Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania International Breastfeeding Journal
Abstract Methods Results Discussion Footnotes References Associated Data Supplementary Materials Data Availability Statement Abstract Background Low birthweight (LBW) infants are at increased risk of morbidity and mortality. Exclusive breastfeeding up to six months is recommended to help them thrive through infection prevention, growth improvements, and enhancements in neurodevelopment. However, limited data exist on the feeding experiences of LBW infants, their caregivers and key community influencers. The qualitative component of the Low Birthweight Infant Feeding Exploration (LIFE) study aimed to understand practices, facilitators, and barriers to optimal feeding options in the first six months for LBW infants in low-resource settings. Methods This study was conducted in four sites in India, Malawi, and Tanzania from July 2019 to August 2020. We conducted 37 focus group discussions with mothers and family members of LBW infants and community leaders and 142 in-depth interviews with healthcare providers, government officials, and supply chain and donor human milk (DHM) experts. Data were analyzed using a framework approach. Results All participants believed that mother’s own milk was best for LBW infants. Direct breastfeeding was predominant and feeding expressed breast milk and infant formula were rare. DHM was a new concept for most. Adequate maternal nutrition, lactation support, and privacy in the facility aided breastfeeding and expression, but perceived insufficient milk, limited feeding counseling, and infant immaturity were common barriers. Most believed that DHM uptake could be enabled through community awareness by overcoming misconceptions, safety concerns, and perceived family resistance. Conclusion This study fills an evidence gap in LBW infant feeding practices and their facilitators and barriers in resource-limited settings. LBW infants face unique feeding challenges such as poor latching and tiring at the breast. Similarly, their mothers are faced with numerous difficulties, including attainment of adequate milk supply, breast pain and emotional stress. Lactation support and feeding counseling could address obstacles faced by mothers and infants by providing psychosocial, verbal and physical support to empower mothers with skills, knowledge and confidence and facilitate earlier, more and better breast milk feeding. Findings on DHM are critical to the future development of human milk banks and highlight the need to solicit partnership from stakeholders in the community and health system. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-023-00597-7. Keywords: Low birthweight, Breastfeeding, Infant feeding, Facilitators, Barriers, Qualitative
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Linda Vesel, Emily Benotti, Sarah Somji et al.. Facilitators, barriers, and key influencers of breastfeeding among low birthweight infants: a qualitative study in India, Malawi, and Tanzania. International Breastfeeding Journal. (2023). https://doi.org/10.1186/s13006-023-00597-7 Linda Vesel, Emily Benotti, Sarah Somji, Roopa M Bellad, Umesh Charantimath, Sangappa M Dhaded, Shivaprasad S Goudar, Chandrashekhar Karadiguddi, Geetanjali Mungarwadi, Sunil S Vernekar, Rodrick Kisenge, Karim Manji, Nahya Salim, Abraham Samma, Christopher R Sudfeld, Irving F Hoffman, Tisungane Mvalo, Melda Phiri, Friday Saidi, Jennifer Tseka, Mercy Tsidya, Bethany A Caruso, Christopher P Duggan, Kiersten Israel-Ballard, Anne CC Lee, Kimberly L Mansen, Stephanie L Martin, Krysten North, Melissa F Young, Eliza Fishman, Katelyn Fleming, Katherine EA Semrau, Lauren Spigel, Danielle E Tuller, Natalie Henrich
1Ariadne Labs at Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA USA 2Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 3KLE Academy of Higher Education and Research’s Jawaharlal Nehru Medical College, Belgaum, Karnataka India 4Departments of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA USA 5Institute for Global Health and Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC USA 6University of North Carolina Project Malawi, Lilongwe, Malawi 7Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA 8Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA 9Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA USA 10Center for Nutrition, Boston Children’s Hospital, Boston, MA USA 11Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, WA USA 12Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA 13Department of Pediatrics, Harvard Medical School, Boston, MA USA 14Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA 15Department of Medicine, Harvard Medical School, Boston, MA USA 16Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA 