Tesfaye Yihenew Alemu, Ekwueme Moses, Biza Heran, Tariku Zerihun, Belew Mulusew, Asefa Meseret, Asnakew Destaw, Gobezayehu Abebe, Young Melissa F, Cranmer John N
Department of Social Anthropology, Bahir Dar University Faculty of Social Sciences, Bahir Dar, Ethiopia
Department of Sociology and Anthropology and Department of Public Health, Dire Dawa University, Dire Dawa, Ethiopia.
BMJ Open. 2025 Aug 25;15(8):e098616. doi: 10.1136/bmjopen-2024-098616.
Breastfeeding is widely recognised as the optimal form of infant nutrition, with the WHO recommending initiation within the first hour after birth and exclusive breastfeeding for the first 6 months. However, small and sick newborns (SSNs) often face challenges in achieving recommended feeding practices, including in facility-based settings. This study explored clinicians' experiences and perspectives on SSN feeding support within selected facilities implementing the Saving Little Lives (SLL) programme in Ethiopia.
A qualitative study employing semistructured indepth interviews and participant observation, analysed thematically.
Government hospitals participating in the SLL programme in the Amhara region of Ethiopia.
Clinicians involved in neonatal care and feeding support for SSN, including nurses, midwives and paediatric care providers.
Clinicians identified multilevel barriers affecting facility-based SSN feeding practices. These were categorised into: (1) facility-level factors, including inadequate clinician training, staff shortages and lack of appropriate feeding tools; (2) neonatal and maternal factors, such as newborn and maternal health complications and concerns about insufficient breast milk production and (3) sociocultural factors, including traditional practices like uvulectomy and prelacteal feeding. A notable facilitator was the involvement of predominantly female clinicians with personal breastfeeding experience, which enhanced support for SSN feeding. Despite the challenges, many barriers were found to be modifiable.
This study highlights critical gaps and opportunities in facility-based SSN feeding support in low-resource settings. The findings suggest that targeted interventions, including improved clinician training, integration of feeding counselling into maternal care, and enhanced access to feeding tools, can strengthen neonatal feeding support and contribute to improved health outcomes for SSN.
母乳喂养被广泛认为是婴儿营养的最佳形式，世界卫生组织建议在出生后一小时内开始母乳喂养，并在头6个月进行纯母乳喂养。然而，体弱多病的新生儿（SSN）在实现推荐的喂养方式方面往往面临挑战，在医疗机构中也是如此。本研究探讨了在埃塞俄比亚实施“拯救小生命”（SLL）计划的选定医疗机构中，临床医生对SSN喂养支持的经验和看法。
一项采用半结构化深入访谈和参与观察的定性研究，进行主题分析。
埃塞俄比亚阿姆哈拉地区参与SLL计划的政府医院。
参与SSN新生儿护理和喂养支持的临床医生，包括护士、助产士和儿科护理人员。
临床医生确定了影响医疗机构中SSN喂养方式的多层次障碍。这些障碍分为：（1）机构层面的因素，包括临床医生培训不足、人员短缺和缺乏合适的喂养工具；（2）新生儿和母亲因素，如新生儿和母亲的健康并发症以及对母乳分泌不足的担忧；（3）社会文化因素，包括诸如悬雍垂切除术和开奶前喂养等传统习俗。一个显著的促进因素是主要由有个人母乳喂养经验的女性临床医生参与，这增强了对SSN喂养的支持。尽管存在挑战，但发现许多障碍是可以改变的。
本研究突出了资源匮乏地区医疗机构中SSN喂养支持方面的关键差距和机遇。研究结果表明，有针对性的干预措施，包括改进临床医生培训、将喂养咨询纳入产妇护理、增加喂养工具的可及性，可以加强新生儿喂养支持，并有助于改善SSN的健康结局。
