Title: Optimizing Care for Low Birth Weight Infants in Rural Malawi
Description: The aim of our study was to explore and understand the factors that affect growth of low birth weight (LBW) infants in a rural district of Neno in Malawi in order to optimize their care.

We surveyed 64 households of LBW infants born between April and June 2014. We collected quantitative data on socio-demographics and food security, and performed nutrition and development assessments of the LBW infants at six months of age. We also conducted qualitative in-depth interviews with a subset of 10 mothers of the LBW infants and with 3 nurses at postnatal clinics. We then merged the quantitative and qualitative datasets for a final interpretation.

At six months of age, LBW infants were more likely to be underweight (mean weight-for-age Z-score -3.01±0.97) or stunted (mean height-for-age Z-score -2.45 ±1.34) than the WHO reference group. The majority (93.8%) of the households had moderate to severe food insecurity. Contributing factors to these poor outcomes included recurrent illness, resource scarcity and lack of social support. Most mothers opted for mixed feeding as a coping mechanism for the LBW infant’s slow growth; this mixed feeding without clean water and proper hygiene, could even worsen the health outcomes of these infants.

Structural violence in poor households causes poor health outcomes of LBW infants. The responsibility of caring for LBW infants is so challenging because these children have so many unmet needs. Optimum care can be achieved with a variety of biosocial interventions.