Mothers' quality of life delivering kangaroo mother care at Malawian hospitals: a qualitative study

Factors Influencing the Implementation of Infant Warming Devices Among Healthcare Workers in Malawian Hospitals

Objectives. Preterm infants are at risk of hypothermia. This study described the available infant warming devices (IWDs) and explored the barriers and facilitators to their implementation in neonates in Malawi. Methods. A qualitative descriptive study was conducted among 19 health care workers in Malawi from January to March 2020. All interviews were digitally recorded, transcribed, and managed using NVivo and analyzed using a thematic approach. Results. The warming devices included radiant warmers, Blantyre hot-cots, wall-mounted heaters, portable warmers, and incubators. Inadequate equipment and infrastructure and gaps in staff knowledge and capacity were reported as the main challenges to optimal IWD implementation. Caregiver acceptance was described as the main facilitator. Strategies to optimize implementation of IWD included continuous practical training and adequate availability of equipment and spare parts. Conclusion. Implementation of warming devices for the management of neonatal hypothermia is effective when there are adequate human and material resources.

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

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.

What matters to families about the healthcare of preterm or low birth weight infants: A qualitative evidence synthesis

OBJECTIVE

We examined what matters to families about the healthcare provided to preterm or LBW infants in hospital and the community, to ensure that care meets the needs of infants and parents.

METHODS

We searched databases to identify eligible studies examining the views and expectations of families. Study quality was assessed using the CASP checklist for qualitative studies. The GRADE-CERQual approach was used to assess confidence in review findings. Studies were sampled and data analysed using thematic synthesis.

RESULTS

222 studies (227 papers) were eligible for inclusion. 54 studies (57 papers) were sampled based on data richness, methodological quality, and representation across settings. Eight analytical themes were identified. Confidence in results was moderate to high. What mattered was a positive outcome for the child; active involvement in care; being supported to cope at home after discharge; emotional support; the healthcare environment; information needs met; logistical support available; and positive relationships with staff.

CONCLUSION

Although parents and family members reported a variety of experiences in the care of their infant, we found high consistency in what matters to families.

PRACTICE IMPLICATIONS

This review identifies approaches to improve experiences of parents which are consistent with the Family Centred Care model of healthcare.

The efficacy of Kangaroo-Mother care to the clinical outcomes of LBW and premature infants in the first 28 days: A meta-analysis of randomized clinical trials

Objective

The objective of this study was to systematically determine the benefits of Kangaroo-Mother Care (KMC) on the clinical outcomes of low birthweight (LBW) and preterm infants.

Methods

For this study, the following databases were retrieved for articles published until November 2021: PubMed, Web of Science, EBSCO, and the Cochrane library. The primary clinical outcome was mortality between enrollment and 28 days. The secondary clinical outcomes were the mean duration of hospital stay, hypothermia, sepsis, exclusive breastfeeding at the end of the neonatal period, and exclusive breastfeeding at discharge.

Results

We conducted a meta-analysis, which included 17 RCTs, involving overall 17,668 participants. The results of this meta-analysis showed that KMC could reduce the primary clinical outcome of mortality between enrollment and 28 days (RR: 0.80, 95% Cl: 0.71-0.91, p < 0.01). For the secondary clinical outcomes, KMC had a varying degree of benefits on the mean duration of hospital stay (SMD: -0.96, 95% Cl: -1.02-0.90, p < 0.001), hypothermia (RR: 0.45, 95% Cl: 0.27-0.75, p < 0.01), and sepsis (RR: 0.79, 95% Cl: 0.70-0.89, p < 0.001). The exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge of KMC had benefits, which was not statistically different though (OR: 2.16, 95% Cl: 0.55-8.41, p = 0.27; OR: 1.16, 95% Cl: 0.82-1.64, p = 0.39, respectively).

Conclusions

KMC was decreased mortality in LBW and premature infants between enrollment and 28 days. In addition, KMC also had a favorable effectiveness on the secondary clinical outcomes, such as mean duration of hospital stay, hypothermia, sepsis. Moreover, KMC also had a slight effectiveness on exclusive breastfeeding at the end of the neonatal period and exclusive breastfeeding at discharge.

Effect of the Kangaroo Mother Method after Preterm Delivery on Maternal Stress and Anxiety in the Context of the COVID-19 Pandemic-A Cohort Study

BACKGROUND

The kangaroo mother method (KMM) may benefit infants and mothers in many ways. However, few studies focused on its efficacy on maternal anxiety and stress, especially in the context of the COVID-19 pandemic.

OBJECTIVE

To examine the effect of the kangaroo mother method (KMM) on postnatal stress and anxiety in mothers of preterm infants in neonatal intensive care, in the context of the COVID-19 pandemic.

METHODS

A cohort study of two groups of 56 mother-infant dyads recruited from a neonatal intensive care unit was conducted. Two groups were compared in terms of the mean duration of KMM during the twelve days of the study: the intervention group (mean duration of more than ninety minutes per day) and the control group (less than ninety minutes). Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale and STAI E/R questionnaire before and after intervention (KMM). Demographic and other maternal covariates were extracted from medical records. Daily NICU records were used to track the frequency and duration of KMM sessions.

RESULTS

Mothers of the intervention group scored lower on the PSS: NICU and STAI E/R, although no statistically significant differences were found (p > 0.05).

CONCLUSIONS

Contrary to research based on biological and physiological parameters in newborns or performed before the COVID-19 pandemic, the differences found in applying subjective scales in mothers in the context of the COVID-19 pandemic were not significant. Therefore, mothers' perception of physical contact with their preterm infants may not have been as positive due to their fear of transmitting COVID.

Effect of Kangaroo Mother Care on the Psychological Stress Response and Sleep Quality of Mothers With Premature Infants in the Neonatal Intensive Care Unit

OBJECTIVE

To investigate the effect of kangaroo mother care on the psychological stress response and sleep quality of mothers with premature infants admitted to the neonatal intensive care unit (NICU).

METHODS

A randomized controlled design was used to recruit participants. The study recruited 126 mothers of premature infants in the NICU from January 2019 to January 2020. The participants were divided into the experimental and control groups according to the random number table method (63 mothers per group). The control group was managed with conventional premature infant treatment, nursing programme, and discharge education, whereas the experimental group was managed with a 4-week kangaroo mother care intervention. The psychological stress state and sleep status of mothers with preterm infants in both the groups were evaluated using the Symptom Check List 90 (SCL-90) and Assens Insomnia Scale (AIS).

RESULTS

After the intervention, the total SCL-90 score and factor scores such as coercion, interpersonal relationships, depression, anxiety, hostility and additional factors, were lower in the experimental group than those in the control group (P < 0.05). The total AIS score and the items such as night waking, total sleep time, total sleep quality, daytime mood and daytime body function were lower in the experimental group than those in the control group (P < 0.05).

CONCLUSIONS

The Kangaroo mother care approach can relieve adverse psychological stress and improve the sleep status of mothers of NICU premature infants after mother-infant separation. It can be promoted and used in mothers of premature infants in the NICU to enhance physical and mental health.