Lessons learned in implementing the Low Birthweight Infant Feeding
Exploration (LIFE) study: a large, multi-site observational study
Abstract
Objective: Globally, early and optimal feeding practices and
strategies for small and vulnerable infants are limited. We aim to share
the challenges faced and implementation lessons learned from a complex,
mixed methods research study on infant feeding. Design: A
formative, multisite, observational cohort study using convergent
parallel, mixed-methods design. Setting: 12 tertiary/secondary,
public/private hospitals in India, Malawi, and Tanzania
Population or Sample: Moderately low birthweight infants (MLBW;
1.50-2.49kg) Methods: We assessed infant feeding and care
practices through: 1) assessment of in-facility documentation of 603
MLBW patient charts; 2) intensive observation of 148 MLBW infants during
facility admission; and 3) prospective one-year follow-up of 1114 MLBW
infants. Focus group discussions and in-depth interviews gathered
perspectives on infant feeding among clinicians, families, and key
stakeholders. Results: Hospital-level guidelines and provision
of care for MLBW infants varied across and within countries. 89% of
charts had missing data on time to first feed; 56% lacked discharge
weights. Among 148 infants observed in-facility, 18.5% were discharged
prior to meeting stated weight goals. Despite challenges during COVID,
90% of the prospective cohort was followed until 12 months of age.
Conclusions: Enrolment and follow-up of this vulnerable
population required additional effort from researchers and the
community. Using a mixed-methods exploratory study allowed for a
comprehensive understanding of MLBW health and evidence-based planning
of targeted large-scale interventions. Multi-site partnerships in global
health research, which require active and equal engagement, are
instrumental in avoiding duplication and building a stronger,
generalizable evidence base.