Childhood anemia in Rural Haiti: the potential role of community health workers

Abstract

Background: Childhood iron deficiency anemia (IDA) is an important contributor to under-five mortality in the developing world. There is evidence that Community Health Worker (CHW) delivered programs to increase maternal knowledge of child health practices may decrease childhood IDA. This study reports findings on the association between a long standing CHW intervention and childhood anemia status in rural Haiti.

Methods: Using structural equations and mediation analyses on data from a household-based survey of 621 mother/child dyads, we tested the hypothesis that CHW would have a direct positive effect on maternal knowledge and an indirect effect on childhood anemia in rural Haiti.

Results: CHW contact was significantly associated with maternal knowledge of key child health practices (β = 0.193, SE = 0.058, p = 0.001). However, knowledge was not associated with childhood anemia (β = -0.008, SE = 0.009, p = 0.382). Maternal knowledge categories significantly affected by CHW contact included diarrheal prevention knowledge (β = 0.111, SE = 0.045, p = 0.013) and signs of malnutrition (β = 0.217, SE = 0.071, p = 0.002). There was no significant association with knowledge of vitamin A and iron rich foods (β = 0.057, SE = 0.032, p = 0.074), which is the intervention most likely to impact childhood anemia. In all path models tested, we identified the control variables low household socio-economic status, mothers' anemia status, and child's age less than 24 months as significant predictors of childhood anemia.

Conclusions: CHWs delivered interventions are associated with improved maternal knowledge of child health practices in rural Haiti; however, this knowledge is not associated with improved childhood anemia. Concurrently with CHW-delivered programs, interventions household poverty are implied to impact childhood health outcomes in resource poor settings.

Keywords: Childhood Anemia; Community Health Worker; Iron Deficiency Anemia; Maternal Knowledge; Structural Equation Modeling Model.

Fig. 1

Structural equation model (SEM) with standardized path coefficients (thicker lines) for the effect of Community Health Worker (CHW) contact on Maternal Knowledge and Childhood Iron Deficiency Anemia (IDA). Model is adjusted for household socio-economic status (SES), child’s age less than 24 months, gender, exclusive breastfeeding status, and mother’s anemia status. Significant paths not shown: SES→Childhood IDA (β = 0.076, SE = 0.034, p = 0.023); Child Age (<24 months) →Childhood IDA (β = 0.186, SE = 0.032, p < .0001); Mother’s IDA→Childhood IDA (β = 0.087, SE = 0.032, p = 0.007); Child Age (<24 months) →Maternal Knowledge (β = -0.125, SE = 0.041, p = 0.002). Model fit: Number of free parameters = 62; ΔX ² = 2.857, Δdf = 3, p = 0.4142. RMSEA = 0.024, CI: 0.011, 0.035, p = 1.000; CFI = 0.972; TLI = 0.959; WRMR = 0.878; *p < .05; **p ≥ .001; ***p < .001

Fig. 2

Structural equation model (SEM) with standardized path coefficients for the effect of Community Health Worker (CHW) contact on each of the three Maternal Knowledge categories and Childhood Iron Deficiency Anemia. Model is adjusted for household socio-economic status (SES), child’s age less than 24 months, gender, exclusive breastfeeding status and mother’s anemia status. Significant paths not shown: SES→Diarrhea Prevention (β = -0.093, SE = 0.033, p = 0.005); Child Age (<24 months) →Vitamin A and Iron Rich Foods (β = -0.071, SE = 0.035, p = 0.042); Child Age (<24 months) →Signs of Malnutrition (β = -0.097, SE = 0.034, p = 0.004); Mother’s Anemia→Signs of Malnutrition (β = -0.074, SE = 0.037, p = 0.043). Model fit: Number of free parameters = 75; ΔX ² = 11.653, Δdf = 4, p = 0.0201. RMSEA = 0.027, CI: 0.015, 0.038, p = 1.000; CFI = 0.969; TLI = 0.946; WRMR = 0.843; *p < .05; **p ≥ .001; ***p < .001