title: Skin infections in children in a New Zealand primary care setting: exploring beneath the tip of the iceberg.
abstract: OBJECTIVE
  Over the past two decades there has been a documented steady rise in the incidence of hospitalised serious skin infections in New Zealand children. However there are few surveillance data from the primary care setting, where the majority of children with skin infections initially present. We aimed to describe the epidemiology of childhood skin infections presenting to primary care in a region of New Zealand with a particularly high burden of infection and compare this to hospitalised cases during the same period.
  
  
  METHODS
  A sample of general practitioners in the Tairawhiti (Gisborne) region recorded all cases of skin infections in 0-14 year old children diagnosed over a 10-week period in 2008. Observed case rates were directly standardised by age and ethnicity to the Tairawhiti population to give estimated rates for the whole region. Demographic data from primary care cases were compared to similar data from hospitalised cases during the same period.
  
  
  RESULTS
  There were 110 incident cases of skin infections seen by the nine participating general practitioners during the study period, equivalent to an annual incidence rate of 106.7 (95%CI: 85.2-127.2) cases per 1000 children in the region. For every one hospitalisation there were an estimated 14 primary care cases. Three quarters of skin infections in both primary care and hospital settings occurred in Maori children. There was no gender predominance in either setting, however hospitalised cases of serious skin infections were more likely to occur in the preschool age group whereas children aged 5-9 years predominated at the primary care level.
  
  
  CONCLUSIONS
  Skin infections are a common childhood complaint in primary care in the Tairawhiti region, with hospital-based surveillance using coded discharge data only capturing a small proportion of the overall community disease burden. Previously observed ethnic disparities in hospitalisation rates for serious skin infections reflect similar disparities in skin infection rates in primary care. The establishment of a sentinel surveillance system in the New Zealand primary care setting would facilitate further research and monitoring of this and other important conditions.
authors.affiliation: Department of Public Health, University of Otago, Wellington, New Zealand.
authors.forename: Cathryn
authors.initials: C
authors.lastname: O'Sullivan
authors.forename: Michael G
authors.initials: MG
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D011159:Population Surveillance; D011320:Primary Health Care; D012307:Risk Factors; D012874:Skin Diseases, Infectious / Q000453:epidemiology* / Q000208:ethnology; D018709:Statistics, Nonparametric