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Darmstadt GL, Al Jaifi NH, Ariff S, Bahl R, Blennow M, Cavallera V, Chou D, Chou R, Comrie-Thomson L, Edmond K, Feng Q, Riera PF, Grummer-Strawn L, Gupta S, Hill Z, Idowu AA, Kenner C, Kirabira VN, Klinkott R, De Leon-Mendoza S, Mader S, Manji K, Marriott R, Morgues M, Nangia S, Rao S, Shahidullah M, Tran HT, Weeks AD, Worku B, Yunis K. Research priorities for care of preterm or low birth weight infants: health policy. EClinicalMedicine 2023; 63:102126. [PMID: 37753444 PMCID: PMC10518498 DOI: 10.1016/j.eclinm.2023.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/05/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Research priorities for preterm or low birth weight (LBW) infants were advanced in 2012, and other research priority-setting exercises since then have included more limited, context-specific research priorities pertaining to preterm infants. While developing new World Health Organization (WHO) guidelines for care of preterm or LBW infants, we conducted a complementary research prioritisation exercise. A diverse, globally representative guideline development group (GDG) of experts - all authors of this paper along with WHO steering group for preterm-LBW guidelines - was assembled by the WHO to examine evidence and consider a variety of factors in intervention effectiveness and implementation, leading to 25 new recommendations and one good practice statement for care of preterm or LBW infants. The GDG generated research questions (RQs) based on contributions to improvements in care and outcomes of preterm or LBW infants, public health impacts, answerability, knowledge gaps, feasibility of implementation, and promotion of equity, and then ranked the RQs based on their likelihood to further change or influence the WHO guidelines for the care of preterm or LBW infants in the future. Thirty-six priority RQs were identified, 32 (89%) of which focused on aspects of intervention effectiveness, and the remaining four addressed implementation ("how") questions. Of the top 12 RQs, seven focused on further advancing new recommendations - such as family involvement and support in caring for preterm or LBW infants, emollient therapy, probiotics, immediate KMC for critically ill newborns, and home visits for post-discharge follow-up of preterm or LBW infants - and three RQs addressed issues of feeding (breastmilk promotion, milk banks, individualized feeding). RQs prioritised here will be critical for optimising the effectiveness and delivery of new WHO recommendations for care of preterm or LBW infants. The RQs encompass unanswered research priorities for preterm or LBW infants from prior prioritisation exercises which were conducted using Child Health and Nutrition Research Initiative (CHNRI) methodology. Funding Nil.
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Darmstadt GL, Al Jaifi NH, Arif S, Bahl R, Blennow M, Cavallera V, Chou D, Chou R, Comrie-Thomson L, Edmond K, Feng Q, Riera PF, Grummer-Strawn L, Gupta S, Hill Z, Idowu AA, Kenner C, Kirabira VN, Klinkott R, De Leon-Mendoza S, Mader S, Manji K, Marriott R, Morgues M, Nangia S, Portela A, Rao S, Shahidullah M, Tran HT, Weeks AD, Worku B, Yunis K. New World Health Organization recommendations for care of preterm or low birth weight infants: health policy. EClinicalMedicine 2023; 63:102155. [PMID: 37753445 PMCID: PMC10518507 DOI: 10.1016/j.eclinm.2023.102155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Approximately 11% of infants are born preterm, and complications of prematurity are the most common cause of death in children aged under five years. Almost one million preterm infants die each year across low, high and middle income countries. In 2021, the World Health Organization (WHO) convened a Guideline Development Group (GDG) to examine evidence and formulate recommendations for care of preterm or low birthweight (LBW) infants according to WHO Guideline Review Committee (GRC) criteria. GRADE methods were used to assess the certainty of evidence and the GDG developed judgements using the DECIDE (Developing and Evaluating Communication strategies to support Informed Decisions and practice based on Evidence) framework. Twenty-five recommendations were made; 11 recommendations were new, and 16 were for preventive and promotive care. Kangaroo Mother Care (KMC) was recommended to start immmediately after birth as routine care for all preterm or LBW newborns (except for critically ill infants who are in shock, unable to breath spontaneously after resuscitation, or require ventilatory support) both in the facility and at home. New recommendations were also made for caffeine to treat apnoea and for extubation; family involvement in routine care for preterm or LBW infants; and for post-discharge home-visit follow-up care. New recommendations were also made to consider use of probiotics, emollient therapy, caffeine for prevention of apnoea, continuous positive airway pressure (CPAP) immediately after birth (with or without respiratory distress) in infants less than 32 weeks gestational age; and for family support to enable the care of preterm or LBW infants. The recommendations confirm the pivotal role of preventive and promotive care for preterm and LBW infants, especially the importance of keeping the baby and mother together, and empowering and supporting families to care for their preterm or LBW infant. WHO is now working to help scale up care for small and sick newborns, including organizational shifts in all 'health system building blocks' such as infrastructure, commodities, workforce and monitoring. Funding Nil.
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Darmstadt GL, Al Jaifi NH, Ariff S, Bahl R, Blennow M, Cavallera V, Chou D, Chou R, Comrie-Thomson L, Edmond KM, Feng Q, Grummer-Strawn L, Riera PF, Gupta S, Hassan RU, Hill Z, Idowu AA, Kenner C, Kirabira VN, Klinkott R, De Leon-Mendoza S, Mader S, Manji K, Marriott R, Morgues M, Nangia S, Portela A, Rao S, Shahidullah M, Tran HT, Weeks AD, Worku B, Yunis K, Paul VK. New WHO recommendations for the care of preterm or low birthweight infants have the potential to transform maternal and newborn health-care delivery. Lancet 2022; 400:1828-1831. [PMID: 36400093 DOI: 10.1016/s0140-6736(22)02186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
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Cattaneo A, Amani A, Charpak N, De Leon-Mendoza S, Moxon S, Nimbalkar S, Tamburlini G, Villegas J, Bergh AM. Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future. BMC Pregnancy Childbirth 2018; 18:170. [PMID: 29769056 PMCID: PMC5956892 DOI: 10.1186/s12884-018-1819-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 05/02/2018] [Indexed: 01/05/2023] Open
Abstract
Background Globally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries. Findings Barriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants. Conclusion It is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.
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Affiliation(s)
- Adriano Cattaneo
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Adidja Amani
- Child and Newborn Health, Ministry of Public Health, Yaoundé, Cameroon
| | | | | | - Sarah Moxon
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Anne-Marie Bergh
- SAMRC Research Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa.
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Bergh AM, de Graft-Johnson J, Khadka N, Om'Iniabohs A, Udani R, Pratomo H, De Leon-Mendoza S. The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia. BMC Int Health Hum Rights 2016; 16:4. [PMID: 26818943 PMCID: PMC4730627 DOI: 10.1186/s12914-016-0080-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 01/22/2016] [Indexed: 12/02/2022]
Abstract
Background Kangaroo mother care has been highlighted as an effective intervention package to address high neonatal mortality pertaining to preterm births and low birth weight. However, KMC uptake and service coverage have not progressed well in many countries. The aim of this case study was to understand the institutionalisation processes of facility-based KMC services in three Asian countries (India, Indonesia and the Philippines) and the reasons for the slow uptake of KMC in these countries. Methods Three main data sources were available: background documents providing insight in the state of implementation of KMC in the three countries; visits to a selection of health facilities to gauge their progress with KMC implementation; and data from interviews and meetings with key stakeholders. Results The establishment of KMC services at individual facilities began many years before official prioritisation for scale-up. Three major themes were identified: pioneers of facility-based KMC; patterns of KMC knowledge and skills dissemination; and uptake and expansion of KMC services in relation to global trends and national policies. Pioneers of facility-based KMC were introduced to the concept in the 1990s and established the practice in a few individual tertiary or teaching hospitals, without further spread. A training method beneficial to the initial establishment of KMC services in a country was to send institutional health-professional teams to learn abroad, notably in Colombia. Further in-country cascading took place afterwards and still later on KMC was integrated into newborn and obstetric care programs. The patchy uptake and expansion of KMC services took place in three phases aligned with global trends of the time: the pioneer phase with individual champions while the global focus was on child survival (1998–2006); the newborn-care phase (2007–2012); and lastly the current phase where small babies are also included in action plans. Conclusions This paper illustrates the complexities of implementing a new healthcare intervention. Although preterm care is currently in the limelight, clear and concerted country-led KMC scale-up strategies with associated operational plans and budgets are essential for successful scale-up.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Pretoria, South Africa.
| | | | - Neena Khadka
- Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA.
| | - Alyssa Om'Iniabohs
- Maternal and Child Survival Program, 1776 Massachusetts Avenue, NW, Suite 300, Washington, DC, 20036, USA.
| | - Rekha Udani
- D Y Patil University, School of Medicine, Nerul, Navi Mumbai, India.
| | - Hadi Pratomo
- Faculty of Public Health, Universitas Indonesia, Depok Campus, Depok 16424, West Java, Indonesia.
| | - Socorro De Leon-Mendoza
- Bless-Tetada Kangaroo Mother Care Foundation Phil., Inc., 7431 P. Burgos Street, San Dionisio Paranaque City Metro, Manila, Philippines.
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