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Nyandiko WM, Kiptoon P, Lubuya FA. Neonatal hypothermia and adherence to World Health Organisation thermal care guidelines among newborns at Moi Teaching and Referral Hospital, Kenya. PLoS One 2021; 16:e0248838. [PMID: 33755686 PMCID: PMC7987163 DOI: 10.1371/journal.pone.0248838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 03/05/2021] [Indexed: 12/02/2022] Open
Abstract
Neonatal hypothermia is a great concern with near epidemic levels globally. In Kenya, its prevalence is as high as 87% with limited local data on the associated factors such as adherence to warm chain guidelines as recommended by the World Health Organisation (WHO) is limited. This study aimed to determine the prevalence of hypothermia and level of adherence to the WHO thermal care guidelines among newborns admitted at Moi Teaching and Referral Hospital (MTRH). It adopted a prospective study design of following up neonates for the first 24 hours of admission to the MTRH newborn unit. Thermometry, interview of mothers and observation of thermal care practices was done. Descriptive and inferential statistical techniques were adopted. Specifically, Pearson's chi-square test of associations between predictors of neonatal hypothermia and management outcomes was conducted with their corresponding risk estimates at 95% confidence interval. Among the 372 participants, 64.5% (n = 240) were born at MTRH, 47.6% (177) were preterm and 53.2% (198) had birth weights below 2500 grams. Admission hypothermia was noted among 73.7% (274) and 13% (49) died on the first day of admission. Only 7.8% (29) newborns accessed optimal thermal care. Prematurity, day one mortality and adherence to the warm chain were significantly (p<0.001) associated with admission hypothermia. Inappropriate thermal appliance, inadequate clothing and late breastfeeding significantly increased the risk of neonatal hypothermia. Absence of admission hypothermia increased the likelihood of neonatal survival more than twenty-fold (AOR = 20.91, 95% CI: 2.15-153.62). Three out four neonates enrolled had admission hypothermia which was significantly associated with prematurity, lack of adherence to warm chain and increased risk of neonatal mortality on the first day of life. There was low adherence to the WHO thermal care guidelines. This should be optimized among preterm neonates to improve likelihood of survival.
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Affiliation(s)
- Winstone Mokaya Nyandiko
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paul Kiptoon
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
| | - Florence Ajaya Lubuya
- Department of Child Health and Paediatrics, Moi University College of Health Science, Eldoret, Kenya
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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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Abdallah Y, Namiiro F, Nankunda J, Mugalu J, Vaucher Y. Mortality among very low birth weight infants after hospital discharge in a low resource setting. BMC Pediatr 2018; 18:239. [PMID: 30031387 PMCID: PMC6054841 DOI: 10.1186/s12887-018-1226-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 07/18/2018] [Indexed: 11/14/2022] Open
Abstract
Background Early discharge of very low birth weight infant (VLBW) in low resource settings is inevitable but to minimize mortality of these infants after discharge we need to identify the death attributes. Method A prospective cohort was conducted among 190 VLBW infants discharged from Mulago Special Care Baby Unit (SCBU) with discharge weight of < 1500 g over an 8 months period. These infants were followed up with the aims of determining the proportion dead 3 months after discharge, identifying factors associated and possible causes of death. Relevant data were captured, transferred in to STATA and imported to SPSS 12.0.1 for analysis. To determine factors associated with mortality bi-variable and multivariable regressions were conducted. A p-value of < 0.05 was considered significant and 95% confidence interval was used. Results Of the enrolled infants 164 (86.3%) completed follow up. The median gestational age of study participants was 32 weeks (range 26-35 weeks), the mean discharge weight was 1119 g (range 760-1470 g), and 59.8% were small for gestational age (SGA). During follow up 32 (19.5%) infants died. Infants discharged with weight of < 1200 g accounted for 81.2% of the deaths. Majority of the deaths (68.7%) occurred in the first month after discharge. Factors independently associated with mortality were discharge weight < 1000 g (OR 3.10, p 0.015) and not being SGA (OR 3.54, p 0.019). The main causes of death were presumed sepsis 50.0% and suspected cot death (25.0%). Conclusion Mortality after hospital discharge among VLBW infants is high. Discharge at weight < 1200 g may not be a safe practice. Measures to prevent sepsis and suspected cot death should be addressed prior to considering early discharge of these infants.
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Affiliation(s)
- Yaser Abdallah
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
| | - Flavia Namiiro
- Department of Paediatrics and Child Health, Mulago National Referral hospital, Kampala, Uganda
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, Mulago National Referral hospital, Kampala, Uganda
| | - Jamiru Mugalu
- Department of Paediatrics and Child Health, Mulago National Referral hospital, Kampala, Uganda
| | - Yvonne Vaucher
- Department of Pediatrics, Division of Neonatal/Perinatal Medicine, School of Medicine, University of California, San Diego, USA
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Smith ER, Bergelson I, Constantian S, Valsangkar B, Chan GJ. Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives. BMC Pediatr 2017; 17:35. [PMID: 28122592 PMCID: PMC5267363 DOI: 10.1186/s12887-016-0769-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite improvements in child survival in the past four decades, an estimated 6.3 million children under the age of five die each year, and more than 40% of these deaths occur in the neonatal period. Interventions to reduce neonatal mortality are needed. Kangaroo mother care (KMC) is one such life-saving intervention; however it has not yet been fully integrated into health systems around the world. Utilizing a conceptual framework for integration of targeted health interventions into health systems, we hypothesize that caregivers play a critical role in the adoption, diffusion, and assimilation of KMC. The objective of this research was to identify barriers and enablers of implementation and scale up of KMC from caregivers’ perspective. Methods We searched Pubmed, Embase, Web of Science, Scopus, and WHO regional databases using search terms ‘kangaroo mother care’ or ‘kangaroo care’ or ‘skin to skin care’. Studies published between January 1, 1960 and August 19, 2015 were included. To be eligible, published work had to be based on primary data collection regarding barriers or enablers of KMC implementation from the family perspective. Abstracted data were linked to the conceptual framework using a deductive approach, and themes were identified within each of the five framework areas using Nvivo software. Results We identified a total of 2875 abstracts. After removing duplicates and ineligible studies, 98 were included in the analysis. The majority of publications were published within the past 5 years, had a sample size less than 50, and recruited participants from health facilities. Approximately one-third of the studies were conducted in the Americas, and 26.5% were conducted in Africa. We identified four themes surrounding the interaction between families and the KMC intervention: buy in and bonding (i.e. benefits of KMC to mothers and infants and perceptions of bonding between mother and infant), social support (i.e. assistance from other people to perform KMC), sufficient time to perform KMC, and medical concerns about mother or newborn health. Furthermore, we identified barriers and enablers of KMC adoption by caregivers within the context of the health system regarding financing and service delivery. Embedded within the broad social context, barriers to KMC adoption by caregivers included adherence to traditional newborn practices, stigma surrounding having a preterm infant, and gender roles regarding childcare. Conclusion Efforts to scale up and integrate KMC into health systems must reduce barriers in order to promote the uptake of the intervention by caregivers.
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Affiliation(s)
- Emily R Smith
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA.
| | - Ilana Bergelson
- Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Stacie Constantian
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA
| | - Bina Valsangkar
- Saving Newborn Lives, Save the Children, Washington, D.C., USA
| | - Grace J Chan
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., Building 1, Boston, MA, 02115, USA.,Division of Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
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White-Traut R, Wink T, Minehart T, Holditch-Davis D. Frequency of Premature Infant Engagement and Disengagement Behaviors During Two Maternally Administered Interventions. ACTA ACUST UNITED AC 2012; 12:124-131. [PMID: 22984346 DOI: 10.1053/j.nainr.2012.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although sensitive maternal behaviors improve later quality of mother-infant interaction and subsequently infant development, little is known regarding how an intervention might promote early premature infant social interactive behavior. This study compared the frequency of premature infant engagement and disengagement behaviors during two maternally administered interventions, the multi-sensory auditory, tactile, visual and vestibular intervention (ATVV) and kangaroo care (KC) for 26 infants between 31 and 46 weeks PMA. The ATVV intervention elicited more disengagement (M = 24 vs. 12, p = .0003), trended toward more engagement (M = 21 vs. 15.7, p = .06) and more potent engagement (M = 24 vs. 12, p = .0003), subtle disengagement (M = 25 vs. 11.9, p < .0001), and potent disengagement (M = 22.9 vs. 14, p = . 006) behaviors than did KC. The ATVV intervention may be an intervention to promote the infant's learning how to regulate engagement and disengagement behaviors.
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Affiliation(s)
- Rosemary White-Traut
- Dr. Rosemary White-Traut, University of Illinois at Chicago College of Nursing, Department Head of Women, Children, and Family Health Science, 845 South Damen Avenue (M/C 802), Chicago, IL 60612-7350
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Blencowe H, Kerac M, Molyneux E. Safety, effectiveness and barriers to follow-up using an 'early discharge' Kangaroo Care policy in a resource poor setting. J Trop Pediatr 2009; 55:244-8. [PMID: 19208684 DOI: 10.1093/tropej/fmn116] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To describe the outcomes of low-birth-weight babies using an 'early discharge' Kangaroo care policy and to identify barriers to their follow-up. METHODS Prospective descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004. Infants were discharged to outpatient care once weighing over 1300 g and gaining weight. Follow-up was carried out until 2500 g. RESULTS Infants [201 of 272 (73.9%)] reached a weight >2500 g; 46 out of 272 (16.9%) died; outcome was unknown in 25 of 272 (9.2%). Outpatient mortality was higher amongst discharges weighing under 1500 g [RR = 2.41(1.25-4.63) P = 0.01]. Discharge below birth weight did not affect mortality [RR = 0.77(0.40-1.46) P = 0.42]. Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness. CONCLUSIONS Early discharge is safe and feasible, but issues regarding access to healthcare need to be addressed. Future research is needed to determine how best high mortality can be reduced in specific subgroups: notably infants <1500 g.
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Affiliation(s)
- Hannah Blencowe
- College of Medicine of Malawi, Paediatric Department, P/Bag 360, Blantyre, Malawi.
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Abstract
Estudo de natureza qualitativa, cujo objetivo é o de identificar o conhecimento que vem sendo produzido e veiculado a respeito do Método Mãe-Canguru (MMC). Foi realizada uma incursão pela literatura, a partir das bases de dados Medline e Lilacs, assim como busca direta aos principais periódicos de enfermagem, durante o período de 1995 a 2004. Foram selecionados 85 artigos, posteriormente catalogados e submetidos à categorização. Após análise dos artigos, foram extraídas quatro categorias sobre a temática. Os resultados levaram à conclusão de que apesar do MMC estar configurando-se como uma mudança paradigmática no cuidado ao recém-nascido, não há total correspondência com a produção teórica, levando a que a prática seja desenvolvida, muitas vezes, sem a devida sustentação teórica. Esta lacuna de conhecimentos dificulta, inclusive, uma adequada avaliação desta prática com relação ao recémnascido e sua família, mas principalmente no que diz respeito à aplicação do MMC junto à equipe neonatal.
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Charpak N, Ruiz JG, Zupan J, Cattaneo A, Figueroa Z, Tessier R, Cristo M, Anderson G, Ludington S, Mendoza S, Mokhachane M, Worku B. Kangaroo Mother Care: 25 years after. Acta Paediatr 2005; 94:514-22. [PMID: 16188735 DOI: 10.1111/j.1651-2227.2005.tb01930.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infant's cognitive development. CONCLUSION Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.
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