Barriers and facilitators in the mitigation of infant mortality due to malnutrition in rural Africa: A qualitative systematic review.

Abstract

Background: Despite adherence to guidelines, severe acute malnutrition in rural Africa leads to over 40% mortality among hospitalized infants. Although some intervention programs have been implemented to address infant mortality due to malnutrition in certain areas of rural Africa, most regions are still grappling with this issue as implementing interventions to address malnutrition in these settings is often hindered by various barriers and influenced by facilitators specific to rural Africa. This study aims to review qualitative research on barriers and facilitators to implementing interventions for reducing infant mortality due to malnutrition in rural Africa.

Methods: CINAHL and Medline were searched using search terms focused specifically on barriers and facilitators to the implementation of interventions aimed at reducing infant mortality due to malnutrition in rural Africa. Grey literature was also examined. Quality assessment was performed, and a directed content analysis approach was used for data extraction. The search yielded 209 records, resulting in 13 eligible papers after duplicates and inclusion/exclusion criteria were applied. Barriers and facilitators were extracted and mapped to Scheirer and Dearing's sustainability framework.

Results: The review identified three overarching themes: characteristics of the intervention, factors in the organizational setting, and factors in the community where the intervention is implemented. Factors such as adherence to protocols, securing sufficient funding, involving stakeholders, improving access and awareness, addressing maternal education and financial resources, utilizing data-supported interventions, enhancing capacity building, fostering community-based social support, and prioritizing nutrition emerged as important facilitators for successful implementation. However, challenges related to inadequate funding, insufficient stakeholder involvement, limited access, cultural practices, and low knowledge of interventions were identified as barriers.

Conclusion: This review holds significance for public health as it increases understanding of the factors that facilitate and hinder interventions aimed at reducing infant mortality caused by malnutrition in rural Africa. Given the elevated rates of infant mortality in these regions, understanding these facilitators and barriers aids in developing more impactful, sustainable interventions. This, in turn, can effectively decrease infant mortality rates and enhance the overall health and well-being of rural African communities.