17
views
0
recommends
+1 Recommend
1 collections
    0
    shares

      To submit to this journal, please click here

      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

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

      research-article
      1 , 2 , 1 , * , , 3 , 4 , 5 , 6 , 7 , 8 , 8 , 9 , 10 , 3 , 11 , 3 , 3 , 3 , 12 , 13 , 5 , 14 , 5 , 5 , 5 , 5 , 4 , 4 , 15 , 16 , 4 , 17 , 4 , 4 , 4 , 18 , 4 , 4 , 11 , 19 , 20 , 20 , 12 , 1 , 1 , 1 , 1 , 1 , 1 , for the LIFE Study Group
      PLOS Global Public Health
      Public Library of Science

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          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.

          Related collections

          Most cited references52

          • Record: found
          • Abstract: found
          • Article: not found

          Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.

          The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project.

            In 2006, WHO published international growth standards for children younger than 5 years, which are now accepted worldwide. In the INTERGROWTH-21(st) Project, our aim was to complement them by developing international standards for fetuses, newborn infants, and the postnatal growth period of preterm infants. INTERGROWTH-21(st) is a population-based project that assessed fetal growth and newborn size in eight geographically defined urban populations. These groups were selected because most of the health and nutrition needs of mothers were met, adequate antenatal care was provided, and there were no major environmental constraints on growth. As part of the Newborn Cross-Sectional Study (NCSS), a component of INTERGROWTH-21(st) Project, we measured weight, length, and head circumference in all newborn infants, in addition to collecting data prospectively for pregnancy and the perinatal period. To construct the newborn standards, we selected all pregnancies in women meeting (in addition to the underlying population characteristics) strict individual eligibility criteria for a population at low risk of impaired fetal growth (labelled the NCSS prescriptive subpopulation). Women had a reliable ultrasound estimate of gestational age using crown-rump length before 14 weeks of gestation or biparietal diameter if antenatal care started between 14 weeks and 24 weeks or less of gestation. Newborn anthropometric measures were obtained within 12 h of birth by identically trained anthropometric teams using the same equipment at all sites. Fractional polynomials assuming a skewed t distribution were used to estimate the fitted centiles. We identified 20,486 (35%) eligible women from the 59,137 pregnant women enrolled in NCSS between May 14, 2009, and Aug 2, 2013. We calculated sex-specific observed and smoothed centiles for weight, length, and head circumference for gestational age at birth. The observed and smoothed centiles were almost identical. We present the 3rd, 10th, 50th, 90th, and 97th centile curves according to gestational age and sex. We have developed, for routine clinical practice, international anthropometric standards to assess newborn size that are intended to complement the WHO Child Growth Standards and allow comparisons across multiethnic populations. Bill & Melinda Gates Foundation. Copyright © 2014 Elsevier Ltd. All rights reserved.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found
              Is Open Access

              National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis

              Summary Background Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Estimates to track progress towards this target are lacking; with this analysis, we aim to assist in setting a baseline against which to assess progress towards the achievement of the World Health Assembly targets. Methods We sought to identify all available LBW input data for livebirths for the years 2000–16. We considered population-based national or nationally representative datasets for inclusion if they contained information on birthweight or LBW prevalence for livebirths. A new method for survey adjustment was developed and used. For 57 countries with higher quality time-series data, we smoothed country-reported trends in birthweight data by use of B-spline regression. For all other countries, we estimated LBW prevalence and trends by use of a restricted maximum likelihood approach with country-level random effects. Uncertainty ranges were obtained through bootstrapping. Results were summed at the regional and worldwide level. Findings We collated 1447 country-years of birthweight data (281 million births) for 148 countries of 195 UN member states (47 countries had no data meeting inclusion criteria). The estimated worldwide LBW prevalence in 2015 was 14·6% (uncertainty range [UR] 12·4–17·1) compared with 17·5% (14·1–21·3) in 2000 (average annual reduction rate [AARR] 1·23%). In 2015, an estimated 20·5 million (UR 17·4–24·0 million) livebirths were LBW, 91% from low-and-middle income countries, mainly southern Asia (48%) and sub-Saharan Africa (24%). Interpretation Although these estimates suggest some progress in reducing LBW between 2000 and 2015, achieving the 2·74% AARR required between 2012 and 2025 to meet the global nutrition target will require more than doubling progress, involving both improved measurement and programme investments to address the causes of LBW throughout the lifecycle. Funding Bill & Melinda Gates Foundation, The Children's Investment Fund Foundation, United Nations Children's Fund (UNICEF), and WHO.
                Bookmark

                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Data curation
                Role: Data curationRole: Investigation
                Role: Data curation
                Role: Conceptualization
                Role: ConceptualizationRole: Supervision
                Role: ConceptualizationRole: Investigation
                Role: Data curationRole: Investigation
                Role: Data curation
                Role: Data curation
                Role: Investigation
                Role: ConceptualizationRole: Investigation
                Role: ConceptualizationRole: Investigation
                Role: Investigation
                Role: Investigation
                Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: InvestigationRole: Project administration
                Role: Data curation
                Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: InvestigationRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: Methodology
                Role: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Visualization
                Role: ConceptualizationRole: Data curationRole: Software
                Role: ConceptualizationRole: Investigation
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                19 April 2023
                2023
                : 3
                : 4
                : e0001789
                Affiliations
                [1 ] Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
                [2 ] Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
                [3 ] Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
                [4 ] Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka, India
                [5 ] University of North Carolina Project Malawi, Lilongwe, Malawi
                [6 ] Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [7 ] Department of Global Health and Population and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
                [8 ] Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
                [9 ] Center for Nutrition, Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, Boston, Massachusetts, United States of America
                [10 ] Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
                [11 ] Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
                [12 ] Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [13 ] Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [14 ] Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
                [15 ] Department of Obstetrics and Gynaecology, SCB Medical College and Hospital, Cuttack, Odisha, India
                [16 ] Department of Obstetrics and Gynaecology, FM Medical College, Balasore, Odisha, India
                [17 ] Department of Obstetrics and Gynaecology, City Hospital, Cuttack, Odisha, India
                [18 ] Department of Paediatrics, SCB Medical College and Hospital, Cuttack, Odisha, India
                [19 ] Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
                [20 ] Maternal, Newborn, Child Health and Nutrition Program, PATH, Seattle, Washington, United States of America
                Public Health Foundation of India, INDIA
                Author notes

                The authors have declared that no competing interests exist.

                ‡ KEAS and RRM denotes co-first authors to this work.

                ¶ Membership of the LIFE Study Group is provided in the Acknowledgments.

                Author information
                https://orcid.org/0000-0002-8360-1391
                https://orcid.org/0000-0002-0796-6313
                https://orcid.org/0000-0002-7069-6408
                https://orcid.org/0000-0002-8680-7053
                https://orcid.org/0000-0002-6775-7919
                https://orcid.org/0000-0001-9738-9857
                https://orcid.org/0000-0003-1190-1499
                https://orcid.org/0000-0003-2820-6695
                https://orcid.org/0000-0003-4383-1704
                https://orcid.org/0000-0003-0240-7245
                https://orcid.org/0000-0003-0613-5566
                https://orcid.org/0000-0002-2015-2066
                https://orcid.org/0000-0001-7846-4890
                Article
                PGPH-D-22-00635
                10.1371/journal.pgph.0001789
                10115266
                37075019
                de10de58-a1db-4ef1-89f5-eb66dd7c7ca0
                © 2023 Semrau et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 April 2022
                : 13 March 2023
                Page count
                Figures: 1, Tables: 5, Pages: 20
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1192260
                Award Recipient :
                This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation, grant number OPP1192260/INV-007326. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. The Bill & Melinda Gates Foundation reviewed the study design, but had no role in data collection, management, analysis, interpretation, writing of the manuscript, or the decision to submit manuscripts for publication. The grant recipient was Dr. Katherine E.A. Semrau. This study was registered at the following: Clinicaltrials.gov (NCT04002908) and the Clinical Trial Registry of India (CTRI/2019/02/017475, http://ctri.nic.in). All coauthors (Named: KEAS, RRM, KM, SSG, TM CRS, MFY, BAC, CPD, SSS, ACCL, MB, KL, RK, LSA, IH, FS, MP, KM, FN, MM, SMD, RMB, SM, SP, SSV, VH, MS, RBN, SYK, SW, KN, KIB, KLM, SLM. KF, KM, AP, LSp, DET, LV; LIFE Group Authorship: BK, SM, GG, MBK, KAC, MJ, VBN, SK, BL, GSV, LGS, SN, SCP, LD JNB, BS, SN, and those acknowledged: CCK, GM, CP, AB, VD, VK, ESS, KDE) received funding from this award to support this work.
                Categories
                Research Article
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Breast Feeding
                Medicine and Health Sciences
                Pediatrics
                Neonatology
                Breast Feeding
                Medicine and Health Sciences
                Endocrinology
                Endocrine Physiology
                Lactation
                Biology and Life Sciences
                Physiology
                Endocrine Physiology
                Lactation
                Biology and Life Sciences
                Physiology
                Reproductive Physiology
                Lactation
                Research and Analysis Methods
                Research Facilities
                Biology and Life Sciences
                Nutrition
                Diet
                Beverages
                Milk
                Breast Milk
                Medicine and Health Sciences
                Nutrition
                Diet
                Beverages
                Milk
                Breast Milk
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Milk
                Breast Milk
                Medicine and Health Sciences
                Anatomy
                Body Fluids
                Milk
                Breast Milk
                Biology and Life Sciences
                Physiology
                Body Fluids
                Milk
                Breast Milk
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Custom metadata
                The data presented here are from the Low Birthweight Infant Feeding Exploration (LIFE) study which is filed with Clinicaltrials.gov NCT04002908 and Clinical Trial Registry of India CTRI/2019/02/017475. De-identified individual participant data (including data dictionaries) will be made available, in addition to study protocols, and the informed consent form in a public, open access repository. The data will be made available upon publication through the Harvard Dataverse Platform under the BetterBirth Dataverse website. This can be found at: https://dataverse.harvard.edu/dataverse/BetterBirthData

                Comments

                Comment on this article