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Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery.

Bar-Zeev SJ, Kruske SG, Barclay LM, Bar-Zeev N, Kildea SV - BMC Health Serv Res (2013)

Bottom Line: Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery.Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months.Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Rural Health, North Coast; Sydney School of Public Health, University of Sydney, New South Wales, Sydney 2480, Australia. sbarzeev@usyd.edu.au

ABSTRACT

Background: Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.

Methods: A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery.

Results: Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery.

Conclusion: Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

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Percent of infants with weight for age Z-score ≤ −2 at each month of age.
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Figure 2: Percent of infants with weight for age Z-score ≤ −2 at each month of age.

Mentions: There were 2346 monthly observations of weight recorded for 372 infants, median number of observations per child was 5 (IQR 4 to 9). There was no evidence for a difference in mean visits by prematurity status (term: 6.1, preterm: 5.9, p = 0.62), or by underweight (>0 episodes weight for age Z-score ≤ −2: 6.1, no such episodes: 6.6, p = 0.12) . The mean weight for age Z-score by infant was −0.80 (SD 1.3) (Figure 1). There was no significant difference by gender. Marginal population mean (SD) prevalence of weight for age Z-score ≤ −2 at each monthly visit is shown in Figure 2. Among 372 infants there were 398 observations of weight for age Z-score≤ −2 of which 122 (122/372 = 32.8%) were first episodes, with mean age at first occasion being 3.9 (SD 3.1) months. Among 296 term infants, 75 (25.3%) had at least 1 episode weight for age Z score ≤ −2 among whom mean age at first episode was 4.4 (SD 3.3) months. Among 68 preterm infants, 45 (66.2%) had at least 1 episode among whom mean age at first episode was 2.9 (SD 2.2) months, p = 0.008 (Figure 3). For 940 observations of length among 354 infants, the mean length for age Z-score was −0.91 (SD 1.6) and for 931 observations of concurrent weight and length, the mean weight for length Z-score was −0.21 (SD 1.4).


Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery.

Bar-Zeev SJ, Kruske SG, Barclay LM, Bar-Zeev N, Kildea SV - BMC Health Serv Res (2013)

Percent of infants with weight for age Z-score ≤ −2 at each month of age.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750842&req=5

Figure 2: Percent of infants with weight for age Z-score ≤ −2 at each month of age.
Mentions: There were 2346 monthly observations of weight recorded for 372 infants, median number of observations per child was 5 (IQR 4 to 9). There was no evidence for a difference in mean visits by prematurity status (term: 6.1, preterm: 5.9, p = 0.62), or by underweight (>0 episodes weight for age Z-score ≤ −2: 6.1, no such episodes: 6.6, p = 0.12) . The mean weight for age Z-score by infant was −0.80 (SD 1.3) (Figure 1). There was no significant difference by gender. Marginal population mean (SD) prevalence of weight for age Z-score ≤ −2 at each monthly visit is shown in Figure 2. Among 372 infants there were 398 observations of weight for age Z-score≤ −2 of which 122 (122/372 = 32.8%) were first episodes, with mean age at first occasion being 3.9 (SD 3.1) months. Among 296 term infants, 75 (25.3%) had at least 1 episode weight for age Z score ≤ −2 among whom mean age at first episode was 4.4 (SD 3.3) months. Among 68 preterm infants, 45 (66.2%) had at least 1 episode among whom mean age at first episode was 2.9 (SD 2.2) months, p = 0.008 (Figure 3). For 940 observations of length among 354 infants, the mean length for age Z-score was −0.91 (SD 1.6) and for 931 observations of concurrent weight and length, the mean weight for length Z-score was −0.21 (SD 1.4).

Bottom Line: Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery.Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months.Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

View Article: PubMed Central - HTML - PubMed

Affiliation: Centre for Rural Health, North Coast; Sydney School of Public Health, University of Sydney, New South Wales, Sydney 2480, Australia. sbarzeev@usyd.edu.au

ABSTRACT

Background: Remote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.

Methods: A mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004-2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians' perspectives on barriers to effective remote health service delivery.

Results: Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians' to impact upon the quality of service delivery.

Conclusion: Among Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians' adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

Show MeSH
Related in: MedlinePlus