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

Sarah Bar-Zeev, Lesley M Barclay, Sue Kruske, Naor Bar-Zeev, Sue Kildea

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    Abstract

    Background: Remote dwelling Aboriginal infants from northern Australia have a high burden of disease andfrequently 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 staffand barriers to effective service delivery in remote settings. 
    Methods: A mixed method study drew data from 24 semi-structured interviews with clinicians working in tworemote communities in northern Australia and a retrospective cohort study of Aboriginal infants from thesecommunities, born 2004–2006 (n = 398). Medical records from remote health centres were audited. The mainoutcome measures were the period prevalence of infants with anaemia and growth faltering and management ofthese conditions according to local guidelines. Qualitative data assessed clinicians’ perspectives on barriers toeffective remote health service delivery. 
    Results: Data from 398 health centre records were analysed. Sixty eight percent of infants were anaemic betweensix and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth databy the authors however found 86% of infants experienced growth faltering over 12 months. Clinical managementand treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staffpoorly 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 occurearly. Diagnosis of growth faltering and clinicians’ adherence to management guidelines for both conditions waspoor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor qualityof care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of careprovided for these infants
    Original languageEnglish
    Article number250
    Pages (from-to)1-12
    Number of pages12
    JournalBMC Health Services Research
    Volume13
    DOIs
    Publication statusPublished - 2013

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