A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

Background: Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. Methods: The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0\u20132 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. Results: A complex set of barriers and facilitators influence mothers\u2019/caregivers\u2019 infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers\u2019/caregivers\u2019 key barriers and facilitators to recommended infant-toddler feeding practices. Conclusions: Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines

Digitally strengthened, midwife-led intervention to reach the unreached mothers across ten conflict-prone provinces of Afghanistan during humanitarian crisis

Background: Coronavirus disease 2019 (COVID-19) pandemic had significant negative impact on sexual and reproductive health (SRH) with devastating impact on pregnant women in resource constrain humanitarian settings. This paper provides detailed account of a community midwife-led intervention in ten humanitarian settings of Afghanistan using world health organization (WHO) emergency disaster risk management (EDRM) framework.Objectives: The project is aimed at increasing access to Integrated Package of Essential SRH Services and Minimal Initial Service Package (MISP) with a specific focus on prevention of Postpartum Haemorrhage (PPH) and screening and management of preeclampsia and eclampsia.Methods: The project was implemented through 150 Community outreach midwives (COMs). Each midwife served 300 households; mentored by gynaecologists and supervisors. Midwives were trained through a digitally enabled, simulation based training and equipped with a set of off-the shelf devices and kits.Results: During COVID-19 pandemic and in absence of health care services during crisis, this intervention has played as a lifesaving intervention for the community in Afghanistan. Variable digital literacy, sociocultural barriers, reluctance in adapting to digital platforms, security and uncertainties were some of the challenges faced. Adaptation of outreach methods integrated high impactful digital technologies has been the most appropriate strategy "to reach the unreached".Conclusion: Through this model, national and global stakeholders were engaged even during the crisis in Afghanistan. It also provided vital inputs for the donors, governments, civil society organizations and other stakeholders for sustaining and advancing the delivery of quality SRH services in humanitarian settings

A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

Background: Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. Methods: The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0\u20132 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. Results: A complex set of barriers and facilitators influence mothers\u2019/caregivers\u2019 infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers\u2019/caregivers\u2019 key barriers and facilitators to recommended infant-toddler feeding practices. Conclusions: Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines