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

Abstract

BackgroundRemote 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.MethodsA 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.ResultsData 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.ConclusionAmong 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.

Improving Aboriginal maternal and infant health services in the ‘Top End’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change

“…There was insufficient time for health promotion [21]. Qualitative analyses of the 2012 evaluation data showed no improvements in infant health service provision [30], however detailed analysis (unpublished) of quantitative and qualitative outcomes for infants is ongoing.…”

Risk factors for preterm, low birthweight and small for gestational age births among Aboriginal women from remote communities in Northern Australia

“…17,[23][24][25][26][27][28] In brief, the study was conducted in two purposively selected remote Aboriginal communities both of approximately 500 km from the regional centre. Although only one hour flight time to the regional centre, a priority one evacuation can take more than four hours to transfer women to the regional centre.…”

Anaemia in pregnancy among Aboriginal and Torres Strait Islander women of Far North Queensland: A retrospective cohort study

“…The high maternal iron requirements mean that anaemia in pregnancy is usually due to iron deficiency and is a strong predictor of early onset anaemia in the child . High rates of early childhood anaemia are a continuing concern in remote Aboriginal and Torres Strait Islander communities of northern Australia …”

“…3,6 High rates of early childhood anaemia are a continuing concern in remote Aboriginal and Torres Strait Islander communities of northern Australia. 7,8 Australian studies reporting anaemia in pregnancy include studies from South Australia (unsupplemented control group: 11% anaemic, births 1997-1999, including 3.3% Aboriginal mothers), Western Australia (6.2% anaemic >18 years, births 2005-2006, 7.3% Aboriginal and Torres Strait Islander mothers) and for all births in South Australia 1999-2005 (7.1% anaemic, 2.5% Aboriginal and Torres Strait Islander mothers). [9][10][11] Higher rates of anaemia in pregnancy have been reported for Aboriginal and Torres Strait Islander women accessing antenatal care in Townsville (34.2% anaemic, births 2001-2003) and in two remote Northern Territory communities (50.0% anaemic, births [2004][2005][2006].…”