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Improving developmental care in primary practice for disadvantaged children
  1. Karen Margaret Edmond1,
  2. Scarlette Tung2,
  3. Kimberley McAuley3,
  4. Natalie Strobel3,
  5. Daniel McAullay3
  1. 1 Health section, Unicef Afghanistan, Kabul, Afghanistan
  2. 2 Child and Adolescent Health Service, Government of Western Australia, Perth, Western Australia, Australia
  3. 3 School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Karen Margaret Edmond, Unicef Afghanistan, Health Section, Kabul, Afghanistan; kedmond{at}


Our primary objective was to assess if sustained participation in continuous quality improvement (CQI) activities could improve delivery of ‘basic developmental care’ to disadvantaged children in primary care settings. Secondary objectives were to assess if delivery of developmental care differed by age and geographic location.Data were analysed using multivariable logistic regression and generalised estimating equations. 109 indigenous primary care centres across Australia from 2012 to 2014 and2466 client files from indigenous children aged 3–59 months were included. Outcome measures were delivery of basic developmental care.We found that the proportion of children who received basic developmental care ranged from 55% (advice about physical and mental stimulation of child) (1279, 55.1%) to 74% (assessment of developmental milestones) (1510, 73.7%). Ninety-three per cent (92.6%, 88) of children received follow-up care. Centres with sustained CQI participation (completed three or more consecutive audit cycles) (508, 53.9%) were twofold more likely to deliver basic developmental care compared with centres without sustained CQI (completed less than three consecutive audit cycles) (118, 31.0%) (adjusted OR (aOR) 2.37, 95% CI 1.33 to 4.23). Children aged 3–11 months (229, 54.9%) were more likely to receive basic developmental care than children aged 24–59 months (151, 38.5%) (aOR 2.42, 95% CI 1.67 to 3.51). Geographic location had little effect (aOR 0.68, 95% CI 0.30 to 1.53). Overall our study found that sustained CQI can improve basic developmental care in primary care settings. However, many disadvantaged children are not receiving services. Improved resourcing of developmental care and CQI in primary care centres is needed.

  • child
  • development
  • primary care
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  • Contributors KME conceptualised and wrote the first draft of the paper and analyses. The other authors all made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; and revised the work critically for important intellectual content.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from all Human Research Ethics Committees (HREC) in the states and territories involved: the Human Research Ethics Committee (HREC) of the Northern Territory Department of Health and Menzies School of Health Research (HREC-EC00153); Central Australian HREC (HREC-12-53); Queensland HREC Darling Downs Health Services District (HREC/11/QTDD/47); South Australian Indigenous Health Research Ethics Committee (04-10-319); Curtin University HREC (HR140/2008); Western Australian Country Health Services Research Ethics Committee (2011/27); Western Australian Aboriginal Health Ethics Committee (111-8/05); and University of Western Australia HREC (RA/4/1/5051).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no available unpublished data from the study.

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