The Aboriginal Birth Cohort (ABC) study examining hypotheses relating early life events to later outcomes

This study was founded by Dr Sue Sayers in 1987

In 1989 Professor David Barker and his team at Southampton published an article in the Lancet that drew attention to the notion that low birth weight babies had a greater risk of developing a number of chronic diseases including heart disease. This paper generated huge international interest and a number of major studies in this area.

Dr Sayers originally started the cohort study to examine the long term outcomes of Aboriginal babies who were born growth retarded.

In 1989, Dr Sayers realized this cohort was an excellent opportunity to examine hypotheses relating early life events with chronic adult disease.

A better understanding of chronic disease development could lead to prevention of the high rates of these diseases in the Aboriginal population.

Some facts about the health of Indigenous people 1. Heart disease deaths are between 7 and 10 times that of non-Indigenous Australians. 2. 10 to 30% have type 2 diabetes. 3. 25 to 30% are obese. 4. Renal disease rates highest in world 5. Life expectancy is 15 to 20 years less than non-Indigenous Australians

There are a number of well-known factors that lead to higher rates of chronic disease.

1. Early programming. Permanent structural and functional changes in response to fetal under nutrition contributing to later chronic disease

2. Pathological processes. Post-streptococcal infection related to rheumatic fever and post streptococcal glomerulonephritis. Skin sores, scabies, respiratory infections otitis media gastroenteritis

3. Life style factors. Poor housing, overcrowding, poor education, low income, poor diet, smoking and psycho-social wellbeing.

Dr Sayers enrolled 686 Aboriginal babies and their mothers into the Clan Cohort study from across the Top End and beyond. To be eligible for this study a baby had to be born at Royal Darwin Hospital between January 1987 and March 1990 to a mother recorded as Aboriginal in the Delivery Suite Register. Detailed maternal and child data were collected

A major finding was that 25% of babies were growth retarded. That is they were born small, but not premature.

The children were then followed up when they were about 11 years old. Dr Sayers and her team had to travel to over 70 different locations.

Community	Outstation

There were a number of challenges for the data collection.....

Cultural	Access

The main results from 11 year follow-up were as follows:

95% of children were still alive and the study team was able to follow up and examine 86% of living children.

Lung function, kidney size, insulin and glucose concentrations were related to child size not birth size. These results contradict the findings from Professor Barker and his team.

It seems that smaller babies tended to become smaller children.

There were significant urban/remote differences where children living in remote areas were smaller and had more health problems compared to children in urban areas.

The study will continue over the life span of the Clan Cohort