Background
Methods
Study setting
Total | Age (months) | Geographic location | |||||
---|---|---|---|---|---|---|---|
6–11 | 12–23 | 24–59 | Remote | Rural | Urban | ||
Total | 2287 | 430 (18.8%) | 532 (23.3%) | 1325 (57.9%) | 1861 (81.4%) | 346 (15.1%) | 80 (3.5%) |
Health Service Characteristics | |||||||
Governance | |||||||
Aboriginal community controlled health service | 528 (23.1%) | 88 (20.5%) | 118 (22.2%) | 322 (24.3%) | 293 (15.7%) | 208 (60.1%) | 27 (33.8%) |
Government health service | 1759 (76.9%) | 342 (79.5%) | 414 (77.8%) | 1003 (75.7%) | 1568 (84.3%) | 138 (39.9%) | 53 (66.3%) |
Health service provider who first saw the child | |||||||
Indigenous health worker | 318 (13.9%) | 49 (11.4%) | 67 (12.6%) | 202 (15.2%) | 205 (11%) | 91 (26.3%) | 22 (27.5%) |
Nurse | 1584 (69.3%) | 321 (74.7%) | 381 (71.6%) | 882 (66.6%) | 1385 (74.4%) | 159 (46%) | 40 (50%) |
GP | 259 (11.3%) | 50 (11.6%) | 60 (11.3%) | 149 (11.3%) | 157 (8.4%) | 85 (24.6%) | 17 (21.3%) |
Other | 109 (4.8%) | 8 (1.9%) | 20 (3.8%) | 81 (6.1%) | 98 (5.3%) | 10 (2.9%) | 1 (1.3%) |
Missing | 17 (0.7%) | 2 (0.5%) | 4 (0.8%) | 11 (0.8%) | 16 (0.9%) | 1 (0.3%) | 0 (0%) |
Year of data collection | |||||||
2012 | 448 (19.6%) | 87 (20.2%) | 107 (20.1%) | 254 (19.2%) | 284 (15.3%) | 144 (41.6%) | 20 (25%) |
2013 | 1251 (54.7%) | 230 (53.5%) | 276 (51.9%) | 745 (56.2%) | 1095 (58.8%) | 156 (45.1%) | 0 (0%) |
2014 | 588 (25.7%) | 113 (26.3%) | 149 (28%) | 326 (24.6%) | 482 (25.9%) | 46 (13.3%) | 60 (75%) |
Population size | |||||||
≤ 500 | 816 (35.7%) | 105 (24.4%) | 196 (36.8%) | 515 (38.9%) | 802 (43.1%) | 14 (4.0%) | 0 (0%) |
501–999 | 458 (20%) | 73 (17%) | 101 (19%) | 284 (21.4%) | 410 (22%) | 39 (11.3%) | 9 (11.3%) |
≥ 1000 | 1013 (44.3%) | 252 (58.6%) | 235 (44.2%) | 526 (39.7%) | 649 (34.9%) | 293 (84.7%) | 71 (88.8%) |
Child characteristics | |||||||
Sex of child | |||||||
Male | 1156 (50.5%) | 217 (50.7%) | 272 (51.1%) | 667 (50.3%) | 941 (50.6%) | 175 (50.6%) | 40 (50%) |
Female | 1131 (49.5%) | 213 (49.5%) | 260 (48.9%) | 658 (49.7%) | 920 (49.4%) | 171 (49.4%) | 40 (50%) |
Type of child health check completed in the last 12 months | |||||||
MBS 715 | 928 (40.6%) | 175 (40.7%) | 229 (43%) | 524 (39.6%) | 928 (40.6%) | 781 (42%) | 117 (33.8%) |
Other child health check | 587 (25.7%) | 120 (27.9%) | 147 (27.6%) | 320 (24.2%) | 587 (25.7%) | 462 (24.8%) | 111 (32.1%) |
Not known / not recorded | 772 (33.8%) | 135 (31.4%) | 156 (29.3%) | 481 (36.3%) | 772 (33.8%) | 618 (33.2%) | 118 (34.1%) |
Reason for last clinic attendance | |||||||
Acute care | 1145 (50.1%) | 210 (48.8%) | 271 (50.9%) | 664 (50.1%) | 1145 (50.1%) | 945 (50.8%) | 163 (47.1%) |
Immunisation | 324 (14.2%) | 80 (18.6%) | 87 (16.4%) | 157 (11.8%) | 324 (14.2%) | 233 (12.5%) | 73 (21.1%) |
Child health check | 515 (22.52%) | 93 (21.63%) | 112 (21.05%) | 310 (23.4%) | 515 (22.52%) | 418 (22.46%) | 80 (23.12%) |
Other | 303 (13.2%) | 47 (10.9%) | 62 (11.7%) | 194 (14.6%) | 303 (13.2%) | 265 (14.2%) | 30 (8.7%) |
Clinic procedures
Data collection
Definitions
Statistical analysis
Results
General characteristics
Eligible primary care centres n (%) | Number of client records assesseda n (%) | Proportion receiving care n (%) | Age (months) | Geographic location | |||||
---|---|---|---|---|---|---|---|---|---|
6–11 n (%) | 12–23 n (%) | 24–59 n (%) | Remote | Rural | Urban | ||||
Total | 109 (100%) | 2287 | 2287 | 430 (18.8%) | 532 (23.3%) | 1325 (57.9%) | 1861 (81.4%) | 346 (15.1%) | 80 (3.5%) |
Anaemia care | |||||||||
Anticipatory guidance | |||||||||
Breastfeeding (< 2 years) | 109 (100%) | 962 (42.1%) | 728 (75.7%) | 376 (87.4%) | 352 (66.2%) | N/A | 638 (80.6%) | 64 (53.8%) | 26 (51%) |
Nutrition advice | 109 (100%) | 2287 (100%) | 1665 (72.8%) | 344 (80%) | 434 (81.6%) | 887 (66.9%) | 1373 (73.8%) | 233 (67.3%) | 59 (73.8%) |
Food security | 109 (100%) | 899 (39.3%) | 92 (10.2%) | 29 (15.9%) | 29 (13.9%) | 34 (6.7%) | 66 (9.4%) | 20 (11.4%) | 6 (25%) |
Child health surveillance | |||||||||
Haemoglobin documented in last 12 months | 109 (100%) | 2096 (91.6%) | 1472 (70.2%) | 195 (49.9%) | 381 (76.5%) | 896 (74.2%) | 1343 (74.8%) | 109 (41.8%) | 20 (50%) |
Follow up of abnormal findingsb | |||||||||
Dietary/nutrition advice | 109 (100%) | 452 (19.8%) | 298 (65.9%) | 51 (65.4%) | 115 (71%) | 132 (62.3%) | 258 (63.5%) | 34 (85%) | 6 (100%) |
Prescription of iron supplement | 109 (100%) | 452 (19.8%) | 253 (56.0%) | 40 (51.3%) | 97 (59.9%) | 116 (54.7%) | 239 (58.9%) | 11 (27.5%) | 3 (50%) |
Follow-up FBE or haemoglobin within 2 months | 109 (100%) | 452 (19.8%) | 219 (48.5%) | 40 (51.3%) | 76 (46.9%) | 103 (48.6%) | 208 (51.2%) | 7 (17.5%) | 4 (66.7%) |
Composite measure of quality of carec | 109 (100%) | 2096 (91.6%) | 1127 (53.8%) | 164 (41.9%) | 322 (64.7%) | 641 (53.1%) | 1012 (56.4%) | 95 (36.4%) | 20 (50%) |
Age and geographic location
Total number | Number that received composite measure | OR (95% CI) | P value | aORa (95% CI) | P value | |
---|---|---|---|---|---|---|
Total | 2096 | 1127 (53.8%) | ||||
Health service characteristics | ||||||
Geographic location | ||||||
Remote | 1795 | 1012 (56.4%) | 1.00 | 1.00 | ||
Non remote | 301 | 115 (38.2%) | 0.30 (0.14, 0.62) | 0.001 | 0.34 (0.15, 0.74) | 0.006 |
CQI participation (number of audits completed) | ||||||
1 | 349 | 149 (42.7%) | 1.00 | 1.00 | ||
2 | 523 | 253 (48.4%) | 1.49 (0.63, 3.50) | 0.360 | 1.06 (0.45, 2.50) | 0.899 |
≥ 3 | 1224 | 725 (59.2%) | 2.27 (1.07, 4.83) | 0.033 | 1.71 (0.81, 3.62) | 0.161 |
Governance | ||||||
Aboriginal community controlled health service | 388 | 194 (50%) | 0.81 (0.44, 1.51) | 0.511 | 1.06 (0.56, 2.03) | 0.856 |
Government health service | 1708 | 933 (54.6%) | 1.00 | 1.00 | ||
Health service provider who first saw the child | ||||||
Indigenous health worker | 255 | 120 (47.1%) | 0.83 (0.65, 1.07) | 0.158 | 0.85 (0.65, 1.10) | 0.220 |
Nurse | 1500 | 822 (54.8%) | 1.00 | 1.00 | ||
General practitioner | 225 | 118 (52.4%) | 1.05 (0.76, 1.45) | 0.770 | 1.11 (0.80, 1.54) | 0.519 |
Other | 99 | 56(56.6%) | 1.02 (0.66, 1.57) | 0.943 | 1.01 (0.65, 1.56) | 0.964 |
Missing | 17 | 11 (64.7%) | ||||
Year of data collection | ||||||
2012 | 418 | 210 (50.2%) | 1.00 | 1.00 | ||
2013 | 1114 | 577 (51.8%) | 0.99 (0.51, 1.92) | 0.976 | 0.68 (0.37, 1.25) | 0.218 |
2014 | 564 | 340 (60.3%) | 1.33 (0.64, 2.77) | 0.445 | 1.20 (0.62, 2.32) | 0.599 |
Population size | ||||||
≤ 500 | 782 | 390 (49.9%) | 1.00 | 1.00 | ||
501–999 | 420 | 250 (59.5%) | 1.41 (0.79, 2.52) | 0.243 | 2.27 (1.22, 4.26) | 0.010 |
≥ 1000 | 894 | 487 (54.5%) | 1.20 (0.74, 1.96) | 0.464 | 2.02 (1.27, 3.20) | 0.003 |
Child characteristics | ||||||
Age of child | ||||||
6-11 m | 391 | 164 (41.9%) | 0.57 (0.41, 0.79) | 0.001 | 0.55 (0.39, 0.78) | 0.001 |
12-23 m | 498 | 322 (64.7%) | 1.60 (1.30, 1.97) | < 0.001 | 1.63 (1.31, 2.03) | < 0.001 |
24-59 m | 1207 | 641 (53.1%) | 1.00 | 1.00 | ||
Sex of child | ||||||
Male | 1055 | 573 (54.3%) | 1.00 | 1.00 | ||
Female | 1041 | 554 (53.2%) | 0.98 (0.85, 1.13) | 0.777 | 0.98 (0.85, 1.14) | 0.827 |
Reason for last clinic attendance | ||||||
Acute care | 1052 | 553 (52.6%) | 0.66 (0.55, 0.79) | < 0.001 | 0.65 (0.54, 0.78) | < 0.001 |
Immunisation | 296 | 119 (40.2%) | 0.63 (0.51, 0.79) | < 0.001 | 0.63 (0.50, 0.79) | < 0.001 |
Child health check | 464 | 275 (59.3%) | 1.00 | 1.00 | ||
Other | 284 | 180 (63.4%) | 0.83 (0.63, 1.11) | 0.206 | 0.81 (0.61, 1.08) | 0.153 |
Abnormal findings
Total number | Evidence of anaemia | |||||
---|---|---|---|---|---|---|
n | n (%) | OR (95% CI) | P value | aOR (95% CI)a | P value | |
Total | 1472 | 452 (30.7%) | ||||
Child characteristics | ||||||
Age of child | ||||||
6-11 m | 195 | 78 (40.0%) | 2.28 (1.62, 3.21) | < 0.001 | 2.36 (1.65, 3.39) | < 0.001 |
12-23 m | 381 | 162 (42.5%) | 2.62 (2.04, 3.35) | < 0.001 | 2.64 (2.07, 3.38) | < 0.001 |
24-59 m | 896 | 212 (23.7%) | 1.00 | 1.00 | ||
Sex of child | ||||||
Male | 748 | 225 (30.1%) | 1.00 | 1.00 | ||
Female | 724 | 227 (31.4%) | 0.99 (0.79, 1.25) | 0.949 | 1.01 (0.79, 1.28) | 0.955 |
Reason for last clinic attendance | ||||||
Acute care | 750 | 236 (31.5%) | 1.13 (0.86, 1.50) | 0.380 | 1.13 (0.84, 1.53) | 0.405 |
Immunisation | 140 | 39 (27.9%) | 0.93 (0.57, 1.52) | 0.773 | 0.87 (0.52, 1.44) | 0.590 |
Child health check | 341 | 87 (25.5%) | 1.00 | 1.00 | ||
Other | 241 | 90 (37.3%) | 1.29 (0.86, 1.95) | 0.223 | 1.42 (0.92, 2.20) | 0.114 |
Health service characteristics | ||||||
Geographic location | ||||||
Remote | 1343 | 406 (30.2%) | 1.00 | 1.00 | ||
Non remote | 129 | 46 (35.7%) | 1.29 (0.68, 2.45) | 0.435 | 0.90 (0.38, 2.12) | 0.805 |
Number of audit rounds completed | ||||||
1 | 215 | 82 (38.1%) | 1.00 | 1.00 | ||
2 | 400 | 145 (36.3%) | 0.93 (0.50, 1.75) | 0.832 | 0.80 (0.44, 1.44) | 0.448 |
≥ 3 | 857 | 225 (26.3%) | 0.54 (0.31, 0.93) | 0.026 | 0.47 (0.28, 0.78) | 0.003 |
Governance | ||||||
Aboriginal community controlled health service | 233 | 92 (39.5%) | 1.58 (1.03, 2.44) | 0.037 | 1.68 (1.00, 2.83) | 0.052 |
Government health service | 1239 | 360 (29.1%) | 1.00 | 1.00 | ||
Health service provider who first saw the child | ||||||
Indigenous health worker | 158 | 39 (24.7%) | 0.78 (0.55, 1.10) | 0.158 | 0.80 (0.57, 1.13) | 0.201 |
Nurse | 1087 | 344 (31.6%) | 1.00 | 1.00 | ||
General practitioner | 133 | 38 (28.6%) | 1.03 (0.71, 1.50) | 0.858 | 0.96 (0.64, 1.43) | 0.833 |
Other | 82 | 28 (34.1%) | 1.19 (0.71, 1.97) | 0.511 | 1.39 (0.80, 2.40) | 0.239 |
Missing | 12 | 3 (25.0%) | ||||
Year of data collection | ||||||
2012 | 253 | 85 (33.6%) | 1.00 | 1.00 | ||
2013 | 763 | 193 (25.3%) | 0.65 (0.40, 1.07) | 0.091 | 0.73 (0.43, 1.25) | 0.255 |
2014 | 456 | 174 (38.2%) | 1.29 (0.77, 2.18) | 0.337 | 1.33 (0.76, 2.34) | 0.315 |
Population size | ||||||
≤ 500 | 564 | 145 (25.7%) | 1.00 | 1.00 | ||
501–999 | 306 | 96 (31.4%) | 1.31 (0.74, 2.32) | 0.348 | 1.57 (0.83, 2.95) | 0.165 |
≥ 1000 | 602 | 211 (35.1%) | 1.56 (1.02, 2.38) | 0.040 | 1.54 (1.02, 2.33) | 0.041 |
Total number | Mean (sd) Hb (g/dl) | Median (IQR) Hb (g/dl) | Range (min-max) Hb (g/dl) | Proportion with Hb < 70 g/dl n (%) | Proportion with Hb < 100 g/dl n (%) | Proportion with Hb < 110 g/dl n (%) | ||
---|---|---|---|---|---|---|---|---|
Total | 1472 | 113.1 (11.1) | 114 (107–120) | 61–158 | 1 (0.1%) | 163 (11.1%) | 475 (32.3%) | |
6–11 months | 195 | 107.8 (12.0) | 108 (100–115) | 61–158 | 1 (0.01%) | 45 (23.1%) | 111 (56.9%) | |
Remote | 184 | 107.8 (11.7) | 108 (100–115) | 75–135 | 0 (0.01%) | 43 (23.4%) | 106 (57.6%) | |
Non-remote | 11 | 107.4 (17.6) | 111 (102–119) | 61–124 | 1 (0.01%) | 2 (18.2%) | 5 (45.5%) | |
12–23 months | 381 | 109.5 (11.8) | 111 (102–117) | 70–148 | 0 (0%) | 73 (19.2%) | 163 (42.8%) | |
Remote | 344 | 109.4 (11.8) | 111 (102–117) | 70–148 | 0 (0%) | 66 (19.2%) | 149 (43.3%) | |
Non-remote | 37 | 110.4 (11.8) | 112 (105–119) | 79–129 | 0 (0%) | 7 (18.9%) | 14 (37.8%) | |
24–59 months | 896 | 115.7 (9.7) | 115 (110–122) | 83–147 | 0 (0%) | 45 (5.0%) | 201 (22.4%) | |
Remote | 815 | 115.9 (9.6) | 115 (110–122) | 87–147 | 0 (0%) | 39 (4.8%) | 172 (21.1%) | |
Non-remote | 81 | 113.0 (10.2) | 113 (107–120) | 83–136 | 0 (0%) | 6 (7.4%) | 29 (35.8%) |