Table 5.
Suggestions for improvement from the participants.
| Neonatologists/pediatricians | ||
|---|---|---|
| Need for comprehensive guidelines | 85 | Most |
| Update and adapt practices quickly according to evolving guidelines | 46 | Some |
| Design guidelines that are feasible for ground-level implementation | 46 | Some |
| All stakeholders and subject experts should come together for formulation | 15 | Few |
| Clarity of guidelines | 23 | Few |
| Need for protocols on attendants | 8 | Few |
| Better logistics and staff management required | 54 | Many |
| Need for more dedicated staff | 38 | Some |
| Logistic supply chain needs to be strengthened | 8 | Few |
| Need for more dedicated space | 15 | Few |
| Make staff deployment more efficient | 15 | Few |
| Facilitate breastfeeding and newborn practices | 54 | Many |
| Create dedicated lactation teams | 46 | Some |
| Arrange for allowing birth companions to help mothers | 8 | Few |
| Create mechanisms to reinforce exclusive breastfeeding for 6 months | 8 | Few |
| Newborn care must be practiced | 8 | Few |
| Need for effective counseling of patients | 46 | Some |
| Ensure skilled counseling for mothers | 31 | Some |
| Improve communication with the patients and providers for better implementation | 15 | Few |
| Training of staff | 38 | Some |
| Training needed for waste disposal | 15 | Few |
| Staff needs training upon return to duty from posting elsewhere | 8 | Few |
| Staff training for kangaroo mother care required | 8 | Few |
| Need to train rotated staff for newborn care | 8 | Few |
| Joint training with clear role rationalization for neonatology and obstetric staff | 8 | Few |
| Training on infection control measures and on handling patients with COVID | 8 | Few |
| Improving inter-departmental support | 15 | Few |
| Need to improve interdepartmental coordination | 15 | Few |
| Departments need to sensitize one another about their SOPs | 8 | Few |
| Motivating and empowering healthcare workers | 23 | Few |
| Identifying and complementing champions | 15 | Few |
| Need for motivational endeavors for staff | 23 | Few |
| Prioritizing and promoting BF practices in newborn | 23 | Few |
| Prioritize health care budget | 8 | Few |
| Promotion of breastfeeding on primetime channels by professionals and ministries | 8 | Few |
| Technological innovation | 8 | Few |
| Obstetricians | ||
| Training of staff | 33 | Some |
| Improve communication with the patients and providers for better implementation | 17 | Few |
| Training on infection control measures or how to handle COVID | 17 | Few |
| Facilitate better BF and newborn practices | 17 | Few |
| Newborn care must be sustained irrespective of pandemic situation | 17 | Few |
| Need for comprehensive guidelines | 17 | Few |
| Provide clear guidelines | 17 | Few |
| Need for effective counseling of patients | 17 | Few |
| Strengthen counseling skills of staff through training | 17 | Few |
| Prioritize effective counseling of RDMs | 17 | Few |
| Residents | ||
| Requirement for better logistics and increase in staff capacity | 50 | Many |
| Increase availability of staff for better monitoring | 7 | Few |
| Allocate more space for mother and baby to room together | 36 | Some |
| Create designated team for COVID mothers for better care | 7 | Few |
| Ensure adequate availability of equipment | 7 | Few |
| Need for effective counseling of patients | 50 | Many |
| Start counseling and communication even before the delivery | 14 | Few |
| Work toward improving quality of counseling | 36 | Some |
| Intensify counseling for patients with COVID | 14 | Few |
| Staff training on effective counseling of mothers | 14 | Few |
| Need for comprehensive guidelines on optimal breastfeeding practices | 29 | Some |
| Create robust (stable) guidelines | 21 | Few |
| Need to involve ground-level staff to formulate guidelines contextually | 7 | Few |
| Prioritizing and promoting breastfeeding practices in newborn | 29 | Some |
| Need for availability of group support | 7 | Few |
| Allocate dedicated specialist nurse for newborn care | 7 | Few |
| Explore options for early discharge without compromising breastfeeding practices | 7 | Few |
| Provide privacy for breastfeeding | 14 | Few |
| Improve staff orientation to guidelines | 7 | Few |
| Nurses | ||
| Facilitate optimal breastfeeding and newborn practices | 54 | Many |
| Infection prevention and control protocol must ‘accommodate' rooming-in | 23 | Few |
| Have an allocated room with staff for Kangaroo mother care and breastfeeding | 15 | Few |
| Discharge and let them be in-home quarantine so that they get some help | 8 | Few |
| Allow mother to see her baby being cared at least from a distance | 8 | Few |
| Have a meeting area where the mothers could meet their family and newborn | 8 | Few |
| Facilitate transportation of expressed breastmilk from mothers to newborn | 8 | Few |
| Need to focus more on practical practice of breastfeeding than documentation | 8 | Few |
| Practice early initiation of breastfeeding and rooming-in | 8 | Few |
| Better logistics required | 31 | Some |
| Need for a better diet as attendants or visitors are not being allowed | 8 | Few |
| Need for more manpower | 8 | Few |
| Need for personal protective equipment kit | 8 | Few |
| Need for setup of NICU adjacent to ward with a glass wall, so that mothers can see the baby anytime they want | 8 | Few |
| Need to have more staff to help us with our work | 8 | Few |
| Postnatal ward and nursery should be near each other | 8 | Few |
| Improve staff skills | 31 | Some |
| Need for more detailed training on counseling during COVID | 8 | Few |
| Need for routine sensitization of healthcare workers to allay fear | 15 | Few |
| Training needed for all staff irrespective of COVID duties | 8 | Few |
| Need for effective counseling of patients | 31 | Some |
| Need for dedicated lactation counselors for better breastfeeding | 15 | Few |
| Need for more effective counseling especially for positive mothers | 15 | Few |
| Need for patient education for establishing breastfeeding | 8 | Few |
| The neonatologist should take a leading role in media to spread awareness | 8 | Few |
| Healthy mother and newborn | ||
| Counsel all first-time mothers beforehand | 6 | Few |
| Counsel on how to clean the breasts to avoid infecting the newborn | 6 | Few |
| Provide information on alternatives to breastmilk for feeding the newborn | 6 | Few |
| Identify a person exclusively for addressing all in-patient queries | 6 | Few |
| Staff should be available to resolve queries during follow up | 6 | Few |
| Provide information on infection prevention and control practices | 6 | Few |
| Mother with COVID-19 and healthy newborn | ||
| Improve treatment and behavior toward infected patients | 11 | Few |
| Provide physical support to the mother (especially if a cesarean section) | 11 | Few |
| Facilitate rooming-in | 5 | Few |
| Improve crowd management in queues for testing for SARS-CoV-2 | 5 | Few |
| Provide further guidance and advice on feeding expressed milk to baby | 5 | Few |
| Provide more information related to COVID-19 | 5 | Few |
| Mother with COVID-19 and sick newborn | ||
| Staff needs to be more empathetic | 13 | Few |
| Provide help for expressing milk (especially, if delivered by cesarean section) | 13 | Few |
| Improve the quality of food supplied in the hospital | 13 | Few |
| Provide more information on feeding baby before discharging | 13 | Few |
| Provide daily updates on the health status of the newborn | 13 | Few |
SOP, Standard Operating Procedure; COVID, Coronavirus disease, SAVS-CoV-2, severe acute respiratory syndrome coronavirus 2.