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ObjectivesTo describe the feeding profile of low birthweight (LBW) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor 6-month growth outcomes.DesignProspective observational cohort study.Setting and participantsStable, moderately LBW (1.50 to Variables of interestKey variables of interest included birth weight, LBW type (combination of preterm/term status and size-for-gestational age at birth), lactation practices and support, feeding profile, birthweight regain by 2 weeks of age and poor 6-month growth outcomes.ResultsBetween 13 September 2019 and 27 January 2021, 1114 infants were enrolled, comprising 4 LBW types. 363 (37.3%) infants initiated early breast feeding and 425 (43.8%) were exclusively breastfed to 6 months. 231 (22.3%) did not regain birthweight by 2 weeks; at 6 months, 280 (32.6%) were stunted, 222 (25.8%) underweight and 88 (10.2%) wasted. Preterm-small-for-gestational age (SGA) infants had 1.89 (95% CI 1.37 to 2.62) and 2.32 (95% CI 1.48 to 3.62) times greater risks of being stunted and underweight at 6 months compared with preterm-appropriate-for-gestational age (AGA) infants. Term-SGA infants had 2.33 (95% CI 1.77 to 3.08), 2.89 (95% CI 1.97 to 4.24) and 1.99 (95% CI 1.13 to 3.51) times higher risks of being stunted, underweight and wasted compared with preterm-AGA infants. Those not regaining their birthweight by 2 weeks had 1.51 (95% CI 1.23 to 1.85) and 1.55 (95% CI 1.21 to 1.99) times greater risks of being stunted and underweight compared with infants regaining.ConclusionLBW type, particularly SGA regardless of preterm or term status, and lack of birthweight regain by 2 weeks are important risk identification parameters. Early interventions are needed that include optimal feeding support, action-oriented growth monitoring and understanding of the needs and growth patterns of SGA infants to enable appropriate weight gain and proactive management of vulnerable infants.Trial registration numberNCT04002908.

Objective To determine prescription practices for non-malarial fever cases among febrile under-fives in the Lake Zone of Tanzania. Methods A health facility-based study was conducted in health facilities of the Lake Zone regions targeting 1 080 medical records. From patients' medical records, we collected information on how non-malarial fever was managed. Statistical analyses involved descriptive statistics and comparisons of proportions of prescribing medications between clinicians working in health facilities supported by Tibu Homa Project against others. Logistic regression analysis was used to assess independent variables associated with irregular prescription of antimalarials to non-malarial fever cases. Results The main clinical diagnoses among febrile under-fives tested negative for malaria were respiratory tract infections (17%), pneumonia (15%) and urinary tract infections (10%). Over-prescription of antimalarial was to 12% (95%, confidence interval: 10%–14%) and only 14% (95%, confidence interval: 12%–16%) under-fives were correctly prescribed antibiotics based on correct final diagnosis. Health care providers from non-Tibu Homa Project supported health facilities, those working in hospitals and inpatient febrile under-fives were independent predictors of prescribing anti-malarial drugs to febrile under-fives with no malaria. Conclusions The proportion of clinicians prescribing antimalarial medications and over-prescribing antibiotics to malaria negative-tested under-fives in the Lake Zone is high, 11%, and as low as 14% of clinicians prescribed antibiotics correctly based on correct final diagnoses. Training of health care workers, health managers and regular supportive supervision may significantly improve prescription practices among clinicians attending under-fives.