Safe infant feeding in healthcare facilities

Assessment of infection prevention and control conditions and behaviors in India, Malawi, and Tanzania

Bibliographic Data

ID19592565
AuthorsBrooke A Caruso (0000-0001-9738-9857, Emory University, corresponding author), Uriel Paniagua (0009-0003-9368-2804, Emory University, corresponding author), Irving Hoffman (0000-0003-0059-5991, University of North Carolina at Chapel Hill, corresponding author), Karim Manji (0000-0002-7069-6408, Muhimbili University of Health and Allied Sciences, corresponding author), Friday Saidi (0000-0003-1190-1499, University of Malawi, corresponding author), Christopher R Sudfeld (0000-0002-3203-3638, Harvard Global Health Institute, corresponding author), Sunil S Vernekar (0000-0002-0635-8041, Jawaharlal Nehru Medical College, corresponding author), Mohamed Bakari (Muhimbili University of Health and Allied Sciences, corresponding author), Christopher Duggan (0000-0001-8083-8193, Boston Children's Hospital, corresponding author), Christopher P Duggan, George C Kibogoyo (Muhimbili University of Health and Allied Sciences, corresponding author), Rodrick Kisenge (0000-0002-3273-8136, Muhimbili University of Health and Allied Sciences, corresponding author), Sarah Somji (0000-0001-6031-830X, Muhimbili University of Health and Allied Sciences, corresponding author), Eddah Kafansiyanji (University of Malawi, corresponding author), Tisungane Mvalo (0000-0002-6775-7919, University of North Carolina at Chapel Hill, corresponding author), Naomie Nyirenda (University of Malawi, corresponding author), Melda Phiri (University of Malawi, corresponding author), Roopa Bellad, Roopa M Bellad (0000-0003-4383-1704, Jawaharlal Nehru Medical College, corresponding author), Sangappa M Dhaded (0000-0001-9575-5251, Jawaharlal Nehru Medical College, corresponding author), Sangappa Dhaded, Chaya K A, K A Chaya (Bapuji Dental College and Hospital, corresponding author), Bhavana Koppad (0000-0001-8859-5421, Jawaharlal Nehru Medical College, corresponding author), Shilpa Nabapure (Shamnur Shivashankarappa Institute of Medical Sciences & Research Centre, corresponding author), Saumya Nanda (0000-0002-5754-8849, Shri Jagannath Sanskrit University, corresponding author), Bipsa Singh (Shri Jagannath Sanskrit University, corresponding author), S Yogeshkumar (Jawaharlal Nehru Medical College, corresponding author), Katelyn Fleming (Brigham and Women's Hospital, corresponding author), Krysten North (0000-0001-9283-4413, Brigham and Women's Hospital, corresponding author), Danielle E Tuller (0000-0002-7643-5268, Brigham and Women's Hospital, corresponding author), Katherine E A Semrau (0000-0002-8360-1391, Brigham and Women's Hospital, corresponding author), Linda Vesel (0000-0003-3753-4172, Brigham and Women's Hospital, corresponding author), Melissa Young (0000-0002-2768-1673, Emory University, corresponding author)
EditorsMelissa Morgan Medvedev
Year2023
Volume3
Issue6
Pagese0001843
Publication date2023-06-08
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0001843
PMID37289720
OpenAlexW4379930460
LanguageEN
Citations received1
References cited36

Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had ‘improved’ water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health

Environmental health · Environmental planning · Geography · Health care · Hygiene · Infection control · Intensive care medicine · Observational study · Psychological intervention · Sanitation · Tanzania · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Medicine · Nursing · Pediatric health and respiratory diseases