News article

Effect of implementing WHO guideline for feeding low birth weight infants

Posted:  Monday, May 30, 2016

Impact of WHO guideline on quality of health care provided to low birth weight infant in India

Low Birth Weight (LBW) is still a challenging, multifaceted public health problem in India. Usually LBW is associated with increased risk of infant morbidity and mortality. WHO is striving hard to reduce the incidence of LBW by implementing guidelines or educating both health care providers (HCP’s) and mothers especially in developing and underdeveloped countries. Implementing one such WHO guideline in India, First Referral Level health facilities will help the HCP’s and mothers in improving the survival and development of low birth infants.

A study published in the journal The Indian Journal of Pediatrics demonstrates the effect of pre and post implementation of WHO guideline “First Referral Level health facilities” for feeding low birth weight infants in India. The knowledge and skills of health care providers (HCPs) about feeding practices of LBW infants were compared during pre and post implementation periods (4 months each), using multiple choice and short answer questions and objective structured clinical examinations.

In a separate cohort study of LBW infants along with their mothers at birth - the quality of care received by the infants, improvement in knowledge and skills of the mothers were assessed at intervals of 24-48 h and at discharge/2 week using semi structured questionnaires and observation checklists.

Post implementation, the overall knowledge (62 ± 16 vs. 75 ± 15, n = 55; p < 0.01) and skill scores (298 ± 37 vs. 348 ± 52, p < 0.05) of HCPs improved. Among mothers the correct knowledge increased at the time of discharge (7.1 % vs. 63.4 %; p < 0.01), also observed was increased uptake of kangaroo mother care (0 vs. 21.9 %; p < 0.01) and alternate methods of feeding (15.9 % vs. 31.7 %; p = 0.03) practices by discharge or at 14 days. However, there was no significant improvement in overall quality of care of LBW infants and maternal feeding skills at either 24–48 h or at the time of discharge.

For effective implementation of these guidelines the HCP’s were specially prepared by conducting training, seminars, workshops, refresher courses and on-job support. According to Agarwal R, Chief Investigator, WHO LBW Feeding Study Group, India, for the guidelines to be more successful, additional efforts on the part of HCPs and efforts to promote generic early feeding practices by both HCP’s and mothers are required.

News Source: Agarwal R et al. The Indian Journal of Pediatrics. June 2016, Volume 83, Issue 6, pp 522-528