Facility-Based Care for Moderately Low Birthweight Infants in India, Malawi, and Tanzania

Download as .RIS

Citation

Semrau, Katherine E. A.; Mokhtar, Rana R.; Manji, Karim; Goudar, Shivaprasad S.; Mvalo, Tisungane; Sudfeld, Christopher R.; Young, Melissa F.; Caruso, Bethany A.; Duggan, Christopher P.; & Somji, Sarah S., et al. (2023). Facility-Based Care for Moderately Low Birthweight Infants in India, Malawi, and Tanzania. PLOS Global Public Health, 3(4), e0001789. PMCID: PMC10115266

Abstract

Globally, increasing rates of facility-based childbirth enable early intervention for small vulnerable newborns. We describe health system-level inputs, current feeding, and discharge practices for moderately low birthweight (MLBW) infants (1500-<2500g) in resource-constrained settings. The Low Birthweight Infant Feeding Exploration study is a mixed methods observational study in 12 secondary- and tertiary-level facilities in India, Malawi, and Tanzania. We analyzed data from baseline facility assessments and a prospective cohort of 148 MLBW infants from birth to discharge. Anthropometric measuring equipment (e.g., head circumference tapes, length boards), key medications (e.g., surfactant, parenteral nutrition), milk expression tools, and human milk alternatives (e.g., donor milk, formula) were not universally available. MLBW infants were preterm appropriate-for-gestational age (38.5%), preterm large-for-gestational age (3.4%), preterm small-for-gestational age (SGA) (11.5%), and term SGA (46.6%). The median length of stay was 3.1 days (IQR: 1.5, 5.7); 32.4% of infants were NICU-admitted and 67.6% were separated from mothers at least once. Exclusive breastfeeding was high (93.2%). Generalized group lactation support was provided; 81.8% of mother-infant dyads received at least one session and 56.1% had 2+ sessions. At the time of discharge, 5.1% of infants weighed >10% less than their birthweight; 18.8% of infants were discharged with weights below facility-specific policy [1800g in India, 1500g in Malawi, and 2000g in Tanzania]. Based on descriptive analysis, we found constraints in health system inputs which have the potential to hinder high quality care for MLBW infants. Targeted LBW-specific lactation support, discharge at appropriate weight, and access to feeding alternatives would position MLBW for successful feeding and growth post-discharge.

URL

http://dx.doi.org/10.1371/journal.pgph.0001789

Reference Type

Journal Article

Year Published

2023

Journal Title

PLOS Global Public Health

Author(s)

Semrau, Katherine E. A.
Mokhtar, Rana R.
Manji, Karim
Goudar, Shivaprasad S.
Mvalo, Tisungane
Sudfeld, Christopher R.
Young, Melissa F.
Caruso, Bethany A.
Duggan, Christopher P.
Somji, Sarah S.
Lee, Anne C. C.
Bakari, Mohamed
Lugangira, Kristina
Kisenge, Rodrick
Adair, Linda S.
Hoffman, Irving F.
Saidi, Friday
Phiri, Melda
Msimuko, Kingsly
Nyirenda, Fadire
Michalak, Mallory
Dhaded, Sangappa
Bellad, Roopa M.
Misra, Sujata
Panda, Sanghamitra
Vernekar, Sunil S.
Herekar, Veena
Sommannavar, Manjunath
Nayak, Rashmita B.
Yogeshkumar, S.
Welling, Saraswati
North, Krysten
Israel-Ballard, Kiersten
Mansen, Kimberly L.
Martin, Stephanie L.
Fleming, Katelyn
Miller, Katharine
Pote, Arthur
Spigel, Lauren
Tuller, Danielle E.
Vesel, Linda

Article Type

Regular

PMCID

PMC10115266

Data Set/Study

Low Birthweight Infant Feeding Exploration (LIFE) Study

Continent/Country

India
Malawi
Tanzania

ORCiD

Martin, S. - 0000-0002-0378-802X
Adair - 0000-0002-3670-8073