Karen Zwi - Academia.edu (original) (raw)

Papers by Karen Zwi

Journal of Paediatrics and Child Health

Journal of Paediatrics and Child Health

International Journal of Environmental Research and Public Health

Background: The aim of this study was to measure young people’s health status and explore associa... more Background: The aim of this study was to measure young people’s health status and explore associations between health status and belonging to one or more socio-culturally marginalised group. Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12–24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures. Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions (p = 0.001), a greater l...

BMJ Paediatrics Open

IntroductionImmigration detention has a profound and negative impact on the physical health, ment... more IntroductionImmigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention.Methods and analysisThis is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective fac...

Journal of Paediatrics and Child Health

Australian Health Review

Objective The aims of the present study were to describe the prevalence of vulnerability in a coh... more Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother–baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson’s Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12–16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, an...

International Journal of Environmental Research and Public Health

Background: Aboriginal Australian children have higher rates of mortality at younger ages than no... more Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children’s Hospitals Network (SCHN) over five years (2011–2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of signi...

European Child & Adolescent Psychiatry

Australian Health Review

Objective The aim of this study is to describe the experience of developing key performance indic... more Objective The aim of this study is to describe the experience of developing key performance indicators (KPIs) for Sydney Children’s Hospital Network (SCHN), the largest paediatric healthcare entity in Australia. Methods Beginning with a published methodology, the process of developing KPIs involved five phases: (1) identification of potential KPIs referencing the organisational strategic plan and pre-existing internal and external documents; (2) consolidation into a pragmatic set; (3) analysis of potential KPIs against selection criteria; (4) mapping these back against the strategic plan and management structure; and (5) presentation to key stakeholders to ensure suitability and traction. Consistent with the strategic plan, a subset of indicators was selected to address quality of care for children from priority populations. Results A pragmatic list of 60 mandated and 50 potential KPIs was created from the 328 new and 397 existing potentially relevant KPIs generated by the executive...

Journal of paediatrics and child health, 2018

To determine the cultural competency training, knowledge and attitudes of health professionals ab... more To determine the cultural competency training, knowledge and attitudes of health professionals about Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health-care delivery. Survey of medical (n = 200), nursing (n = 200) and other health professionals (n = 210) working in two tertiary paediatric hospitals in December 2013. The main outcome measures were training in Aboriginal health-care delivery, knowledge of Aboriginal health and services, attitudes to identification of Aboriginal patients and suggested ways to improve health-care delivery to Aboriginal patients. We received responses from 286 of 572 (50.0%) staff with valid emails: 75 medical, 88 nursing and 123 other health professionals. A minority reported receiving specific Aboriginal health training (126/286, 44.8%) and Aboriginal cultural competency training (106/286, 37.1%). Medical staff were less likely than others to report Aboriginal health-care training (P = 0.01), cultural competency training...

Journal of paediatrics and child health, Jan 14, 2018

The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosi... more The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children. This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed. Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207; 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI; 13 (39%) had concordant TST and QGIT results and 20 (61%...

Archives of disease in childhood, 2018

Archives of Disease in Childhood

AimThis longitudinal study investigated protective factors for social-emotional well-being in ref... more AimThis longitudinal study investigated protective factors for social-emotional well-being in refugee children in Australia.MethodsNewly arrived refugee children aged 4–15 years were recruited between 2009 and 2013 and assessments were conducted at two points, at years 2 and 3 postarrival. Social-emotional well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). Protective factors were assessed by structured interview and the Social Readjustment Rating Scale (SRRS); scores <150 reflect fewer stressful life events in the previous year.ResultsForty-three eligible refugee children were recruited. The SDQ was completed by parents in 90% and protective factor data in 80% at years 2 and 3 of follow-up. Protective factors for normal SDQ scores were: originating from Africa (p=0.01), father present on arrival (p=0.019) and family SRRS scores <150 at year 2 (p=0.045). The median number of protective factors was 4 (range 1–8). Better SDQ scores were associated w...

Journal of paediatrics and child health, Jan 29, 2017

This study aimed to describe refugee children, their families and settlement characteristics, and... more This study aimed to describe refugee children, their families and settlement characteristics, and how their development and social-emotional well-being change over time. We conducted a longitudinal study of 61 refugee children (6 months to 15 years) in an Australian setting, over 2009-2013 and measured child, family and settlement factors as well as physical health, development and social-emotional well-being (Strengths and Difficulties Questionnaire, SDQ). Questionnaires were completed with parents of 54 (89%) children at year 2 and 52 (100%) at year 3. Forty percent of parents had low levels of education, 30% of fathers were absent on arrival, 13% of children were born in refugee camps and 11% of parents self-disclosed previous trauma. Over time, there was increased parental employment (P = 0.001), improved English proficiency for partners (P = 0.02) and reduced stressful life events in the last 12 months (P = 0.003). At years 2 and 3, parents were studying English (96%; 76%), acc...

BMC pediatrics, Oct 21, 2016

Australian Aboriginal children experience a disproportionate burden of social and health disadvan... more Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, a...

Child Abuse & Neglect, 2016

In Australia, paediatricians and Child Protection Specialists provide the medical and forensic ex... more In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.

Journal of tropical pediatrics, Jan 4, 2016

This study aimed to determine the prevalence of health conditions in newly arrived refugee childr... more This study aimed to determine the prevalence of health conditions in newly arrived refugee children and access to timely heath screening. Cross-sectional data from screening of refugee children in regional Australia (2007-12) were analysed for health conditions and timeliness of primary care access. The health of 376 newly arrived refugee children (0-15 years) was assessed. Refugee children came from African (45%), Southeast Asian (29%) and Eastern Mediterranean (10%) regions. Access to primary care screening was present in 367 children (97% of arrivals). Completion of all recommended screening tests was 72%. Of 188 children with arrival and screening dates recorded, 88% were screened within 1 month and 96% within 6 months of arrival. Timely access of remaining children could not be assessed. Primary care was highly accessible to almost all newly arrived refugee children. Health screening was timely in those children with complete medical records.

Child: care, health and development, 2015

While current strategies to address the needs of vulnerable child populations in Australia aim to... more While current strategies to address the needs of vulnerable child populations in Australia aim to reduce inequities, they are isolated, group specific and disparate. The aim of this study was to address health inequities by generating tools that are useful in clinical service settings to assist with the identification, prioritization and monitoring of all vulnerable populations. Current local and national initiatives to address inequities were reviewed. Shared strategies in delivering health services to vulnerable populations were highlighted, and existing tools used for identification and prioritization were adapted. Analysis of at-risk populations resulted in the formulation of four key questions to identify vulnerable children at presentation to services and strategies for prioritizing children within services. An existing refugee child health service delivery framework was adapted as a proposal for use in the development and evaluation of services for all vulnerable child popula...

Child: care, health and development, 2015

Children and young people from vulnerable population groups, including Indigenous Australians, th... more Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectivene...

Journal of Paediatrics and Child Health

Journal of Paediatrics and Child Health

International Journal of Environmental Research and Public Health

Background: The aim of this study was to measure young people’s health status and explore associa... more Background: The aim of this study was to measure young people’s health status and explore associations between health status and belonging to one or more socio-culturally marginalised group. Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12–24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures. Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions (p = 0.001), a greater l...

BMJ Paediatrics Open

IntroductionImmigration detention has a profound and negative impact on the physical health, ment... more IntroductionImmigration detention has a profound and negative impact on the physical health, mental health, development and social-emotional well-being of children, adolescents and their families. Australian clinicians will report results from detailed health and well-being assessments of asylum seeking children and adolescents who have experienced prolonged immigration detention.Methods and analysisThis is a national, multicentre study with a longitudinal cohort design that will document health and well-being outcomes of the children and adolescents who have been detained in offshore detention on the remote island of Nauru. Outcome measures will be reported from the time arrival in Australia and repeated over a 5-year follow-up period. Measures include demographics, residency history and refugee status, physical health and well-being outcomes (including mental health, development and social-emotional well-being), clinical service utilisation and psychosocial risk and protective fac...

Journal of Paediatrics and Child Health

Australian Health Review

Objective The aims of the present study were to describe the prevalence of vulnerability in a coh... more Objective The aims of the present study were to describe the prevalence of vulnerability in a cohort of newborns, identify the factors that increase the risk of vulnerability and examine whether those who are most vulnerable are receiving home visits. Methods A prospective cross-sectional study was performed using data collected from questionnaires completed by child and family health nurses and obstetric discharge summaries for each mother–baby dyad. Descriptive frequencies and percentages are used to describe the proportions of children who were vulnerable, offered services and had risk factors for vulnerability. Categorical data were compared using Pearson’s Chi-squared analysis. Results In all, 1517 newborns were included in the present study. Of these, 40.5% were identified as vulnerable and 13.9% had two or more risk factors for vulnerability (95% confidence interval (CI) 12–16%). The most common risk factors were biological. Across all newborns, 33.7% were visited at home, an...

International Journal of Environmental Research and Public Health

Background: Aboriginal Australian children have higher rates of mortality at younger ages than no... more Background: Aboriginal Australian children have higher rates of mortality at younger ages than non-Aboriginal Australian children. We aimed to (i) calculate the case fatality rate (CFR) for Aboriginal and non-Aboriginal children admitted to children’s hospitals in New South Wales (NSW) and (ii) identify predictors of CFR. Methods: We used a retrospective cross-sectional analysis of data from electronic medical records for in-patient admissions to the Sydney Children’s Hospitals Network (SCHN) over five years (2011–2015). Logistic regression analysis was used to identify predictors of mortality and excess deaths in Aboriginal children were calculated. Results: There were 241,823 presentations over the 5-year period. The CFR for Aboriginal children was double that of non-Aboriginal children (0.4% vs. 0.2%, p = 0.002), with Aboriginal children under 2 years and from remote and regional Australia at highest risk of excess mortality. Predictors of death for all children in order of signi...

European Child & Adolescent Psychiatry

Australian Health Review

Objective The aim of this study is to describe the experience of developing key performance indic... more Objective The aim of this study is to describe the experience of developing key performance indicators (KPIs) for Sydney Children’s Hospital Network (SCHN), the largest paediatric healthcare entity in Australia. Methods Beginning with a published methodology, the process of developing KPIs involved five phases: (1) identification of potential KPIs referencing the organisational strategic plan and pre-existing internal and external documents; (2) consolidation into a pragmatic set; (3) analysis of potential KPIs against selection criteria; (4) mapping these back against the strategic plan and management structure; and (5) presentation to key stakeholders to ensure suitability and traction. Consistent with the strategic plan, a subset of indicators was selected to address quality of care for children from priority populations. Results A pragmatic list of 60 mandated and 50 potential KPIs was created from the 328 new and 397 existing potentially relevant KPIs generated by the executive...

Journal of paediatrics and child health, 2018

To determine the cultural competency training, knowledge and attitudes of health professionals ab... more To determine the cultural competency training, knowledge and attitudes of health professionals about Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) health-care delivery. Survey of medical (n = 200), nursing (n = 200) and other health professionals (n = 210) working in two tertiary paediatric hospitals in December 2013. The main outcome measures were training in Aboriginal health-care delivery, knowledge of Aboriginal health and services, attitudes to identification of Aboriginal patients and suggested ways to improve health-care delivery to Aboriginal patients. We received responses from 286 of 572 (50.0%) staff with valid emails: 75 medical, 88 nursing and 123 other health professionals. A minority reported receiving specific Aboriginal health training (126/286, 44.8%) and Aboriginal cultural competency training (106/286, 37.1%). Medical staff were less likely than others to report Aboriginal health-care training (P = 0.01), cultural competency training...

Journal of paediatrics and child health, Jan 14, 2018

The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosi... more The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children. This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed. Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207; 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI; 13 (39%) had concordant TST and QGIT results and 20 (61%...

Archives of disease in childhood, 2018

Archives of Disease in Childhood

AimThis longitudinal study investigated protective factors for social-emotional well-being in ref... more AimThis longitudinal study investigated protective factors for social-emotional well-being in refugee children in Australia.MethodsNewly arrived refugee children aged 4–15 years were recruited between 2009 and 2013 and assessments were conducted at two points, at years 2 and 3 postarrival. Social-emotional well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). Protective factors were assessed by structured interview and the Social Readjustment Rating Scale (SRRS); scores <150 reflect fewer stressful life events in the previous year.ResultsForty-three eligible refugee children were recruited. The SDQ was completed by parents in 90% and protective factor data in 80% at years 2 and 3 of follow-up. Protective factors for normal SDQ scores were: originating from Africa (p=0.01), father present on arrival (p=0.019) and family SRRS scores <150 at year 2 (p=0.045). The median number of protective factors was 4 (range 1–8). Better SDQ scores were associated w...

Journal of paediatrics and child health, Jan 29, 2017

This study aimed to describe refugee children, their families and settlement characteristics, and... more This study aimed to describe refugee children, their families and settlement characteristics, and how their development and social-emotional well-being change over time. We conducted a longitudinal study of 61 refugee children (6 months to 15 years) in an Australian setting, over 2009-2013 and measured child, family and settlement factors as well as physical health, development and social-emotional well-being (Strengths and Difficulties Questionnaire, SDQ). Questionnaires were completed with parents of 54 (89%) children at year 2 and 52 (100%) at year 3. Forty percent of parents had low levels of education, 30% of fathers were absent on arrival, 13% of children were born in refugee camps and 11% of parents self-disclosed previous trauma. Over time, there was increased parental employment (P = 0.001), improved English proficiency for partners (P = 0.02) and reduced stressful life events in the last 12 months (P = 0.003). At years 2 and 3, parents were studying English (96%; 76%), acc...

BMC pediatrics, Oct 21, 2016

Australian Aboriginal children experience a disproportionate burden of social and health disadvan... more Australian Aboriginal children experience a disproportionate burden of social and health disadvantage. Avoidable hospitalizations present a potentially modifiable health gap that can be targeted and monitored using population data. This study quantifies inequalities in pediatric avoidable hospitalizations between Australian Aboriginal and non-Aboriginal children. This statewide population-based cohort study included 1 121 440 children born in New South Wales, Australia, between 1 July 2000 and 31 December 2012, including 35 609 Aboriginal children. Using linked hospital data from 1 July 2000 to 31 December 2013, we identified pediatric avoidable, ambulatory care sensitive and non-avoidable hospitalization rates for Aboriginal and non-Aboriginal children. Absolute and relative inequalities between Aboriginal and non-Aboriginal children were measured as rate differences and rate ratios, respectively. Individual-level covariates included age, sex, low birth weight and/or prematurity, a...

Child Abuse & Neglect, 2016

In Australia, paediatricians and Child Protection Specialists provide the medical and forensic ex... more In Australia, paediatricians and Child Protection Specialists provide the medical and forensic examinations of child victims of sexual assault. There are workforce challenges in the recruitment and retention of doctors to undertake child sexual assault (CSA) work particularly in remote and rural areas. Pediatric Sexual Assault Nurse Examiner (PSANE) programs have existed in the USA and the UK for many years. Using Rapid Evidence Assessment (REA) methodology, a systematic search of the literature was performed to ascertain what is known about SANE programs, to evaluate the evidence for their effectiveness across a number of domains (accessibility, health and legal outcomes and cost effectiveness) and to inform policy on models of care and elements of best practice which may be appropriate for local implementation in Australia. This review showed that despite the limited evidence available and significant gaps in the evidence, SANEs provide a high standard of medical care and are not detrimental to the legal process. By providing recommendations regarding the potential value, effectiveness and feasibility of establishing a PSANE program in Australia, this article may be of interest to other high income countries facing similar workforce challenges in meeting the needs of children with alleged sexual assault.

Journal of tropical pediatrics, Jan 4, 2016

This study aimed to determine the prevalence of health conditions in newly arrived refugee childr... more This study aimed to determine the prevalence of health conditions in newly arrived refugee children and access to timely heath screening. Cross-sectional data from screening of refugee children in regional Australia (2007-12) were analysed for health conditions and timeliness of primary care access. The health of 376 newly arrived refugee children (0-15 years) was assessed. Refugee children came from African (45%), Southeast Asian (29%) and Eastern Mediterranean (10%) regions. Access to primary care screening was present in 367 children (97% of arrivals). Completion of all recommended screening tests was 72%. Of 188 children with arrival and screening dates recorded, 88% were screened within 1 month and 96% within 6 months of arrival. Timely access of remaining children could not be assessed. Primary care was highly accessible to almost all newly arrived refugee children. Health screening was timely in those children with complete medical records.

Child: care, health and development, 2015

While current strategies to address the needs of vulnerable child populations in Australia aim to... more While current strategies to address the needs of vulnerable child populations in Australia aim to reduce inequities, they are isolated, group specific and disparate. The aim of this study was to address health inequities by generating tools that are useful in clinical service settings to assist with the identification, prioritization and monitoring of all vulnerable populations. Current local and national initiatives to address inequities were reviewed. Shared strategies in delivering health services to vulnerable populations were highlighted, and existing tools used for identification and prioritization were adapted. Analysis of at-risk populations resulted in the formulation of four key questions to identify vulnerable children at presentation to services and strategies for prioritizing children within services. An existing refugee child health service delivery framework was adapted as a proposal for use in the development and evaluation of services for all vulnerable child popula...

Child: care, health and development, 2015

Children and young people from vulnerable population groups, including Indigenous Australians, th... more Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectivene...