Evaluation of low birth weight infant post-discharge outcomes and development of community-based follow-up and monitoring strategies in Africa
Medical Research Council
Aga Khan University, Kenya
Globally, every year 2.5 million newborns die. Low birth weight (LBW) infants (birth weight< 2,500g) who constitute 15% of all newborns, have the highest risk of mortality and adverse long-term growth, health and neurodevelopmental outcomes. They include both preterm and intrauterine growth restricted infants and majority are born in low-and middle-income countries (LMICs) in sub-Saharan Africa and Southern Asia. Over the past two decades, interventions to improve facility-based care in LMICs for LBW infants have been tested and implemented, but the scarcity of longitudinal data to determine the predictors of poor outcomes and inform the design and timing of interventions have hampered progress in improving their post-discharge outcomes. LBW infants in impoverished communities are particularly vulnerable and community-based strategies to monitor and address gaps in their care in a timely manner have the potential to improve their outcomes. Community-based peer support for mothers is effective in improving breast feeding practices in infants in low resource settings and has the potential to improve post-discharge survival outcomes for LBW infants. We propose to evaluate the predictors of stunting and neurodevelopmental impairment among LBW infants using a cohort of well-characterised mother-infant dyads recruited from one rural and two urban health facilities in Kenya and The Gambia over a period of 30 months. In addition, using a mixed methods approach, we will explore the feasibility and acceptability of embedding mother-to-mother peer support for LBW infants in community-level quality improvement strategies for maternal and child health in Kenya over a 12-month period. The data from these two studies will enable us to refine a community-based package of interventions for LBW infants and inform the design of a cluster randomised trial to rigorously evaluate the impact of these interventions on LBW infant survival, growth and neurodevelopmental outcomes.
8.1 Organisation and delivery of services / Research Grant