| Description |
Anemia is a global health problem that disproportionately affects children aged 6 to 59 months. Haiti has one of the world's highest anemia prevalence rates. Despite the availability of efficacious interventions, evidence-based guidelines, and decades of collaboration between the Haitian government and international partners, anemia remains a severe public health problem. The reasons for this persistence of childhood anemia are not well understood. The primary purpose of this study was to examine the effects of an anemia-prevention intervention bundle implemented in a rural, remote, and resource-poor community (Timo, Haiti). The specific aims were to (a) determine the association between interventions from an anemia-prevention program and blood-hemoglobin concentration across time, and (b) elicit the perspectives of specified stakeholders about anemia determinants and prevention. The mixed-method study combined retrospective quantitative secondary analysis with prospective qualitative data. The research was guided by the social ecological model. The main factors associated with improvement in hemoglobin concentration were age at first visit and having multiple clinic visits. Participation in the anemia-prevention program was associated with improvements in moderate to severe anemia and remaining stable for those who had mild anemia or no anemia. Anemia-prevention barriers included lack of access to clean water and sanitation facilities, lack of adult role modeling of hygiene principles, issues with medication acceptance, and inadequate caregiver counseling. Social disadvantage was an important iv driver of inability to adhere to nutrition recommendations. The study uncovered a few local practices that potentially interfered with treatment and likely led to underdosing of medications. The study revealed that anemia remains a persistent problem for children under age 5 in this rural Haitian community. Given that anemia is multifaceted in etiology, it is clear that treatment approaches should also be multifaceted. Social and economic barriers were found to be widespread, and persistent commitment at all levels of social determinants over time is sine qua non for managing the rising anemia epidemic. |
