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some Aboriginal communities are associated with the highest worldwide rates ofacute rheumatic fever (Currie and Carapetis 2000). 1the major pathogen of skin infection, group A streptococcus, is also associated withchronic renal failure — a prevalent and highly burdensome condition of Aboriginaladults. (Zubrick et al. 2004, p.150)In Australia, many childhood diseases are generally prevented or successfullytreated without requiring hospitalisation. The main focus of this indicator is toexamine the range of diseases and injuries experienced by children that result in ahospital admission.A wide range of social, cultural, physical and economic factors influence the healthof children. Health initiatives of communities and governments can assist in theprevention of disease and promote the health of children. These initiatives includeeducation on the benefits of breastfeeding, good nutrition and sanitation, and theprovision of adequate housing (see chapter 10 for more information on diseasesassociated with poor environmental health). Access to effective and appropriatehealth care services (including dental and immunisation services) can also influencethe health of children in both the short and long term. More information onimmunisation rates in children and the prevalence of vaccine preventable diseasesas well as access to primary health care in general, is included in section 9.3.Section 5.4 includes information on ear infections in children and section 5.5 coverstooth decay in children.1 The role of group A streptococcal bacteria (in skin and throat infections) leading to acuterheumatic fever is contentious but it appears likely in Australia that it plays a role. Interventionswhich aim to reduce group A streptococcal throat and skin infection are likely to reduce the rateof acute rheumatic fever. Acute rheumatic fever is an auto-immune disease initiated by infectionwith group A streptococcal bacteria. The important of acute rheumatic fever is its majorcomplication, rheumatic heart disease. After an initial episode of acute rheumatic fever, a personis at risk of recurrent episodes, each of which can increase the risk of rheumatic heart disease.Rheumatic heart disease is caused by the damage done to the heart valves during an episode ofacute rheumatic fever (ABS and AIHW 2003; Online Medical Dictionary 2005). Acute rheumaticfever and rheumatic heart disease are now rare in populations with good living conditions —optimal hygiene and minimal household overcrowding — and easy access to quality medical care(things that Indigenous people often lack).EARLY CHILDDEVELOPMENT ANDGROWTH5.5