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Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi-site
Sunil S Vernekar1, Sarah Somji2, Kingsly Msimuko3
1Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.
Insights
Implementing optimal infant feeding for moderately low birthweight infants presents challenges. This mixed-methods study in India, Malawi, and Tanzania offers lessons for improving care for vulnerable newborns globally.
Area of Science:
- Global Health
- Pediatric Nutrition
- Implementation Science
Background:
- Limited global data exists on early and optimal feeding practices for small and vulnerable infants.
- Improving feeding strategies for moderately low birthweight infants (MLBW) is crucial for better health outcomes.
- Complex research studies are needed to understand and address challenges in infant feeding implementation.
Purpose of the Study:
- To share implementation lessons learned from a complex, mixed-methods research study on infant feeding.
- To understand current practices and standard of care for feeding LBW infants.
- To assess the feasibility and acceptability of infant feeding interventions for MLBW infants.
Main Methods:
- A formative, multi-site, observational cohort study with a convergent parallel, mixed-methods design.
- Involved 12 hospitals across India, Malawi, and Tanzania.
- Data collection included chart reviews (603 MLBW infants), in-facility observations (148 MLBW infants), 1-year prospective follow-up (1114 MLBW infants), and qualitative interviews/discussions.
Main Results:
- Significant variability in hospital-level guidelines and care provision for MLBW infants was observed.
- High rates of missing data in patient charts (89% for time to first feed, 56% for discharge weight).
- 18.5% of observed infants were discharged before meeting weight goals; 90% cohort follow-up achieved despite COVID-19 challenges.
Conclusions:
- Enrolling and following vulnerable populations requires significant effort from researchers and communities.
- Mixed-methods research provides a comprehensive understanding for planning targeted interventions for MLBW infants.
- Effective multi-site global health research partnerships are essential for building a generalizable evidence base.
Objective:
Globally, early and optimal feeding practices and strategies for small and vulnerable infants are limited. We aim to share the challenges faced and implementation lessons learned from a complex, mixed methods research study on infant feeding.
Design:
A formative, multi-site, observational cohort study using convergent parallel, mixed-methods design.
Setting:
Twelve tertiary/secondary, public/private hospitals in India, Malawi and Tanzania.
Population Or Sample:
Moderately low birthweight infants (MLBW; 1.50-2.49 kg).
Methods:
We assessed infant feeding and care practices through: (1) assessment of in-facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1-year follow-up of 1114 MLBW infants. Focus group discussions and in-depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders.
Main Outcome Measures:
The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system-level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants.
Results:
Hospital-level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in-facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12 months of age.
Conclusions:
Enrolment and follow-up of this vulnerable population required additional effort from researchers and the community. Using a mixed-methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence-based planning of targeted large-scale interventions. Multi-site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.
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