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Exploring strategies for integrating breastfeeding peer supporters in public hospitals in Kenya

探索在肯尼亚公立医院整合母乳喂养同伴支持者的策略

基本信息

批准号：
MR/R002738/1
负责人：
MARTHA MWANGOME
金额：
$ 23.45万
依托单位：
ARCH - KWTRP
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2018
资助国家：
英国
起止时间：
2018 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FR002738%2F1
关键词：
Exploring strategies integrating breastfeeding peer

项目摘要

Acute malnutrition among infants aged under 6 months is a major public health problem. Recent reports indicate that globally, 8.5 million infants under 6 months suffer from moderate or severe acute malnutrition. Malnourished infants are significantly more likely to be hospitalized and die from treatable infectious diseases than non-malnourished infants. Studies have shown that the majority of these infants (up to 90%) are not exclusively breastfed, even though evidence suggests that exclusive breastfeeding is particularly important for recovery and survival among this group. To improve the nutritional status of hospitalized malnourished infants, the World Health Organization (WHO) recommends the re-establishment of exclusive breastfeeding. However, challenges such as shortages of appropriately trained health workers and lack of information on "how" exclusive breastfeeding can most effectively be re-established have hampered the effective implementation of these recommendations in many low-income settings, including Kenya. In Kenya, as elsewhere in sub-Saharan Africa, breastfeeding lay peer supporters (mothers from the local community trained in breastfeeding assistance) are used to promote and support exclusive breastfeeding among mothers of healthy infants in their communities. We are currently undertaking a study (IBAMI) in a hospital in Kenya investigating the maintenance of exclusive breastfeeding amongst infants recovering from acute malnutrition and infection after they have been discharged from hospital. We have introduced breastfeeding peer supporters in the hospital to help the health workers implement the WHO guidelines. With the support of study staff and funding, peer supporters have become a central part of the inpatient treatment management team undertaking tasks integral to the breastfeeding treatment plan. Our experiences from the IBAMI study suggest that breastfeeding lay peer supporters might be an effective strategy for enhancing the implementation of the WHO guidelines. However, the supportive financial and management conditions provided by the IBAMI study are unlikely to be repeated in resource constrained hospital settings in Kenya and routine implementation would involve introducing a new low skilled, as yet unrecognised cadre into complex, multi-professional hospital environments. To understand when, where and how breastfeeding peer supporters might be integrated into the routine treatment of inpatient malnourished infants, we propose to undertake a pilot study investigating the health system factors that are likely to enhance or constrain the use of breastfeeding peer supporters in the implementation the WHO guidelines for nutrition rehabilitation of inpatient infants under routine conditions in two public hospitals in Kenya. To gauge policy level interest in the approach, we will identify and engage with key policy makers at national and county levels in Kenya; determine their views on employing lay peer supporters in a hospital setting and discuss potential barriers and facilitators to implementation. To assess the feasibility of using breastfeeding peer supporters, we will collaborate with the Kilifi County Ministry of Health (MoH), to identify two hospitals and in each we will work with the hospital management team, frontline health workers, UNICEF and National MoH to develop and agree on a strategy for the implementation of a breastfeeding peer supporters' intervention. During strategy implementation, quarterly meetings to review progress and identify factors enhancing or constraining the integration process will be held. After 12 months, we will estimate the costs of implementing the strategy and hold review meetings and interviews in each of the two hospital to assess perceptions of its feasibility, acceptability and sustainability. The findings from this study will generate new knowledge to improve the hospital management and treatment of malnourished infants under 6 months.

6个月以下婴儿的急性营养不良是一个主要的公共卫生问题。最近的报告表明，全球有850万6个月以下的婴儿患有中度或重度急性营养不良。营养不良的婴儿比非营养不良的婴儿更有可能因可治疗的传染病住院和死亡。研究表明，这些婴儿中的大多数（高达90%）不是纯母乳喂养的，尽管有证据表明纯母乳喂养对这一群体的康复和生存特别重要。为了改善住院营养不良婴儿的营养状况，世界卫生组织（世卫组织）建议恢复纯母乳喂养。然而，诸如缺乏经过适当培训的卫生工作者和缺乏关于“如何”最有效地恢复纯母乳喂养的信息等挑战阻碍了这些建议在包括肯尼亚在内的许多低收入环境中的有效实施。在肯尼亚，如同在撒哈拉以南非洲的其他地方一样，母乳喂养的非专业同伴支持者（来自当地社区的母亲接受过母乳喂养援助培训）被用来促进和支持其社区中健康婴儿的母亲的纯母乳喂养。我们目前正在肯尼亚的一家医院进行一项研究（IBAMI），调查从急性营养不良和感染中康复的婴儿出院后纯母乳喂养的维持情况。我们在医院引入了母乳喂养同伴支持者，以帮助卫生工作者实施世卫组织的指导方针。在研究人员和资金的支持下，同伴支持者已成为住院治疗管理团队的核心部分，承担母乳喂养治疗计划不可或缺的任务。我们从IBAMI研究中获得的经验表明，母乳喂养的非专业同伴支持者可能是加强世卫组织指南实施的有效策略。然而，IBAMI研究提供的支持性财务和管理条件不太可能在肯尼亚资源有限的医院环境中重复，常规实施将涉及向复杂的多专业医院环境引入新的低技能，尚未得到认可的干部。为了了解母乳喂养同伴支持者何时、何地以及如何被纳入住院营养不良婴儿的常规治疗，我们建议开展一项试点研究，调查卫生系统因素，这些因素可能会增强或限制母乳喂养同伴支持者在肯尼亚两家公立医院常规条件下实施世卫组织住院婴儿营养康复指南。为了衡量政策层面对该方法的兴趣，我们将确定并与肯尼亚国家和县一级的主要政策制定者进行接触;确定他们对在医院环境中雇用非专业同行支持者的看法，并讨论实施的潜在障碍和促进者。为了评估使用母乳喂养同伴支持者的可行性，我们将与基利菲县卫生部（MoH）合作，确定两家医院，并在每家医院与医院管理团队、一线卫生工作者、联合国儿童基金会和国家卫生部合作，制定并商定实施母乳喂养同伴支持者干预的战略。在战略执行期间，将举行季度会议，审查进展情况，并确定加强或限制整合进程的因素。12个月后，我们将估计实施该战略的成本，并在两家医院分别举行审查会议和面谈，以评估其可行性、可接受性和可持续性。这项研究的结果将产生新的知识，以改善医院管理和6个月以下营养不良婴儿的治疗。