Anemia Management in Rural Haitian Children: A Mixed Methods Study

Abstract

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.

Keywords

anemia social determinants of health multilevel analysis Haiti disease prevention primary patient explanatory model nutrition water sanitation hygiene (WaSH)culturally congruent care mixed methods

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