Improving infant nutrition

Walbira Murray is a Research Officer with Central Australia Aboriginal Congress. Walbira participated in the JBI Evidence Implementation Training Program through the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange (CREATE). Her evidence-based implementation project focused on determining if current interventions used by Central Australia Aboriginal Congress to promote and support infant nutrition are consistent and if they meet current National Infant Feeding Guidelines.

Background

Central Australia Aboriginal Congress is committed to the improvement of Aboriginal health in Central Australia, and Aboriginal infants and young children account for a significant number of its clients. The substantial health issues that affect many young children in the region have been well documented, but best practice and consistent culturally appropriate nutrition advice to caregivers of Aboriginal infants has the capacity to address some of these health issues.

Throughout their lives, many Indigenous people suffer major disorders of nutrition and growth. At birth, Aboriginal and Torres Strait Islander babies are substantially lighter than non-Aboriginal and Torres Strait Islander babies. Most significantly, the proportion of Indigenous babies of low birth weight is more than twice that of non-Indigenous babies. From birth, the growth of most Indigenous infants tends to be satisfactory until breast milk becomes insufficient by itself, at which time they need complementary food and become more directly exposed to the substandard environment in which many Indigenous people live. At this time, they become vulnerable to a wide range of infections, in many cases entering the vicious synergistic cycle of infection-malnutrition.

Many Indigenous people carry this legacy of impaired growth into early adulthood, where it has a significant impact on the health of mothers, and of the next generation. Indeed, insufficient nutrition has many health outcomes for infants.

Under-nutrition early in life has major consequences for future educational, income and productivity outcomes as well as health outcomes. Under-nutrition diminishes the ability to fight infection; impairs the immune system and increases the risk of some infections; impairs growth; increases the chance of infant and young child mortality; heightens fatigue and apathy; and hinders cognitive and mental development.

Image courtesy of R McPherson and the Australian Breastfeeding Association

Identifying the gap in infant nutrition support

While significant improvements in Aboriginal Health have been made, anaemia, wasting and growth faltering have been an issue for many infants and their caregivers in Central Australia. Population-based approaches for their prevention and management are required, but at the time of Walbira’s project, Central Australia Aboriginal Congress did not have a framework for supporting staff to give culturally appropriate best practice nutrition advice to caregivers of infants.

As part of the program of work for CREATE, Walbira participated in the JBI Evidence Implementation Training Program. This involved two weeks of intensive training in Adelaide and being mentored by a JBI Research Fellow for six months as she developed and implemented her evidence-based project for the JBI Evidence Implementation Training Program.

Walbira’s focus was on contributing to the promotion of evidence-based practice in infant nutrition advice and interventions, thereby improving clinicians’ skills and confidence to enhance patient outcomes. At the same time, Walbira assessed compliance with evidence-based criteria regarding Aboriginal infant nutrition advice given by clinicians to caregivers in Congress Clinics and Services.

Demonstrating impact

Walbira used a mixed-methods approach in the evaluation project, integrating focus groups, observations, interviews and surveys with clinicians to identify barriers to high quality remote health service delivery. Six months of data were collected.

A baseline audit was conducted, revealing non-compliance between current practice and best practice for the criterion: “Do healthcare staff receive education regarding infant nutrition?”  

Consequently, a bundled education strategy was developed and implemented to provide a best practice training intervention for all clinicians who provide infant feeding advice to caregivers. The training intervention included an 'Introduction to Solids' workshop developed and delivered in conjunction with the Northern Territory Health Department and Congresses Dietitians and the Family First Partnership team.

A follow up audit demonstrated significantly improved outcomes across the 'Education for Clinicians' best practice criteria.

The baseline audit also clearly demonstrated that a high percentage of clinicians were not familiar with the National Infant Feeding Guidelines, or confident in using them. The intervention—practical educational workshops covering the main points of the National Feeding Guidelines—was designed and delivered to improve clinicians’ confidence and familiarity with using them. Eight weeks post training showed that 92% participants reported that their awareness of the Guidelines had grown as a result of the training and that 76% were applying the Guidelines in their practice.

Sustainability

By the end of Walbira’s six-month evidence-based implementation project, the Public Health Officer of Congress had commenced implementing other infant nutrition training for staff.

Importantly, Walbira’s project transformed attitudes toward interventions from having a passive to an active focus for all clinicians, with their focus directed to appropriate engagement with caregivers of infants. Future audits and training sessions are planned to ensure continuous improvement.

Conclusion

Walbira’s evidence-implementation project findings reveal how clinical audits following JBI methodology may be used to promote best practice in infant nutrition interventions, and that focused education and provision of relevant resources for clinicians can have an immediate and positive impact on their clinical practice.

Promoting evidence-based practice in infant nutrition advice and interventions, and assessing compliance with evidence-based criteria regarding Aboriginal infant nutrition advice given by clinicians to caregivers, has helped break the cycle of under-nutrition in generations. This initiative addresses and the long-term, major consequences for future educational, income and productivity outcomes that can be associated with under-nutrition early in life.

Take home messages

• Culturally appropriate, evidence-based education empowers clinicians to provide consistent, high-quality infant nutrition advice, helping address critical early-life health disparities among Aboriginal infants.
   
• Targeted training interventions significantly improved clinician confidence and adherence to the National Infant Feeding Guidelines, highlighting the value of tailored professional development in remote healthcare settings.
   
• Systematic audit and feedback processes, guided by JBI methodology, can drive sustainable change, transforming clinical attitudes and practices from passive to proactive engagement with caregivers.
   

References

Australian Government. (n.d.). Closing the gap reports. Closing the Gap.

Australian Institute of Health and Welfare. (2023). Aboriginal and Torres Strait Islander mothers and babies: Birthweight. Australian Government.

Additional resources

National Infant Feeding Guidelines