Key Points
Question
What are the associations between maternal milk feeding and cognitive, academic, and behavioral outcomes of preterm infants born at less than 33 weeks’ gestation?
Findings
In this cohort study of 586 preterm infants, higher maternal milk intake during neonatal hospitalization was associated with higher performance IQ, better academic achievement in reading and math, and fewer attention-deficit/hyperactivity symptoms at 7 years of age. These associations persisted after adjustment for clinical and social confounders and were generally more pronounced among infants born at lower gestational ages.
Meaning
These findings affirm recommendations to provide maternal milk to hospitalized very preterm infants based on potential long-term benefits to neurodevelopment.
Background: Poor health system experiences negatively affect the lives of poor people throughout the world. In East Africa there is a growing body of evidence of poor quality that in some cases goes as far as disrespectful or abusive care. This study will assess whether community feedback through report cards (with and without non-financial rewards) can improve patient experience. The patient experience includes aspects of patient dignity, autonomy, confidentiality, communication, timely attention, quality of basic amenities, and social support.Methods/Design: This cluster-randomized controlled study will randomize 75 primary health care facilities in rural Pwani Region, Tanzania to one of three arms: private feedback (intervention), social recognition reward (intervention), or no feedback (control). Within both intervention arms, we will give the providers at the study facilities feedback using the baseline data. Facilities randomized to the social recognition reward arm will also have a star-chart displaying their achieved level of patient experience publicly posted and potential recognition from senior officials at the local NGO and/or the Ministry of Health. We will use surveys with parents/ guardians of sick children to measure patient experience, and surveys with healthcare providers to assess potential mechanisms of effect.
Conclusion:Results from this study will provide evidence for whether, and through what mechanisms, patient reported feedback can affect interpersonal quality of care.
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