Exploring the acceptability and adherence of the integrated MAMI care pathway for supporting vulnerable infants and their mothers in South Sudan: a qualitative study

BackgroundOne in four infants is born too small or too early, increasing the risk of poor growth, development, ill health, and death. This risk is exacerbated by recurring conflict and climatic shocks. The management of small and nutritionally at-risk infants under 6 months and their mothers (MAMI) care pathway was integrated into primary healthcare to ensure continuous mother-infant-centered care in South Sudan. This study explored the acceptability of the MAMI approach for service providers and users and the factors influencing their adherence. MethodsA qualitative study was embedded in a mixed-methods study following 521 vulnerable mother-infant pairs. MAMI care included sensitization and screening in the community and health facility, in-depth assessment, and risk-based care addressing physical, mental and nutritional vulnerability of infants and mothers. Semi-structured interviews of 20 health workers and 30 mothers explored acceptability and adherence to MAMI care provision and use. ResultsThemes of perceived acceptability of MAMI care were mapped across coherence, self-efficacy, affective attitude, burden, ethicality, opportunity cost, and perceived effectiveness. Health workers were most apprehensive about the additional workload and time required to implement the care pathway. Mothers expressed concern over the numerous health visits far from their homes and not having supportive family members. Factors promoting adherence to MAMI care provision and use were mapped across capability, opportunity, and motivation. Health workers self-confidence was boosted by the new knowledge and skills they acquired through training and mentorship. Mothers reported learning practical ways to care for their infants independently and to witness the positive impact on their infants thriving. ConclusionMAMI care was accepted for addressing the needs of a previously overlooked vulnerable group. To ensure effective adoption, delivery and use, challenges must be resolved. Adapting the MAMI care pathway to the local health system context will encourage adherence from both providers and users. Key messagesO_LIWhat is already known on this topic - The 2023 WHO updated guideline on preventing and treating wasting in children under 5 includes care for infants under 6 months at risk of poor growth and development and their mothers within primary healthcare. Understanding and effectively delivering care to this previously overlooked vulnerable group is critical for national policymakers and implementers to address persistently high levels of infant mortality. C_LIO_LIWhat this study adds - This study explored the acceptability of the MAMI care pathway-a risk-based, mother-infant centered care approach-among service providers and users in South Sudan, as well as the factors influencing their adherence. It offers recommendations for effectively adapting the approach to the local health system context to promote adherence from both providers and users. C_LIO_LIHow this study might affect research, practice or policy - The study generated valuable insights and learning at both national and global levels to enhance policies and practices. It also laid the foundation for future research and intervention development, particularly in settings with similar demographics and healthcare challenges. C_LI