About this item:

32 Views | 12 Downloads

Author Notes:

Emaill: rmokhtar@ariadnelabs.org

The authors would like to thank clinical leadership and staff at all study facilities for their partnership, support and contribution to this work; the mothers and infants for allowing us to have a glimpse into their experiences and sharing key moments of their lives; community members, government officials and subject experts for sharing their perspectives; and all data collectors and study staff for conducting study activities. We wish to acknowledge Dr Chandrashekhar C Karadiguddi, Mrs Geetanjali Mungarwadi, Dr. Chidbhusan Panda, Dr. Amrit Behera, Vaibhav Dhamanekar, Varun Kusagar, and ES Siddhartha for their implementation support and guidance in Karnataka and Odisha states of India and Dr. Ki-Do Eum for analytic review. We appreciate the deep dedication to this work in trying to understand the lives of clinicians and families with vulnerable newborns, particularly in the context of the global pandemic.


Research Funding:

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.

he 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.


  • low birthweight infants

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

Show all authors Show less authors


Journal Title:

PLOS Glob Public Health


Volume 3, Number 4


, Pages e0001789-e0001789

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2023 Semrau et al

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Export to EndNote