Abstract
BackgroundAnemia rates are over 60% in disadvantaged children yet there is little information about the quality of anemia care for disadvantaged children.MethodsOur primary objective was to assess the burden and quality of anemia care for disadvantaged children and to determine how this varied by age and geographic location. We implemented a cross-sectional study using clinical audit data from 2287 Indigenous children aged 6–59 months attending 109 primary health care centers between 2012 and 2014. Data were analysed using multivariable regression models.ResultsChildren aged 6–11 months (164, 41.9%) were less likely to receive anemia care than children aged 12–59 months (963, 56.5%) (adjusted odds ratio [aOR] 0.48, CI 0.35, 0.65). Proportion of children receiving anemia care ranged from 10.2% (92) (advice about ‘food security’) to 72.8% (728) (nutrition advice). 70.2% of children had a hemoglobin measurement in the last 12 months. Non-remote area families (115, 38.2) were less likely to receive anemia care compared to remote families (1012, 56.4%) (aOR 0.34, CI 0.15, 0.74). 57% (111) aged 6–11 months were diagnosed with anemia compared to 42.8% (163) aged 12–23 months and 22.4% (201) aged 24–59 months. 49% (48.5%, 219) of children with anemia received follow up.ConclusionsThe burden of anemia and quality of care for disadvantaged Indigenous children was concerning across all remote and urban locations assessed in this study. Improved services are needed for children aged 6–11 months, who are particularly at risk.
Highlights
Anemia rates are over 60% in disadvantaged children yet there is little information about the quality of anemia care for disadvantaged children
[1] Prevalence is reported to be 70% in children living in low income countries and over 30% in disadvantaged Indigenous children aged under 5 years worldwide. [2, 3] Children are born with high hemoglobin concentrations but levels drop after 6 months of age due to depletion of iron stores with the most vulnerable period between 6 and 11 months. [4,5,6,7] Iron deficiency is the most important cause of anemia
The Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program was developed for Australian Indigenous primary health care centers for the prevention and management of chronic disease. [15,16,17] The ABCD program aims to improve service delivery using plan-do-study-act (PDSA) cycles. [15]
Summary
Anemia rates are over 60% in disadvantaged children yet there is little information about the quality of anemia care for disadvantaged children. Despite the high burden, to our knowledge only one study has assessed anemia burden and the quality of anemia care provided to infants aged 6–11 months. The Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program was developed for Australian Indigenous primary health care centers for the prevention and management of chronic disease. [15,16,17] The ABCD program aims to improve service delivery using plan-do-study-act (PDSA) cycles (including analysing current practice, implementing change and encouraging service providers to assess the impact of the change). Our primary objective was to assess the quality of anemia care provided to disadvantaged children attending the ABCD primary care centers and to determine how this varied by age. Secondary objectives were to assess the effect of geographic location and to describe the burden of anemia (hemoglobin < 110 g/dl) in children aged 6–59 months
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