Dudeja Nonita, Sharma Divita, Maria Arti, Pawar Priyanka, Mukherjee Ritika, Nargotra Shikha, Mohapatra Archisman
Generating Research Insights for Development (GRID) Council, Executive Office, Noida, Uttar Pradesh, India.
Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Front Nutr. 2023 Jul 31;10:1142089. doi: 10.3389/fnut.2023.1142089. eCollection 2023.
Breastfeeding practices in institutional settings got disrupted during the COVID-19 pandemic. We reviewed the challenges faced and the "work-around" solutions identified for implementing recommended breastfeeding practices in institutionalized mother-newborn dyads in resource constrained settings during the pandemic with the aim to identify learnings that could be potentially adapted to the Indian and relatable contexts, for building resilient health systems.
We conducted a scoping review of literature using the PRISMA ScR Extension guidelines. We searched the Medline via PubMed and Web of Science databases for literature published between 1st December 2019 and 15th April 2022. We included original research, reviews, and policy recommendations published in English language and on India while others were excluded. Further, we searched for relevant gray literature on Google (free word search), websites of government and major professional bodies in India. Three reviewers independently conducted screening and data extraction and the results were displayed in tabular form. Challenges and potential solutions for breastfeeding were identified and were categorized under one or more suitable headings based on the WHO building blocks for health systems.
We extracted data from 28 papers that were deemed eligible. Challenges were identified across all the six building blocks. Lack of standard guidelines for crisis management, separation of the newborn from the mother immediately after birth, inadequate logistics and resources for infection prevention and control, limited health workforce, extensive use of formula and alternative foods, inconsistent quality of care and breastfeeding support, poor awareness among beneficiaries about breastfeeding practices (and especially, about its safety during the pandemic) were some of the challenges identified. The solutions primarily focused on the development of standard guidelines and operating procedures, restricted use of formula, use of telemedicine services for counseling and awareness and improving resource availability for risk mitigation through strategic mobilization.
The COVID-19 pandemic has provided rich learning opportunities for health system strengthening in India. Countries must strengthen learning mechanisms to identify and adapt best practices from within their health systems and from other relatable settings.
在新冠疫情期间，机构环境中的母乳喂养行为受到了干扰。我们回顾了在疫情期间资源受限环境下，为在机构化母婴二元组中实施推荐的母乳喂养行为所面临的挑战以及确定的“变通”解决方案，目的是找出可潜在适用于印度及相关背景的经验教训，以建立有韧性的卫生系统。
我们使用PRISMA ScR扩展指南对文献进行了范围综述。我们通过PubMed和科学网数据库在Medline中搜索了2019年12月1日至2022年4月15日期间发表的文献。我们纳入了以英文发表且关于印度的原创研究、综述和政策建议，其他则被排除。此外，我们在谷歌（自由词搜索）、印度政府和主要专业机构的网站上搜索了相关灰色文献。三位评审员独立进行筛选和数据提取，结果以表格形式呈现。确定了母乳喂养的挑战和潜在解决方案，并根据世卫组织卫生系统的组成部分归类在一个或多个合适的标题下。
我们从28篇被认为符合条件的论文中提取了数据。在所有六个组成部分中都发现了挑战。危机管理缺乏标准指南、新生儿出生后立即与母亲分离、感染预防和控制的后勤和资源不足、卫生人力有限、配方奶和替代食品的广泛使用、护理和母乳喂养支持质量不一致、受益人对母乳喂养行为（特别是对疫情期间其安全性）的认识不足是发现的一些挑战。解决方案主要集中在制定标准指南和操作程序、限制配方奶的使用、利用远程医疗服务进行咨询和提高认识，以及通过战略动员改善资源可用性以降低风险。
新冠疫情为印度加强卫生系统提供了丰富的学习机会。各国必须加强学习机制，以识别和采用其卫生系统内部以及其他相关环境中的最佳实践。
