anemia, social determinants of health, multilevel analysis, Haiti, disease prevention, primary, patient explanatory model, nutrition, water, sanitation, hygiene (WaSH), culturally congruent care, mixed methods


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.

Original Publication Citation

Martial, M. A., Sward, K. A., Morse, J. M., Wilson, A. R., Martial, C., Penney, D. S., & Nicolas, E. (2021). Anemia management in rural Haitian children: A mixed methods study. Journal of Transcultural Nursing.

Document Type

Peer-Reviewed Article

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University Standing at Time of Publication

Assistant Professor

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Nursing Commons