The collective findings of formative interviews with mothers, fathers and grandmothers gave three broad themes:
- Low birth weight infants and their care needs.
- Perceptions of care practices related to LBW babies.
- Perceptions and attitude towards use of lactoferrin.
Low birth weight neonates and their care needs
This theme explored participants’ understanding about LBW babies, and health problems and care needs associated with LBW babies. Unanimously, family support provided to the mother and baby was also assessed. We explored the challenges faced by caregivers of LBW infants and evaluated their awareness of the treatments offered. The role of key decision makers in care seeking was also assessed.
Characteristics of normal birth weight and LBW babies
Most of the participants were able to distinguish between normal birth weight and LBW babies. They identified a LBW baby as “smaller than normal” with reduced muscle tone, lean, and with less activity compared to a normal weight baby. Half of the mothers considered a LBW baby to have immature lungs, poor suckle reflex, and at a greater risk to acquire respiratory problems.
“When I hold a small baby, I am afraid and doubt in my mind that baby may slip from my hands because he is very small.” (Mother)
Whereas they defined healthy babies as active, well hydrated, bright pink in colour andan ability to demand feed when hungry.
“Normal birth weight babies look pink with chubby cheeks.” (Mother).
Some fathers described LBW babies as being pale with fragile and loose skin, having breathing difficulties, feeble cry and poor suckling that resulted in feeding problems. Most grandmothers narrated that LBW babies are unable to maintain their body temperature and have poor ability to suckle.
“They do not have enough strength to suck the breast milk.” (Grandmother)
Association of birth weight and health outcomes
Almost all mothers believed that LBW babies have delayed milestones and weak immune systems, which make them vulnerable to infections. A couple of mothers expressed that LBW babies can acquire micronutrient deficiencies and diseases in later life.
“They remain physically and mentally weak, and they learn to sit, walk, hold their neck late.” (Mother)
“They catch infections and allergies easily and develop multiple deficiencies like vitamin B and low iron.” (Mother)
Similar concerns were shared by fathers and grandmothers. Additionally, few grandmothers highlighted frequent respiratory and gastrointestinal problems among LBW babies. However, most of the grandmothers were optimistic about health outcomes of LBW babies as one grandmother stated: “As these babies grow, they gain weight and become like normal weight born babies.” Only a few fathers discussed possibility of hypothermia and hypoglycaemia in early days of life.
Perceptions of LBW babies care practices
Challenges in caring for LBW babies
Almost all mothers expressed a disrupted routine life due to the extra time and effort required for care of LBW babies. Their inability to complete household chores further added stress and made them irritable. They also complained of painful breasts, backaches, and insufficient milk production in their initial days. Majority of the mothers verbalized sleep deprivation and an inability to look after themselves. Undesirable comments from visitors further lead to anxiety and depression.
“When people visit, they usually pass comments like ‘your child is very weak and small’ which stressed me a lot.” (Mother)
Similar views were given by fathers. One father said: “LBW babies need constant vigilance and mothers stay awake the whole night leading to exhaustion and sleep deprivation.” However, half of the fathers had no idea about the challenges faced in care of LBW babies.
“This is not my problem (It does not concern me), please ask the mother.” (Father)
Majority of the women reflected difficulties in bathing and dressing their LBW babies, as one participant stated: “It is a bit difficult to bathe him and change his clothes.” Fathers also endorsed mothers’ opinion that it is difficult to hold, feed, and bathe these babies.
On the other hand, most of grandmothers said that they faced no issues when offering care for LBW babies, as they had previous experience in handling LBW babies.
“We know how to carry, feed, bathe, hold and lift the baby with proper positioning. However, caring for the baby does disturb our daily routine.” (Grandmother)
Family support system
A majority of the parents in our study shared that they took decisions themselves. On the other hand, some mothers expressed that grandparents and elders of the family were the main decision makers in their household. All grandmothers stated that both parents and grandparents of the baby usually took joint decisions in seeking health care for LBW babies.
“We must value our parents’ and in-laws’ experience in caring for low birth weight babies.” (Father)
During the early postnatal period, all mothers acknowledge support from their mothers-in-law, sisters-in-law and at times, husbands. Support was usually required during the day as mothers had additional house chores to complete. Fathers and grandmothers specifically identified support from paternal and maternal grandmothers. Grandmothers added that sisters (of both the mother and father) also extended their support.
Majority of the fathers found it difficult to support mothers in caring LBW babies because of their workload at their places of employment. Very few fathers stated that they support their spouse to care for the baby or do household chores while taking leave from work.
Care seeking behaviors
Majority of the mothers verbalized the need to seek the advice of a doctor for their newborn care, but the others preferred to follow the advice of their partner or elder family member. Those who preferred to seek care from doctors preferred to visit specialized doctors, (“paediatrician”) to treat their LBW babies. However, all of the participants believed that medical treatment had some side effects and should be used with caution. Only one mother identified taking advice from recently experienced parents of LBW babies.
“Parents who have had LBW babies can guide properly, like they share their experiences about things to take care off.” (Mother)
Fathers have mixed opinions. Few favoured allopathic treatments and some considered home remedies and spiritual healing as treatment options.
“Doctors are the most reliable individual we trust as they have the education and skills along with their experience to make the correct diagnosis.” (Father)
Unlike parents, all grandmothers preferred home remedies as treatment of minor illnesses. Some home remedies listed by them were herbed syrups, honey, oil massage and exposure to sunlight.
Administration of medications
Most of the mothers had experience in administration of medications to LBW babies and listed spoons, droppers and syringes as useful modalities to administer medications. On enquiring about the duration and frequency to administer medicines, mothers said, “We do as per doctor’s prescription”. All participants preferred droppers as they were the best at measuring the quantity and controlling the speed of administration. Further, they said that the baby could swallow the medicine easily with no spillage and with fewer chances of aspiration.
Perceptions and attitude towards use of lactoferrin
Opinions about lactoferrin
Most of the parents were convinced that lactoferrin is beneficial for their LBW babies’ growth and agreed to add it in the newborns feeding milk. A few grandmothers feared about the side effects of mixing a nutrient substance in the mother’s milk or in formula milk.
“My baby’s growth will be enhanced perhaps my milk does not contain sufficient nutrients therefore it’s better to give lactoferrin to my baby.” (Mother)
“For elders there are food supplements to overcome deficiencies so why not for baby? This nutrient will improve the health of my baby.” (Father)
Mode of administration of lactoferrin
Parents preferred the liquid form of lactoferrin instead of the powder, as it was easier to dissolve in milk. However, two grandmothers preferred powder over liquid but gave no reason for it. Parents were of the opinion that it should be preferably be mixed in breast milk and fed via bottles. Few mothers also stated that mixing in formula milk and feeding with droppers and spoons is also acceptable.
Frequency of administration of lactoferrin
Majority of the mothers were in favour of giving Lactoferrin as one single dose while the rest preferred to divide the total dose in small quantities throughout the day. In addition, most mothers idealised daytime hours to give lactoferrin so that they could closely monitor neonates for indigestion, feeding intolerance and other possible side effects. Only a few preferred night-time doses and believed it would help the baby to sleep soundly. Similar views were shared by fathers and grandmothers.
Experince of using bLF
After using bLF for two weeks, most of the mothers expressed their satisfaction. They found that bLF was easy to administer, had no side effects and increased the neonate’s weight during the two weeks when bLF was administered. However, a third of mothers did not disclose bLF usage to their family members.
“It was a great experience, I am happy as it increased my baby’s weight, it was easy to use and should be given to all LBW babies.” (Mother)
Most of the mothers stated that use of the Nifty Cup was convenient and effective as a container for mixing and feeding their baby. They added that 5-10 mL of breast milk was sufficient to dissolve bLF.
A few mothers reported that mixing bLF powder in breast milk was frustrating, and household chores suffered due to time spent in expressing milk and mixing bLF.