{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T12:08:07Z","timestamp":1770466087997,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T00:00:00Z","timestamp":1689811200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV\u2010007326"],"award-info":[{"award-number":["INV\u2010007326"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A formative, multi\u2010site, observational cohort study using convergent parallel, mixed\u2010methods design.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Twelve tertiary\/secondary, public\/private hospitals in India, Malawi and Tanzania.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or Sample<\/jats:title><jats:p>Moderately low birthweight infants (MLBW; 1.50\u20132.49\u2009kg).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed infant feeding and care practices through: (1) assessment of in\u2010facility documentation of 603 MLBW patient charts; (2) intensive observation of 148 MLBW infants during facility admission; and (3) prospective 1\u2010year follow\u2010up of 1114 MLBW infants. Focus group discussions and in\u2010depth interviews gathered perspectives on infant feeding among clinicians, families, and key stakeholders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The outcomes of the primary study were: (1) To understand the current practices and standard of care for feeding LBW infants; (2) To define and document the key outcomes (including growth, morbidity, and lack of success on mother's own milk) for LBW infants under current practices; (3) To assess the acceptability and feasibility of a system\u2010level Infant and Young Child Feeding (IYCF) intervention and the proposed infant feeding options for LBW infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hospital\u2010level guidelines and provision of care for MLBW infants varied across and within countries. In all, 89% of charts had missing data on time to first feed and 56% lacked discharge weights. Among 148 infants observed in\u2010facility, 18.5% were discharged prior to meeting stated weight goals. Despite challenges during COVID, 90% of the prospective cohort was followed until 12\u2009months of age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Enrolment and follow\u2010up of this vulnerable population required additional effort from researchers and the community. Using a mixed\u2010methods exploratory study allowed for a comprehensive understanding of MLBW health and evidence\u2010based planning of targeted large\u2010scale interventions. Multi\u2010site partnerships in global health research, which require active and equal engagement, are instrumental in avoiding duplication and building a stronger, generalisable evidence base.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17603","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T07:51:12Z","timestamp":1689839472000},"page":"99-106","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi\u2010site observational study"],"prefix":"10.1111","volume":"130","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0635-8041","authenticated-orcid":false,"given":"Sunil S.","family":"Vernekar","sequence":"first","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed\u2010to\u2010be\u2010University)  Belgaum Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Somji","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kingsly","family":"Msimuko","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi  Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Yogeshkumar","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed\u2010to\u2010be\u2010University)  Belgaum Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashmita B.","family":"Nayak","sequence":"additional","affiliation":[{"name":"S C B Medical College  Cuttack Odisha India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilpa","family":"Nabapure","sequence":"additional","affiliation":[{"name":"S S Institute of Medical Sciences &amp; Research Centre  Davangere Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varun B.","family":"Kusagur","sequence":"additional","affiliation":[{"name":"J J M Medical College  Davangere Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Friday","family":"Saidi","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi  Lilongwe Malawi"},{"name":"Department of Obstetrics and Gynecology, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melda","family":"Phiri","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi  Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eddah","family":"Kafansiyanji","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi  Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher R.","family":"Sudfeld","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"},{"name":"Department of Nutrition Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrick","family":"Kisenge","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Moshiro","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle E.","family":"Tuller","sequence":"additional","affiliation":[{"name":"Ariadne Labs Harvard T.H. Chan School of Public Health\/Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Vesel","sequence":"additional","affiliation":[{"name":"Ariadne Labs Harvard T.H. Chan School of Public Health\/Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8360-1391","authenticated-orcid":false,"given":"Katherine E. A.","family":"Semrau","sequence":"additional","affiliation":[{"name":"Ariadne Labs Harvard T.H. Chan School of Public Health\/Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sangappa M.","family":"Dhaded","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed\u2010to\u2010be\u2010University)  Belgaum Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roopa M.","family":"Bellad","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed\u2010to\u2010be\u2010University)  Belgaum Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6775-7919","authenticated-orcid":false,"given":"Tisungane","family":"Mvalo","sequence":"additional","affiliation":[{"name":"University of North Carolina Project Malawi  Lilongwe Malawi"},{"name":"Department of Pediatrics, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim","family":"Manji","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Muhimbili University of Health and Allied Sciences  Dar es Salaam Tanzania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,20]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"ICD\u201010: international statistical classification of diseases and related health problems: tenth revision","author":"World Health Organization","year":"2004"},{"key":"e_1_2_13_3_1","volume-title":"Low birthweight: country, regional and global estimates","author":"World Health Organisation (WHO)","year":"2004"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyq267"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.108.1.111"},{"key":"e_1_2_13_6_1","volume-title":"Optimal feeding of low\u2010birth\u2010weight infants: technical review","author":"World Health Organization","year":"2006"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(08)60136\u20101"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(18)30565\u20105"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13176"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102020\u2010048216"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102022\u2010067316"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.29392\/001c.25975"},{"key":"e_1_2_13_13_1","volume-title":"Guidelines on optimal feeding of low birth\u2010weight infants in low\u2010 and middle\u2010income countries","author":"World Health Organization","year":"2011"},{"key":"e_1_2_13_14_1","volume-title":"WHO recommendations for care of the preterm or low birth weight infant","year":"2022"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102019\u2010001937"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed\u20102015\u2010205277"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41687\u2010018\u20100043\u20108"},{"key":"e_1_2_13_18_1","unstructured":"Ariadne Labs & LIFE Consortium.Webinar: Low Birthweight Infant Feeding Exploration (LIFE) study findings: a one\u2010year birth cohort[cited 2022 Apr 27]. 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Available from:https:\/\/www.ariadnelabs.org\/wp\u2010content\/uploads\/2022\/03\/exec\u2010summaryMarch31_2022FINAL.pdf"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(18)30239\u20100"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001418"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1471-0528.17603","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T01:45:58Z","timestamp":1708566358000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.17603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,20]]},"references-count":20,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/1471-0528.17603"],"URL":"https:\/\/doi.org\/10.1111\/1471-0528.17603","archive":["Portico"],"relation":{},"ISSN":["1470-0328","1471-0528"],"issn-type":[{"value":"1470-0328","type":"print"},{"value":"1471-0528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,20]]},"assertion":[{"value":"2023-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-07-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}