Individualized breastfeeding support for acutely ill, malnourished infants under 6 months old

Abstract

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition (midupper-arm circumference < 11.0 cm OR weight-for-age z score < −2 OR weightfor-length z score < -2). Infants were followed daily while in hospital then every 2 weeks for 6 weeks after discharge with data collected on breastfeeding, infant growth, morbidity, and mortality. Of 106 infants with acute malnutrition at admission, 51 met the inclusion criteria for the study. Most enrolled mothers had multiple breastfeeding challenges, which were predominantly technique based. Exclusive breastfeeding was 55% at admission and 81% at discharge; at discharge 67% of infants had attained a weight velocity of >5 g/kg/day for three consecutive days on breastmilk alone. Gains in weight-for-length z score and weight-for-age z score were generally not sustained beyond 2 weeks after discharge. BFPS operated effectively in an inpatient setting, applying the 2013 updated WHO guidelines and increasing rates of exclusive breastfeeding at discharge. However, lack of continued increase in anthropometric Z scores after discharge suggests the need for more sustained interventions.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

A scoping review of breastfeeding peer support models applied in hospital settings

“…La Leche League and should include an assessment of participant knowledge and awards given. 14 Singleton, (2018) [ 30 ] USA Postpartum ward Employed by the county through partnership offering one-to-one support While hospitalized Not described 15 Potter, (2013) [ 31 ] England – Volunteers but unclear on the type of support – 10 weeks of training by an accredited training program 16 Healey, (2013) [ 32 ] UK Maternity, neonatal and paediatric unit Employed peer by Wigan public health offering one-to-one support While hospitalized Not described 17 Whitmore, (2013) [ 33 ] England Maternity, neonatal and paediatric unit Combined employed and volunteers by Blackpoll council through small grants to offer one-to-one support While hospitalized Unclear 18 Mwangome, et al 2019 [ 13 ] Kenya Paediatric ward Contracted during the study period offering one-to-one support Daily during hospitalization up to 6 weeks post-discharge Yes. 5-day training on introduction to lactation management.…”

“…These were categorized as healthy infants. Seven studies [ 13 , 15 , 17 , 19 , 20 , 25 , 28 ] described breastfeeding peer support offered to mothers with infants born with clinical illness or admitted with illness. These were categorised as unhealthy infants.…”

“…These were categorised as unhealthy infants. In three studies [ 17 , 19 , 25 ], the infants were admitted in the NICU or the general paediatric ward with clinical conditions such as overweight [ 15 ], premature [ 20 ], diarrhoea [ 28 ] and malnutrition [ 13 ]. Five studies described breastfeeding peer support offered to both healthy and unhealthy infants while the remaining two studies were unclear on the status of the mother and/or infant being supported.…”

“…The target populations included in each study differed based on the condition of the child and the mother. Four studies [13][14][15]28] described breastfeeding peer support offered to the mother who had interest in initiating breastfeeding even though their infants had no clinical illness. These were categorized as healthy infants.…”

“…A recent study in Kenya explored the use of BFPS in a hospital setting to support ill malnourished infants aged between one and four months [ 13 ]. Findings from the study indicate that BFPS are effective to increase the rate of exclusive breastfeeding in hospitalized infants.…”