Feasibility assessment of an ergonomic baby wrap for kangaroo mother care: A mixed methods study from Nepal

Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs

INTRODUCTION

Neonatal mortality remains significant in low-income and middle-income countries (LMICs) with in-hospital mortality rates similar to those following discharge from healthcare facilities. Care continuity interventions have been suggested as a way of reducing postdischarge mortality by better linking care between facilities and communities. This scoping review aims to map and describe interventions used in LMICs to improve care continuity for newborns after discharge and examine assumptions underpinning the design and delivery of continuity.

METHODS

We searched seven databases (MEDLINE, CINAHL, Scopus, Web of Science, EMBASE, Cochrane library and (Ovid) Global health). Publications with primary data on interventions focused on continuity of care for newborns in LMICs were included. Extracted data included year of publication, study location, study design and type of intervention. Drawing on relevant theoretical frameworks and classifications, we assessed the extent to which interventions adopted participatory methods and how they attempted to establish continuity.

RESULTS

A total of 65 papers were included in this review; 28 core articles with rich descriptions were prioritised for more in-depth analysis. Most articles adopted quantitative designs. Interventions focused on improving continuity and flow of information via education sessions led by community health workers during home visits. Extending previous frameworks, our findings highlight the importance of interpersonal continuity in LMICs where communication and relationships between family members, healthcare workers and members of the wider community play a vital role in creating support systems for postdischarge care. Only a small proportion of studies focused on high-risk babies. Some studies used participatory methods, although often without meaningful engagement in problem definition and intervention implementation.

CONCLUSION

Efforts to reduce neonatal mortality and morbidity should draw across multiple continuity logics (informational, relational, interpersonal and managerial) to strengthen care after hospital discharge in LMIC settings and further focus on high-risk neonates, as they often have the worst outcomes.

Government-led initiative increased the effective use of Kangaroo Mother Care in a region of North India

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.

Designing dress (Sarbebe) for kangaroo care, the effect of kangaroo care provided with this dress on mother and newborn's comfort†

The aims of the researchers were to design the clothes to be worn by the mothers in kangaroo care (KC) and to determine the effect of the KC provided with these clothes on the comfort of the mother and infant. This study was experimentally carried out as a methodological, randomized controlled trial for the designing of clothes for KC. Data were collected using the "Parent and Newborn Information Form", "KC Comfort Scale" and "Newborn Comfort Behavior Scale (Comfort-Neo)". The body temperature, heart rate, oxygen saturation, respiration rate parameters of the newborns were evaluated. The data were transferred to the IBM SPSS Statistics 23 program and evaluated. Our results showed that the KC Comfort Scale total score was 71.1 ± 14.8 in the control group and 84.0 ± 1.5 in the intervention group and "Newborn Comfort Behavior Scale" total scores were found to be 12.47 ± 6.90 in the control group and 8.67 ± 3.46 in the intervention group. It was determined that the KC Comfort Scale (z: -4.785 p: 0.000) in the intervention group were significantly higher compared to the control group (p < 0.05). Pain (z: -4.439 p: 0.000) and distress (z: -4.601 p: 0.000) levels of the control group were found to be significantly higher compared to the intervention group. Sarbebe is recommended to be used in KC practices since it was concluded that maternal comfort and satisfaction was high and the pain and distress scores of the newborn were low after KC provided with Sarbebe.

How to improve the effectiveness and efficiency of Kangaroo Mother Care: a literature review of equipment supporting continuous Kangaroo Mother Care

OBJECTIVE

The objective of this study was to provide an overview of the equipment supporting Kangaroo Mother Care (KMC).

METHOD

The review adopted a five-stage methodological framework that included research question identification, relevant study identification and selection, and data charting, collating, summarizing, and reporting. We conducted reviews to analyze the current research on the design of KMC-supporting devices. Publications were identified from January 2008 to July 2020.

RESULTS

Using the inclusion criteria, 17 relevant studies were identified that concerned the design of supporting equipment for KMC. Five types of equipment improved the comfort of the mothers performing KMC, another five monitored the health and development of the infants, and four served as therapy for the infants. Three equipment types showed no significant effect in supporting KMC.

CONCLUSIONS

This study provides information on equipment that effectively and efficiently improves the quality of KMC.

Improving Skin-to-Skin Practice for babies in Kangaroo Mother Care in Malawi through the use of a customized baby wrap: A randomized control trial

Background

Complications of prematurity are a leading cause of newborn death in Malawi. Despite early adoption of Kangaroo mother care (KMC), coverage remains low and women have expressed challenges in using the traditional wrapper–chitenje. In 2016, a study was conducted to evaluate the acceptability and effectiveness of a customized KMC wrap in improving adherence to KMC practices among mothers.

Methods

Mother-baby dyads (301) were randomized to receive either a customized CarePlus Wrap developed by Lærdal Global Health or a traditional chitenje. Enrolled mother-baby dyads were assessed in the KMC ward at 2–3 days after of admission, and then again at 7–15 days post-discharge. Topics covered included skin-to-skin practices, breastfeeding, perceptions of the wrap, and family/community support. Chi square tests were used to assess associations between wrap type and KMC practices. The study received ethics approval.

Results

This study found that a customized KMC wrap is highly acceptable to women and improved skin-to-skin practices in facility-based KMC: 44% of mothers using a customized wrap reported 20 or more hours per day, compared to 33% of mothers using the traditional chitenje. Women using the customized wrap reported being comfortable in keeping the baby in skin-to-skin position more often than women using the chitenje (96% vs. 71%), and they were able to tie on the wrap themselves (86% vs. 10%). At the time of discharge from KMC, more women who used the customized wrap were satisfied with the wrap than those who used the traditional chitenje (94% vs. 56%). The customized wrap did not appear to impact other newborn practices, such as breastfeeding.

Conclusions

This study provides evidence that a customized KMC wrap is highly acceptable to mothers, and it can contribute to better skin-to-skin practices. Use of a customized wrap may be one mechanism to support mothers in practicing KMC and skin-to-skin contact in addition to other interventions.