Exploring the acceptability and adherence of the integrated MAMI care pathway for supporting vulnerable infants and their mothers in South Sudan: a qualitative study.

Introduction: 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-infant-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. Methods: A qualitative study was embedded in a mixed-methods study following vulnerable mother-infant 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. Results: 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' 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' thriving. Conclusions: 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.