Invisible Pursuit: A Scoping Review of Global Policy for Continuity of Care of Vulnerable Infants Under 6 Months and Their Mothers in Low- and Middle-Income Countries

TL;DR

Global policies for caring for vulnerable infants under 6 months and their mothers are fragmented and lack coherence, leading to gaps in continuity of care.

Contribution

This study identifies fragmentation and gaps in global policy guidance for vulnerable infants and proposes a managed living guideline system to improve coherence.

Findings

Global policy guidance is fragmented and lacks coherence, masking synergies and gaps.

Health-oriented guidance lacks anthropometric markers of risk, weakening differentiated pediatric care.

WHO policies are out of sync with the latest evidence and require a living policy system for better coordination.

Abstract

What are the main findings?
Fragmented global policy guidance masks important synergies and gaps that hinder interdisciplinary continuity of care.Anthropometric markers of risk are lacking in health-oriented guidance, which weakens risk-differentiated paediatric care.

Fragmented global policy guidance masks important synergies and gaps that hinder interdisciplinary continuity of care.

Anthropometric markers of risk are lacking in health-oriented guidance, which weakens risk-differentiated paediatric care.

What are the implications of the main findings?
There are immediate opportunities for interdisciplinary policy cooperation in global and country guidance development processes underway.A managed living guideline system would improve accessibility, coherence, and content of global policy for vulnerable infants under 6 months and their mothers.

There are immediate opportunities for interdisciplinary policy cooperation in global and country guidance development processes underway.

A managed living guideline system would improve accessibility, coherence, and content of global policy for vulnerable infants under 6 months and their mothers.

Background/Objectives: Worldwide, millions of infants under 6 months are at increased risk of poor growth and development, illness, and death. We investigated the coherence of global policy characteristics, vulnerability, and continuity of care, which guides the care of vulnerable infants under 6 months and their mothers. Methods: We conducted a scoping review according to PRISMA-ScR guidance. We included English publications with no time limit, applicable to low- and middle-income countries, sourced through Google Scholar, contacts, WHO and UNICEF databases, global networks, and agency websites. The search was conducted from August 2023 to February 2024. We identified 34 documents for review. We categorised policies into guidelines, namely, WHO evidence-based recommendations and multi-source guidance documents with implementation details. We consolidated 49 vulnerability descriptors into 28 vulnerability factors and four sub-groups. We did not assess policy quality. Results: We found rich but fragmented global policy guidance. Multiple terminologies create superficial differences and mask important ones. Growth appraisal was mostly limited to nutrition-oriented guidance and was lacking in health-centric documents. Continuity of care lacked scope and depth. WHO policies are out of sync with each other and the latest evidence on mortality risk markers. WHO procedures need to accommodate non-UN documents to leverage existing guidance potential. A living policy system to manage evidence-to-policy processes and policy interactions is needed. The WHO-INTEGRATE evidence for decision frameworks could help country-led adaptations, system-sensitive global support, and WHO methodological development. Conclusions: There are immediate opportunities for interdisciplinary policy cooperation. Action is urgently needed to secure coherent evidence-based policies for equitable and effective care.

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