1. Critical issues in feeding LBW babies in Kenya
Alison Talbert
Kisumu, June 5th 2018
MRC Confidence in Global Nutrition and Health Research
Improving the survival, growth and development of low birth weight newborns through better nutrition: the Neonatal Nutrition Network project

2. How many LBW babies are there in Kenya?
Country profile for Kenya* reported that birth weight was measured in only 47% of births
Estimated 12% of births are preterm: 193,000 births per year
Low birth weight estimated at 8% of births (World Bank 2009) *

3. Place of birth (Kenya statistical abstract 2017)

4. What/how to feed low birth weight babies?
No published trials from Kenya Cochrane review (Quigley and McGuire 2014) formula milk increases risk of necrotizing enterocolitis Kenya guidelines advise giving expressed breastmilk (EBM) Donor milk not available yet –acceptability studies conducted in Nairobi

5. Kenya basic paediatric protocols 4th ed 2016

9. Supporting mothers to express EBM for LBW
High patient to nurse ratio: 7-15 patients per nurse in Nairobi neonatal units (Murphy 2018) Few nurses trained in breastfeeding support Hospital nutritionists – management of malnutrition Breastfeeding peer supporters in hospital are accepted by mothers and nurses –where do they fit into health systems? (Mwangome IBAMI and SIBs studies)

10. Criteria for discharge from hospital (Kilifi)
When baby is gaining weight on breastfeeding alone.
Maintaining temperature in open cot.
Mother is confident with feeding.

11. Hospital discharge is delayed by failure to breastfeed
Prolonged stay increases risk of hospital acquired infections Home hygiene conditions not optimal for supplementation with breastmilk substitutes – constraints in water and fuel supply Poverty –high cost of formula milk relative to incomes

12. Vitamin & mineral supplementation post-discharge for VLBW infants
WHO 2011 guidelines on “Optimal feeding of low birth weight infants in low and middle income countries” recommends supplementation for VLBW infants of: Iron and vitamin D to 6 months Calcium and phosphorus during first few months of life – but not available in Kenyan multivitamin syrup formulations

13. Feeding problems of LBW babies born at home
Timing of first feed - attitudes towards giving colostrum
Prelacteal feeds – cultural practices –sugar water, coconut water
“Plan B” if perceived insufficient breastmilk – cows’ milk, maize porridge
Postnatal visits – babies brought for BCG immunization by grandmothers
Missed opportunities at clinics for counselling on infant feeding

14. Post-discharge follow up of LBW
Low birth weight is a risk factor for acute malnutrition in infants under 6 months (MAMI)
Tools are being developed for screening for nutritional vulnerability in infants under 6 months (includes LBW)
Need to be simplified and integrated into existing clinics