ArticleInternational breastfeeding journal2021
Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi.
Article in International breastfeeding journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Exclusive breastfeeding practices and challenges in Nigeria, Sub-Saharan Africa: an integrative review.International breastfeeding journal · 2026Review
- Poor access to breastfeeding counseling services and associated factors among lactating mothers who had optimal antenatal care follow-up in Sub-saharan Africa: a multilevel analysis of the recent Demographic and Health Survey.BMC health services research · 2024Article
- Health professional competency building for the Baby-Friendly Hospital Initiative in Malawi.Maternal & child nutrition · 2024Article
- Participatory Health Cadre Model to Improve Exclusive Breastfeeding Coverage with King's Conceptual System.Journal of multidisciplinary healthcare · 2024Article
- Facility-based care for moderately low birthweight infants in India, Malawi, and Tanzania.PLOS global public health · 2023Article
- Implementing two national responsibilities of the revised UNICEF/WHO Baby-Friendly Hospital Initiative: A two-country case study.Maternal & child nutrition · 2023Article
- Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals.BMC pediatrics · 2022Article
- Healthcare worker perspectives on mother's insufficient milk supply in Malawi.International breastfeeding journal · 2022Article
- Beyond early initiation: A qualitative study on the challenges of hospital-based postpartum breastfeeding support.PLOS global public health · 2022Article
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Authors and funding
16 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundExclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi.
methodsThe study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy.
resultsThe district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers.
conclusionsBreastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.
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