GenderFemale 33 46% 63 46.7%

Male 39 54% 71 52.6%

Unknown 0 0% 1 0.7%

Total 72 100% 135 100%

Aboriginal StatusAboriginal 61 85% 84 62%

Non‑Aboriginal 11 15% 51 38%

Total 72 100% 135 100%

LocationGreaterDarwin 18 25% 55 41%

RestofNT 54 75% 80 59%

Total 72 100% 135 100%

Age Group<1year 29 40% 92 68%

1‑4years 12 17% 11 8%

5‑9years 5 7% 4 3%

10‑14years 10 14% 11 8%

15‑17years 16 22% 17 13%

Total 72 100% 135 100%


22


Chapter 4 – Underlying causes of child deaths in the Northern Territory, 2014-2018

This section provides information about the Underlying Cause of Death (UCOD) for 191 of the 207 child deaths in this five year reporting period. At the time of this report, there were 16 deaths awaiting the outcome of coronial investigations. One of these deaths is from 2016, 3 are from 2017 and the remaining 12 are from 2018.

Underlying cause of death by ICD-10 chapter and year, NT, 2014-2018Tables12to15provideacomparativebreakdownoftheUCODbyreportingyears,genderandAboriginalstatus,usualresidenceandagegroups.

Table12details theunderlyingcauseofdeath forchildren,whichhasbeenclassifiedusing thestandardinternationalcodingsystematbroadchapterlevel.Conditionsoriginatingintheperinatalperiod(75)andexternalcausesofmorbidityandmortality(49)madeupthegreatestnumberofdeathsinthe207total.


23

Table 12: UnderlyingcauseofdeathbyICD‑10chapterandyear,NT,2014‑2018

ICD-10-AM

Chapter No.Code prefix

ICD-10-AM Chapter Descriptions

2014 2015 2016 2017 2018Grand Total

1 A and B Certaininfectiousandparasiticdiseases 2 2 4 3 2 13

2 C and D Neoplasms 2 1 2 1 3 9

4 E Endocrine,nutritionalandmetabolicdiseases 0 1 0 0 0 1

6 G Diseasesofthenervoussystem 1 0 0 1 0 2

9 I Diseasesofthecirculatorysystem 1 1 0 0 1 3

10 J Diseasesoftherespiratorysystem 0 0 1 0 0 1

11 K Diseasesofthedigestivesystem 0 0 0 1 0 1

16 P Certainconditionsoriginatingintheperinatalperiod 18 11 18 17 11 75

17 QCongenitalmalformations,deformationsandchromosomalabnormalities

1 6 2 7 5 21

18 RSymptoms,signsandabnormalclinicalandlaboratoryfindings,notelsewhereclassified

4 5 2 3 2 16

20 U-Y Externalcausesofmorbidityandmortality 18 11 7 11 2 49

Not yet coded

Awaitingcoronialfindingsand/orcauseofdeath* 0 0 1 3 12 16

Total Total 47 38 37 47 38 207

Source:NTChildDeathsRegister Proportionsmaydifferfromlastyear’sreportduetoupdatednumbers,lateregistrationetc

*includes16deathswhicharestillopencoronialcases

24


Underlying cause of death by ICD-10 chapter, gender and Aboriginal status, NT, 2014-2018Table 13 shows for all sub‑groups the leading coded causes of death were “certain conditionsoriginating in theperinatalperiodandexternalcausesofmorbidityandmortality”.Thereweresimilarnumbers of male and female deaths over this period and significantly more Aboriginal (n=145, 70%) thannon‑Aboriginal(n=62,30%).

Table 13:UnderlyingcauseofdeathbyICD‑10chapter,genderandAboriginalstatus,NT,2014‑2018


Gender Aboriginal Status

Female Male Unknown Aboriginal Non-Aboriginal

Certaininfectiousandparasiticdiseases 10 3 0 10 3

Neoplasms 2 7 0 4 5

Endocrine,nutritionalandmetabolicdiseases 0 1 0 1 0

Diseasesofthenervoussystem 2 0 0 1 1

Diseasesofthecirculatorysystem 2 1 0 2 1

Diseasesoftherespiratorysystem 0 1 0 0 1

Diseasesofthedigestivesystem 0 1 0 1 0

Certainconditionsoriginatingintheperinatalperiod

36 38 1 58 17

Congenitalmalformations,deformationsandchromosomalabnormalities

10 11 0 10 11

Symptoms,signsandabnormalclinicalandlaboratoryfindings,notelsewhereclassified

7 9 0 11 5

Externalcausesofmorbidityandmortality

19 30 0 33 16

Awaitingcoronialfindingsand/orcauseofdeath*

8 8 0 14 2

Total 96 110 1 145 62

Source:NTChildDeathsRegister&NationalCoronialInformationSystem(NCIS)


Fortyninedeathsweredueto‘externalcausesofmorbidityandmortality’ofwhich(n=33,67.3%)deathswereofAboriginalchildrenand(n=16,32.7%)werenon‑Aboriginalchildren.Ofthese20(40.8%)childrenwho diedwere the result of intentional self‑harm, 15Aboriginal and 5 non‑Aboriginal deaths. Therewere 5 (10.2%) childrenwho died fromdrowning, 3Aboriginal and2 non‑Aboriginal and therewere 13(26.5%)childrenwhodiedfrommotorvehicle‑relatedaccidents,9Aboriginaland4non‑Aboriginal.


25

Underlying cause of death by ICD-10 chapter and gender, and chapter and Aboriginal status, NT, 2014-2018Figures 3 and 4 provide a comparison by gender and Aboriginal status for each of the ICD‑10‑AMchapters.

Figure 3: UnderlyingcauseofdeathbyICD‑10chapterandgender,NT,2014‑2018




Congenialmalformations,deformationsandchromosomalabnormalities


Diseasesoftherespitorysystem

Diseasesofthecirculatorysystem

Diseasesofthedigestivesystem

Diseasesofthenervoussystem

Neoplasms

Endocrine,nutritionalandmetabolicdiseases

Certaininfectiousandparasiticdiseases

0102030405060708090100110120

Female

Male

Total

26


Figure 4: UnderlyingcauseofdeathbyICD‑10chapterandAboriginalstatus,NT,2014‑2018










Neoplasms



0102030405060708090100110120130140150

Aboriginal Status Aboriginal

Aboriginal Status Non-Aboriginal

Total


27

Underlying cause of death by ICD-10 chapter and usual residence, NT, 2014-2018 Table 14: UnderlyingcauseofdeathbyICD‑10chapterandusualresidence,NT,2014‑2018

ICD-10-AM Chapter Descriptions Greater Darwin Rest of NT

Certaininfectiousandparasiticdiseases2 11

Neoplasms 6 3

Endocrine,nutritionalandmetabolicdiseases 0 1

Diseasesofthenervoussystem 1 1

Diseasesofthecirculatorysystem 2 1

Diseasesoftherespiratorysystem 1 0

Diseaseofthedigestivesystem 0 1

Certainconditionsoriginatingintheperinatalperiod 21 54

Congenital malformations, deformations andchromosomalabnormalities

11 10

Symptoms, signs and abnormal clinical andlaboratoryfindings,notelsewhereclassified 7 9

Externalcausesofmorbidityandmortality 20 29

Awaitingcoronialfindingsand/orcauseofdeath* 2 14

Total 73 134



Ofthe207childdeathsrecorded,(n=134,64.8%)werefromtheRestoftheNT.TheleadingcauseofdeathinGreaterDarwinwas‘certainconditionsoriginatingintheperinatalperiod’(n=21,10.1%)andintheRestofNTwas‘certainconditionsoriginatingintheperinatalperiod’(n=54,26.1%).

28


Figure 5: UnderlyingcauseofdeathbyICD‑10chapterandusualresidence,NT,2014‑2018









051015202530354045505560

Greater Darwin

Rest of NT



Neoplasms





29

Underlying cause of death by ICD-10 chapter and age group, NT, 2014-2018Thelargestnumberofdeaths inchildrenagedlessthan1yearwasfrom‘conditionsoriginatingintheperinatal period’ (n=74, 61.1%) followedby ‘congenitalmalformations, deformations and chromosomalabnormalities’(n=18,14.9%).Forallotheragegroups,theleadingcauseofdeathwas‘externalcauses’.AspreviouslystatedunderTable13 ‘externalcauses’ includesmotorvehicleaccidents,drowningsandintentionalself‑harmwhicharepotentiallypreventablecausesofdeath.

Table 15: UnderlyingcauseofdeathbyICD‑10chapterandagegroup,NT,2014‑2018


< 1 year1 - 4 years

5 - 9 years

10 - 14 years

15 - 17 years


4 6 1 1 1

Neoplasms 1 2 2 2 2


0 1 0 0 0

Diseasesofthenervoussystem 0 0 0 1 1


2 0 0 0 1

Diseasesoftherespiratorysystem

0 1 0 0 0


0 1 0 0 0


74 1 0 0 0

Congenitalmalformations,deformationsandchromosomalabnormalities

18 0 2 1 0


14 2 0 0 0


3 7 4 13 22


5 2 0 3 6

Total 121 23 9 21 33

Source:NTChildDeathsRegister Proportionsmaydifferfromlastyear’sreportduetoupdatednumbers,lateregistrationetc.


30


Appendices Appendix 1:TableofunderlyingcauseofchilddeathsbyICD‑10chapters,NT,2014‑2018

Number of Deaths

Causes - ICD-10 Chapter 1: Certain infectious and parasitic diseases (A00-B99)

1 Acutemeningococcaemia2 Cytomegaloviraldisease,unspecified1 Enterovirusinfection,unspecifiedsite1 Gastroenteritisandcolitisofunspecifiedorigin1 Haemophilusinfluenzaeinfection,unspecifiedsite1 Meningococcalmeningitis1 Naegleriasis1 Otherandunspecifiedinfectiousdiseases1 SepsisduetoPseudomonas1 Sepsisduetounspecifiedstaphylococcus1 Sepsis,unspecified1 Sequelaeofviralencephalitis

13 Total1 Sepsis, unspecified

Number of Deaths

ICD-10 Chapter 2: Neoplasms (C00-D48)

2 Acutemyeloblasticleukaemia[AML],withoutmentionofremission1 Malignantneoplasmofadrenalgland,unspecified1 Malignantneoplasmofboneandarticularcartilage,unspecified1 Malignantneoplasmofbrainstem2 Malignantneoplasmofbrain,unspecified1 Malignantneoplasmofkidney,exceptrenalpelvis1 Malignantneoplasmoflowerlobe,bronchusorlung9 Total

Number of Deaths

ICD-10 Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E99)

1 Othersphingolipidosis1 Total

Number of Deaths

ICD-10 Chapter 6: Diseases of the nervous system (G00-G99)

1 Cerebralpalsy,unspecified1 Epilepsy,unspecified,withoutmentionofintractableepilepsy2 Total


31

Number of Deaths

ICD-10 Chapter 9: Diseases of the circulatory system (I00-I99)

1 Dilatedcardiomyopathy1 Ventriculartachycardia1 Myocarditis,unspecified3 Total

Number of Deaths

ICD-10 Chapter 10: Diseases of the respiratory system (J00-J99)

1 PneumoniaduetoMycoplasmapneumoniae1 Total

Number of Deaths

ICD-10 Chapter 11: Disease of the digestive system (K00-K99)

1 Acuteperiodontitis1 Total

Number of Deaths

ICD-10 Chapter 16: Certain conditions originating in the perinatal period (P00-P96)

2 Extremeimmaturity,24ormorecompletedweeksbutlessthan28completedweeks6 Extremeimmaturity,lessthan24completedweeks11 Extremelylowbirthweight499gorless5 Extremelylowbirthweight500‑749g1 Fetalbloodlossfromrupturedcord14 Fetusandnewbornaffectedbychorioamnionitis4 Fetusandnewbornaffectedbyincompetentcervix3 Fetusandnewbornaffectedbymaternalinfectiousandparasiticdiseases3 Fetusandnewbornaffectedbymultiplepregnancy1 Fetusandnewbornaffectedbyoligohydramnios1 Fetusandnewbornaffectedbyotherandunspecifiedconditionsofumbilicalcord2 Fetusandnewbornaffectedbyotherformsofplacentalseparationandhaemorrhage2 Fetusandnewbornaffectedbyothermaternalcomplicationsofpregnancy1 Fetusandnewbornaffectedbyothermaternalconditions5 Fetusandnewbornaffectedbyprematureruptureofmembranes2 Intraventricular(nontraumatic)haemorrhage,grade3,offetusandnewborn1 Neonatalaspirationofmeconium1 Otherbacterialsepsisofnewborn1 Otherlowbirthweight1250‑1499g1 Otherlowbirthweight1500‑2499g1 Prematurity,unspecified1 Slowfetalgrowth,unspecified2 Terminationofpregnancy,affectingfetusandnewborn3 Unspecifiedintraventricular(nontraumatic)haemorrhageoffetusandnewborn1 Unspecifiedpulmonaryhaemorrhageoriginatingintheperinatalperiod

75 Total

32


Number of Deaths

ICD-10 Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)

1 Anencephaly,unspecified1 AtresiaofforaminaofMagendieandLuschka3 Chromosomalabnormality,unspecified1 Congenitaleventrationofdiaphragm1 Congenitalmalformationoftongue,unspecified1 Doubleoutletrightventricle1 Down'ssyndrome,unspecified1 Edwards'syndrome,unspecified3 Hypoplasticleftheartsyndrome1 Microcephaly2 Otherspecifiedchromosomeabnormalities1 Patau'ssyndrome,unspecified2 Patentductusarteriosus1 Renalagenesis,unspecified1 TetralogyofFallot

21 Total21 Total

Number of Deaths

ICD-10 Chapter 18: Symptoms, signs and abnormal clinical an laboratory findings, not elsewhere classified (R00-R99)

4 Otherill‑definedandunspecifiedcausesofmortality1 Otherspecifiedgeneralsymptomsandsigns11 Suddeninfantdeathsyndromewithmentionofautopsy16 Total


33

Number of Deaths

ICD-10 Chapter 20: External causes of morbidity and mortality (V00-Y99)

1 Accidentalpoisoningbyandexposuretoliquefiedpetroleumgas[LPG]1 Accidentalpoisoningbyandexposuretootherspecifiedgasandvapours3 Accidentalsuffocationandstrangulationinbed2 Assaultbyknife,parent1 Bittenorstruckbycrocodileoralligator

1Car occupant injured in collisionwith car, pick‑up truck or van, driver, traffic accident,sedan

3Car occupant injured in noncollision transport accident, passenger, traffic accident, all‑terrainfour‑wheeldrive

1 Caroccupantinjuredinnoncollisiontransportaccident,passenger,trafficaccident,sedan1 Drowningandsubmersionfollowingfallintonaturalwater1 Drowningandsubmersionfollowingfallintoswimming‑pool2 Drowningandsubmersionwhileinnaturalwater1 Exposuretouncontrolledfireinbuildingorstructure2 Hanging,strangulationandsuffocation,undeterminedintent18 Intentionalself‑harmbyhanging1 Intentionalself‑harmbyknife

1Motorcycleriderinjuredincollisionwithcar,pick‑uptruckorvan,driver,trafficaccident,motorcycledesignedprimarilyforoff‑roaduse

1Occupantof pick‑up truckor van injured in noncollision transport accident, persononoutsideofvehicle,nontrafficaccident

1 Otherspecifieddrowningandsubmersion1 Otherspecifiedfallfromoneleveltoanother1 Pedalcyclistinjuredincollisionwithcar,pick‑uptruckorvan,driver,trafficaccident1 Pedestrianinjuredincollisionwithcar,pick‑uptruckorvan,nontrafficaccident3 Pedestrianinjuredincollisionwithcar,pick‑uptruckorvan,trafficaccident1 Struckbythrown,projectedorfallingobject

67 Total

Number of Deaths

Not yet coded

16 Awaitingcoronialfindings16 Total

207 deaths over 2014-2018 Period

34


ReferencesAustralianBureauofStatistics‑Australian Demographic Statistics, Dec 2016, 1971 to 2016, Cat No. 3101.0,June2018:Canberra.

AustralianBureauofStatistics‑Population by Age and Sex, Regions of Australia, Cat No. 3235.0,Aug2018:Canberra.

NorthernTerritoryofAustralia,Births, Deaths and Marriages Registration Act 1996(asinforceat1July2010).

WorldHealthOrganisation (2008), ICD-10 International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Volume 2 Instruction Manual,33‑34.

child deaths prevention committee annual report …...nt child deaths review and prevention...

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