{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:57:04Z","timestamp":1792191424186,"version":"4.4.0"},"reference-count":34,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Nutritional vulnerability under the age of 6 months is prevalent in low\u2010 and middle\u2010income countries with 20.1% infants underweight, 21.3% wasted and 17.6% stunted in a recent review. A novel Care Pathway for improved management of small and nutritionally at\u2010risk infants under 6 months and their mothers (MAMI) has recently been developed to provide outpatient care at large coverage. We aimed to investigate stakeholders\u2019 views on the feasibility of its implementation and to identify barriers and enablers. This was an early stage formative mixed\u2010methods study: an online survey plus in\u2010depth interviews with country\u2010level stakeholders in nutrition and child health from different geographical regions and stakeholder groups. 189 stakeholders from 42 countries responded to the online survey and 14 remote interviews were conducted. Participants expressed an urgent need for improved detection and care for small and nutritionally at\u2010risk infants under 6 months. Whilst they considered the MAMI Care Pathway feasible and relevant, they noted it was largely unknown in their country. The most mentioned implementation barriers were: community\u2010specific needs and health care seeking barriers, health workers\u2019 lack of competence in breastfeeding counselling and the absence of a validated anthropometric screening method. Possible enablers for its implementation were: patients\u2019 preference for outpatient care, integrating the MAMI care pathway into existing maternal and child health programmes and the possibility of a local pilot project. Adaptation to the local context was considered crucial in further scale\u2010up.<\/jats:p>","DOI":"10.1111\/mcn.13455","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T11:51:31Z","timestamp":1668426691000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Implementing a Care Pathway for small and nutritionally at\u2010risk infants under six months of age: A multi\u2010country stakeholder consultation"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8809-3886","authenticated-orcid":false,"given":"Tabitha D.","family":"van Immerzeel","sequence":"first","affiliation":[{"name":"Department for Population Health, Faculty of Epidemiology &amp; Population Health London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maty","family":"Diagne","sequence":"additional","affiliation":[{"name":"University Cheick Anta Diop  Dakar Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indou","family":"Deme\/Ly","sequence":"additional","affiliation":[{"name":"University Cheick Anta Diop  Dakar Senegal"},{"name":"Centre Hospitalier National D'Enfants Albert Royer  Dakar Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda E.","family":"Murungi","sequence":"additional","affiliation":[{"name":"Mulago National Referral Hospital  Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saliou","family":"Diouf","sequence":"additional","affiliation":[{"name":"University Cheick Anta Diop  Dakar Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3745-7317","authenticated-orcid":false,"given":"Marko","family":"Kerac","sequence":"additional","affiliation":[{"name":"Department for Population Health, Faculty of Epidemiology &amp; Population Health London School of Hygiene &amp; Tropical Medicine  London UK"},{"name":"Centre for Maternal, Adolescent, Reproductive &amp; Child Health (MARCH) London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos S.","family":"Grijalva\u2010Eternod","sequence":"additional","affiliation":[{"name":"Department for Population Health, Faculty of Epidemiology &amp; Population Health London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise T.","family":"Day","sequence":"additional","affiliation":[{"name":"Department for Population Health, Faculty of Epidemiology &amp; Population Health London School of Hygiene &amp; Tropical Medicine  London UK"},{"name":"Centre for Maternal, Adolescent, Reproductive &amp; Child Health (MARCH) London School of Hygiene &amp; Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.46544.1"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001812"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1179556518771698"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-020-01003-0"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019079"},{"issue":"62","key":"e_1_2_11_7_1","article-title":"C\u2010MAMI tool evaluation: Learnings from Bangladesh and Ethiopia","volume":"58","author":"Butler S.","year":"2018","journal-title":"Field Exchange"},{"key":"e_1_2_11_8_1","unstructured":"Engl M. &Kerac M.(2021). Management of at\u2010risk mothers and infants< 6 months in national and international SAM guidelines: AGREE scoring of guidelines and guideline content spreadsheet. 10.17037\/DATA.00002534."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-8-35"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003161"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","unstructured":"Grijalva\u2010Eternod C. S. Beaumont E. Rana R. Abate N. Barthorp H. McGrath M. Negesse A. Abera M. Abdissa A. Girma T. Allen E. Kerac M. &Berhane M.(2021).Malnutrition in infants aged under 6 months attending community health centres: A cross sectional survey.Pre\u2010prints.https:\/\/doi.org\/10.20944\/preprints202106.0332.v1","DOI":"10.20944\/preprints202106.0332.v1"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12345"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/11795565211049904"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-019-3903-x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s43058-021-00207-9"},{"key":"e_1_2_11_16_1","doi-asserted-by":"crossref","unstructured":"Kerac M. James P. T. McGrath M. Brennan E. Opondo C. &Frison S. (2021).Infant malnutrition in low\u2010 and middle\u2010income countries: Assessment and prevalence of small and nutritionally at\u2010risk infants aged under 6 months in 54 Demographic & Health Survey datasets. medRxiv.","DOI":"10.1101\/2021.12.23.21268306"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/15648265150361S105"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41256-021-00206-2"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.7.3.149"},{"key":"e_1_2_11_20_1","article-title":"A technique for the measurement of attitudes","author":"Likert R.","year":"1932","journal-title":"Archives of Psychology"},{"key":"e_1_2_11_21_1","unstructured":"MAMI Global Network & ENN. (2021). Management of small and nutritionally at\u2010risk infants under six months and their mothers (MAMI). MAMI Global Network Strategy (2021\u20132025). Strong Infants Strong Mothers Strong Futures: Building Bridges Towards 2030."},{"key":"e_1_2_11_22_1","unstructured":"MAMIGlobalNetwork. (2021). MAMI Global Network Strategy 2021\u20102025."},{"key":"e_1_2_11_23_1","article-title":"Management of small and nutritionally at risk infants under six months and their mothers (MAMI)","author":"McGrath M.","year":"2021","journal-title":"ENN"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czab047"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02036.x"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.26596\/wn.2020112108-120"},{"key":"e_1_2_11_27_1","first-page":"27","article-title":"Community management of uncomplicated malnourished infants under six months old: Barriers to national policy change","volume":"57","author":"Read S.","year":"2018","journal-title":"Field Exchange"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001384"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12738"},{"key":"e_1_2_11_30_1","volume-title":"Tools for data demand and use in the health sector: Stakeholder engagement tool","author":"Salentine S.","year":"2011"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980019004415"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06737-1"},{"key":"e_1_2_11_33_1","volume-title":"Nurturing care for early childhood development: A framework for helping children survive and thrive to transform health and human potential","author":"UNICEF","year":"2018"},{"key":"e_1_2_11_34_1","unstructured":"UNICEF WHO & C M. (2016). Global strategy for women's children's and adolescents' health (2016\u20102030)."},{"key":"e_1_2_11_35_1","unstructured":"World Health Organization(2013). Guideline: Updates on the management of severe acute malnutrition in infants and children (9241506326)."}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13455","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.13455","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.13455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,20]],"date-time":"2023-08-20T09:53:29Z","timestamp":1692525209000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.13455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,14]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1111\/mcn.13455"],"URL":"https:\/\/doi.org\/10.1111\/mcn.13455","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,14]]},"assertion":[{"value":"2022-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13455"}}