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Kiragu JM, Osika Friberg I, Erlandsson K, Wells MB, Wagoro MCA, Blomgren J, Lindgren H. Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100893. [PMID: 37586305 DOI: 10.1016/j.srhc.2023.100893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. METHODS We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). RESULTS At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives' participation time costs (56 %) for scenario 1 (collaborative), trainers' material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. CONCLUSION Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.
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Affiliation(s)
- John Macharia Kiragu
- Department of Public and Global Health, University of Nairobi, Kenya; Department of Nursing Sciences, University of Nairobi, Kenya.
| | | | - Kerstin Erlandsson
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Institution for Health and Welfare, Dalarna University, Falun, Sweden.
| | - M B Wells
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | | | - Johanna Blomgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden.
| | - Helena Lindgren
- Women's and Children's Health, Karolinska Institutet, Solna, Sweden; Sophiahemmet University, Sweden.
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Dhage VD, Rannaware A, Choudhari SG. Kangaroo Mother Care for Low-Birth-Weight Babies in Low and Middle-Income Countries: A Narrative Review. Cureus 2023; 15:e38355. [PMID: 37274008 PMCID: PMC10232296 DOI: 10.7759/cureus.38355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/30/2023] [Indexed: 06/06/2023] Open
Abstract
In low and middle-income countries (LMICs), the infant mortality rate is much higher than the high-income countries (HICs). The higher infant mortality is due to low birth weight (LBW) a combination of intra-uterine growth retardation (IUGR) and prematurity, which are risk factors for acquiring infectious diseases amongst newborns. Kangaroo mother care (KMC) is a neonatal procedure that is carried out in newborn infants, especially in preterm babies and LBW babies. It is skin-to-skin contact between a mother's bare chest and a stable infant. KMC is an important intervention in reducing infant mortality rates in LMICs. A comprehensive literature and data search was done using key databases like PubMed and Google Scholar. A total of 42 articles out of 1,168 articles were selected for review after screening and elimination of the repeated articles. Through this review we have tried to analyse the benefits of KMC in newborns, the need for the participation of fathers and family members, and the need for implementation of this practice at a broader level by policy formulation in LMICs. We have also discussed the need for KMC for the prevention of infant mortality in LBW newborns in LMICs.
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Affiliation(s)
- Vaishnavi D Dhage
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Asmita Rannaware
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sonali G Choudhari
- School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Hill Z, Tawiah-Agyemang C, Kirkwood B, Kendall C. Are verbatim transcripts necessary in applied qualitative research: experiences from two community-based intervention trials in Ghana. Emerg Themes Epidemiol 2022; 19:5. [PMID: 35765012 PMCID: PMC9238251 DOI: 10.1186/s12982-022-00115-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Conducting qualitative research within public health trials requires balancing timely data collection with the need to maintain data quality. Verbatim transcription of interviews is the conventional way of recording qualitative data, but is time consuming and can severely delay the availability of research findings. Expanding field notes into fair notes is a quicker alternative method, but is not usually recommended as interviewers select and interpret what they record. We used the fair note methodology in Ghana, and found that where research questions are relatively simple, and interviewers undergo sufficient training and supervision, fair notes can decrease data collection and analysis time, while still providing detailed and relevant information to the study team. Interviewers liked the method and felt it made them more reflective and analytical and improved their interview technique. The exception was focus group discussions, where the fair note approach failed to capture the interaction and richness of discussions, capturing group consensus rather than the discussions leading to this consensus.
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Affiliation(s)
- Zelee Hill
- Institute for Global Health, University College London, 30 Guilford St., London, WC1N 1EH, UK.
| | | | - Betty Kirkwood
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2350, New Orleans, LA, 70112, USA
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Hadi EN, Tambunan ES, Pratomo H, Priyohastono S, Rustina Y. Health education to improve low-birthweight infant care practices in Central Jakarta, Indonesia. HEALTH EDUCATION RESEARCH 2022; 37:133-141. [PMID: 35257144 DOI: 10.1093/her/cyac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 06/14/2023]
Abstract
This study aimed to assess the impact of health education on the caring practices of low-birthweight (LBW) infant mothers in Central Jakarta, Indonesia. A quasi-experiment design with a pretest-post-test control group model was conducted on 159 mothers (78 in the intervention group and 81 in the control group) of LBW infants treated in the perinatology ward of three hospitals in Central Jakarta. Provision of health education to mothers of LBW infants consisted of counselling sessions and one-on-one visits provided by primary health centre nurses. Data were collected four times consecutively over 6 weeks. A generalized estimating equation model with a linear link function was employed to examine LBW infant practice score changes due to intervention and other influential factors at four time points. Results: The LBW infant care practice scores were higher in the intervention group than in the control group at each measurement point. After controlling for maternal attitudes, LBW infant health education increased mothers' infant care practices at 2, 6 and 12 weeks by 2.179, 2.803 and 2.981 points, respectively, and reduced infant morbidity. Six weeks of health education had an effective impact on mothers' home LBW infant care practices and infant health status.
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Affiliation(s)
- Ella N Hadi
- Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Jl. Lingkar Kampus Raya, Kampus UI, Depok, West Java 16424, Indonesia
| | - Eviana S Tambunan
- Department of Pediatric Nursing, Politeknik Kesehatan Kemenkes Jakarta III (Health Polytechnic of Jakarta III), Ministry of Health of Republic of Indonesia, Jl. Arteri JORR Jatiwarna, Kota Bekasi, West Java 17415, Indonesia
| | - Hadi Pratomo
- Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Jl. Lingkar Kampus Raya, Kampus UI, Depok, West Java 16424, Indonesia
| | - Sutanto Priyohastono
- Department of Biostatistics and Demography, Faculty of Public Health, Universitas Indonesia, Jl. Lingkar Kampus Raya, Kampus UI, Depok, West Java 16424, Indonesia
| | - Yeni Rustina
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Jl. Prof. Dr. Sudjono. D. Pusponegoro, Kukusan, Depok, West Java 16425, Indonesia
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Sakyi KS, Lartey MY, Kennedy CE, Denison JA, Sacks E, Owusu PG, Hurley EA, Mullany LC, Surkan PJ. Stigma toward small babies and their mothers in Ghana: A study of the experiences of postpartum women living with HIV. PLoS One 2020; 15:e0239310. [PMID: 33064737 PMCID: PMC7567350 DOI: 10.1371/journal.pone.0239310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/04/2020] [Indexed: 01/30/2023] Open
Abstract
Infants born to HIV-infected mothers are more likely to be low birthweight (LBW) than other infants, a condition that is stigmatized in many settings worldwide, including sub-Saharan Africa. Few studies have characterized the social-cultural context and response to LBW stigma among mothers in sub-Saharan Africa or explored the views of women living with HIV (WLHIV) on the causes of LBW. We purposively sampled thirty postpartum WLHIV, who had given birth to either LBW or normal birthweight infants, from two tertiary hospitals in Accra, Ghana. Using semi-structured interviews, we explored women's understanding of the etiology of LBW, and their experiences of caring for a LBW infant. Interviews were analyzed using interpretive phenomenology. Mothers assessed their babies' smallness based on the baby's size, not hospital-recorded birthweight. Several participants explained that severe depression and a loss of appetite, linked to stigma following an HIV diagnosis during pregnancy, contributed to infants being born LBW. Women with small babies also experienced stigma due to the newborns' "undesirable" physical features and other people's unfamiliarity with their size. Consequently, mothers experienced blame, reluctance showing the baby to others, and social gossip. As a result of this stigma, women reported self-isolation and depressive symptoms. These experiences were layered on the burden of healthcare and infant feeding costs for LBW infants. LBW stigma appeared to attenuate with increased infant weight gain. A few of the women also did not breastfeed because they thought their baby's small size indicated pediatric HIV infection. Among WLHIV in urban areas in Ghana, mother and LBW infants may experience LBW-related stigma. A multi-component intervention that includes reducing LBW incidence, treating antenatal depression, providing psychosocial support after a LBW birth, and increasing LBW infants' weight gain are critically needed.
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Affiliation(s)
- Kwame S. Sakyi
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Margaret Y. Lartey
- Department of Medicine & Therapeutics, CHS, University of Ghana School of Medicine & Dentistry, Accra, Ghana
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Julie A. Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Emma Sacks
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Prince G. Owusu
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
| | - Emily A. Hurley
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Health Services and Outcomes Research, Children’s Mercy, Kansas City, Missouri, United States of America
| | - Luke C. Mullany
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, United States of America
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Pamela J. Surkan
- Center for Learning and Childhood Development-Ghana, Accra, Ghana
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Jamali QZ, Shah R, Shahid F, Fatima A, Khalsa S, Spacek J, Regmi P. Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan. PLoS One 2019; 14:e0213225. [PMID: 31206544 PMCID: PMC6576778 DOI: 10.1371/journal.pone.0213225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background More than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives. Materials and methods We conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices. Results The findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs. Conclusion The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level.
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Affiliation(s)
- Qamar Zaman Jamali
- Department of Health, Save the Children International, Islamabad, Pakistan
| | - Rashed Shah
- Department of Global Health, Save the Children US, Washington DC, United States of America
- * E-mail:
| | | | - Aisha Fatima
- Department of Health, Save the Children International, Islamabad, Pakistan
| | - Saraswati Khalsa
- Department of Global Health, Save the Children US, Washington DC, United States of America
| | - Jana Spacek
- Department of Global Health, Save the Children US, Washington DC, United States of America
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Schuler C, Ntow GE, Agbozo F. Mothers' Experiences with Neonatal Care for Low Birth Weight Infants at Home; A Qualitative Study in the Hohoe Municipality, Ghana. J Pediatr Nurs 2019; 45:e44-e52. [PMID: 30660426 DOI: 10.1016/j.pedn.2018.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To explore knowledge and beliefs of mothers on low birth weight (LBW), examine care provision at home and societal perceptions of LBW infants. DESIGN AND METHODS This qualitative study was conducted using hermeneutic phenomenological approach. Data of mothers who delivered LBW infants within 2 years preceding the study were purposively extracted from the medical records of the Hohoe Municipality Hospital in Ghana. Twenty semi-structured interviews and three focus group discussions were conducted. A thematic analysis approach was performed using Atlas.ti. RESULTS Mothers identified and described LBW babies based on frailty, size and activity levels. LBW recognition was easier for multiparous mothers by comparing with previous deliveries. LBW was linked to poor maternal diet, diseases during pregnancy and heavy workload. Although most mothers perceived their LBW babies as healthy irrespective of the size a few home-care practises differed. Smaller LBW infants were less likely to be socially accepted. In the first few weeks after birth the care of LBW infants is the core responsibility of grandmothers. Primiparous mothers and those whose infants were smaller (<2 kg) quested for more information and support on LBW newborn care at home. CONCLUSION There is a need to increase knowledge on risk factors and tackle lapses in the recognition and care of LBW infants. Counselling on recommended neonatal care should begin during antenatal care and reiterated during postnatal care. PRACTICAL IMPLICATION Tailored in-depth and culturally-adapted counselling, discharge instructions and home-based postnatal visits targeted at LBW infants and their primary caregivers could improve care.
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Affiliation(s)
- Christina Schuler
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana; Ghana Health and Education Initiative, Sefwi Bekwai, Ghana.
| | - George Edward Ntow
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana; Institute of Public Health, Medical Faculty, University of Heidelberg, Germany
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Watkins HC, Morgan MC, Nambuya H, Waiswa P, Lawn JE. Observation study showed that the continuity of skin-to-skin contact with low-birthweight infants in Uganda was suboptimal. Acta Paediatr 2018; 107:1541-1547. [PMID: 29603791 PMCID: PMC6120530 DOI: 10.1111/apa.14344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/17/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
Abstract
AIM Kangaroo mother care (KMC) is a safe and effective method of reducing neonatal mortality in resource-limited settings, but there has been a lack of data on the duration of skin-to-skin contact (SSC) in busy, low-resource newborn units. Previous studies of intermittent KMC suggest the duration of SSC ranged from 10 minutes to 17 hours per day. METHODS This was an observational study of newborn infants born weighing less than 2000 g, which collected quantitative data on SSC over the first week after birth. The study took place in July 2016 in the newborn unit of a low-resource facility in Uganda. RESULTS The mean daily duration of SSC over the first week after birth was three hours. This differed significantly from the World Health Organization recommendation of at least 20 hours of SSC per day. SSC was provided by mothers most of the time (73.5%), but other family members also took part, especially on the day of birth. CONCLUSION Our study found a disappointingly low daily duration of SSC in this Ugandan newborn unit. However, advocacy and community education of SSC may help to decrease the stigma of KMC, improve overall acceptance and reduce the age at SSC initiation.
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Affiliation(s)
- Heather C. Watkins
- Faculty of Public Health and PolicyLondon School of Hygiene & Tropical MedicineLondonUK
- The Centre for Maternal, Adolescent, Reproductive, and Child HealthLondon School of Hygiene & Tropical MedicineLondonUK
| | - Melissa C. Morgan
- The Centre for Maternal, Adolescent, Reproductive, and Child HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Harriet Nambuya
- Department of PaediatricsJinja Regional Referral HospitalJinjaUganda
| | - Peter Waiswa
- School of Public HealthMakerere UniversityKampalaUganda
- Division of Global HealthKarolinska InstitutetStockholmSweden
| | - Joy E. Lawn
- The Centre for Maternal, Adolescent, Reproductive, and Child HealthLondon School of Hygiene & Tropical MedicineLondonUK
- Faculty of Epidemiology and Population HealthLondon School of Hygiene & Tropical MedicineLondonUK
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Rasaily R, Ganguly KK, Roy M, Vani SN, Kharood N, Kulkarni R, Chauhan S, Swain S, Kanugo L. Community based kangaroo mother care for low birth weight babies: A pilot study. Indian J Med Res 2018; 145:51-57. [PMID: 28574014 PMCID: PMC5460573 DOI: 10.4103/ijmr.ijmr_603_15] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background & objectives: Kangaroo mother care (KMC - early continuous skin-to-skin contact between mother and infants) has been recommended as an alternative care for low birth weight infants. There is limited evidence in our country on KMC initiated at home. The present study was undertaken to study acceptability of KMC in different community settings. Methods: A community-based pilot study was carried out at three sites in the States of Odisha, Gujarat and Maharashtra covering rural, urban and rural tribal population, respectively. Trained health workers provided IEC (information, education and communication) on KMC during antenatal period along with essential newborn care messages. These messages were reinforced during the postnatal period. Outcome measures were the proportion of women accepting KMC, duration of KMC/day and total number of days continuing KMC. Focus group discussions and in-depth interviews were also carried out. Results: KMC was provided to 101 infants weighing 1500-2000 g; 57.4 per cent were preterm. Overall, 80.2 per cent mothers received health education on KMC during antenatal period, family members (68.3%) also attended KMC sessions along with pregnant women and 55.4 per cent of the women initiated KMC within 72 h of birth. KMC was provided on an average for five hours per day. Qualitative survey data indicated that the method was acceptable to mothers and family members; living in nuclear family, household work, twin pregnancy, hot weather, etc., were cited as reasons for not being able to practice KMC for a longer duration. Interpretation & conclusions: It was feasible to provide KMC using existing infrastructure, and the method was acceptable to most mothers of low birth infants.
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Affiliation(s)
- Reeta Rasaily
- Central Technical Coordinating Unit, Division of Reproductive Biology & Maternal Health & Child Health, Indian Council of Medical Research, New Delhi, India
| | - K K Ganguly
- Central Technical Coordinating Unit, Division of Reproductive Biology & Maternal Health & Child Health, Indian Council of Medical Research, New Delhi, India
| | - M Roy
- Central Technical Coordinating Unit, Division of Reproductive Biology & Maternal Health & Child Health, Indian Council of Medical Research, New Delhi, India
| | - S N Vani
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, India
| | - N Kharood
- Department of Paediatrics, Pramukhswami Medical College, Karamsad, India
| | - R Kulkarni
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - S Chauhan
- Department of Operational Research, ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - S Swain
- National Institute of Applied Human Research and Development, Cuttack, India
| | - L Kanugo
- National Institute of Applied Human Research and Development, Cuttack, India
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Koenraads M, Phuka J, Maleta K, Theobald S, Gladstone M. Understanding the challenges to caring for low birthweight babies in rural southern Malawi: a qualitative study exploring caregiver and health worker perceptions and experiences. BMJ Glob Health 2017; 2:e000301. [PMID: 29082008 PMCID: PMC5656136 DOI: 10.1136/bmjgh-2017-000301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) babies account for >80% of neonatal mortality in sub-Saharan Africa and South Asia and those who survive the neonatal period are still at risk of detrimental outcomes. LBW is a major public health problem in Malawi and strongly contributes to the country's high neonatal mortality rate. We aimed to get a better understanding of the care of LBW babies in rural Malawi in order to inform action to improve their outcomes. METHODS Qualitative methods were used to identify challenges faced by caregivers and health workers within communities and at the rural facility level. We conducted 33 in-depth interviews (18 with caregivers; 15 with health workers) and 4 focus group discussions with caregivers. Interviews were recorded, transcribed and translated. Thematic analysis was used to index the data into themes and develop a robust analytical framework. RESULTS Caregivers referred to LBW babies as weak, with poor health, stunted growth, developmental problems and lack of intelligence. Poor nutrition of the mother and illnesses during pregnancy were perceived to be important causes of LBW. Discrimination and stigma were described as a major challenge faced by carers of LBW babies. Problems related to feeding and the high burden of care were seen as another major challenge. Health workers described a lack of resources in health facilities, lack of adherence to counselling provided to carers and difficulties with continuity of care and follow-up in the community. CONCLUSION This study highlights that care of LBW babies in rural Malawi is compromised both at community and rural facility level with poverty and existing community perceptions constituting the main challenges. To make progress in reducing neonatal mortality and promoting better outcomes, we must develop integrated community-based care packages, improve care at facility level and strengthen the links between them.
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Affiliation(s)
- Marianne Koenraads
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - John Phuka
- Department of Community Health, University of Malawi, Zomba, Malawi
| | - Kenneth Maleta
- Department of Public Health, School of Public Health and Family Medicine, University of Malawi, Zomba, Malawi
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Melissa Gladstone
- Department of Women and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Callaghan‐Koru JA, Estifanos AS, Sheferaw ED, Graft‐Johnson J, Rosado C, Patton‐Molitors R, Worku B, Rawlins B, Baqui A. Practice of skin-to-skin contact, exclusive breastfeeding and other newborn care interventions in Ethiopia following promotion by facility and community health workers: results from a prospective outcome evaluation. Acta Paediatr 2016; 105:e568-e576. [PMID: 27644765 DOI: 10.1111/apa.13597] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/23/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
Abstract
AIM To assess the effects of a facility and community newborn intervention package on coverage of early skin-to-skin contact (SSC) and exclusive breastfeeding - the therapeutic components of kangaroo mother care. METHODS A multilevel community and facility intervention in Ethiopia trained health workers in 10 health centres and the surrounding communities to promote early SSC and exclusive breastfeeding for all babies born at home or in the facility. Changes in SSC and exclusive breastfeeding were assessed by comparing baseline and endline household surveys. RESULTS Overall practice of SSC at any time following delivery increased significantly from 13.1 to 44.1% of mothers. Coverage of immediate SSC also increased significantly from 8.4 to 24.1%. Breastfeeding within the first hour increased from 51.4 to 67.9% and exclusive breastfeeding within the first three days increased from 86 to 95.8%. At endline, SSC was significantly higher among facility births than home births and community health workers had limited contact with mothers. CONCLUSION While targeted behaviours improved overall, the programme did not achieve adequate increases in SSC and exclusive breastfeeding among home deliveries to expect a reduction in mortality for low birthweight babies. Newborn care programs in Ethiopia should continue to encourage facility delivery while strengthening coverage of community programmes.
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Affiliation(s)
- Jennifer A. Callaghan‐Koru
- Department of Sociology, Anthropology, and Health Administration and Policy University of Maryland Baltimore County Baltimore MD USA
- International Center for Maternal and Newborn Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
- Maternal and Child Health Integrated Program Washington DC USA
| | - Abiy Seifu Estifanos
- Department of Reproductive Health and Health Service Management School of Public Health College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | | | | | - Carina Rosado
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Rachel Patton‐Molitors
- Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
| | - Bogale Worku
- Department of Pediatrics Addis Ababa University Addis Ababa Ethiopia
| | - Barbara Rawlins
- Maternal and Child Health Integrated Program Washington DC USA
| | - Abdullah Baqui
- International Center for Maternal and Newborn Health Department of International Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
- Maternal and Child Health Integrated Program Washington DC USA
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Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016; 11:CD003519. [PMID: 27885658 PMCID: PMC6464366 DOI: 10.1002/14651858.cd003519.pub4] [Citation(s) in RCA: 324] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior. OBJECTIVES To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials that compared immediate or early SSC with usual hospital care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact). AUTHORS' CONCLUSIONS Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.
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Affiliation(s)
- Elizabeth R Moore
- Vanderbilt UniversitySchool of Nursing314 Godchaux Hall21st Avenue SouthNashvilleTennesseeUSA37240‐0008
| | - Nils Bergman
- University of Cape TownSchool of Child and Adolescent Health, and Department of Human BiologyCape TownSouth Africa
| | - Gene C Anderson
- Professor Emerita, University of FloridaCase Western Reserve UniversityOak Hammock at the University of Florida5000 SW 25th Boulevard #2108GainesvilleFLUSA32608‐8901
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics 2016; 137:peds.2015-2238. [PMID: 26702029 PMCID: PMC4702019 DOI: 10.1542/peds.2015-2238] [Citation(s) in RCA: 331] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns. OBJECTIVE Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. DATA SOURCES PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). STUDY SELECTION We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. DATA EXTRACTION Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures. RESULTS 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. LIMITATIONS Lack of data on KMC limited the ability to assess dose-response. CONCLUSIONS Interventions to scale up KMC implementation are warranted.
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Affiliation(s)
| | | | - Donna Spiegelman
- Departments of Epidemiology,,Biostatistics, and,Departments of Global Health and Population, and
| | - Wafaie W. Fawzi
- Departments of Epidemiology,,Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;,Departments of Global Health and Population, and
| | - Stacey A. Missmer
- Departments of Epidemiology,,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ellice Lieberman
- Departments of Epidemiology,,Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts;,Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Grace J. Chan
- Departments of Global Health and Population, and,Save the Children, Washington, DC; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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14
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Chan GJ, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bull World Health Organ 2015; 94:130-141J. [PMID: 26908962 PMCID: PMC4750435 DOI: 10.2471/blt.15.157818] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/17/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate factors influencing the adoption of kangaroo mother care in different contexts. METHODS We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization's regional databases, for studies on "kangaroo mother care" or "kangaroo care" or "skin-to-skin care" from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems. FINDINGS We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption. CONCLUSION Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake.
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Affiliation(s)
- Grace J Chan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Amy S Labar
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
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15
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Seidman G, Unnikrishnan S, Kenny E, Myslinski S, Cairns-Smith S, Mulligan B, Engmann C. Barriers and enablers of kangaroo mother care practice: a systematic review. PLoS One 2015; 10:e0125643. [PMID: 25993306 PMCID: PMC4439040 DOI: 10.1371/journal.pone.0125643] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 03/24/2015] [Indexed: 11/19/2022] Open
Abstract
Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: "Issues with the facility environment / resources," "negative impressions of staff attitudes or interactions with staff," "lack of help with KMC practice or other obligations," and "low awareness of KMC / infant health." Considering only publications from low- and middle-income countries, "pain / fatigue" was ranked higher than when considering all publications. Top enablers to practice were included "mother-infant attachment" and "support from family, friends, and other mentors." Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.
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Affiliation(s)
- Gabriel Seidman
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Emma Kenny
- Boston Consulting Group, New York City, New York, United States of America
| | - Scott Myslinski
- Boston Consulting Group, Boston, Massachusetts, United States of America
| | - Sarah Cairns-Smith
- Boston Consulting Group, Boston, Massachusetts, United States of America
| | - Brian Mulligan
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Cyril Engmann
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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Bloch-Salisbury E, Zuzarte I, Indic P, Bednarek F, Paydarfar D. Kangaroo care: cardio-respiratory relationships between the infant and caregiver. Early Hum Dev 2014; 90:843-50. [PMID: 25463830 DOI: 10.1016/j.earlhumdev.2014.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 08/15/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kangaroo care, i.e., skin-to-skin cohabitation (SSC) between an infant and caregiver, is often used in neonatal intensive care units to promote bonding, breastfeeding and infant growth. The direct salutary effects of SSC on cardio-respiratory control in preterm infants remain equivocal; some reports suggest improved breathing stability, others indicate worsening of apnea, bradycardia and hypoxemia. AIM The purpose of this study was to investigate physiological relationships between the infant and caregiver during SSC. We hypothesized that respiratory stability of the premature infant is influenced by the caregiver's heartbeat. DESIGN A prospective study was performed in eleven preterm infants (6 female; mean PCA 32 wks). SSC was compared to a preceding incubator-control period (CTL) matched for time from feed and condition duration. Abdominal respiratory movement, electrocardiogram, skin temperature and blood-oxygen levels were recorded from the infant and the caregiver. RESULTS During CTL, infant interbreath interval variance (IBIv; respiratory instability) was directly related to its own heart rate variance (HRv; rho=0.770, p=0.009). During SSC, infant IBIv and apnea incidence were each related to caregiver HRv (rho 0.764, p=0.006; rho 0.677, p=0.022, respectively). Infant cardio-respiratory coupling was also enhanced during SSC compared to CTL in the eupneic frequency range (0.7-1.5 Hz, p=0.018) and reduced for slower frequencies (0.15-0.45 Hz; p=0.036). CONCLUSION These findings suggest that during SSC, respiratory control of the premature infant is influenced by the caregiver's cardiac rhythm. We propose that the caregiver's heartbeat causes sensory perturbations of the infant via somatic or other afferents, revealing a novel cohabitation-induced feed-back mechanism of respiratory control in the neonate.
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Affiliation(s)
- Elisabeth Bloch-Salisbury
- Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Ian Zuzarte
- Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Premananda Indic
- Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Francis Bednarek
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - David Paydarfar
- Department of Neurology University of Massachusetts Medical School, Worcester, MA 01655, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
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Hunter EC, Callaghan-Koru JA, Al Mahmud A, Shah R, Farzin A, Cristofalo EA, Akhter S, Baqui AH. Newborn care practices in rural Bangladesh: Implications for the adaptation of kangaroo mother care for community-based interventions. Soc Sci Med 2014; 122:21-30. [PMID: 25441314 DOI: 10.1016/j.socscimed.2014.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 01/21/2023]
Abstract
Bangladesh has one of the world's highest rates of low birth weight along with prevalent traditional care practices that leave newborns highly vulnerable to hypothermia, infection, and early death. We conducted formative research to explore existing newborn care practices in rural Bangladesh with an emphasis on thermal protection, and to identify potential facilitators, barriers, and recommendations for the community level delivery of kangaroo mother care (CKMC). Forty in-depth interviews and 14 focus group discussions were conducted between September and December 2012. Participants included pregnant women and mothers, husbands, maternal and paternal grandmothers, traditional birth attendants, village doctors, traditional healers, pharmacy men, religious leaders, community leaders, and formal healthcare providers. Audio recordings were transcribed and translated into English, and the textual data were analyzed using the Framework Approach. We find that harmful newborn care practices, such as delayed wrapping and early initiation of bathing, are changing as more biomedical advice from formal healthcare providers is reaching the community through word-of-mouth and television campaigns. While the goal of CKMC was relatively easily understood and accepted by many of the participants, logistical and to a lesser extent ideological barriers exist that may keep the practice from being adopted easily. Women feel a sense of inevitable responsibility for household duties despite the desire to provide the best care for their new babies. Our findings showed that participants appreciated CKMC as an appropriate treatment method for ill babies, but were less accepting of it as a protective method of caring for seemingly healthy newborns during the first few days of life. Participants highlighted the necessity of receiving help from family members and witnessing other women performing CKMC with positive outcomes if they are to adopt the behavior themselves. Focusing intervention messages on building a supportive environment for CKMC practice will be critical for the intervention's success.
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Affiliation(s)
- Erin C Hunter
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Jennifer A Callaghan-Koru
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E8608, Baltimore, MD 21205, USA.
| | - Abdullah Al Mahmud
- Centre for Child and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh.
| | - Rashed Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Azadeh Farzin
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 8513-8S, Baltimore, MD 21287, USA.
| | - Elizabeth A Cristofalo
- Department of Pediatrics, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 8513B-8S, Baltimore, MD 21287, USA.
| | - Sadika Akhter
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh.
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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Pagel C, Prost A, Hossen M, Azad K, Kuddus A, Roy SS, Nair N, Tripathy P, Saville N, Sen A, Sikorski C, Manandhar DS, Costello A, Crowe S. Is essential newborn care provided by institutions and after home births? Analysis of prospective data from community trials in rural South Asia. BMC Pregnancy Childbirth 2014; 14:99. [PMID: 24606612 PMCID: PMC4016384 DOI: 10.1186/1471-2393-14-99] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/24/2014] [Indexed: 11/10/2022] Open
Abstract
Background Provision of essential newborn care (ENC) can save many newborn lives in poor resource settings but coverage is far from universal and varies by country and place of delivery. Understanding gaps in current coverage and where coverage is good, in different contexts and places of delivery, could make a valuable contribution to the future design of interventions to reduce neonatal mortality. We sought to describe the coverage of essential newborn care practices for births in institutions, at home with a skilled birth attendant, and at home without a skilled birth attendant (SBA) in rural areas of Bangladesh, Nepal, and India. Methods We used data from the control arms of four cluster randomised controlled trials in Bangladesh, Eastern India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used these data to identify essential newborn care practices as defined by the World Health Organization. Each birth was allocated to one of three delivery types: home birth without an SBA, home birth with an SBA, or institutional delivery. For each study, we calculated the observed proportion of births that received each care practice by delivery type with 95% confidence intervals, adjusted for clustering and, where appropriate, stratification. Results After exclusions, we analysed data for 8939 births from Eastern India, 27 553 births from Bangladesh, 6765 births from Makwanpur and 15 344 births from Dhanusha. Across all study areas, coverage of essential newborn care practices was highest in institutional deliveries, and lowest in home non-SBA deliveries. However, institutional deliveries did not provide universal coverage of the recommended practices, with relatively low coverage (20%-70%) across all study areas for immediate breastfeeding and thermal care. Institutions in Bangladesh had the highest coverage for almost all care practices except thermal care. Across all areas, fewer than 20% of home non-SBA deliveries used a clean delivery kit, the use of plastic gloves was very low and coverage of recommended thermal care was relatively poor. There were large differences between study areas in handwashing, immediate breastfeeding and delayed bathing. Conclusions There remains substantial scope for health facilities to improve thermal care for the newborn and to encourage immediate and exclusive breastfeeding. For unattended home deliveries, increased handwashing, use of clean delivery kits and basic thermal care offer great scope for improvement.
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Affiliation(s)
- Christina Pagel
- Clinical Operational Research Unit, University College London, 4 Taviton Street, London WC1H 0BT, UK.
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Affiliation(s)
- Betty Kirkwood
- Maternal and Child Health Intervention Research Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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