{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:04:22Z","timestamp":1784037862186,"version":"3.55.0"},"reference-count":18,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["cooperative agreement #7200AA20CA00005"],"award-info":[{"award-number":["cooperative agreement #7200AA20CA00005"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>One in four infants is born too small or too early, increasing the risk of poor growth, development, ill health and death. This risk is exacerbated by recurring conflict and climatic shocks. The management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) care pathway was integrated into primary healthcare to ensure continuous mother\u2013infant-centred care in South Sudan. This study explored the acceptability of the MAMI approach for service providers and users and the factors influencing their adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study was embedded in a mixed-methods study following vulnerable mother\u2212infant pairs. MAMI care included sensitisation and screening in the community and health facility, in-depth assessment and risk-based care addressing physical, mental and nutritional vulnerability of infants and mothers. Semi-structured interviews of 20 health workers and 30 mothers explored acceptability and adherence to MAMI care provision and use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Themes of perceived acceptability of MAMI care were mapped across coherence, self-efficacy, affective attitude, burden, ethicality, opportunity cost and perceived effectiveness. Health workers were most apprehensive about the additional workload and time required to implement the care pathway. Mothers expressed concern over the numerous health visits far from their homes and not having supportive family members. Factors promoting adherence to MAMI care provision and use were mapped across capability, opportunity and motivation. Health workers\u2019 self-confidence was boosted by the new knowledge and skills they acquired through training and mentorship. Mothers reported learning practical ways to care for their infants independently and to witness the positive impact on their infants\u2019 thriving.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MAMI care was accepted for addressing the needs of a previously overlooked vulnerable group. Effective integrated MAMI care requires resolving delivery and use gaps and overcoming challenges that undermine adherence from both providers and users.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003377","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T13:10:20Z","timestamp":1784034620000},"page":"e003377","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the acceptability and adherence of the integrated MAMI care pathway for supporting vulnerable infants and their mothers in South Sudan: a qualitative study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6166-9584","authenticated-orcid":false,"given":"Marlene","family":"Traore Hebie","sequence":"first","affiliation":[{"name":"Corus International, Washington, DC, USA"},{"name":"MOMENTUM Integrated Health Resilience, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1552-2402","authenticated-orcid":false,"given":"Hedwig","family":"Deconinck","sequence":"additional","affiliation":[{"name":"Public Health and Primary Care, UCLouvain, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelina","family":"Nasira Boi","sequence":"additional","affiliation":[{"name":"IMA World Health, an affiliate of Corus International, Juba, South Sudan"},{"name":"MOMENTUM Integrated Health Resilience, Juba, South Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirk","family":"Dearden","sequence":"additional","affiliation":[{"name":"Corus International, Washington, DC, USA"},{"name":"MOMENTUM Integrated Health Resilience, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Obure","sequence":"additional","affiliation":[{"name":"Corus International, Washington, DC, USA"},{"name":"MOMENTUM Integrated Health Resilience, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"2026071406101150000_4.3.e003377.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00522-6"},{"key":"2026071406101150000_4.3.e003377.2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(13)60937-x"},{"key":"2026071406101150000_4.3.e003377.3","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs (OCHA) . South Sudan humanitarian needs overview 2023. 2022. Available: https:\/\/www.unocha.org\/publications\/report\/south-sudan\/south-sudan-humanitarian-needs-overview-2023-november-2022"},{"key":"2026071406101150000_4.3.e003377.4","unstructured":"South Sudan . Gavi, the vaccine alliance. 2022. Available: https:\/\/www.gavi.org\/programmes-impact\/country-hub\/africa\/south-sudan"},{"key":"2026071406101150000_4.3.e003377.5","unstructured":"MOMENTUM Integrated Health Resilience (MIHR) . MAMI South Sudan capacity analysis. Internal Report; 2022."},{"key":"2026071406101150000_4.3.e003377.6","unstructured":"Deconinck H , Wrottesley SV , McGrath M , et al . Implementing care for vulnerable infants under six months and their mothers. \u2018Learning by doing\u2019 case study series: South Sudan. oxford, united kingdom of great britain and Northern Ireland: emergency nutrition network (ENN); 2024."},{"key":"2026071406101150000_4.3.e003377.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7125.133"},{"key":"2026071406101150000_4.3.e003377.8","unstructured":"MAMI Global Network, Emergency Nutrition Network (ENN), London School of Hygiene and Tropical Medicine (LSHTM) . MAMI care pathway package, version 3. 2021. Available: https:\/\/www.ennonline.net\/resource\/mami\/mami-care-pathway-package-version-3"},{"key":"2026071406101150000_4.3.e003377.9","unstructured":"MOMENTUM Integrated Health Resilience (MIHR) . Protocol of the pilot study on the integrated management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) care pathway in South Sudan. Internal Report; 2022."},{"key":"2026071406101150000_4.3.e003377.10","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework","volume":"17","author":"Sekhon","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2026071406101150000_4.3.e003377.11","doi-asserted-by":"crossref","unstructured":"Michie S , van Stralen MM , West R . The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Sci 2011;6. doi:10.1186\/1748-5908-6-42","DOI":"10.1186\/1748-5908-6-42"},{"key":"2026071406101150000_4.3.e003377.12","unstructured":"Mayne J . The capabilities, opportunities and motivation behaviour-based theory of change model. 2016. 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