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Implementing a Care Pathway for small and nutritionally at-risk infants under six months of age: A multi-country
Tabitha D van Immerzeel1, Maty Diagne2, Indou Deme/Ly2,3
1Department for Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Insights
A new care pathway for managing nutritionally at-risk infants under 6 months (MAMI) shows promise for outpatient care. Stakeholders find it feasible but highlight barriers like training needs and lack of screening tools for wider implementation.
Area of Science:
- Global Health
- Pediatrics
- Nutrition Science
Background:
- Nutritional vulnerability in infants under 6 months is a significant issue in low- and middle-income countries, with high rates of underweight, wasting, and stunting.
- A novel Management of Infants and Mothers at risk of Malnutrition (MAMI) Care Pathway has been developed for widespread outpatient management.
Purpose of the Study:
- To assess stakeholders' perceptions of the feasibility of implementing the MAMI Care Pathway.
- To identify key barriers and enablers for the successful implementation of the MAMI Care Pathway.
Main Methods:
- A formative mixed-methods study involving an online survey and in-depth interviews with country-level nutrition and child health stakeholders.
- 189 stakeholders from 42 countries completed the survey, and 14 remote interviews were conducted.
Main Results:
- Stakeholders recognized an urgent need for improved infant malnutrition care and viewed the MAMI Care Pathway as relevant and feasible.
- Key implementation barriers include community-specific needs, healthcare-seeking challenges, insufficient breastfeeding counseling skills among health workers, and lack of validated anthropometric screening tools.
- Potential enablers include patient preference for outpatient care, integration into existing maternal and child health programs, and pilot projects.
Conclusions:
- The MAMI Care Pathway is a potentially valuable tool for addressing infant nutritional vulnerability, but successful scale-up requires addressing identified barriers.
- Adapting the pathway to local contexts and addressing health worker training and screening tool availability are crucial for effective implementation and wider adoption.
Abstract:
Nutritional vulnerability under the age of 6 months is prevalent in low- and middle-income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders' views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed-methods study: an online survey plus in-depth interviews with country-level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at-risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community-specific needs and health care seeking barriers, health workers' lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients' preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale-up.
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