Stakeholder perspectives on the type and duration of supplemental milk for infants under six months with growth faltering

Background Growth faltering is a significant public health issue among infants aged <6 months (m). Supplemental milk is commonly used for infants with growth faltering, with variations in type and duration. We systematically synthesized and examined evidence from qualitative studies on stakeholder perspectives about equity, feasibility, and acceptability of the type and duration of supplemental milk for infants aged <6m with growth faltering to inform the latest WHO guideline on prevention and management of growth faltering in infants aged <6m. Methods We conducted a comprehensive search of six electronic databases in addition to manual searches to identify all qualitative studies published during January 2000 to June 2022 on stakeholder perspectives on type and duration of supplemental milk. Identified articles were screened in two stages against the inclusion criteria with titles and abstract screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist. The primary outcomes were equity, feasibility, and acceptability of the type and duration of supplemental milk for infants <6m with growth faltering. Results Eighteen studies, reporting perspectives of mothers, fathers, grandmothers and healthcare providers were included. Studies were conducted in North America (9), Africa (5), Asia (3) and South Australia (1). Donor human milk (DHM) (13) and infant formula (9) were the most commonly reported supplementary milks followed by cow/goat milk (2). Key factors that were seen to influence equity, feasibility, and acceptability were: education/awareness, socio-economic status (SES), race and religion, practicality, availability of resources, sustainability, cost, affective attitude, perceived effectiveness and ethicality. Maternal/caregiver related factors was a key sub-theme in stakeholder perspectives across all three supplemental milk feeds, acting as either a barrier or facilitator for uptake. Conclusions DHM and infant formula were the most commonly reported supplemental feed for infants aged <6m with growth faltering. The importance of maternal/care giver factors need to be taken into consideration to ensure equity, feasibility, and acceptability with respect to type and duration of supplemental milk for infants aged <6m with growth faltering.