Health professionals and women's knowledge and experiences of caring for small gestational age (SGA) infants in Pakistan

Abstract

Background
In Pakistan, every third baby is born small for gestational age (SGA). Early antenatal detection of SGA helps with birth planning and initial treatment of mother and baby, thereby reducing complications. Screening and diagnosis of SGA however are challenging, especially in low and middle-income countries where access to technological advances may be limited and there is a lack of routine antenatal screening.

Aims
To explore the current practices, knowledge, and experiences of caring for SGA infants with women and health professionals in Pakistan.

Design
A cross-sectional survey with healthcare professionals and focus groups or interviews with health professionals and mothers of SGA babies were undertaken. Survey data were analysed descriptively and integrated with the qualitative data using thematic data analysis.

Subjects
78 completed surveys were returned and eight FGDs and five interviews were undertaken with 77 participants – 67 healthcare professionals (gynecologists/obstetricians, neonatologists, Lady Health Workers, and Lady Health Visitors) and 10 mothers of SGA infants aged under 12 months.

Results
The survey highlighted a general lack of training on SGA for all health care professionals, but particularly amongst community staff who often act as primary caregivers for women. Five qualitative themes described the challenges and issues faced in the management, treatment, and prevention of SGA in Pakistan: Lack of policies and training, Lack of resources, Lack of access to healthcare, Not following the guidance, and Lack of data and reporting.

Conclusions
A whole system approach to improve service provision and outcomes is needed. This should include epidemiological research, country-specific policies, training for healthcare professionals and awareness raising amongst women and community members.