Safe infant feeding in healthcare facilities: Assessment of infection prevention and control conditions and behaviors in India, Malawi, and Tanzania.

• Type of Material: Article
• Authors: Bethany Caruso, Emory University; Uriel Paniagua, Emory University; Irving Hoffman, University of North Carolina at Chapel Hill School of Medicine; Karim Manji, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Friday Saidi, University of North Carolina Project Malawi, Lilongwe, Malawi.; Christopher R Sudfeld, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.; Sunil S Vernekar, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.; Mohamed Bakari, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Christopher P Duggan, Center for Nutrition, Boston Children's Hospital, Boston, Massachusetts, United States of America.; George C Kibogoyo, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Rodrick Kisenge, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Sarah Somji, Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.; Eddah Kafansiyanji, University of North Carolina Project Malawi, Lilongwe, Malawi.; Tisungane Mvalo, University of North Carolina Project Malawi, Lilongwe, Malawi.; Naomie Nyirenda, University of North Carolina Project Malawi, Lilongwe, Malawi.; Melda Phiri, University of North Carolina Project Malawi, Lilongwe, Malawi.; Roopa Bellad, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.; Sangappa Dhaded, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.; Chaya K A, Bapuji Child Health Institute & Research Centre, Davangere, Karnataka, India.; Bhavana Koppad, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.; Shilpa Nabapure, SS Institute of Medical Sciences & Research Centre, Davangere, Karnataka, India.; Saumya Nanda, Shri Jagannath Medical College and Hospital, Puri, Odisha, India.; Bipsa Singh, Shri Jagannath Medical College and Hospital, Puri, Odisha, India.; S Yogeshkumar, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belgaum, Karnataka, India.; Katelyn Fleming, Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Krysten North, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.; Danielle E Tuller, Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Katherine EA Semrau, Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Linda Vesel, Ariadne Labs, Harvard T.H. Chan School of Public Health / Brigham and Women's Hospital, Boston, Massachusetts, United States of America.; Melissa Young, Emory University
• Language: English
• Date: 2023
• Publisher: Emory University Libraries
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Caruso et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pgph.0001843
• Title of Journal or Parent Work: PLOS Glob Public Health
• Volume: 3
• Issue: 6
• Start Page: e0001843
• End Page: e0001843
• Grant/Funding Information: This work was financially supported by the Bill & Melinda Gates Foundation in the form of a grant (OPP1192260/INV-007326) awarded to KEAS. 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. This grant also financially supported by the Bill & Melinda Gates Foundation in the form of salaries for BAC, UP, IH, KM, FS, CRS, SSV, MB, CPD, GCK, RK, SS, EK, TM, NN, MP, RB, SD, CKA, BK, S. Nabapure, S. Nanda, BS, SY, KF, DET, KEAS, LV, and MFY. The specific roles of these authors are articulated in the ‘author contributions’ section. No additional external funding was received for this study. 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 findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation.
• Keywords: Tanzania; Malawi; infection prevention; India

Abstract

Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had 'improved' water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health.