Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi-site...

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.