Evaluation of low birth weight infant post-discharge outcomes and development of community-based follow-up and monitoring strategies in Africa

背景：全世界每年有250万新生儿死亡。低出生体重婴儿（出生体重< 2500克，LBW）在新生儿期死亡的风险最高，而那些存活下来的婴儿往往生长发育不良，特别是在撒哈拉以南非洲和南亚的贫困社区。然而，撒哈拉以南非洲在减少新生儿死亡方面的进展速度比世界其他区域慢得多。此外，一旦出院，低出生体重婴儿的随访受到社区与卫生系统之间薄弱联系的阻碍。因此，当母亲带着这些婴儿返回社区时，可能会感到孤立。由于社区对婴儿的生存和发展潜力存在误解，这些婴儿的照顾需求往往没有得到优先考虑。因此，由于与保健服务的接触有限，他们的问题没有得到及时解决，到他们去就诊时，他们已经发育不全（通常表现为发育迟缓，与年龄相比太矮）和残疾，往往无法得到充分解决或扭转。这些低体重婴儿生长失败和残疾共存的机制尚不完全清楚，因此限制了干预的设计和时机。一个优先事项是增强社区保健队的权能，使其能够向这些脆弱的婴儿及其母亲提供支持，特别是在贫困社区，由于财政限制或距离遥远，这些社区可能无法定期使用保健设施。以社区为基础的母亲对母亲同伴支持在改善撒哈拉以南非洲和亚洲非低体重婴儿的母乳喂养做法方面是有效的，因此可以改善低体重婴儿的喂养和护理做法。之前的工作：为了测试肯尼亚LBW婴儿母亲对母亲同伴支持（peer mothers）的可行性和可接受性，我最近在肯尼亚西部的一个农村社区完成了一项研究。在6个月的时间里，我们收集了60名低体重婴儿出院后的数据，并由14名同龄母亲组成的团队进行了随访。我们还采访了18位母亲、5位保健提供者和14位同龄母亲，探讨她们对以社区为基础的新生儿支持的看法，以及她们对社区为低出生体重婴儿母亲提供同伴支持的看法。这一干预措施得到了母亲、同龄母亲和卫生保健提供者的重视和接受，所有婴儿在随访期间体重都有所增加，没有出现不良事件。当前项目：该项目旨在探索和评估社区层面的战略，以改善撒哈拉以南非洲贫困社区的低体重妇女的生存、成长和发展成果。在第一项研究中，我们将评估低体重婴儿从胎儿到24个月的生长发育情况，并将其与非低体重婴儿进行比较，详细评估婴儿喂养和母亲心理健康等不良结局的可能预测因素。在第二项研究中，我们将测试将LBW同伴支持纳入社区妇幼保健质量改进战略的可行性和可接受性，该战略将侧重于提高妇幼保健指标数据的质量。这将涉及对同龄母亲和社区保健小组进行培训，使其了解小婴儿喂养和护理战略以及收集、理解和使用其数据的原则，以改善社区中母亲及其子女的健康。我们将与母亲、社区保健小组和其他利益攸关方进行面谈，探讨他们对这一战略的可接受性的看法。我们还将利用社区卫生小组的登记册和总结报告，评估这一战略在跟踪和监测低出生体重婴儿方面的效果。该项目将为设计一项以社区为基础的务实试验提供信息，以严格评估这些干预措施对LBW结果的影响。

Background: Every year 2.5 million newborns die worldwide. Low birth weight infants (birth weight< 2,500g, LBW) have the highest risk of dying in the newborn period and those who survive often suffer from poor growth and development, particularly in impoverished communities of sub-Saharan Africa and Southern Asia. However, the rate of progress in reducing newborn deaths in sub-Saharan Africa has been much slower than in other regions of the world. In addition, once discharged from hospital care, the follow-up of LBW infants is hampered by the weak linkage between the community and the health system. As a result, mothers may feel isolated when they return to the community with these infants whose care needs are often not prioritised due to community misconceptions of their potential to survive and thrive. Consequently, their problems are not addressed in a timely manner due to limited contact with health services and by the time they present to services they have established growth failure (commonly in the form of stunting, where they are too short for their age) and disabilities that can often not be adequately addressed or reversed. The mechanisms by which growth failure and disabilities co-exist in these LBW infants is not fully understood therefore limiting the design and timing of interventions. Empowering community health teams to provide support to these vulnerable babies and their mothers, particularly in impoverished communities where regular access to health facilities may not be possible due to financial constraints or physical distance, is a priority. Community-based mother-to-mother peer support is effective in improving breastfeeding practices in non-LBW infants in sub-Saharan Africa and Asia and could therefore improve feeding and care-giving practices for LBW infants. Previous work: To test the feasibility and acceptability of mother-to-mother peer support (peer mothers) for LBW infants in Kenya, I recently completed a study in a rural community in western Kenya. Over a period of 6 months, we collected data on 60 LBW infants post-discharge and followed up by a team of 14 peer mothers. We also spoke to 18 mothers, 5 health care providers and 14 peer mothers to explore their views on community-based support for newborns and their perceptions on peer support for mothers of LBW infants in the community. This intervention was valued and accepted by mothers, peer mothers and health care providers and all infants gained weight during the period of follow-up with no adverse events. Current project: This project aims to explore and evaluate community-level strategies to improve the survival, growth and developmental outcomes of LBW in impoverished communities in sub-Saharan Africa. In the first study, we will evaluate the growth and development of LBW infants from foetal life to 24 months and compare them with non-LBW infants, with detailed assessments of possible predictors of poor outcomes including infant feeding and maternal mental health. In the second study, we will test the feasibility and acceptability of integrating LBW peer support into community quality improvement strategies for maternal and child health that will focus on improving the quality of data on maternal and child health indicators. This will involve training of peer mothers and community health teams on LBW feeding and care strategies as well as on the principles of collecting, understanding and using their data to improve the health of mothers and their children in the community. We will conduct interviews with mothers, community health teams and other stakeholders to explore their perceptions on the acceptability of this strategy. We will also evaluate the effect of this strategy on the follow-up and monitoring of LBW infants using the community health team registers and summary reports. This project will inform the design of a community-based pragmatic trial to rigorously evaluate the effect of these interventions on LBW outcomes.