Enhancing growth and development among malnourished infants recovering from serious illness (360G-Wellcome-221997_Z_20_Z)

Globally, acute malnutrition affects 8.5 million infants under 6 months of age (u6m). Malnourished infants u6m are at elevated risk of death during admission and after discharge from hospital and of subsequent neurodevelopmental impairment. WHO nutritional rehabilitation guidelines for u6m focus on re- establishing exclusive breastfeeding (EBF) with discharge when consistent weight gain (>5g/kg/day) is achieved on breastmilk alone. My pilot study examined breastfeeding peer supporters to facilitate guideline implementation among hospitalised malnourished infants. We achieved 81% exclusive breastfeeding by discharge with 67% attaining the WHO recommended growth velocity on breastmilk alone. However, criteria for full nutritional recovery were generally not met 6 weeks after discharge. I now hypothesise that providing support during transition to home will improve nutritional recovery. In Phase 1 I will develop and pilot a breastfeeding support intervention among 30 recovering infants u6m. In Phase 2 I will apply a randomised controlled trial to evaluate effectiveness of the finalised intervention compared with standard care among 250 malnourished infants (4-12 weeks old) recovering from an illness. The primary outcome is growth (weight gain) assessed at age 6 months, with follow up to 12 months. Results will inform efforts to improve post-discharge management of recovering vulnerable infants u6m.