Evaluation of anaemia management in three remote Aboriginal communities in the Katherine East region, Northern Territory
This project sought to evaluate an anaemia prevention program and fidelity to anaemia best practice guidelines in three East Katherine regional communities.
Program leader: Dr Therese Kearns, epidemiologist and Senior Research Fellow, Menzies School of Health Research
- Sunrise Health, an Aboriginal corporation for improving the health and wellbeing of people in the east Katherine region
- three East Katherine regional communities
- Menzies School of Health Research.
The project was co-led by Raelene Wing, a Wanyii/Garrawa woman from Katherine who was an Aboriginal Health Practitioner, coordinator for Child Health and the Mothers and Babies Program, and Child and Maternal Cluster Manager within Sunrise Health.
Project timeline: 1 December 2015-31 December 2018
The researchers sought to determine:
- if the anaemia prevention program impacted anaemia rates in Community A
- what elements of the program contributed to a reduction in anaemia prevalence in Community A
- whether the reduction in anaemia prevalence had an impact on clinic presentations and children presenting with infectious conditions in Community A
- enablers and barriers to implementing the program in Communities B and C.
Record reviews were conducted on electronic primary health care (PHC) records of primary health care presentations in the first 2 years of life for children born between January 2010 and July 2014 in all three East Katherine communities.
They sought to assess the fidelity of anaemia best practice guidelines and identify any perinatal or child risk factors associated with the development of childhood anaemia.
Elements of the programs included.
- Under the Anaemia Prevention Program in Community A, children were given three prophylactic doses of iron per week from the age of 6 months.
- In Community A, interviews were conducted with health practitioners and mothers of children involved with the Anaemia Prevention Program to determine what ingredients made up the program and if they were replicable in other communities.
- An Aboriginal community-based researcher was employed and trained to conduct the research activities.
- The nationally accredited training program, ‘10513NAT - Certificate II in Community Health Research’ was developed specifically for Aboriginal researchers by the co-investigator Dr Therese Kearns.
- Primary health care records from Communities A, B and C were reviewed to assess adherence to anaemia best practice guidelines and identify risk factors.
The findings of the project include:
- Maternal anaemia in third trimester pregnancy is a greater predictor of anaemia at age six months than being born preterm or low birth weight.
- Only a small proportion of children with anaemia had a record of receiving a complete course of iron treatment.
- Children in Community A had lower rates of anaemia than the two communities that did not employ the program.
- From interviews with community members, elements thought to contribute to the program’s effectiveness included:
- Aboriginal leadership
- community acceptance
- strong relationships between the community and health clinic
- choice of iron medication used and how it was administered to the children
- continuity of the program provider.
- Insight into factors that predict anaemia in children, particularly that anaemia in the final trimester of pregnancy is a stronger predictor of anaemia than being born pre-term or with low birth weight.
- Rates of anaemia among pregnant women in East Kimberley communities were higher than previously reported.
- Community A, which received the anaemia prevention program, had lower rates of anaemia than other communities.
- Improved awareness of the associations of infant anaemia with maternal anaemia in pregnancy and the benefits of iron supplementation to prevent infant anaemia.
- Changes to public health practice and policy regarding preventative treatment to infants born to mothers with anaemia in the last trimester of pregnancy.
- Incorporating factors identified to enable more effective anaemia prevention (i.e. Aboriginal leadership, community acceptance, strong relationships between the community and health clinic, choice of iron medication used, method of administration and continuity of the program provider).
- Introduction of Communicare SMS messaging to recall mothers and their babies for preventative iron supplementation.
- Community members were employed and trained to conduct research activities through the Certificate II in Community Health Research.
- Two students undertaking Masters of Public Health investigated the high prevalence of maternal anaemia, and the development and delivery of the anaemia prevention program, respectively.