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Anemia Management in Rural Haitian Children: A Mixed Methods Study
Marc-Aurel Martial1, Katherine A Sward2, Janice M Morse2
1Brigham Young University, Provo, UT, USA.
Insights
A rural anemia prevention program reduced prevalence by 21.2%. However, socioeconomic factors and local practices hindered treatment adherence, highlighting the need for culturally congruent care strategies.
Area of Science:
- Pediatrics
- Public Health
- Health Services Research
Background:
- Anemia remains a significant public health issue in rural populations, particularly affecting children.
- Effective prevention programs are crucial for improving pediatric health outcomes.
Purpose of the Study:
- To evaluate factors influencing anemia outcomes in rural children post-prevention program implementation.
- To identify predictors of improved hemoglobin levels and sustained recovery.
Main Methods:
- A mixed-methods approach combining statistical modeling and qualitative analysis.
- Retrospective chart review of 161 children (6-59 months) and prospective interviews with 51 parents and 19 clinicians.
Main Results:
- Anemia prevalence decreased by 21.2% following the program.
- Increased clinic visits and earlier first visits predicted higher hemoglobin levels.
- Children who improved were likely to remain improved; however, ecological barriers were noted.
Conclusions:
- While the program showed success, socioeconomic factors and local practices impede guideline-concordant behaviors.
- Addressing social determinants of health is essential for sustained anemia management in this population.
- Culturally congruent care requires acknowledging the complexity of behavior change.
Introduction:
We examined factors influencing anemia outcomes in rural children following implementation of a prevention program.
Method:
Mixed methods study of children, parents, and clinicians utilized statistical modeling and content/ethnographic analysis. Retrospective chart abstraction evaluated treatments administered and measured hemoglobin in children aged 6 to 59 months (n = 161). Prospective interviews/questionnaires examined parent (n = 51) and clinician (n = 19) perceptions.
Results:
Anemia prevalence decreased by 21.2%. Predictors of increased hemoglobin were clinic visit number and age at first visit. Once anemia improved, children were likely to remain improved (P = .65). Despite favorable program perceptions, stakeholders emphasized ecological barriers, including social disadvantage and local practices.
Discussion:
Socioeconomic factors prevented guideline concordant behaviors. Persistent attention to intrapersonal, interpersonal, and community social determinants is a sine qua non for successfully managing the epidemic. The first step to provide culturally congruent care is to explicitly acknowledge that guideline-concordant behaviors are often complex.
