Invisible pursuit: A scoping review of global policy guidance on care of vulnerable infants under 6 months and their mothers

Millions of infants worldwide are born vulnerable or become so in their first six months of life, which carries immediate and long-term risks. We conducted a scoping review to examine coherence of global policy content to inform national policy development. We included policy guidance on vulnerable infants under six months and their mothers applicable to multiple settings in low- and middle-income countries. We applied JBI updated methodology and PRISMA-ScR guidance. We included English publications only with no time limit. We sourced documents through Google Scholar, personal contacts, databases, global networks and agency websites. The search was conducted from August 2023 to February 2024. From 91 identified documents, we prioritised 34 documents for review. We categorised policy into guidelines - WHO documents with evidence-based recommendations, and guidance - multi-source documents with implementation details. We investigated characteristics, vulnerability descriptors, and continuity of care. We consolidated 49 vulnerability descriptors into 28 vulnerability factors and four sub-groups. We did not assess policy quality or undertake formal policy analysis. We found rich but inaccessible global policy guidance. Multiple terminologies create superficial differences and mask important ones. Growth appraisal was mostly limited to nutrition-oriented guidance and lacking in health-centric documents. Continuity of care was present in principle but lacked depth, especially for mothers. WHO policies are out of sync with each other and the latest evidence on mortality risk markers. Potential to leverage what exists needs WHO procedures to accommodate non-UN documents. There are immediate opportunities and necessity for cross-speciality policy cooperation. A living policy system to navigate evidence-to-policy process and manage policy interactions is warranted for this vulnerable group. Applying the WHO-INTEGRATE tool to policy contextualisation could help country-led adaptations, system-sensitive global support, and WHO methodological development. Ambition, investment and accountable action is urgently needed to secure coherent, evidenced policy for equitable and effective care.