Strengthening implementation of integrated care for small and nutritionally at‐risk infants under six months and their mothers
Pre‐trial feasibility study
Datos Bibliográficos
An integrated care pathway to manage small and nutritionally at-risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario-based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person-centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes
Consistency (knowledge bases · Economic growth · Health care · Randomized controlled trial · Work (physics · Child Nutrition and Water Access · Food Security and Health in Diverse Populations · Global Maternal and Child Health · Medicine · Nursing
Revisiting maternal and child undernutrition in low-income and middle-income countries
Studying complexity in health services research
Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions
How We Design Feasibility Studies
A new framework for developing and evaluating complex interventions
Maternal and child undernutrition
Patient-centred access to health care
Consolidated criteria for reporting qualitative research (Coreq)
The uses of knowledge in global health
Severe malnutrition or famine exposure in childhood and cardiometabolic non-communicable disease later in life
Caring for providers to improve patient experience (CPIPE)
Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis
Legal harvest and illegal trade
From complex social interventions to interventions in complex social systems
Social protection and resilience
Measuring implementation strength
Assessing scalability of an intervention
Providers’ perceptions of disrespect and abuse during childbirth
R = MC 2 readiness building process
Reflexive Integration of Research Elements in Mixed-Method Research
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