Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 19;3(4):e0001789.
doi: 10.1371/journal.pgph.0001789. eCollection 2023.

Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania

Katherine E A Semrau  1   2 , Rana R Mokhtar  1 , Karim Manji  3 , Shivaprasad S Goudar  4 , Tisungane Mvalo  5   6 , Christopher R Sudfeld  7 , Melissa F Young  8 , Bethany A Caruso  8 , Christopher P Duggan  9   10 , Sarah S Somji  3 , Anne C C Lee  11 , Mohamed Bakari  3 , Kristina Lugangira  3 , Rodrick Kisenge  3 , Linda S Adair  12 , Irving F Hoffman  13 , Friday Saidi  5   14 , Melda Phiri  5 , Kingsly Msimuko  5 , Fadire Nyirenda  5 , Mallory Michalak  5 , Sangappa M Dhaded  4 , Roopa M Bellad  4 , Sujata Misra  15   16 , Sanghamitra Panda  4   17 , Sunil S Vernekar  4 , Veena Herekar  4 , Manjunath Sommannavar  4 , Rashmita B Nayak  18 , S Yogeshkumar  4 , Saraswati Welling  4 , Krysten North  11   19 , Kiersten Israel-Ballard  20 , Kimberly L Mansen  20 , Stephanie L Martin  12 , Katelyn Fleming  1 , Katharine Miller  1 , Arthur Pote  1 , Lauren Spigel  1 , Danielle E Tuller  1 , Linda Vesel  1 ; LIFE Study Group
Affiliations

Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania

Katherine E A Semrau et al. PLOS Glob Public Health. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Observed feeding patterns in the first week of life prior to facility discharge among moderately low birthweight infants across 12 facilities in India, Malawi, and Tanzania.
See this image and copyright information in PMC

References

    1. Ashorn P, Black RE, Lawn JE, Ashorn U, Klein N, Hofmeyr J, et al.. The Lancet Small Vulnerable Newborn Series: science for a healthy start. Lancet. 2020;396(10253): 743–745. doi: 10.1016/S0140-6736(20)31906-1 - DOI - PubMed
    1. McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med. 1985;312(2): 82–90. doi: 10.1056/NEJM198501103120204 - DOI - PubMed
    1. Delivery care—UNICEF DATA [Internet]. UNICEF. [cited 2021 Oct 15]. Available from: https://data.unicef.org/topic/maternal-health/delivery-care/
    1. Blencowe H, Krasevec J, de Onis M, Black RE, An X, Stevens GA, et al.. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2019;7(7): e849–e860. doi: 10.1016/S2214-109X(18)30565-5 - DOI - PMC - PubMed
    1. Stein REK, Siegel MJ, Bauman LJ. Are children of moderately low birth weight at increased risk for poor health? A new look at an old question. Pediatrics. 2006;118(1): 217–223. doi: 10.1542/peds.2005-2836 - DOI - PubMed

LinkOut - more resources