Adaptation of MAMI criteria

Dear Melanie,

The context you describe and the challenge of the common use of water in addition to breastmilk is one that is shared by many. There may be many reasons why this prevails despite advice to exclusively breastfeed. For example, qualitative research in Ethiopia (ahead of an RCT of the MAMI Care Pathway) found that use of water was common and linked to social and cultural norms, with famly members recommending this to mothers and it being considered neglectful not to provide it. Alive and Thrive have developed some wonderful resources as part of their Stronger with Breastmilk Only Campaign in West and Central Africa that you may find helpful to apply. (available in French and English).  https://www.breastmilkonly.com/fr  As part of this it may be helpful to investigate more closely with the mothers what are the reasons behind using water and who advises them to do so.  It may well be that you then need to target those who influence mothers and may be giving conflicting advice which puts her in a diffiuclt position.

In terms of 'adaptation' of the MAMI Care Pathway, I'm not quite sure what you mean so apologies if I have misinterpreted. 

For those infants that you identify in hospital, if they are newborns, it would be wise to pay particular attention to those born low birth weight as they are at higher risk.  So making sure they have breastfeeding support pre-discharge and then doing what you can to secure follow up in the community, such as in growth monitoring and encouraging them to present to a health clinic if there are health/growth problems or concerns.

For those infants coming for vaccination, this is a great opportunity to assess infants attending and identify those at risk. So assessing weight (to identify if underweight), asking for any breastfeeding problems/concerns (like you are wisely doing).   As well as applying the national SAM treatment guidelines, you can also consider to apply IMCI guidelines/protocols that exist (and upon which the MAMI Care Pathway is based and supports). IMCI uses weight for age as a criterion, as well as health indicators, to triage for problems and [provides community based guidance so may be useful to apply in your context too, helping to identify relevant existing services to link babies you identify in hospital or at vaccination.

I hope that helps but please continue to ask further questions/add clarifications as you wish, as I know there are many out there who both share your challenges and can also contribute to this discussion.

Best regards, Marie

Dear Melanie,

The context you describe and the challenge of the common use of water in addition to breastmilk is one that is shared by many. There may be many reasons why this prevails despite advice to exclusively breastfeed. For example, qualitative research in Ethiopia (ahead of an RCT of the MAMI Care Pathway) found that use of water was common and linked to social and cultural norms, with famly members recommending this to mothers and it being considered neglectful not to provide it. Alive and Thrive have developed some wonderful resources as part of their Stronger with Breastmilk Only Campaign in West and Central Africa that you may find helpful to apply. (available in French and English).  https://www.breastmilkonly.com/fr  As part of this it may be helpful to investigate more closely with the mothers what are the reasons behind using water and who advises them to do so.  It may well be that you then need to target those who influence mothers and may be giving conflicting advice which puts her in a diffiuclt position.

In terms of 'adaptation' of the MAMI Care Pathway, I'm not quite sure what you mean so apologies if I have misinterpreted. 

For those infants that you identify in hospital, if they are newborns, it would be wise to pay particular attention to those born low birth weight as they are at higher risk.  So making sure they have breastfeeding support pre-discharge and then doing what you can to secure follow up in the community, such as in growth monitoring and encouraging them to present to a health clinic if there are health/growth problems or concerns.

For those infants coming for vaccination, this is a great opportunity to assess infants attending and identify those at risk. So assessing weight (to identify if underweight), asking for any breastfeeding problems/concerns (like you are wisely doing).   As well as applying the national SAM treatment guidelines, you can also consider to apply IMCI guidelines/protocols that exist (and upon which the MAMI Care Pathway is based and supports). IMCI uses weight for age as a criterion, as well as health indicators, to triage for problems and [provides community based guidance so may be useful to apply in your context too, helping to identify relevant existing services to link babies you identify in hospital or at vaccination.

I hope that helps but please continue to ask further questions/add clarifications as you wish, as I know there are many out there who both share your challenges and can also contribute to this discussion.

Best regards, Marie