Anemia Management in Rural Haitian Children: A Mixed Methods Study.

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. [ABSTRACT FROM AUTHOR]