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Li J, Wang H, Yang J, Chen X, Cao A, Yang C, Xiong X. Kangaroo mother care enhances exclusive breastmilk feeding and shortens time to achieve full enteral feeding in extremely preterm infants requiring non-invasive assisted ventilation. Int Breastfeed J 2024; 19:52. [PMID: 39085931 PMCID: PMC11292878 DOI: 10.1186/s13006-024-00662-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/28/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Extremely preterm infants (EPIs) frequently encounter challenges in feeding due to their underdeveloped digestive systems. Attaining full enteral feeding at the earliest possible stage can facilitate the removal of vascular catheters and decrease catheter-related complications. METHODS We performed a retrospective cohort study comprising 145 extremely preterm infants with a gestational age < 28 weeks who underwent non-invasive mechanical ventilation at Shenzhen Maternity & Child Healthcare Hospital between January 2019 and June 2020. The KMC group received standard nursing care along with KMC, while the control group received standard nursing care without KMC. KMC initiation took place three weeks after admission and continued for a period of two weeks or more while maintaining stable vital signs. We evaluated the rate of exclusive breastmilk feeding within 24 h prior to discharge and the time to full enteral feeding throughout hospitalization. Additionally, we conducted a multiple linear regression analysis to identify the independent factors associated with exclusive breastmilk feeding rates and the time to full enteral feeding. RESULTS The KMC group exhibited a significantly higher rate of exclusive breastmilk feeding in the 24 h before discharge in comparison to the Non-KMC group (52.8% vs. 31.5%, OR 2.43; 95% CI 1.24, 4.78). Moreover, the KMC group achieved full enteral feeding in a shorter duration than the Non-KMC group (43.1 ± 9.6 days vs. 48.7 ± 6.9 days, p < 0.001). Multiple linear regression analysis revealed that KMC was an independent protective factor associated with improved exclusive breastmilk feeding rates (OR 2.43; 95% CI 1.24, 4.78) and a reduction in the time to full enteral feeding (β -5.35, p < 0.001) in extremely preterm infants. CONCLUSION Kangaroo Mother Care (KMC) can expedite the achievement of full enteral feeding and enhance exclusive breastmilk feeding rates in extremely preterm infants receiving non-invasive assisted ventilation. These findings highlight the beneficial effects of KMC on the feeding outcomes of this vulnerable population, underscoring the importance of implementing KMC as a part of comprehensive care for extremely preterm infants.
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Affiliation(s)
- Jiaxin Li
- College of Nursing, Shanxi University of Chinese medicine, Jinzhong, 030619, China
| | - Huiyan Wang
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Jiaming Yang
- College of Nursing, Shanxi University of Chinese medicine, Jinzhong, 030619, China
| | - Xueyu Chen
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Aifen Cao
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Chuanzhong Yang
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Xiaoyun Xiong
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China.
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Tumukunde VS, Katongole J, Namukwaya S, Medvedev MM, Nyirenda M, Tann CJ, Seeley J, Lawn JE. Kangaroo mother care prior to clinical stabilisation: Implementation barriers and facilitators reported by caregivers and healthcare providers in Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002856. [PMID: 39083500 PMCID: PMC11290675 DOI: 10.1371/journal.pgph.0002856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
Kangaroo mother care (KMC) is an evidence-based method to improve newborn survival. However, scale-up even for stable newborns has been slow, with reported barriers to implementation. We examined facilitators and barriers to initiating KMC before stabilisation amongst neonates recruited to the OMWaNA study in Uganda. The OMWaNA study was a randomised controlled trial that examined the mortality effect of KMC prior to stabilisation amongst newborns weighing ≤2000 grams. At the four trial hospitals, we conducted focus group discussions (FGD) separately with caregivers and healthcare providers, in-depth interviews (IDI) with caregivers and key informant interviews (KII) with hospital administrators and healthcare providers. The World Health Organisation (WHO) Health Systems Building Blocks were used to guide thematic analysis. Eight FGDs (4 caregivers, 4 healthcare providers), 41 caregiver IDIs (26 mothers, 8 grandmothers, 7 fathers), and 23 KIIs were conducted. Key themes based on the building blocks were; family and community support/ involvement, health workforce, medical supplies and commodities, infrastructure and design, financing, and health facility leadership. We found that the presence of a family member in the hospital, adequate provision of healthcare workers knowledgeable in supporting KMC prior to stability, and adequate space for KMC beds where neonatal care is being delivered, can enable implementation of KMC before stability. Implementation barriers included fear of inadvertently causing harm to the newborn, inadequate space to practice KMC in the neonatal unit, and a limited number of trained healthcare workers coupled with insufficient medical supplies.
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Affiliation(s)
- Victor S. Tumukunde
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stella Namukwaya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Melissa M. Medvedev
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of California San Francisco, San Francisco, California, United States of America
| | - Moffat Nyirenda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Cally J. Tann
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Neonatal Medicine, University College London, London, United Kingdom
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joy E. Lawn
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Paediatrics, University of California San Francisco, San Francisco, California, United States of America
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Ribeiro AL, Costa MFP, Silva PYF, Lima RO, Bezerra RB, Bezerra IFD, Torres VB, Alvarez CDDL, Azevedo IG, Pereira SA. Effects of the use of a cocoon on the autonomic, motor, and regulatory systems in preterm newborns: Randomized clinical trial. Arch Pediatr 2024; 31:250-255. [PMID: 38538471 DOI: 10.1016/j.arcped.2024.01.005] [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: 07/11/2023] [Revised: 11/04/2023] [Accepted: 01/05/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The wrapping of the newborn in an orthopedic tubular mesh, simulating a cocoon, can allow the infant to regain the feeling of security and stability experienced in the uterus given that the movement of one of the parts of the body exerts tactile and pressure variation in others. OBJECTIVE We aimed to evaluate the influence of an orthopedic tubular mesh, simulating a cocoon, in therapeutic positioning, on the variables of the autonomous, motor, and regulatory systems of preterm newborns. METHODS A controlled and randomized clinical trial was conducted with preterm newborns positioned in dorsal decubitus and divided into two groups: (a) cocoon - newborns covered with an orthopedic tubular mesh, and (b) control - newborns positioned according to the sector's routine and without the use of an orthopedic mesh. During the follow-up, each newborn was placed in the position for 30 min and was recorded for a total of 2 min, once at the beginning and again at the end of the observation period. Variables related to the autonomous system (heart rate, respiratory rate, and peripheral oxygen saturation), motor system (general movements), and regulatory system (Neonatal Infant Pain Scale) were evaluated before and after the intervention. The videos were evaluated by a researcher blind to the purpose of the study, and the resulting data were analyzed using SPSS. RESULTS Of the 40 preterm newborns evaluated (32.5 ± 1.83 weeks), 21 were female, and 20 were allocated to the cocoon group. The variables related to the autonomous, motor, and regulatory systems remained unchanged following the positioning in the cocoon, as compared to the typical positioning employed in the neonatal unit. CONCLUSION The simulation of a cocoon, utilizing an orthopedic tubular mesh, when applied to preterm newborns admitted to a neonatal intensive care unit can contribute to maintaining low levels of stress, without altering variables of the autonomous, motor, and regulatory systems.
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Affiliation(s)
- Anni Lima Ribeiro
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Mayara Fabiana Pereira Costa
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Pedro Ykaro Fialho Silva
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Rayane Oliveira Lima
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Ruth Batista Bezerra
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | | | - Vanessa Braga Torres
- Januário Cicco Maternity School, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil
| | | | - Ingrid Guerra Azevedo
- Academic Vicerectory, Catholic University of Temuco, Rudecindo Ortega 03694, Edificio EDI 2 Piso, Manuel Montt 56, Temuco, La Araucanía, Chile
| | - Silvana Alves Pereira
- Department of Physical Therapy, Federal University of Rio Grande do Norte, UFRN, Natal, Rio Grande do Norte, Brazil.
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Bhuiya NA, Liu S, Muyodi D, Bucher SL. Feasibility and acceptability of a novel biomedical device to prevent neonatal hypothermia and augment Kangaroo Mother Care in Kenya: Qualitative analysis of focus group discussions and key Informant Interviews. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0001708. [PMID: 38626201 PMCID: PMC11020951 DOI: 10.1371/journal.pgph.0001708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/17/2024] [Indexed: 04/18/2024]
Abstract
Hypothermia is a leading newborn complication, especially among premature and/or low birth weight infants. Within low/middle-income countries where incubators and radiant warmers are often in short supply, leading to gaps in the thermal care chain, neonatal hypothermia underlies high rates of newborn morbidity and mortality. Kangaroo Mother Care/Skin-to-skin care is an effective method for prevention of hypothermia in premature and low birthweight babies but can be very burdensome for families and healthcare providers. Our international multidisciplinary team has developed a prototype for a wearable biomedical device ("NeoWarm") to provide continuous thermal care and augment kangaroo mother care practices in low-resource settings. The objective of this study was to assess the feasibility and acceptability of NeoWarm and to obtain user design feedback for an early prototype from among adult end-users in Western Kenya. We performed key informant interviews (n = 17) among healthcare providers and 5 focus group discussions (FGDs) among 3 groups of adult stakeholders of premature babies, including: (1) parents/family members of premature babies aged 6 weeks or less (3 FGDs); (2) healthcare providers of newborns (e.g., nurses; physicians; 1 FGD); (3) community opinion leaders and stakeholders (e.g., traditional birth attendants; pastors; village elders; 1 FGD). Content and thematic analyses of transcripts indicate that NeoWarm is acceptable and feasible in promoting facility-based kangaroo mother care in the Kenyan setting. Novel findings derived from respondents include (1) the ability of the device to potentially overcome several barriers to traditional kangaroo mother care methods and (2) user-driven encouragement to expand the use case of the device to potentially include community-based kangaroo mother care and neonatal transport. User design feedback obtained during the interviews informed several key design iterations for subsequent prototypes of the device.
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Affiliation(s)
- Nudar A. Bhuiya
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Scott Liu
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - David Muyodi
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sherri L. Bucher
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University—Indianapolis and Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Bluhm NDP, Tomlin GM, Hoilett OS, Lehner EA, Walters BD, Pickering AS, Bautista KA, Bucher SL, Linnes JC. Preclinical validation of NeoWarm, a low-cost infant warmer and carrier device, to ameliorate induced hypothermia in newborn piglets as models for human neonates. Front Pediatr 2024; 12:1378008. [PMID: 38633325 PMCID: PMC11021732 DOI: 10.3389/fped.2024.1378008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Approximately 1.5 million neonatal deaths occur among premature and small (low birthweight or small-for gestational age) neonates annually, with a disproportionate amount of this mortality occurring in low- and middle-income countries (LMICs). Hypothermia, the inability of newborns to regulate their body temperature, is common among prematurely born and small babies, and often underlies high rates of mortality in this population. In high-resource settings, incubators and radiant warmers are the gold standard for hypothermia, but this equipment is often scarce in LMICs. Kangaroo Mother Care/Skin-to-skin care (KMC/STS) is an evidence-based intervention that has been targeted for scale-up among premature and small neonates. However, KMC/STS requires hours of daily contact between a neonate and an able adult caregiver, leaving little time for the caregiver to care for themselves. To address this, we created a novel self-warming biomedical device, NeoWarm, to augment KMC/STS. The present study aimed to validate the safety and efficacy of NeoWarm. Methods Sixteen, 0-to-5-day-old piglets were used as an animal model due to similarities in their thermoregulatory capabilities, circulatory systems, and approximate skin composition to human neonates. The piglets were placed in an engineered cooling box to drop their core temperature below 36.5°C, the World Health Organizations definition of hypothermia for human neonates. The piglets were then warmed in NeoWarm (n = 6) or placed in the ambient 17.8°C ± 0.6°C lab environment (n = 5) as a control to assess the efficacy of NeoWarm in regulating their core body temperature. Results All 6 piglets placed in NeoWarm recovered from hypothermia, while none of the 5 piglets in the ambient environment recovered. The piglets warmed in NeoWarm reached a significantly higher core body temperature (39.2°C ± 0.4°C, n = 6) than the piglets that were warmed in the ambient environment (37.9°C ± 0.4°C, n = 5) (p < 0.001). No piglet in the NeoWarm group suffered signs of burns or skin abrasions. Discussion Our results in this pilot study indicate that NeoWarm can safely and effectively warm hypothermic piglets to a normal core body temperature and, with additional validation, shows promise for potential use among human premature and small neonates.
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Affiliation(s)
- Nick D. P. Bluhm
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Grant M. Tomlin
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Orlando S. Hoilett
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, United States
| | - Elena A. Lehner
- The Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Benjamin D. Walters
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Alyson S. Pickering
- School of Materials Engineering, Purdue University, West Lafayette, IN, United States
| | | | - Sherri L. Bucher
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University-Indianapolis, Indianapolis, IN, United States
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Jacqueline C. Linnes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Brazy-Nancy E, Mattern C, Rakotonandrasana BI, Andrianarisoa VR, Norolalao P, Al-Rashid A. Anthropological overview of kangaroo care in community settings in Madagascar. BMC Womens Health 2023; 23:623. [PMID: 37996854 PMCID: PMC10668420 DOI: 10.1186/s12905-023-02781-7] [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: 08/02/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
The management of preterm births remains a major challenge in Madagascar, given the lack of equipped facilities in rural areas, and the absence of precise data concerning the incidence of such births. The World Health Organization (WHO) recommends the kangaroo method (skin-to-skin contact) for the management of preterm infants. In this article, we examine the conditions for success and the obstacles facing kangaroo care in community settings in Madagascar. We performed a qualitative research, collecting data from the districts of Antananarivo and Mahajanga in 2021. In total, 54 semi-structured interviews and two focus group sessions were conducted with the parents of preterm infants and healthcare professionals.The obstacles identified by the research included incomplete and inaccurate knowledge, leading to heterogeneity in the practice of kangaroo care: arbitrary duration, lack of kangaroo care at night, exclusive breastfeeding, and only partially practiced skin-to-skin contact. We found that the conditions for success depended on: (1) the healthcare system, (2) local interpretations of pregnancy, and (3) the structure of the infant's family. Failings of the medical system, cultural habits going against kangaroo care, and "nuclear" and/or "single parent" family structures undermine the application of this practice, jeopardizing upscaling efforts. We hope that the results of this research will guide community strategies for the management of preterm infants and kangaroo care.
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Affiliation(s)
- Emilia Brazy-Nancy
- Institut Pasteur de Madagascar, 1274 Ambatofotsikely Avaradoha, 101, Antananarivo, BP, Madagascar.
| | - Chiarella Mattern
- Institut Pasteur de Madagascar, 1274 Ambatofotsikely Avaradoha, 101, Antananarivo, BP, Madagascar
| | - Brigitte Irene Rakotonandrasana
- Family Health Department of the Ministry of Public Health of Madagascar, Ministry of Public Health, 9 Printsy Ratsimamanga Ambohidahy, 101, Antananarivo, Madagascar
| | - Vonimboahangy Rachel Andrianarisoa
- Family Health Department of the Ministry of Public Health of Madagascar, Ministry of Public Health, 9 Printsy Ratsimamanga Ambohidahy, 101, Antananarivo, Madagascar
| | - Patricia Norolalao
- USAID/Madagascar, Lot 207 A, Point Liberty-Andranoro Antehiroka -, 105, Antananarivo, Madagascar
| | - Azzah Al-Rashid
- USAID/Madagascar, Lot 207 A , Point Liberty - Andranoro Antehiroka -, 105, Antananarivo, Madagascar
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Bisanalli S, Balachander B, Shashidhar A, Raman V, Josit P, Rao SP. The beneficial effect of early and prolonged kangaroo mother care on long-term neuro-developmental outcomes in low birth neonates - A cohort study. Acta Paediatr 2023; 112:2400-2407. [PMID: 37543716 DOI: 10.1111/apa.16939] [Citation(s) in RCA: 1] [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: 04/06/2023] [Revised: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
AIM Kangaroo mother care (KMC) has immense short-term benefits, but data on long-term outcomes are scarce. Hence, this study aimed to compare the neurodevelopmental outcomes at 12 months of corrected age (CA) in infants <2000 g receiving early and prolonged KMC to a control group. METHODS This was a cohort study that was conducted from January 2017 to November 2018. All neonates<2000 g were eligible for the study. Neonates that received early initiation (<72 h of life) and prolonged KMC comprised the intervention group and were compared to neonates without the intervention. Bayley Scales of Infant and Toddler Development, Third edition (BSID-III) was done at 12 months of CA, and this was analysed using t-test and multi-linear regression analysis. RESULTS There were 75 neonates in the intervention and 69 in the control group. Baseline characteristics were comparable. We found higher composite scores for cognition (110.38 ± 9.89 vs. 105.44 ± 8.77, p value = 0.023), language (107.51 ± 10.72 vs. 101.05 ± 12.06, p value = 0.014) and adaptive behaviour (87.97 ± 9.97 vs. 80 ± 9.1, p value<0.001) in the early and prolonged KMC group in comparison to the control group. CONCLUSION Infants with early and prolonged KMC have better neurodevelopmental outcomes in terms of cognition, language and adaptive behaviour at 12 months of CA.
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Affiliation(s)
- Shridevi Bisanalli
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Bharathi Balachander
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Vijaya Raman
- Department of Psychiatry, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Pavitra Josit
- St.John's Research Institute, Bangalore, Karnataka, India
| | - Suman Pn Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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Foong WC, Foong SC, Ho JJ, Gautam D, Leong JJ, Tan PY, Baskaran M. Exploring factors influencing the uptake of kangaroo mother care: key informant interviews with parents. BMC Pregnancy Childbirth 2023; 23:706. [PMID: 37789260 PMCID: PMC10548712 DOI: 10.1186/s12884-023-06021-6] [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: 05/27/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The updated World Health Organization (WHO) guideline recommends immediate kangaroo mother care (KMC) for all infants, particularly those born preterm. However, its uptake and sustainability have been unsatisfactory. Therefore, we aimed to gain deeper insight into factors influencing the uptake of KMC practice in our setting, and thereby identify possible solutions for the development of relevant interventions to improve its adoption and make KMC a routine practice for all infants. METHODS Using the Triandis model of social behaviour as our framework, we conducted key informant interviews with parents and healthcare providers. Trained interviewers conducted interviews with nine parents, recruited via purposive sampling. These parents were parents of preterm infants who had been introduced to KMC. Data was transcribed and analysed based on Triandis' Theory of Interpersonal Behaviour. This paper only reports the results of the parent interviews. RESULTS Major findings were how positive feelings like warmth and contentment, the sense of parenthood with KMC, the benefits of KMC for their infant and parents being enablers for KMC uptake. Conversely, the lack of KMC awareness, the initial negative feelings such as fear, uncertainty and embarrassment, the prioritization of time for milk expression, overcrowding in the ward, lack of space and privacy, limited visiting hours, lack of support and poor communication resulting in misapprehension about KMC were major barriers. CONCLUSION A deeper understanding of the factors influencing the uptake of KMC using the Triandis behavioural model provided a way forward to help improve its uptake and sustainability in our settings. TRIAL REGISTRATION This study was registered with the National Medical Research Registry (NMRR-17-2984-39191).
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Affiliation(s)
- Wai Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus, George Town, Penang, Malaysia.
| | - Siew Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus, George Town, Penang, Malaysia
| | - Jacqueline J Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus, George Town, Penang, Malaysia
| | - Divya Gautam
- Department of Obstetrics and Gynaecology, University Hospital Galway, Galway, Ireland
| | - Jen Jen Leong
- Department of Paediatrics, Sunway Medical Centre, Perai, Penang, Malaysia
| | - Pek Yong Tan
- Department of Paediatrics, Island Hospital, George Town, Penang, Malaysia
| | - Mehala Baskaran
- Department of Paediatrics, Pulau Pinang Hospital, Ministry of Health, George Town, Penang, Malaysia
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Bucher SL, Young A, Dolan M, Padmanaban GP, Chandnani K, Purkayastha S. The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs). PLOS DIGITAL HEALTH 2023; 2:e0000216. [PMID: 37878575 PMCID: PMC10599536 DOI: 10.1371/journal.pdig.0000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/12/2023] [Indexed: 10/27/2023]
Abstract
Premature birth and neonatal mortality are significant global health challenges, with 15 million premature births annually and an estimated 2.5 million neonatal deaths. Approximately 90% of preterm births occur in low/middle income countries, particularly within the global regions of sub-Saharan Africa and South Asia. Neonatal hypothermia is a common and significant cause of morbidity and mortality among premature and low birth weight infants, particularly in low/middle-income countries where rates of premature delivery are high, and access to health workers, medical commodities, and other resources is limited. Kangaroo Mother Care/Skin-to-Skin care has been shown to significantly reduce the incidence of neonatal hypothermia and improve survival rates among premature infants, but there are significant barriers to its implementation, especially in low/middle-income countries (LMICs). The paper proposes the use of a multidisciplinary approach to develop an integrated mHealth solution to overcome the barriers and challenges to the implementation of Kangaroo Mother Care/Skin-to-skin care (KMC/STS) in LMICs. The innovation is an integrated mHealth platform that features a wearable biomedical device (NeoWarm) and an Android-based mobile application (NeoRoo) with customized user interfaces that are targeted specifically to parents/family stakeholders and healthcare providers, respectively. This publication describes the iterative, human-centered design and participatory development of a high-fidelity prototype of the NeoRoo mobile application. The aim of this study was to design and develop an initial ("A") version of the Android-based NeoRoo mobile app specifically to support the use case of KMC/STS in health facilities in Kenya. Key functions and features are highlighted. The proposed solution leverages the promise of digital health to overcome identified barriers and challenges to the implementation of KMC/STS in LMICs and aims to equip parents and healthcare providers of prematurely born infants with the tools and resources needed to improve the care provided to premature and low birthweight babies. It is hoped that, when implemented and scaled as part of a thoughtful, strategic, cross-disciplinary approach to reduction of global rates of neonatal mortality, NeoRoo will prove to be a useful tool within the toolkit of parents, health workers, and program implementors.
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Affiliation(s)
- Sherri Lynn Bucher
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Allison Young
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Madison Dolan
- Scholarly Concentration in Public Health Certificate Program, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Geetha Priya Padmanaban
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Khushboo Chandnani
- Department of Human Centered Computing, Human-Computer Interaction, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
| | - Saptarshi Purkayastha
- Department of BioHealth Informatics, Data Science and Health Informatics, Luddy School of Informatics, Computing, and Engineering, Indiana University–Indianapolis, Indianapolis, Indiana, United States of America
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Washington M, Macaden L, Smith A, Selvam S, Mony PK. Determinants of Kangaroo Mother Care Uptake for Small Babies Along the Health Facility to Community Continuum in Karnataka, India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200457. [PMID: 37348942 PMCID: PMC10285725 DOI: 10.9745/ghsp-d-22-00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Kangaroo mother care (KMC) scale-up is a proposed strategy to accelerate reduction in neonatal mortality rates. We aimed to identify determinants of KMC uptake for small babies (less than 2,000 g birth weight) along the health facility to community continuum in Karnataka, India. METHODS From June 2017 to March 2020, data on characteristics of health facilities and health care workers (HCWs) from 8 purposively selected health facilities were assessed. Knowledge, attitude, and support the mothers received for KMC uptake were assessed once between 4 weeks and 8 weeks unadjusted age of the cohort of babies. Secondary data on KMC were obtained from the district-wide implementation research project database. Bivariate analysis was used to assess the association of characteristics of health facilities, HCWs, mothers, and small babies with the day of KMC initiation and its duration. Log-binomial regression analysis was then computed to identify determinants of KMC. RESULTS We recruited 227 (91.5%) of 248 babies eligible to participate with a mean unadjusted age of 35.6 days (±7.5) and 1,693.9 g (±263.1 g) birth weight. KMC was initiated for 95.2% of 227 babies at the health facility; initiated at 3 days or earlier of life for 59.6% of 226 babies; and babies continued to receive KMC for more than 4 weeks (30.2 days [±8.4]) at home. Determinants of KMC initiation were HCWs' attitudes, initiation support at the health facility, and place of hospitalization. Determinants of KMC maintenance at the health facility were HCWs' skills and support the mother received at the facility after initiating KMC. Place of hospitalization and HCWs' knowledge determined KMC duration at home 1 week after discharge. CONCLUSION These findings emphasize the importance of competent HCWs and support for mothers at the health facility for initiation and maintenance of KMC within the health facility and 1 week after discharge.
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Affiliation(s)
- Maryann Washington
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India.
| | - Leah Macaden
- Nursing Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Annetta Smith
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sumithra Selvam
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
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Mohammadi M, Bergh AM, Jahdi NS, Valizadeh L, Hosseini M, Hakimi S. Launching continuous kangaroo mother care through participatory action research in Iran. BMC Health Serv Res 2023; 23:436. [PMID: 37143074 PMCID: PMC10159671 DOI: 10.1186/s12913-023-09372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND This study describes the launching of a unit for continuous kangaroo mother care (KMC) in a teaching hospital (Taleghani) in Iran. METHODS We used a participatory three-stage action research approach to establish a unit for continuous KMC: design (needs identification and planning for change); implementation (and reflection); and evaluation (and institutionalization). As part of the design and implementation stages, individual and focus group interviews were conducted with mothers, physicians, nurses, other healthcare personnel and policy makers. The evaluation was done by means of a standardized tool specifically developed for monitoring progress with the implementation of KMC. RESULTS Four themes relating to potential barriers to implementation emerged from the analysis of the staff interviews, namely barriers associated with the mother, the father, the physician and the health system. Mothers' experiences of barriers were grouped into five themes: personal discomfort, fear, healthcare provider attitudes and actions, infrastructure constraints and family matters. An implementation progress score of 27.05 out of 30 was achieved, indicating that the continuous KMC unit was on the path to institutionalization. Some of the gaps identified related to policies on resource allocation, the discharge and follow-up system, and the transportation of infants in the KMC position. CONCLUSION The study findings indicated that participatory action research is a suitable method for studying the establishment of a continuous KMC unit. When action research is practiced, there is a prospect of turning knowledge into action in the real world.
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Affiliation(s)
- Marzieh Mohammadi
- Student's Research Committee, Tabriz University of Medical Science, Tabriz, Iran
| | - Anne-Marie Bergh
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Niloufar Sattarzadeh Jahdi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Sevil Hakimi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran.
- Department of Midwifery, Faculty of Nursing and Midwifery. Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran.
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Sjömar J, Ottesen H, Banik G, Rahman AE, Thernström Blomqvist Y, Rahman SM, Målqvist M. Exploring caregivers' experiences of Kangaroo Mother Care in Bangladesh: A descriptive qualitative study. PLoS One 2023; 18:e0280254. [PMID: 36689433 PMCID: PMC9870098 DOI: 10.1371/journal.pone.0280254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/22/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is an evidence-based intervention recommended by the World Health Organization (WHO) to reduce preterm mortality and morbidity. The aim of this study was to explore caregivers' experiences of providing KMC in hospital settings and after continuation at home in Bangladesh in order to assess enablers and barriers to optimal implementation. METHODS Interviews with fifteen caregivers were conducted using an interview guide with semi-structured questions in August 2019 and March 2020. Convenience sampling was used to select hospitals and participants for the study. The inclusion criteria were being a caregiver currently performing KMC in the hospital or having been discharged one week earlier from the KMC ward. The interviews were audio recorded, transcribed verbatim, and translated. The data were analyzed using thematic analysis with an inductive approach. RESULTS Three themes were identified as regards the caregivers' experiences of providing KMC: conducive conditions, an empowering process, and suboptimal implementation. The results showed that there are supporting circumstances for caregivers performing KMC in Bangladesh, including social support structures and positive attitudes to the method of care. It also appeared that the caregivers felt strengthened in their roles as caregivers by learning and performing KMC. However, the implementation of KMC was suboptimal due to late initiation of KMC, difficulties with keeping the baby skin-to-skin, and pain after cesarean section hampering skin-to-skin practice. CONCLUSIONS The social and cultural conditions for the caregivers to perform KMC as well as the empowerment the parents felt in their roles as caregivers when performing KMC are facilitating factors for this method of care. Initial separation and late initiation of KMC, as well as disregard for the mothers' needs for care and support, were barriers to optimal practice leading to missed opportunities. These facilitators and barriers need to be addressed in order to succeed in scaling up the national KMC program.
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Affiliation(s)
- Johanna Sjömar
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Hedda Ottesen
- Department of Women’s and Children’s Health, Uppsala University, Sweden
| | - Goutum Banik
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Research, Bangladesh
| | | | | | - Mats Målqvist
- Department of Women’s and Children’s Health, Uppsala University, Sweden
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Pellegrino J, Kanyangarara M, Agbinko-Djobalar B, Owusu PG, Sakyi KS, Baffoe P, Sackey A, Sagoe-Moses I, Dail RB. Occurrence of neonatal hypothermia and associated risk factors among low birth weight (LBW) infants in Accra, Ghana. JOURNAL OF GLOBAL HEALTH REPORTS 2023. [DOI: 10.29392/001c.55766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Neonatal hypothermia is a prominent issue in low-resource settings. Preterm and low birth weight (LBW) infants are at increased risk for developing hypothermia. If left untreated, hypothermia can lead to hypoxia, sepsis, hypoglycemia, apnea, and poor weight gain in neonates, contributing to neonatal morbidity and mortality. Identifying risk factors for neonatal hypothermia is important, especially in low-resource settings, where the burden of neonatal mortality is highest. The study sought to describe the distribution of neonatal hypothermia and examine risk factors associated with neonatal hypothermia among LBW infants admitted to Korle-Bu Teaching Hospital in Accra, Ghana. Methods Infants in the neonatal intensive care unit (NICU) at Korle-Bu Teaching Hospital, who were less than 28 days old, weighing less than <2,500 grams, and clinically stable, were enrolled. Infants of mothers under 18 years old and those expected to be discharged within 24 hours were excluded from the study. A standardized questionnaire was administered to collect information on the mother, infant, pregnancy, and birth characteristics. Axillary temperature readings were taken every 4 hours over a 24-hour monitoring period and during hypothermic events detected by the continuous temperature monitoring bracelet. Univariate and multivariate linear regression analyses with generalized estimating equations were used to examine risk factors associated with temperature. Results Of the 254 infants included in the analysis, 42.1% were male, 49.6% were very LBW (<1,500 grams), and 94.1% were preterm (<37 weeks). Of the 1,948 temperature readings, 44.5% were hypothermic (<36.5oC). Hypothermia occurred in 85.8% of infants during the 24-hour monitoring period. Multivariate linear regression demonstrated that being very LBW, having no skin-to-skin contact immediately after birth, not being wrapped or treated in an incubator at the time of temperature, and mixed feeding (compared to exclusive breastfeeding) were associated with lower neonatal temperatures. Conclusions Neonatal hypothermia was common among infants admitted to the NICU. The findings highlight the importance of thermal practices such as wrapping, exclusive breastfeeding and skin-to-skin contact. Increased education to promote thermal care is needed.
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Affiliation(s)
| | | | | | - Prince Gyebi Owusu
- Center for Learning and Childhood Development-Ghana
- Michigan State University
| | - Kwame Sarfo Sakyi
- Center for Learning and Childhood Development-Ghana
- Oakland University
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Jain H, Chandrasekaran I, Balakrishnan U, Amboiram P, D V. Quality improvement initiative approach to increase the duration of Kangaroo Mother Care in a neonatal intensive care unit of a tertiary care institute in South India during the COVID-19 pandemic. J Pediatr Nurs 2023; 68:74-78. [PMID: 36192284 DOI: 10.1016/j.pedn.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/11/2022] [Accepted: 09/11/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Kangaroo mother care (KMC) provided to stable babies in hospitals is associated with 40% relative risk reduction in death, 65% risk reduction in nosocomial infections. Despite clear existing evidence of advantages of KMC, its implementation remains limited.This study aimed to improve the median KMC practice hours in eligible preterm and low birth weight (LBW) neonates by 50% from the baseline practice. METHODS This was a Quality Improvement study conducted at Neonatal unit of a tertiary care institute in South India. All stable preterm and LBW neonates were included after obtaining written informed consent from mother. Those who needed interruption in KMC due to medical reason were excluded. A team comprising of 2 principal investigators (UG students), 2 consultants and 2 in-charge nurses was formed. Baseline data were collected between January and February 2021 to find out the median duration of KMC practice and to identify limiting factors (barriers) and the facilitating ones through in-depth interviews and team meetings. The study was conducted over a 10 month period. Steps were taken to tackle these in two PDSA cycles, each lasting for 3 weeks (1st PDSA: Education of Mothers and Nurses; 2nd PDSA: KMC technique, orders by residents). The PDSA was followed by monitoring for 10 weeks for sustenance. RESULTS The baseline data showed that the median duration (in hours) of KMC practice was 2.6 which increased to 5.0 and 5.5 h by the end of first and second PDSA cycle, respectively and showed a lasting change, peaking at a median value of 6.1 h during the sustenance phase over the next 10 weeks. CONCLUSION Through simple measures and closing the communication gap between health care workers and mothers, we were able to increase the duration of KMC, which remained high during the 10 week follow up period.
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Affiliation(s)
- Harsh Jain
- Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | | | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Vanitha D
- Department of Nursing, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
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Rahmatika QT, Aditya RS, Yusuf A, Almutairi RL, Al Razeeni DM, Kotijah S, Sulistyorini A. We are facing some barriers: A qualitative study on the implementation of kangaroo mother care from the perspectives of healthcare providers. J Public Health Afr 2022. [PMID: 37497131 PMCID: PMC10367030 DOI: 10.4081/jphia.2022.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Health systems at all levels are under pressure to provide comprehensive and high quality of care based on the best evidencebased interventions. The kangaroo mother care (KMC) is one way to care for Low Birth Weight babies (LBW) especially in developing country where the rates of preterm and LBW neonates are higher and the resources are limited. The purpose of this paper is to explore healthcare providers’ perspectives of kangaroo mother care implementation in perinatology ward in the rural surgical hospital of East Java Province, Indonesia. We conducted an in-depth interviews to identify KMC implementations. Ten healthcare providers engaged with KMC were interviewed. Data was analyzed using a thematic analysis. Healthcare providers reported positives perceptions of KMC and acknowledged their important roles to give education. The barriers in implementing the KMC including the level of knowledge and the age of the mother of LBW babies. KMC as a method of treating LBW babies is effective intervention care of preterm and LBW babies. This research provides information regarding the need of supports from all levels in KMC implementation.
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Li Y, Hu Y, Chen Q, Li X, Tang J, Xu T, Feng Z, Mu D. Clinical practice guideline for kangaroo mother care in preterm and low birth weight infants. J Evid Based Med 2022; 15:408-424. [PMID: 36529837 DOI: 10.1111/jebm.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Kangaroo mother care has reduced mortality and morbidity in preterm and low birth weight infants and has many benefits, such as promoting breastfeeding. Based on the current evidence in China and international, we developed a clinical practice guideline for kangaroo mother care in preterm and low birth weight infants using the Grading of Recommendations, Assessment, Development and Evaluation and proposed 34 recommendations for 20 key questions. Our goal is to promote the appropriate implementation of kangaroo mother care in clinical practice.
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Affiliation(s)
- Yingxin Li
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Yanlin Hu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Qiong Chen
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Xiaowen Li
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
- West China School of Nursing, Sichuan University, Chengdu, P.R. China
| | - Jun Tang
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Zhichun Feng
- Department of Neonatology, Faculty of Pediatrics, Chinese PLA General Hospital, Beijing, P.R. China
| | - Dezhi Mu
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, P.R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, P.R. China
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Cai Q, Chen DQ, Wang H, Zhang Y, Yang R, Xu WL, Xu XF. What influences the implementation of kangaroo mother care? An umbrella review. BMC Pregnancy Childbirth 2022; 22:851. [PMID: 36401193 PMCID: PMC9675107 DOI: 10.1186/s12884-022-05163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Kangaroo mother care (KMC) is an evidence-based intervention that reduces morbidity and mortality in preterm infants. However, it has not yet been fully integrated into health systems around the world. The aim of this study is to provide a cogent summary of the evidence base of the key barriers and facilitators to implementing KMC. Methods An umbrella review of existing reviews on KMC was adopted to identify systematic and scoping reviews that analysed data from primary studies. Electronic English databases, including PubMed, Embase, CINAHL and Cochrane Library, and three Chinese databases were searched from inception to 1 July 2022. Studies were included if they performed a review of barriers and facilitators to KMC. Quality assessment of the retrieved reviews was performed by at least two reviewers independently using the Joanna Briggs Institute (JBI) critical appraisal checklist and risk of bias was assessed with the Risk of Bias Assessment Tool for Systematic Reviews (ROBIS) tool. This umbrella review protocol was documented in the PROSPERO registry (CRD42022327994). Results We generated 531 studies, and after the removal of duplicates and ineligible studies, six eligible reviews were included in the analysis. The five themes identified were environmental factors, professional factors, parent/family factors, access factors, and cultural factors, and the factors under each theme were divided into barriers or facilitators depending on the specific features of a given scenario. Conclusions Support from facility management and leadership and well-trained medical staff are of great significance to the successful integration of KMC into daily medical practice, while the parents of preterm infants and other family members should be educated and encouraged in KMC practice. Further research is needed to propose strategies and develop models for implementing KMC. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05163-3.
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Early skin-to-skin contact and risk of late-onset-sepsis in very and extremely preterm infants. Pediatr Res 2022:10.1038/s41390-022-02383-3. [PMID: 36376509 DOI: 10.1038/s41390-022-02383-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the association between exposure to early skin-to-skin contact (SSC) and incidence of late-onset sepsis (LOS) in extremely and very preterm infants. METHODS Observational study using the national population-based EPIPAGE-2 cohort in 2011. A propensity score for SSC exposure was used to match infants with and without exposure to SSC before day 4 of life and binomial log regression used to estimate risk ratios and CIs in the matched cohort. The primary outcome was at least one episode of LOS during hospitalization. Secondary outcomes were the occurrence of any late-onset neonatal infection (LONI), LOS with Staphylococcus or Staphylococcus aureus, incidence of LOS and LONI per 1000 central venous catheter days. RESULTS Among the 3422 included infants, 919 were exposed to early SSC. The risk ratio (RR) for LOS was 0.86 (95% CI, 0.67-1.10), for LONI was 1.00 (95% CI, 0.83-1.21), and for LOS with Coagulase-negative Staphylococcus or Staphylococcus aureus infection was 0.91 (95% CI, 0.68-1.21) and 0.77 (95% CI, 0.31-1.87). The incidence RR for LOS per-catheter day was 0.87 (95% CI, 0.64-1.18). CONCLUSION Early SSC exposure was not associated with LOS or LONI risk. Thus, their prevention should not be a barrier to a wider use of SSC. IMPACT Kangaroo Mother Care decreased neonatal infection rates in middle-income countries. Skin-to-skin contact is beneficial for vulnerable preterm infants but barriers exist to its implementation. In a large population-based study using a propensity score methods, we found that skin-to-skin contact before day 4 of life was not associated with a decreased risk of late-onset-sepsis in very and extremely preterm infants. Early skin-to-skin contact was not associated with an increased risk of any late-onset-neonatal-infection, in particular with staphylococcus. The fear of neonatal infection should not be a barrier to a wider use of early skin-to-skin contact in this population.
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Cavallin F, Trevisanuto D, Tiep TV, Diep NTN, Hao VT, Ngan DT, Thuy NT, Hoi NTX, Moccia L. Kangaroo Mother Care in Vietnam: A National Survey of a Middle-Income Country. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111667. [PMID: 36360395 PMCID: PMC9688394 DOI: 10.3390/children9111667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
Background: Kangaroo mother care (KMC) is a low-cost intervention that is indicated to be a highly effective practice for which adoption and implementation are lacking. We investigated the current provision of KMC in Vietnam and explored differences among levels of healthcare facility. Methods: A survey form was sent to 187 hospitals in Vietnam, representing the three levels (central, provincial and district) of public hospital-based maternity services. Results: Overall response rate was 74% (138/187 hospitals). Routine KMC implementation was estimated in 49% of the hospitals. Where KMC was implemented or was being introduced, half of the hospitals had a written protocol and a KMC-dedicated room, and held educational courses on KMC. KMC was mainly performed by the mother. Skin-to-skin contact was mostly performed for <12 h/day (55%), exclusive breastfeeding at discharge was very frequent (89%) and early discharge was considered in half of the hospitals (54%), while follow-up was not performed in 29% of the hospitals. Participants considered follow-up after discharge as the main barrier to KMC implementation, and indicated education (of both parents and health caregivers) and environment upgrades (KMC-dedicated room and equipment) as the most important facilitators. Conclusions: Our survey estimated a limited implementation of KMC in Vietnamese maternity hospitals, with marked variations across the different levels of maternity services. Areas of improvements include increasing the duration of skin-to-skin contact, arranging dedicated spaces for KMC, involving the relatives (especially at district level), extending the availability of a written protocol, improving the eligibility process, and implementing early discharge and follow-up monitoring.
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Affiliation(s)
| | - Daniele Trevisanuto
- Department of Woman and Child Health, University of Padova, 35128 Padova, Italy
- Correspondence:
| | - Tran Viet Tiep
- Vietnam-Sweden Uong Bi General Hospital, Uong Bi 02306, Vietnam
| | - Nguyen Thi Ngoc Diep
- Pediatrics Department, Vietnam-Sweden Uong Bi General Hospital, Uong Bi 02306, Vietnam
| | - Vuong Thi Hao
- Newborn Department, Vietnam-Sweden Uong Bi General Hospital, Uong Bi 02306, Vietnam
| | - Doan Thi Ngan
- Newborn Department, Vietnam-Sweden Uong Bi General Hospital, Uong Bi 02306, Vietnam
| | - Nguyen Thi Thuy
- Research Office, Training and Direction of Health Activities Center, Vietnam-Sweden Uong Bi General Hospital, Uong Bi 02306, Vietnam
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Doukouré D, Kourouma KR, Agbré Yacé ML, Cissé L, Some Méazieu C, N'Guetta Manouan M, Lasme EA, Bayo S, Aké-Tano SOP, Sackou Kouakou J, Konan Kouakou V. Acceptability of the Kangaroo Mother Care at the University Hospital of Treichville in Côte d’Ivoire. J Public Health Afr 2022; 13:2165. [PMCID: PMC9627761 DOI: 10.4081/jphia.2022.2165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Kangaroo Mother Care (KMC) is a low-tech, highimpact intervention for preterm and low-birth-weight newborns. In 2019, Côte d’Ivoire opened its first KMC unit. We wanted to determine KMC’s acceptability in Côte d’Ivoire after a year. Methods This qualitative study used semi-structured interviews in September 2020 at the Teaching Hospital of Treichville’s first KMC unit. Mothers of preterm and low birth weight babies who received KMC were studied. Deductive (TFA-driven) framework analysis was performed. Coded using Nvivo 12. Results KMC was acceptable overall. Mothers knew KMC’s goal and benefits, including self-confidence and breastfeeding benefits. Most women reported that the method was easy to implement and were confident in implementing KMC at the unit or in the household, even though some of them found KMC not aligned with their cultural values. Some mothers, especially housewives and self-employed, highlighted the benefits of KMC, but they must have given up. Conclusions Our study highlighted the need to increase KMC awareness, advocacy, education, and training for pregnant women and the community to reduce preterm and low birth weight infant mortality and morbidity.
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Affiliation(s)
- Daouda Doukouré
- Reproductive Health Research Unit, National Institute of Public Health, Côte d'Ivoire,National Institute of Public Health, BP V 74 Abidjan, Côte d’Ivoire. +225.07.59213840.
| | | | | | - Lassina Cissé
- Pediatric Ward, University Hospital of Treichville, Côte d'Ivoire
| | | | | | - Ester Annick Lasme
- Reproductive Health Research Unit, National Institute of Public Health, Côte d'Ivoire
| | - Syntyche Bayo
- Reproductive Health Research Unit, National Institute of Public Health, Côte d'Ivoire
| | | | - Julie Sackou Kouakou
- Reproductive Health Research Unit, National Institute of Public Health, Côte d'Ivoire
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Hadush MY, Gebremariam DS, Beyene SA, Abay TH, Berhe AH, Zelelew YB, Asmelash T, Ashebir F, Amare SY, Hadush Z, Medhanyie AA. Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research. Pediatric Health Med Ther 2022; 13:297-307. [PMID: 36106330 PMCID: PMC9467444 DOI: 10.2147/phmt.s369858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Marta Yemane Hadush
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- Correspondence: Marta Yemane Hadush, Email
| | | | - Selemawit Asfaw Beyene
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tedros Hailu Abay
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Amanuel Hadgu Berhe
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yibrah Berhe Zelelew
- School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | | | | | - Znabu Hadush
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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22
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Muttau N, Mwendafilumba M, Lewis B, Kasprzyk K, Travers C, Menon JA, Mutesu-Kapembwa K, Mangangu A, Kapesa H, Manasyan A. Strengthening Kangaroo Mother Care at a tertiary level hospital in Zambia: A prospective descriptive study. PLoS One 2022; 17:e0272444. [PMID: 36048848 PMCID: PMC9436113 DOI: 10.1371/journal.pone.0272444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Globally, complications due to preterm birth are the leading contributor to neonatal mortality, resulting in an estimated one million deaths annually. Kangaroo Mother Care (KMC) has been endorsed by the World Health Organisation as a low cost, safe, and effective intervention in reducing morbidity and mortality among preterm infants. The objective of this study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary level hospital in Lusaka, Zambia.
Methods
We conducted a prospective descriptive study using data collected from the KMC room at the University Teaching Hospital between January 2016 and September 2017. Mothers and government nurses were trained in KMC. We monitored skin-to-skin and breastfeeding practices, weight at admission, discharge, and length of admission.
Results
We enrolled 573 neonates into the study. Thirteen extremely low weight infants admitted to the KMC room had graduated to Group A (1,000g-1,499g) at discharge, with a median weight gain of 500g. Of the 419 very low weight neonates at admission, 290 remained in Group A while 129 improved to Group B (1,500g-2,499g), with a median weight gain of 280g. Among the 89 low weight neonates, 1 regressed to Group A, 77 remained in Group B, and 11 improved to Group C (≥2,500g), individually gaining a median of 100g. Of the seven normal weight neonates, 6 remained in Group C individually gaining a median of 100g, and 1 regressed to Group B. Among all infants enrolled, two (0.35%) died in the KMC room.
Conclusions
Based on the RE-AIM metrics, our results show that KMC is a feasible intervention that can improve neonatal outcomes among preterm infants in Zambia. The study findings show a promising, practical approach to scaling up KMC in Zambia.
Trial registration
The trial is registered under ClinicalTrials.gov under the following ID number: NCT03923023.
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Affiliation(s)
- Nobutu Muttau
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Martha Mwendafilumba
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Branishka Lewis
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Keilya Kasprzyk
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- The Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Colm Travers
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - J. Anitha Menon
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Kunda Mutesu-Kapembwa
- Department of Neonatology, Women and Newborn Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Aaron Mangangu
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Herbert Kapesa
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Albert Manasyan
- Department of Reproductive, Maternal, Newborn, and Child Health, Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Lydon MM, Lwesha V, Likomwa D, Chimtembo L, Guenther T, Longwe M. Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00727. [PMID: 36041831 PMCID: PMC9426989 DOI: 10.9745/ghsp-d-21-00727] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 06/14/2022] [Indexed: 12/02/2022]
Abstract
Successful kangaroo mother care (KMC) efforts must understand and address social norms that influence this practice. The current study offers a model for how to connect social norms analysis to specific actions to improve KMC implementation. Introduction: Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program. Methods: In this qualitative study, we conducted 11 focus group discussions and 20 in-depth interviews. Participants were identified through purposive and snowball sampling and included pregnant women, parents engaged in KMC, health workers, community members, and religious leaders. Audio recordings were transcribed and translated into English. An inductive thematic analysis was applied. Results: Our analysis revealed 3 key injunctive norms influencing KMC engagement in this setting: (1) a perception that although preterm infants are abnormal, they should still be cared for, (2) an understanding that men should provide for their families while women should care for their families, and (3) families and communities should support one another. These norms operated at the community, family, household, and individual levels. Community members enforced social norms but also offered social support. Family members supported KMC parents as well. Both KMC parents actively engaged in the practice; however, their interest in and ability to manage its demands were influenced by the prevailing social norms, their economic situation, family obligations, and the mother’s health status. Conclusion: KMC efforts can be strengthened by incorporating context-specific actions to bolster social norms that align with KMC and shift those that discourage it. Activities must include a focus on the community and family levels to engender meaningful change at the household level.
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Kumar GA, George S, Akbar M, Bhattacharya D, Nanda P, Dandona L, Dandona R. Implications of the availability and distribution of birth weight on addressing neonatal mortality: population-based assessment from Bihar state of India. BMJ Open 2022; 12:e061934. [PMID: 35728896 PMCID: PMC9214371 DOI: 10.1136/bmjopen-2022-061934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE A large proportion of neonatal deaths in India are attributable to low birth weight (LBW). We report population-based distribution and determinants of birth weight in Bihar state, and on the perceptions about birth weight among carers. DESIGN A cross-sectional household survey in a state representative sample of 6007 live births born in 2018-2019. Mothers provided detailed interviews on sociodemographic characteristics and birth weight, and their perceptions on LBW (birth weight <2500 g). We report on birth weight availability, LBW prevalence, neonatal mortality rate (NMR) by birth weight and perceptions of mothers on LBW implications. SETTING Bihar state, India. PARTICIPANTS Women with live birth between October 2018 and September 2019. RESULTS A total of 5021 (83.5%) live births participated, and 3939 (78.4%) were weighed at birth. LBW prevalence among those with available birth weight was 18.4% (95% CI 17.1 to 19.7). Majority (87.5%) of the live births born at home were not weighed at birth. LBW prevalence decreased and birth weight ≥2500 g increased significantly with increasing wealth index quartile. NMR was significantly higher in live births weighing <1500 g (11.3%; 95% CI 5.1 to 23.1) and 1500-1999 g (8.0%; 95% CI 4.6 to 13.6) than those weighing ≥2500 g (1.3%, 95% CI 0.9 to 1.7). Assuming proportional correspondence of LBW and NMR in live births with and without birth weight, the estimated LBW among those without birth weight was 35.5% (95% CI 33.0 to 38.0) and among all live births irrespective of birth weight availability was 23.0% (95% CI 21.9 to 24.2). 70% of mothers considered LBW to be a sign of sickness, 59.5% perceived it as a risk of developing other illnesses and 8.6% as having an increased probability of death. CONCLUSIONS Missing birth weight is substantially compromising the planning of interventions to address LBW at the population-level. Variations of LBW by place of delivery and sociodemographic indicators, and the perceptions of carers about LBW can facilitate appropriate actions to address LBW and the associated neonatal mortality.
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Affiliation(s)
- G Anil Kumar
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Sibin George
- Public Health Foundation of India, Gurgaon, Haryana, India
| | - Md Akbar
- Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Priya Nanda
- Bill & Melinda Gates Foundation India, New Delhi, India
| | - Lalit Dandona
- Public Health Foundation of India, Gurgaon, Haryana, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rakhi Dandona
- Public Health Foundation of India, Gurgaon, Haryana, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Jadaun AS, Dalpath SK, Trikha S, Upadhyay RP, Bhandari N, Punia JS, Rawal M, Martines JC, Bahl R, Agarwal R, Mazumder S. Government-led initiative increased the effective use of Kangaroo Mother Care in a region of North India. Acta Paediatr 2022. [PMID: 35665961 DOI: 10.1111/apa.16376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
AIM To learn how to achieve high-quality, effective coverage of Kangaroo Mother Care (KMC), defined as 8 hours or more of skin-to-skin contact per day and exclusive breastfeeding in district Sonipat in North India, and to develop and evaluate an implementation model. METHODS We conducted implementation research using a mixed-methods approach, including formative research, followed by repeated, rapid cycles of implementation, evaluation and refinement until a model with the potential for high and effective coverage was reached. Evaluation of this model was conducted over a 12-month period. RESULTS Formative research findings informed the final implementation model. Programme learning was critical to achieve high coverage. The model included improving the identification of small babies, creating KMC wards, modification in hospitalisation criteria, private sector engagement and in-built programme learning to refine implementation progress. KMC was initiated in 87% of eligible babies. At discharge, 85% received skin-to-skin contact care, 60% effective KMC and 80% were exclusively breastfed. At home, 7-day post discharge, 81% received skin-to-skin care and 79% were exclusively breastfed in the previous 24 hours. CONCLUSION Achieving high KMC coverage is feasible in the study setting using a model responsive to the local context and led by the Government.
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Affiliation(s)
- Arun S. Jadaun
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Suresh K. Dalpath
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Sonia Trikha
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Ravi P. Upadhyay
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Jaswant Singh Punia
- Department of Health District Hospital, Government of Haryana Sonipat Haryana India
| | - Manoj Rawal
- Bhagat Phool Singh Government Medical College Sonipat Haryana India
| | - Jose Carlos Martines
- Department of Global Public Health and Primary Care Centre for Intervention Science in Maternal and Child Health University of Bergen Bergen Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization Geneva Switzerland
| | - Ramesh Agarwal
- Department Pediatrics All India Institute of Medical Sciences New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies New Delhi India
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Weber AM, Jackson YC, Elder MR, Remer SL, Parikh NA, Hofherr JJ, Voos KC, Kaplan HC. Application of a Risk Management Framework to Parent Sleep During Skin-to-Skin Care in the NICU. J Obstet Gynecol Neonatal Nurs 2022; 51:336-348. [PMID: 35288109 PMCID: PMC9086109 DOI: 10.1016/j.jogn.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
As NICU staff work to increase the frequency, duration, and comfort of skin-to-skin care (SSC) sessions, barriers to implementation are frequently encountered. Safety concerns are often raised when parents fall asleep during SSC intentionally or unintentionally. We present a risk management framework that we use in clinical practice to address risk related to parent sleep during SSC. Our approach is based on the steps of the Risk Management Life Cycle, which include the following: establish context, identify risk, analyze risk, respond to risk, and monitor and adapt response to risk. Clinicians may use this framework in clinical practice to manage risks related to prolonged SSC, specifically when parents relax and fall asleep during SSC.
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Kwesiga D, Wanduru P, Ssegujja E, Inhensiko J, Waiswa P, Franck L. Improving Post-discharge Practice of Kangaroo Mother Care: Perspectives From Communities in East-Central Uganda. Front Pediatr 2022; 10:934944. [PMID: 35911828 PMCID: PMC9326122 DOI: 10.3389/fped.2022.934944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Kangaroo mother care (KMC) is among the most cost-effective and easily accessible solutions for improving the survival and wellbeing of small newborns. In this study, we examined the barriers and facilitators to continuity of KMC at home following hospital discharge in rural Uganda. METHODS We conducted this study in five districts in east-central Uganda, within six hospitals and at the community level. We used a qualitative approach, with two phases of data collection. Phase 1 comprised in-depth interviews with mothers who practiced KMC with their babies and caretakers who supported them and key informant interviews with health workers, district health office staff, community health workers, and traditional birth attendants. We then conducted group discussions with mothers of small newborns and their caretakers. We held 65 interviews and five group discussions with 133 respondents in total and used a thematic approach to data analysis. RESULTS In hospital, mothers were sensitized and taught KMC. They were expected to continue practicing it at home with regular returns to the hospital post-discharge. However, mothers practiced KMC for a shorter time at home than in the hospital. Reasons included being overburdened with competing domestic chores that did not allow time for KMC and a lack of community follow-up support by health workers. There were increased psycho-social challenges for mothers, alongside some dangerous practices like placing plastic cans of hot water near the baby to provide warmth. Respondents suggested various ways to improve the KMC experience at home, including the development of a peer-to-peer intervention led by mothers who had successfully done KMC and community follow-up of mothers by qualified health workers and community health workers. CONCLUSION Despite wide acceptance of KMC by health workers, challenges to effective implementation persist. Amid the global and national push to scale up KMC, potential difficulties to its adherence post-discharge in a rural, resource-limited setting remain. This study provides insights on KMC implementation and sustainability from the perspectives of key stakeholders, highlighting the need for a holistic approach to KMC that incorporates its adaptability to community settings and contexts.
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Affiliation(s)
- Doris Kwesiga
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre of Excellence for Maternal Newborn and Child Health Research, Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Phillip Wanduru
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Centre of Excellence for Maternal Newborn and Child Health Research, Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Eric Ssegujja
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Justine Inhensiko
- Centre of Excellence for Maternal Newborn and Child Health Research, Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Peter Waiswa
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Centre of Excellence for Maternal Newborn and Child Health Research, Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Linda Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, United States
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Cho YC, Gai A, Diallo BA, Samateh AL, Lawn JE, Martinez-Alvarez M, Brotherton H. Barriers and enablers to kangaroo mother care prior to stability from perspectives of Gambian health workers: A qualitative study. Front Pediatr 2022; 10:966904. [PMID: 36090565 PMCID: PMC9459153 DOI: 10.3389/fped.2022.966904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS Kangaroo mother care (KMC) is an evidence-based intervention recommended for stable newborns <2,000 g. Recent trials have investigated survival benefits of earlier initiation of KMC, including prior to stability, with WHO's iKMC trial showing 25% relative risk reduction for mortality of neonates 1-1.8 kg at tertiary Indian and African neonatal units (NNU). However, evidence is lacking about how to safely deliver this intervention to the most vulnerable neonates in resource limited settings (RLS). Our study aimed to understand barriers and enablers for early KMC prior to stability from perspectives of neonatal health care workers (HCW) in a high neonatal mortality RLS. METHODS This qualitative study was conducted at Edward Francis Small Teaching Hospital (EFSTH), the main neonatal referral unit in The Gambia. It was ancillary study to the eKMC clinical trial. Ten semi-structured interviews were conducted with all neonatal HCW cadres (4 nurses; 1 nurse attendant; 5 doctors; all Gambian). Study participants were purposively selected, and saturation was reached. Thematic analysis was conducted using Atun's conceptual framework for evaluation of new health interventions with methods to ensure data reliability and trustworthiness. RESULTS HCW's perceptions of early KMC prior to stability included recognition of potential benefits as well as uncertainty about effectiveness and safety. Barriers included: Unavailability of mothers during early neonatal unit admission; safety concerns with concomitant intravenous fluids and impact on infection prevention control; insufficient beds, space, WASH facilities and staffing; and lack of privacy and respectful care. Enablers included: Education of HCW with knowledge transfer to KMC providers; paternal and community sensitization and peer-to-peer support. CONCLUSIONS Addressing health systems limitations for delivery of KMC prior to stability is foundational with linkage to comprehensive HCW and KMC provider education about effectiveness, safe delivery and monitoring. Further context specific research into safe and respectful implementation is required from varied settings and should include perceptions of all stakeholders, especially if there is a shift in global policy toward KMC for all small vulnerable newborns.
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Affiliation(s)
- Ying Chun Cho
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Abdou Gai
- MRC Unit the Gambia at LSHTM, Fajara, Gambia.,Pediatric Department, Edward Francis Small Teaching Hospital, Banjul, Gambia
| | | | | | - Joy E Lawn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Melisa Martinez-Alvarez
- MRC Unit the Gambia at LSHTM, Fajara, Gambia.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Helen Brotherton
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom.,MRC Unit the Gambia at LSHTM, Fajara, Gambia
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Lee J, Parikka V, Lehtonen L, Soukka H. Parent-infant skin-to-skin contact reduces the electrical activity of the diaphragm and stabilizes respiratory function in preterm infants. Pediatr Res 2022; 91:1163-1167. [PMID: 34088986 PMCID: PMC8176875 DOI: 10.1038/s41390-021-01607-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The physiological benefit of parent-infant skin-to-skin contact (SSC) is uncertain for preterm infants with ventilatory support. We aimed to investigate whether SSC stabilizes the respiration compared to incubator care in mechanically ventilated preterm infants. METHODS The prospective observational study was performed in Turku University Hospital, Finland. Preterm infants were eligible if they were born before 36 weeks gestation and received respiratory support with either invasive or non-invasive neurally adjusted ventilatory assist (NAVA). SSC was applied as soon as possible after birth. Respiratory variables were collected from the ventilator log data, and SSC episodes were compared with matched control periods during incubator care. RESULTS A total of 167 episodes of SSC were recorded from 17 preterm infants: 138 episodes during invasive NAVA and 29 episodes during non-invasive NAVA. During invasive NAVA, peak electrical activity of the diaphragm (Edi), minimum Edi, respiratory rate, time on backup ventilation, peak inspiratory pressure, and mean airway pressure were significantly lower in SSC than in incubator care. During non-invasive NAVA, peak Edi, minimum Edi, time on backup ventilation, and peak inspiratory pressure were significantly lower in SSC than in incubator care. CONCLUSIONS SSC stabilized and improved the respiratory physiology in mechanically ventilated preterm infants. IMPACT Skin-to-skin contact reduced work of breathing compared to incubator care in mechanically ventilated preterm infants. Skin-to-skin contact reduced the need for backup ventilation during neurally adjusted ventilatory assist in preterm infants. Skin-to-skin contact among ventilated preterm infants was not only safe but also stabilized and improved their respiratory physiology.
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Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Incheon, Republic of Korea. .,Department of Pediatrics, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Vilhelmiina Parikka
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
| | - Liisa Lehtonen
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
| | - Hanna Soukka
- grid.410552.70000 0004 0628 215XDepartment of Pediatrics, Turku University Hospital, Turku, Finland ,grid.1374.10000 0001 2097 1371Department of Pediatrics, University of Turku, Turku, Finland
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30
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Collados-Gómez L, Esteban-Gonzalo L, López-López C, Jiménez-Fernández L, Piris-Borregas S, García-García E, Fernández-Gonzalo JC, Martínez-Miguel E. Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:293. [PMID: 35010554 PMCID: PMC8750690 DOI: 10.3390/ijerph19010293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. MATERIAL AND METHODS A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. DISCUSSION There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.
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Affiliation(s)
- Laura Collados-Gómez
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Laura Esteban-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Candelas López-López
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lucía Jiménez-Fernández
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
| | - Salvador Piris-Borregas
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Researcher at the Maternity and Childhood Health Research Group (Area 4), 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Esther García-García
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Juan Carlos Fernández-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Esther Martínez-Miguel
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
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Mohammadi M, Sattarzadeh N, Heidarzadeh M, Hosseini MB, Hakimi S. Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses. J Caring Sci 2021; 10:137-144. [PMID: 34849357 PMCID: PMC8609115 DOI: 10.34172/jcs.2021.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized.
Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software.
Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers.
Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.
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Affiliation(s)
- Marzieh Mohammadi
- Student's Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Niloufar Sattarzadeh
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Heidarzadeh
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Bagher Hosseini
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sevil Hakimi
- School of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
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Kourouma KR, Agbré-Yacé ML, Doukouré D, Cissé L, Some-Méazieu C, Ouattara J, Tano-Kamelan A, Konan Kouakou V. Barriers and facilitators to kangaroo mother care implementation in Cote d'Ivoire: a qualitative study. BMC Health Serv Res 2021; 21:1211. [PMID: 34753464 PMCID: PMC8576306 DOI: 10.1186/s12913-021-07086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. Method This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. Results A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. Conclusion Our study highlighted the challenges to implement KMC in Cote d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07086-9.
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Affiliation(s)
- Kadidiatou Raïssa Kourouma
- Cellule de Recherche en Santé de la Reproduction, Institut National de Santé Publique, Abidjan, Côte d'Ivoire.
| | - Marie Laurette Agbré-Yacé
- Cellule de Recherche en Santé de la Reproduction, Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Daouda Doukouré
- Cellule de Recherche en Santé de la Reproduction, Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Lassina Cissé
- Service de Pédiatrie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Chantière Some-Méazieu
- Service de Pédiatrie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Joseph Ouattara
- Service de Pédiatrie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire
| | - Akoua Tano-Kamelan
- Cellule de Recherche en Santé de la Reproduction, Institut National de Santé Publique, Abidjan, Côte d'Ivoire
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Naloli M, Ssenyonga LV, Kagoya EK, Nteziyaremye J, Nekaka R. KANGAROO MOTHER CARE: A QUALITATIVE STUDY ON THE PRACTICE AND EXPERIENCES OF MOTHERS OF PRETERM NEONATES IN A TERTIARY TEACHING HOSPITAL IN EASTERN UGANDA. INTERNATIONAL JOURNAL FOR RESEARCH IN HEALTH SCIENCES AND NURSING 2021; 7:1890. [PMID: 36817802 PMCID: PMC9938524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Introduction Globally, neonatal deaths continues to be a challenge especially to to attainment of sustainable development goal 3. About 4 million neonatal deaths per year, with 99% of the deaths occurring in low and middle resource countries, 75% of these occurring in the first week of life. Prematurity remains an indirect leading cause of mortality and morbidity. Uganda's progress on the improvement of perinatal morbidity and mortality has largely stagnated at 27 deaths per 1,000 live births from the year 2006. One of the cost-effective readily available interventions that would curtail perinatal mortality is kangaroo mother care(KMC)- a low tech four decades old intervention. However challenges about its implementation persist on in Uganda despite intensified implementation and roll-out startegies in 2010. This study, the first of its kind to the best of our knowledge in eastern Uganda sought to find the facilitators and barriers of KMC. Materials and methods This was a qualitative study using in-depth interviews(IDI) carried out at a tertiary university teaching hospital. Twenty IDIs were carried out among mothers/caretakers using the phenomena theory. After each IDI, each transcript was analyzed by two researchers working independently using NVIVO software version 11 plus (QSR International, Burlington, Massachusetts) and themes and subthemes developed. Results Majority of mothers/caretakers, were adolescents and young adults and primiparous at 55%. The major facilitators to KMC were supportive staff that facilitated positive attitude, ability to substitute provider and family support.The major barriers were lack of family support, lack of male involvement, maternal stress and poor health and multiple gender roles, infrastructural challenges, and misconceptions associated with preterm births such as early sexual intercourse and lack of herbal medicine use. Conclusion More facility leadership involvement and engagement of mothers during antenatal, community and promotion of male involvement in sexual and reproductive health matters will improve uptake of KMC. This can be spearheadded by sexual and reproductive health, and neonatal and child health care service providers.
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Affiliation(s)
- Mercy Naloli
- Department of Nursing, Faculty of Health Sciences Busitema University
| | | | - Enid Kawala Kagoya
- Department of of Community and Public Health, Faculty of Health Sciences Busitema University
| | - Julius Nteziyaremye
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences Busitema University,Department of Gynaecological Oncology, Uganda Cancer Institute(UCI),Corresponding author; Julius Nteziyaremye, jntezigmail.com, +256 706614213
| | - Rebecca Nekaka
- Department of of Community and Public Health, Faculty of Health Sciences Busitema University
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Mehjabeen S, Matin M, Gupta RD, Sutradhar I, Mazumder Y, Kim M, Sharmin S, Islam J, Sarker M. Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study. Implement Sci Commun 2021; 2:115. [PMID: 34625121 PMCID: PMC8501568 DOI: 10.1186/s43058-021-00215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and prolonged skin-to-skin contact between an infant and caregiver, exclusive breastfeeding, early discharge from the hospital, and post-discharge follow-up. The purpose of this study was to investigate the fidelity of this intervention’s implementation according to national guidelines across all tiers of government (public) health facilities of Bangladesh. Methods We adopted a triangulation mixed-methods approach of both quantitative and qualitative components in this research to support and explain the information obtained from quantitative observation with the help of qualitative interviews on the fidelity of KMC practice. We used an observation checklist to find the fidelity of KMC practice and used semi-structured guidelines to explain and understand the moderators of fidelity through key informant interviews and in-depth interviews. We undertook eight facility visits in four districts, observed twenty-three neonates and their caregivers during KMC practice at those facilities, and conducted twenty-seven key informant interviews with facility managers, health care providers, and five in-depth interviews with caregivers. Extracted information was triangulated and arranged under the themes of the fidelity framework. Results Despite being a low-cost intervention, findings exhibit some adherence to the national guideline with several gaps in practice. Leadership played a critical role in ensuring the KMC practice. Specific components of KMC practice, like duration, nutrition maintenance, discharge criteria, and follow-up, were not consistent as recommended. Infrastructure, human resources, developmental partner support, and the demand-side and supply-side responsiveness played a critical role in enacting this human-centric approach’s fidelity. The observed interruption found in the implementation process posed threats to achieve the intended outcome as these caused violations of the basic principles of KMC. Conclusions The study findings will help find ways to effectively deliver this intervention so that fidelity of practice is maintained, enhancing KMC services’ quality and advocating towards the successful scale-up of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00215-9.
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Affiliation(s)
- Saima Mehjabeen
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mowtushi Matin
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Rajat Das Gupta
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,University of South Carolina, Columbia, USA
| | - Ipsita Sutradhar
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Yameen Mazumder
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Minjoon Kim
- Health Section, United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - Shamina Sharmin
- Health Section, United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - Jahurul Islam
- MNCAH, Directorate General of Health Services (DGHS), Dhaka, Bangladesh
| | - Malabika Sarker
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh. .,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
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Mathias CT, Mianda S, Ohdihambo JN, Hlongwa M, Singo-Chipofya A, Ginindza TG. Facilitating factors and barriers to kangaroo mother care utilisation in low- and middle-income countries: A scoping review. Afr J Prim Health Care Fam Med 2021; 13:e1-e15. [PMID: 34476975 PMCID: PMC8424722 DOI: 10.4102/phcfm.v13i1.2856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) has been widely adopted in low-and middle-income countries (LMICs) to minimise low birthweight infants' (LBWIs) adverse outcomes. However, the burden of neonatal and child mortality remains disproportionately high in LMICs. AIM Thus, this scoping review sought to map evidence on the barriers, challenges and facilitators of KMC utilisation by parents of LBWIs (parent of low birthweight infant [PLBWI]) in LMICs. METHODS We searched for studies conducted in LMICs and published in English between January 1990 and August 2020 from SciELO, Google Scholar, JSTOR, LILACS, Academic search complete, PubMed, CINAHL with full text, and Medline databases. We adopted Arksey and O'Malley's framework for conducting scoping reviews. Potential studies were exported to Endnote X7 reference management software for abstract and full article screening. Two independent reviewers did a parallel abstract and full article screening using a standardised form. The results were analysed using thematic content analysis. RESULTS We generated 22 040 studies and after duplicate removal, 42 studies were eligible for full-text screening and 22 studies, most form sub-Saharan Africa, were included in the content analysis. Eight themes emerged from the analysis: access, buy-in, co-ordination and collaboration, medical issues, motivation, social support-gender obligation and empowerment, time and timing and traditional/cultural norms. CONCLUSION Identifying factors affecting KMC may optimise KMC utilisation. Additional studies aiming at identifying influencing factors that affect KMC utilisation amongst PLBWIs' in LMICs need to be conducted to provide evidence-based strategies to enhance practice, inform policy and decision-makers in KMC utilisation amongst the PLBWIs in LMICs and beyond.
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Affiliation(s)
- Christina T Mathias
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban.
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Nyondo-Mipando AL, Kinshella MLW, Hiwa T, Salimu S, Banda M, Vidler M, Molyneux E, Dube Q, Goldfarb DM, Kawaza K. Mothers' quality of life delivering kangaroo mother care at Malawian hospitals: a qualitative study. Health Qual Life Outcomes 2021; 19:186. [PMID: 34321038 PMCID: PMC8317316 DOI: 10.1186/s12955-021-01823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Kangaroo mother care is known to help save the lives of preterm and low birthweight infants, particularly in resource-limited health settings, yet barriers to implementation have been documented. Mothers and their families are very involved in the process of providing kangaroo mother care and the impact on their well-being has not been well explored. The objective of this research was to investigate the perspectives and experiences of a mother’s quality of life while delivering facility-based kangaroo mother care.
Methods This study is a secondary analysis of the qualitative data collected within the “Integrating a neonatal healthcare package for Malawi” project. Twenty-seven health workers and 24 caregivers engaged with kangaroo mother care at four hospitals in southern Malawi were interviewed between May–August 2019. All interviews were face-to-face and followed a topic guide. Content analysis was conducted on NVivo 12 (QSR International, Melbourne, Australia) based on the six World Health Organization Quality of Life domains (physical, psychological, level of independence, social relationships, environment, spirituality). Results Fifty-one interviews were conducted with 24 caregivers and 14 health workers. Mothers experienced multidimensional challenges to their quality of life while delivering facility-based KMC. Though kangaroo mother care was considered a simple intervention, participants highlighted that continuous kangaroo mother care was difficult to practice. Kangaroo mother care was an exhausting experience for mothers due to being in one position for prolonged periods, compromised sleep, restricted movement, boredom, and isolation during their stay at the hospital as well as poor support for daily living needs such as food. Discussion A heavy burden is placed on mothers who become the key person responsible for care during kangaroo mother care, especially in resource-limited health settings. More focus is needed on supporting caregivers during the delivery of kangaroo mother care through staff support, family inclusion, and conducive infrastructure. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01823-8.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital,, University of British Columbia, Vancouver, Canada
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Sangwani Salimu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwai Banda
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital,, University of British Columbia, Vancouver, Canada
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
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Bayo P, Alobo G, Sauvé C, Feyissa GT. Mothers' perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa: a systematic review of qualitative evidence. JBI Evid Synth 2021; 20:297-347. [PMID: 34171891 DOI: 10.11124/jbies-20-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Pontius Bayo
- Department of Obstetrics and Gynecology, St. Mary's Hospital Lacor, Gulu, Uganda Centre Hospitalier de l'Université de Montréal, Quebec, Canada Department of Health, Behavior and Society, Jimma University Institute of Health, Jimma, Ethiopia Ethiopian Evidence Based Healthcare and Development Centre: A JBI Centre of Excellence, Jimma, Ethiopia
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Weber A, Jackson Y. A Survey of Neonatal Clinicians' Use, Needs, and Preferences for Kangaroo Care Devices. Adv Neonatal Care 2021; 21:232-241. [PMID: 32858546 PMCID: PMC7907250 DOI: 10.1097/anc.0000000000000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decades of research supports the benefits of kangaroo care (KC) for the parent and newborn. Supportive KC devices may be an important tool clinicians can use to assist parents with KC. In recent years, there has been a rise in the availability of KC devices. However, the use, needs, and preferences for these supportive devices by neonatal clinicians have not been documented. PURPOSE To survey clinicians' use, needs, and preferences of KC supportive devices, and examine whether differences exist based on clinician and organizational characteristics. METHODS A cross-sectional, online survey was sent through neonatal organization Web sites, conferences, and social media. RESULTS Many clinicians (n = 68, 43%; N = 158) facilitated KC with a supportive device, with 81% of devices provided by the clinician's employer. The most important "Must Have" feature of a KC device was "Safety: Reduces patient falls if caregiver sleeps or needs to use hands" (84% of respondents) followed by washability (82%), and "immediate, effective access to the baby" (78%). Clinicians' responses did not differ based on hospital setting, type of unit, KC experience, or experience using a KC device. IMPLICATIONS FOR PRACTICE To support safe use of KC devices in neonatal intensive care unit (NICU) clinical care, a device must hold the proper KC position consistently, allow immediate access to the infant, and hold the infant in place without the parent's hands to prevent falls. Training is needed to ensure safe device use. IMPLICATIONS FOR RESEARCH Future research should evaluate the safety, efficacy, and cost-effectiveness of these devices.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati, Proctor Hall, College of Nursing,
3110 Vine Street, Cincinnati OH, 45221 USA
| | - Yamile Jackson
- Nurtured by Design, P.O. Box 3276 Sugar Land, TX, 77487
USA
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Gill VR, Liley HG, Erdei C, Sen S, Davidge R, Wright AL, Bora S. Improving the uptake of Kangaroo Mother Care in neonatal units: A narrative review and conceptual framework. Acta Paediatr 2021; 110:1407-1416. [PMID: 33289201 DOI: 10.1111/apa.15705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/06/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
Kangaroo Mother Care is a beneficial intervention for high-risk infants; however, global uptake is lacking. Recent systematic reviews have collated the numerous studies that identify diverse barriers and enablers to the use of Kangaroo Mother Care. In this narrative review, we combine the findings of these systematic reviews with more recent studies to propose a conceptual framework, encompassing factors that may affect the initiation and maintenance of Kangaroo Mother Care in neonatal units. CONCLUSION: This conceptual framework includes parental, healthcare professional, and healthcare system factors, and highlights the potential interplay between them. In line with this, we suggest strategies to improve the uptake of Kangaroo Mother Care in neonatal units.
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Affiliation(s)
- Victoria R. Gill
- Mothers, Babies and Women’s Health Program Mater Research Institute Faculty of Medicine The University of Queensland South Brisbane QLD Australia
| | - Helen G. Liley
- Mothers, Babies and Women’s Health Program Mater Research Institute Faculty of Medicine The University of Queensland South Brisbane QLD Australia
| | - Carmina Erdei
- Department of Pediatric Newborn Medicine Brigham and Women’s HospitalHarvard Medical School Boston MA USA
| | - Sarbattama Sen
- Department of Pediatric Newborn Medicine Brigham and Women’s HospitalHarvard Medical School Boston MA USA
| | - Ruth Davidge
- Maternal, Child and Women's Health Department of Health Pietermaritzburg KZN South Africa
| | - Amy L. Wright
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
| | - Samudragupta Bora
- Mothers, Babies and Women’s Health Program Mater Research Institute Faculty of Medicine The University of Queensland South Brisbane QLD Australia
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Norholt H. Delivering Clinically on Our Knowledge of Oxytocin and Sensory Stimulation: The Potential of Infant Carrying in Primary Prevention. Front Psychol 2021; 11:590051. [PMID: 33995157 PMCID: PMC8116555 DOI: 10.3389/fpsyg.2020.590051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
Oxytocin (OT) is one of the most intensively researched neuropeptides during the three past decades. In benign social contexts, OT exerts a range of desirable socioemotional, stress-reducing, and immunoregulatory effects in mammals and humans and influences mammalian parenting. Consequentially, research in potential pharmacological applications of OT toward human social deficits/disorders and physical illness has increased substantially. Regrettably, the results from the administration of exogenous OT are still relatively inconclusive. Research in rodent maternal developmental programming has demonstrated the susceptibility of offspring endogenous OT systems to maternal somatosensory stimulation, with consequences for behavioral, epigenetic, cognitive, and neurological outcomes. A translation of this animal research into practically feasible human parenting recommendations has yet to happen, despite the significant prevention potential implied by the maternal developmental programming research. Extended physical contact with full-term healthy infants in the months following birth (infant carrying) might constitute the human equivalent of those specific rodent maternal behaviors, found to positively influence emerging OT systems. Findings from both OT and maternal programming research parallel those found for infants exposed to such extended parental physical contact, whether through skin-to-skin contact or infant carrying. Clinical support of parents to engage in extended physical contact represents a feasible intervention to create optimum conditions for the development of infant OT systems, with potential beneficial long-term health effects.
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Affiliation(s)
- Henrik Norholt
- SomAffect - The Somatosensory & Affective Neuroscience Group, Liverpool, United Kingdom
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Brotherton H, Daly M, Johm P, Jarju B, Schellenberg J, Penn-Kekana L, Lawn JE. "We All Join Hands": Perceptions of the Kangaroo Method Among Female Relatives of Newborns in The Gambia. QUALITATIVE HEALTH RESEARCH 2021; 31:665-676. [PMID: 33292063 PMCID: PMC7882999 DOI: 10.1177/1049732320976365] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Family support is essential for kangaroo mother care (KMC), but there is limited research regarding perceptions of female relatives, and none published from West African contexts. In-depth interviews were conducted from July to August 2017 with a purposive sample of 11 female relatives of preterm neonates admitted to The Gambia's referral hospital. Data were coded in NVivo 11, and thematic analysis was conducted applying an inductive framework. Female relatives were willing to support mothers by providing KMC and assisting with domestic chores and agricultural labor. Three themes were identified: (a) collective family responsibility for newborn care, with elder relatives being key decision makers, (b) balance between maintaining traditional practices and acceptance of KMC as a medical innovation, and (c) gendered expectations of women's responsibilities postnatally. Female relatives are influential stakeholders and could play important roles in KMC programs, encourage community ownership, and contribute to improved outcomes for vulnerable newborns.
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Affiliation(s)
- Helen Brotherton
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Helen Brotherton, Maternal Adolescent Reproductive & Child Health (MARCH) Centre, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Maura Daly
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Penda Johm
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Bintou Jarju
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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Artese C, Paterlini G, Mascheroni E, Montirosso R. Barriers and Facilitators to Conducting Kangaroo Mother Care in Italian Neonatal Intensive Care Units. J Pediatr Nurs 2021; 57:e68-e73. [PMID: 33189484 DOI: 10.1016/j.pedn.2020.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This work aimed to investigate obstacles and facilitators for carrying out Kangaroo Mother Care (KMC) across Italian NICUs. DESIGN AND METHODS A survey that investigated Unit's characteristics, policies toward parents and KMC practice and policies was carried out. Data from 86 NICUs (80.4%) was collected. Descriptive statistics and Multiple Regression Models were computed. RESULTS Eighty-one NICUs provided KMC. These NICUs had a less restricted parental access policies (chi2 = 7.373, p = .007). More than the 70% of the units did not have adequate facilities for parents. KMC daily length was positively predicted (R2 = 0.18, F = 7.91, p = .001) by repeated sessions and documentation of KMC. CONCLUSION The implementation of KMC is characterized by different barriers and facilitators that determine the parent's possibility to provide KMC. Structural factors (e.g., adequate space and facilities) can support families in providing KMC. A unique result of this survey is that KMC documentation on medical records appears critical for improving its practice. PRACTICE IMPLICATIONS Although most of the Italian units provide KMC as a routine practice, improving its practical support would be beneficial to its implementation. A more formalized approach to KMC may strengthen staff habits to consider KMC like a standard care treatment.
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Affiliation(s)
- Claudia Artese
- SOD Neonatology and Neonatal Intensive Care Unit, Careggi Hospital-University, Italy
| | - Giuseppe Paterlini
- Department of Mother's and Child's Health, Neonatology and Neonatal Intensive Care Unit, Poliambulanza Foundation Hospital Institute, Italy
| | - Eleonora Mascheroni
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy.
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Italy
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Coutts S, Woldring A, Pederson A, De Salaberry J, Osiovich H, Brotto LA. What is stopping us? An implementation science study of kangaroo care in British Columbia's neonatal intensive care units. BMC Pregnancy Childbirth 2021; 21:52. [PMID: 33435903 PMCID: PMC7805090 DOI: 10.1186/s12884-020-03488-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers' perspectives on the barriers and enablers of implementing KC. METHODS This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. RESULTS Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. CONCLUSIONS A 'one size fits all' approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.
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Affiliation(s)
- Sarah Coutts
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada.
| | - Alix Woldring
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada
| | - Ann Pederson
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada
- BC Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Horacio Osiovich
- BC Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Lori A Brotto
- Women's Health Research Institute, H214 - 4500 Oak Street, Box 42B, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Bilal SM, Tadele H, Abebo TA, Tadesse BT, Muleta M, W/Gebriel F, Alemayehu A, Haji Y, Kassa DH, Astatkie A, Asefa A, Teshome M, Kawza A, Wangoro S, Brune T, Singhal N, Worku B, Aziz K. Barriers for kangaroo mother care (KMC) acceptance, and practices in southern Ethiopia: a model for scaling up uptake and adherence using qualitative study. BMC Pregnancy Childbirth 2021; 21:25. [PMID: 33413193 PMCID: PMC7789316 DOI: 10.1186/s12884-020-03409-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/10/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. METHODS A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. RESULTS Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. CONCLUSIONS Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.
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Affiliation(s)
- Selamawit Mengesha Bilal
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia.
| | - Henok Tadele
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
- Department of Pediatrics and Child Health, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Abuka Abebo
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | | | - Fitsum W/Gebriel
- Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Yusuf Haji
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Ayalew Astatkie
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Aknaw Kawza
- South Nations and Nationalities Regional Health Bureau Head, Hawassa, Ethiopia
| | - Shemels Wangoro
- South Nations and Nationalities Regional Health Bureau, Maternal and Child Health Director, Hawassa, Ethiopia
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | - Bogale Worku
- School of Medicine, Addis Ababa University, Ethiopian Paediatrics Society, Addis Ababa, Ethiopia
| | - Khalid Aziz
- Paediatrics, University of Alberta, Edmonton, Canada
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Nyondo-Mipando AL, Kinshella MLW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Njirammadzi J, Hiwa T, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K. "It brought hope and peace in my heart:" Caregivers perceptions on kangaroo mother care services in Malawi. BMC Pediatr 2020; 20:541. [PMID: 33261568 PMCID: PMC7709227 DOI: 10.1186/s12887-020-02443-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
Background Kangaroo mother care (KMC) is an effective intervention for preterm and low birth weight infants. Effective implementation of KMC relies on a multidisciplinary team centering on the newborn’s caregiver, who delivers care with support from health care workers. This study explored the experiences of caregivers on the implementation of KMC. Methods We conducted a descriptive qualitative study in the phenomenological tradition, an interpretative approach to describe the caregivers’ lived experience with KMC at four health facilities in Malawi from April and June 2019 through 10 non-participatory observations and 24 face-to-face interviews. We drew a purposive sample of 14 mothers, six fathers, three grandmothers, and one grandfather of infants receiving KMC in three secondary and one tertiary level hospitals. Data were analyzed following a thematic approach. Results Caregivers had limited information on KMC before admission with most of the information learned from peers rather than medical professionals. Stories of positive outcomes following KMC contributed to a shift in perceptions of premature babies and acceptability of KMC as an effective intervention. Unintended consequences resulting from admission due to KMC disrupts responsibilities around the home and disrupts economic activities. Gender division of roles exists with the implementation of KMC and a mother’s support networks are crucial. Conclusion Kangaroo mother care is feasible and acceptable among caregivers. KMC babies are described more positively with the potential to grow into strong and healthy children. KMC remains focused on the mother, which undervalues the important roles of her support network. A change in the nomenclature from kangaroo mother care to kangaroo care would include fathers and others delivering care.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi. .,College of Medicine, IMCHA Project, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | | | | | - Felix Chikoti
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | | | | | - Mwai Banda
- College of Medicine, IMCHA Project, Blantyre, Malawi
| | - Laura Newberry
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jenala Njirammadzi
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | - Queen Dube
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth Molyneux
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- College of Medicine, IMCHA Project, Blantyre, Malawi.,Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
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García-Portuguez VA, Muñoz-Serrano M, Uribe-Torres C. Father Committed to Early Parenting from the First Father-child Contact Experienced at Birth. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To know how the phenomenon of active paternal upbringing is shown from the father-child contact experience during birth.
Method: Analysis of secondary information from a qualitative study of a phenomenological nature. Transcripts of interviews and focus groups of all the fathers who participated in a father-child contact protocol for a doctoral thesis.
Results: The study revealed the global structure of the phenomenon, whose central axis corresponds to “father who advances towards the integral connection with his child and is committed with parenting”, and its three comprehensive categories: expectations of being a father and actor in parenting; the experience of being a father at birth time; and the everyday of the upbringing.
Conclusion: Prenatal preparation and skin-to-skin contact during birth mobilize the father towards commitment and involvement with the upbringing of his child from the beginning.
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Weber A, Elder M, Voos KC, Lambert JW, Kaplan HC, Jackson YC. Clinician Opinions and Approaches to Manage Risk Related to Safe Sleep During Skin-to-Skin Care. J Obstet Gynecol Neonatal Nurs 2020; 49:464-474. [PMID: 32726581 PMCID: PMC7492480 DOI: 10.1016/j.jogn.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To understand the opinions of clinicians about the risks, benefits, barriers, and facilitators to the practice of parent sleep during skin-to-skin care in hospital settings. DESIGN Cross-sectional survey. SETTING Online survey. PARTICIPANTS Clinicians who self-identified as infant care providers, that is, neonatal clinicians (N = 158). METHODS We sent an online survey invitation to neonatal clinicians through neonatal websites, conferences, and social media sites in the United States and used snowball recruitment. We used a risk management framework to analyze qualitative data. We used descriptive statistics and the chi-square and Fisher's exact tests to determine if opinions differed based on clinician and organizational characteristics. RESULTS Respondents' support of parent sleep during skin-to-skin care (yes/no) did not differ on the basis of whether the clinician had taken a formal course on skin-to-skin care, facilitated skin-to-skin care more than 100 times, or frequently promoted skin-to-skin care in current practice. Respondents who supported parent sleep (n = 93, 59% of respondents) reported greater implementation of risk control strategies than nonsupporters (n = 53 [57%] vs. n = 3 [5%]; p < .001), such as frequent monitoring of vital signs (n = 33 [35%] vs. n = 2 [3%]; p < .001), use of devices to support skin-to-skin care (n = 49 [53%] vs. n = 19 [29%]; p = .003), and proper positioning (n = 20 [22%] vs. n = 0 [0%]; p < .001). Nonsupporters more frequently reported that parent sleep during skin-to-skin care violates safe sleep recommendations, is habit forming for home, poses a fall risk, and jeopardizes the infant's airway. CONCLUSION Most respondents supported parent sleep during skin-to-skin care, but concerns regarding safety for the infant remained a barrier. The use of a risk management framework may help facilitate a systematic approach to improve the implementation of safe skin-to-skin practices.
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Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. BMC Public Health 2020; 20:1234. [PMID: 32791972 PMCID: PMC7427278 DOI: 10.1186/s12889-020-09337-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
Background Kangaroo mother care (KMC) has been proved to be a safe and cost-effective standard of care for preterm babies. China hasn’t adopted the KMC practice widely until recently. We aim to assess barriers and facilitators of KMC adoption in neonatal intensive care units (NICUs) and postnatal wards in China. Methods We conducted clinical observations and semi-structured interviews with nurses, physicians, and parents who performed KMC in seven NICUs and postnatal wards housed in five hospitals in different provinces of China between August and September 2018. The interviews provided first-hand stakeholder perspectives on barriers and facilitators of KMC implementation and sustainability. We further explored health system’s readiness and families’ willingness to sustain KMC practice following its pilot introduction. We coded data for emerging themes related to financial barriers, parent- and hospital-level perceived barriers, and facilitators of KMC adoption, specifically those unique in the Chinese context. Results Five hospitals with KMC pilot programs were selected for clinical observations and 38 semi-structured interviews were conducted. Common cultural barriers included concerns with the conflict with traditional postpartum confinement (Zuo-yue-zi) practice and grandparents’ resistance, while a strong family support is a facilitator for KMC adoption. Some parents reported anxiety and guilt associated with having a preterm baby, which can be a parental-level barrier to KMC. Hospital-level factors such as fear of nosocomial infection and shortage of staff and spaces impeded the KMC implementation, and supportive community and peer group organized by the hospital contributed to KMC uptake. Financial barriers included lodging costs for caregivers and supply costs for hospitals. Conclusions We provided a comprehensive in-depth report on the multi-level KMC barriers and facilitators in China. We recommend policy interventions specifically addressing these barriers and facilitators and increase family and peer support to improve KMC adoption in China. We also recommend that well-designed local cultural and economic feasibility and acceptability studies should be conducted before the KMC uptake.
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A Randomized Trial of Continuous Versus Intermittent Skin-to-Skin Contact After Premature Birth and the Effects on Mother-Infant Interaction. Adv Neonatal Care 2020; 20:E48-E56. [PMID: 31764209 DOI: 10.1097/anc.0000000000000675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Premature birth affects opportunities for interaction between infants and mothers. Skin-to-skin contact (SSC) is standard care in neonatal care but has not been sufficiently studied regarding the effects on interaction between preterm infant and mothers. PURPOSE The purpose of this study was to compare interaction between preterm infants and their mothers after continuous versus intermittent SSC from birth to discharge. A secondary aim was to study a potential dose-response effect between time in SSC and quality of interaction. METHODS Families were randomly assigned to either continuous (n = 17) or intermittent (n = 14) SSC before delivery. Interaction was measured from videotapes of a Still-Face Paradigm collected at 4 months' corrected age. Face-to-face interaction was coded according to Ainsworth's Maternal Sensitivity Scales and the Maternal Sensitivity and Responsivity Scales-R. Dose-response correlations were calculated between mean time spent in SSC and each of the interaction scales. RESULTS There were no statistically significant differences between groups in maternal interactive behavior toward their infants regarding sensitivity, interference, availability, acceptance, withdrawal, or intrusivity. There was no correlation between mean time in SSC and quality of interaction. IMPLICATIONS FOR PRACTICE Continuous SSC from birth to discharge was not superior to intermittent SSC concerning mother-infant interaction between preterm infants and their mothers at 4 months' corrected age. However, compared with other studies, mean time in SSC was also high in the intermittent group. IMPLICATIONS FOR RESEARCH Further studies are needed to find out how interaction between parents and preterm infants can be improved, supported, and facilitated in the neonatal intensive care unit (NICU) and whether there is an optimal dose for SSC.
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Barriers and facilitators to the implementation of Kangaroo Mother Care in the community - A qualitative study. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jnn.2019.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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