Journal
JOURNAL OF TRANSCULTURAL NURSING
Volume 32, Issue 6, Pages 672-680Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1043659620986616
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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The study examined factors influencing anemia outcomes in rural children following implementation of a prevention program, finding a 21.2% decrease in anemia prevalence with clinic visit number and age at first visit as predictors of increased hemoglobin. Once anemia improved, children were likely to remain improved.
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.
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