Design and implementation of a community-based mother-to-mother peer support programme for the follow-up of low birthweight infants in rural western Kenya

Background: Globally, low birthweight (LBW) infants ( Methods: Key informant interviews were conducted with 10 mothers of neonates (infants days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen completing all the visits over a 6-month period. A mixed methods approach was used to evaluate the implementation of the programme. Quantitative data of peer mother socio-demographic characteristics, recruitment, and retention was collected. Two post-training focus group discussions were conducted with the peer mothers to explore their experiences of the programme. Descriptive statistics were generated from the quantitative data and the qualitative data was analysed using a thematic framework. Results: The median age of the peer mothers was 26 years (range 21–43). From March-August 2019, each peer mother conducted a median of 28 visits (range 7–77) with fourteen (88%) completing all their assigned follow-up visits. Post training, our interviews suggest that peer mothers felt empowered to promote appropriate infant feeding practices. They gave multiple examples of improved health seeking behaviours as a result of the peer mother training programme. Conclusion: Our peer mother training programme equipped peer mothers with the knowledge and skills for the post-discharge follow-up of LBW infants in this rural community in Kenya. Community-based interventions for LBW infants, delivered by appropriately trained peer mothers, have the potential to address the current gaps in post-discharge care for these infants

Caregiver experiences and health care worker perspectives of accessing health care for low birth weight infants in rural Kenya.

BACKGROUND Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes. AIM To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya. METHODS This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data. RESULTS At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers. CONCLUSION Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome.

Design and implementation of a community-based mother-to-mother peer support programme for the follow-up of low birthweight infants in rural western Kenya

Background: Globally, low birthweight (LBW) infants (<2,500 g) have the highest risk of mortality during the first year of life. Those who survive often have adverse health outcomes. Post-discharge outcomes of LBW infants in impoverished communities in Africa are largely unknown. This paper describes the design and implementation of a mother-to-mother peer training and mentoring programme for the follow-up of LBW infants in rural Kenya. Methods: Key informant interviews were conducted with 10 mothers of neonates (infants <28 days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen completing all the visits over a 6-month period. A mixed methods approach was used to evaluate the implementation of the programme. Quantitative data of peer mother socio-demographic characteristics, recruitment, and retention was collected. Two post-training focus group discussions were conducted with the peer mothers to explore their experiences of the programme. Descriptive statistics were generated from the quantitative data and the qualitative data was analysed using a thematic framework. Results: The median age of the peer mothers was 26 years (range 21–43). From March-August 2019, each peer mother conducted a median of 28 visits (range 7–77) with fourteen (88%) completing all their assigned follow-up visits. Post training, our interviews suggest that peer mothers felt empowered to promote appropriate infant feeding practices. They gave multiple examples of improved health seeking behaviours as a result of the peer mother training programme. Conclusion: Our peer mother training programme equipped peer mothers with the knowledge and skills for the post-discharge follow-up of LBW infants in this rural community in Kenya. Community-based interventions for LBW infants, delivered by appropriately trained peer mothers, have the potential to address the current gaps in post-discharge care for these infants

1145 Improving postnatal breastfeeding support for mothers of low-birth-weight infants in rural Kenyan hospitals- a feasibility study

Aims To assess the feasibility and acceptability of using trained peer mothers to deliver breastfeeding support to mothers of low-birth-weight (LBW, <2500g) infants in healthcare facilities in rural, western Kenya. Methods The study was conducted in Homa Bay County. Seventeen peer mothers attended a 4-day training programme that focussed on communication skills, breastfeeding support, Kangaroo Mother Care, hygiene and identification of danger signs. Competency-based scenarios were used to select the 10 (59%) peer mothers, who delivered the interventions to the mother-LBW infant pairs (<28 post-delivery) across 8 healthcare facilities in Homa Bay County. A mixed methods approach was employed using structured observations and post-intervention semi-structured interviews with mothers, healthcare providers and peer mothers. Descriptive statistics were used to analyse the quantitative data. A thematic framework was used to analyse the qualitative data. Results From September-November 2021, 23 mother-LBW infant pairs (3 sets of twins so 26 infants) were recruited and received the intervention. The median maternal age was 25 years (Interquartile range, IQR 22, 29) and all infants were born in hospital. The median age of the infants was 1 day (IQR 1,3), median birth weight 2100g (IQR 1900, 2260) and median gestation was 34 weeks (IQR 34,36). Although all the mothers who received the intervention looked well, worryingly 4 (17%) showed no signs for bonding with the infant. Peer mothers consistently explored mothers’ wellbeing (25, 100%), positioning on the breast (21, 87%) and supported mothers with expressing breast milk but were less consistent with supporting and observing infant breast attachment (15, 63%) and suckling (13, 54%) during feeds. Only one infant was noted to be too weak to suckle and was referred to the health care providers. Key themes from the interviews were the promotion of resilience in infant feeding decision making among mothers, against community misconceptions of practices such as expressing breast milk; and the enhancement of positive interactions between mothers, peer mothers and health care providers in the context of healthcare facility restrictions on visitors due to COVID-19 and staff shortages. Insufficient breastmilk was a recurrent theme sometimes attributed to poor maternal diet. Conclusion Facility-based breastfeeding peer support for mothers of LBW infants has the potential to improve uptake of appropriate infant feeding practices and their post-discharge survival and growth outcomes in rural communities in Kenya. These preliminary data, including the observed implementation challenges will be used to inform the design of a future trial to rigorously evaluate this potentially sustainable approach to addressing adverse post discharge outcomes of these vulnerable infants