Background A contributory factor to childhood undernutrition is poor gut health occurring within the first 6-12 weeks of life despite exclusive breast feeding. Pro/synbiotic administration may protect gut health. A qualitative study was conducted amongst mothers/carers and healthcare workers (HCWs) to explore their perceptions and the acceptability of pro/synbiotics administration in early life.

Methods This study was nested within a randomised, open, clinical trial of pro/synbiotics with 32 doses administered under supervision to infants between age 0-5 months in western Kenya. Semi-structured interviews were conducted with mothers/carers, Peer Mothers and health care workers (HCWs) selected by purposive critical and key informant sampling. Interviews were transcribed and analysed using a thematic coding framework.

Findings Satisfaction with pro/synbiotic administration was very high amongst all three groups. Commonly perceived benefits included protection from diseases, healthy growth of the infant and improved appetite. The main barriers were working mothers and other commitments making it difficult to stick to scheduled administration visits, adverse judgment and opinions in the community and lack of engagement of fathers. Insights were gained into different means of administering pro/synbiotics to young infants. Triangulation of findings of the mothers/carers with HCWs showed that most identified motivations and challenges were similar.

Conclusions Pro/synbiotic administration was well-accepted by mothers/carers and HCWs and generally perceived to have health benefits. Administration of pro/synbiotics by mothers/carers themselves to their infants may be feasible and overcome logistical challenges. Greater efforts to sensitise and engage fathers and communities would likely be critical for a community-based program.

The authors have declared no competing interest.

PACTR202003893276712

The PROSYNK trial is funded by the Childrens Investment Fund Foundation; no additional funding was available for this qualitative research.

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Ethical approval was obtained from the Kenya Medical Research Institutes Scientific and Ethics Review Unit (KEMRI/SERU/CGHR/320/3917) and the Liverpool School of Tropical Medicine Research Ethics Committee (19-048).

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