1
|
Hassan MM, Ameeq M, Tahir MH, Naz S, Fatima L, Kargbo A. Investigating socioeconomic disparities of Kangaroo mother care on preterm infant health outcomes. J Psychosom Obstet Gynaecol 2024; 45:2299982. [PMID: 38189314 DOI: 10.1080/0167482x.2023.2299982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024] Open
Abstract
Several studies have been conducted to examine the complicated relationships between various factors that influence Kangaroo mother care (KMC) for preterm infants. However, the extended socio-economic model has not been seen in any of the previous studies that looked into the factors related to KMC and how it affects the health outcomes of babies born before in our study population. This study examines the various dimensions of KMC implementation and its influence on the health outcomes of premature infants. The current cross-sectional study was carried out in South Punjab, Pakistan, covering both private and public KMC units in obstetrics and gynecology departments. The study included a sample size of 719 patients and was conducted during a period covering 21 September 2022 to 14 October 2023. Multinomial logistic regression analysis is employed to ascertain the factors by using SPSS-26 (SPSS Inc., Chicago, IL). The use of folic acid (OR: 1.44; 95% CI: 0.87-3.11) and factor anemia (OR: 8.82; 95% CI: 1.69-14.59) no significantly correlated with better health outcomes, while environmental toxin exposure had a negative impact (OR: 0.90). The findings underscore the need for comprehensive interventions and policies to bridge socioeconomic gaps, ensuring all preterm infants benefit from KMC.
Collapse
Affiliation(s)
| | - Muhammad Ameeq
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - M H Tahir
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - Sidra Naz
- Department of Statistics, The Islamia University, Bahawalpur, Pakistan
| | - Laraib Fatima
- National College of Business Administration and Economics, Lahore, Pakistan
| | - Alpha Kargbo
- Department of Physical and Natural Sciences, University of The Gambia, Serrekunda, The Gambia
| |
Collapse
|
2
|
Mihretu E, Genie YD, Adugnaw E, Shibabaw AT. Survival status and predictors of mortality among preterm neonates admitted in Bench Sheko Zone, Sheka Zone and Keffa Zone Governmental Hospitals, Southwest Ethiopia (2021): prospective follow-up study. BMJ Open 2024; 14:e083897. [PMID: 38658009 DOI: 10.1136/bmjopen-2024-083897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Prematurity presents a significant challenge to the global community due to the rapid increase in its incidence and its disproportionate contribution to increased infant mortality rates. OBJECTIVE To assess the survival status and predictors of mortality among preterm neonates. DESIGN A multicentre prospective follow-up study was used. SETTING 625 preterm neonates were admitted to hospitals for secondary level of care. The study covers the Bench Maji Zone, Keffa Zone, Sheka Zone, nearby woredas and portions of the Gambella area in Southwest Ethiopia. PARTICIPANTS 614 preterm neonates with gestational age less than 37 weeks were entered for follow-up and 400 neonates were censored. Neonates with severe fetal malformations and neonates who need urgent referral were excluded from the study. RESULTS Overall, 200 (32.57%) participants died with an incidence rate of 61.69 deaths per 1000 person-day observations (95% CI: 53.71 to 70.86). Poor kangaroo mother care (KMC) services (adjusted HR (AHR)=0.19, 95% CI: 0.12 to 0.29), sex (AHR=0.66, 95%, CI: 0.47 to 0.94), not initiating breast feeding (HR=2.78, 95% CI: 1.8 to 4.28), hypothermia (AHR=0.63, 95% CI: 0.44 to 0.92), anaemia (AHR=6.2, 95% CI: 2.34 to 16.43) and gestational age less than 28 weeks (AHR=9.28, 95% CI: 1.78 to 48.42) were independent predictors. CONCLUSION AND RECOMMENDATION The rate of preterm neonatal mortality was high compared with the Ethiopia Demographic and Health Survey report nationally. Healthcare workers should encourage KMC services and breastfeeding initiation and prevent preterm neonates from being anaemic to increase their chances of survival.
Collapse
Affiliation(s)
- Esmelealem Mihretu
- Pediatrics and Child Health Nursing, Debre Markos University, Debre Markos, Ethiopia
| | | | - Emebet Adugnaw
- Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | | |
Collapse
|
3
|
Ludington-Hoe SM, Addison C. Sudden Unexpected Postnatal Collapse: Review and Management. Neonatal Netw 2024; 43:76-91. [PMID: 38599773 DOI: 10.1891/nn-2023-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript.
Collapse
|
4
|
Nel S, Wenhold F, Botha T, Feucht U. One-year anthropometric follow-up of South African preterm infants in kangaroo mother care: Which early-life factors predict malnutrition? Trop Med Int Health 2024; 29:292-302. [PMID: 38327260 DOI: 10.1111/tmi.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Preterm infants often have poor short- and long-term growth. Kangaroo mother care supports short-term growth, but longer-term outcomes are unclear. METHODS This study analysed longitudinally collected routine clinical data from a South African cohort of preterm infants (born <37 weeks gestation) attending the outpatient follow-up clinic of a tertiary-level hospital (Tshwane District, South Africa) for 1 year between 2012 and 2019. At 1 year, small-for-gestational age (SGA) and appropriate-for-gestational age (AGA) infants were compared with regard to age-corrected anthropometric z-scores (weight-for-age [WAZ], length-for-age [LAZ], weight-for-length [WLZ] and BMI-for-age [BMIZ]) and rates of underweight (WAZ < -2), stunting (LAZ < -2), wasting (WLZ < -2) and overweight (BMIZ> + 2). Multiple regression analysis was used to investigate associations between maternal/infant characteristics and rates of underweight, stunting, wasting and overweight. RESULTS At 1 year, compared with AGA infants (n = 210), SGA infants (n = 111) had lower WAZ (-1.26 ± 1.32 vs. -0.22 ± 1.24, p < 0.001), LAZ (-1.50 ± 1.11 vs. -0.60 ± 1.06, p < 0.001), WLZ (-0.66 ± 1.31 vs. 0.11 ± 1.24, p < 0.001) and BMIZ (-0.55 ± 1.31 vs. 1.06 ± 1.23, p < 0.001), despite larger WAZ gains from birth (+0.70 ± 1.30 vs. +0.05 ± 1.30, p < 0.001). SGA infants had significantly more stunting (34.2% vs. 9.1%; p < 0.001), underweight (31.2% vs. 7.2%; p < 0.001) and wasting (12.6% vs. 4.3%, p = 0.012), with no difference in overweight (4.5% vs. 7.7%, p = 0.397). In multiple regression analysis, birth weight-for-GA z-score more consistently predicted 1-year malnutrition than SGA. CONCLUSION Preterm-born SGA infants remain more underweight, stunted and wasted than their preterm-born AGA peers at 1 year, despite greater WAZ gains. Interventions for appropriate catch-up growth especially for SGA preterm infants are needed.
Collapse
Affiliation(s)
- Sanja Nel
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
| | - Friede Wenhold
- Department of Human Nutrition, University of Pretoria, Pretoria, South Africa
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
| | - Tanita Botha
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
- Department of Statistics, University of Pretoria, Pretoria, South Africa
| | - Ute Feucht
- Fetal, Newborn & Child Health Care Strategies, Kalafong Hospital, University of Pretoria Research Centre for Maternal, Atteridgeville, South Africa
- South African Medical Research Council (SA MRC) Maternal and Infant Health Care Strategies Unit, Kalafong Hospital, Atteridgeville, South Africa
- Department of Paediatrics, University of Pretoria, Pretoria, South Africa
- Gauteng Department of Health, Tshwane District Health Services, Pretoria, South Africa
| |
Collapse
|
5
|
Kabir FH, Razavinia F, Keshavarz M, Mousavi SS, Haghani H. Effect of Companion Presence during Skin-to-Skin Contact on Maternal Anxiety: A Randomized Clinical Trial. Indian Pediatr 2024; 61:230-236. [PMID: 38469838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To compare the effect of companion presence versus midwife presence during skin-to-skin contact (SSC) at birth on maternal anxiety and satisfaction, and neonatal physiological parameters. METHODS A randomized controlled trial was conducted on 92 pregnant women who were randomized to provide SSC to their newly borns for one hour postpartum, in the presence of a companion (study group) or a midwife (control group). Maternal anxiety (using the Visual Analogue Scale) and the neonatal physiological parameters (including temperature, heart rate, and oxygen saturation) were assessed in four stages viz., immediately after birth, and at 30, 60 and 90 minutes after birth. Maternal satisfaction was also evaluated after transferring the mother to the postpartum ward. RESULTS We analyzed 86 mother-infant dyads (43 per group). Having a companion significantly reduced maternal anxiety after birth as compared to having a midwife at 30, 60, and 90 minutes after birth (P = 0.04, P = 0.01, and P = 0.04, respectively). There was also a small to medium effect size of the presence of companion compared to midwife in terms of maternal anxiety at 30 minutes (Cohen's d = 0.45; 95% CI = 0.02, 0.87), 60 minutes (Cohen's d = 0.52; 95% CI = 0.08, 0.94) and 90 minutes after birth (Cohen's d = 0.45; 95% CI = 0.02, 0.88). However, there was no significant effect of the same on neonatal physiological parameters. Having a companion versus a midwife led to higher maternal satisfaction rates (P = 0.02); 65.1% of mothers in the study group and 37.2% of mothers in the control group were desirous of the same care in future (P = 0.02). CONCLUSION Companion presence during SSC leads to a significant reduction in maternal anxiety compared to midwife presence.
Collapse
Affiliation(s)
- Fatemeh Harati Kabir
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Razavinia
- Midwifery Department, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Keshavarz
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran and Reproductive Sciences and Technology Research Center, Department of Anatomy, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Saeedeh Mousavi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran and Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Correspondence to: Dr Seyedeh Saeedeh Mousavi, Assistant Professor, Department of Reproductive Health and Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Hamid Haghani
- Department of Biostatistics, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Tembo D, Abobo FDN, Kaonga P, Jacobs C, Bessing B. Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka. Sci Rep 2024; 14:5231. [PMID: 38433271 PMCID: PMC10909865 DOI: 10.1038/s41598-024-56020-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0-42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0-46.0) in 2018 to 37.3% (95% CI 35.0-40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46-1.96), preterm birth (ARR: 1.59, 95% CI 1.36-1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34-1.88), low birthweight (ARR: 1.57, 95% CI 1.37-1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25-1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22-0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68-0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95-0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.
Collapse
Affiliation(s)
- Deborah Tembo
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia.
- Zambia National Public Health Institute, Lusaka, Zambia.
| | | | - Patrick Kaonga
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia
| | | |
Collapse
|
7
|
Chawla D. Kangaroo Mother Care and Neonatal Skin Microbiome. Indian J Pediatr 2024; 91:213-214. [PMID: 38114861 DOI: 10.1007/s12098-023-04984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Deepak Chawla
- Department of Neonatology, Government Medical College Hospital, Chandigarh, India.
| |
Collapse
|
8
|
Buil A, Thomas N, Chevalier B, Devouche E. Effects of skin-to-skin contact in supported diagonal flexion positioning on movement quality in very preterm infants at term age. Early Hum Dev 2024; 190:105954. [PMID: 38340687 DOI: 10.1016/j.earlhumdev.2024.105954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Preterm birth is associated with a high risk of long-term neuromotor disabilities such as coordination of movements, deficient antigravity limb movement, less adaptive postural control strategies, head deformities… AIMS: The aim of the present study was to examine the potential positive impact of a Supported Diagonal Flexion (SDF) skin-to-skin contact (SSC) positioning on the neuromotor development and movement quality of very preterm infants at term age. STUDY DESIGN Monocentric prospective matched-pair case-control study. SUBJECTS Thirty very preterm infants and their mother were proposed either SDF SSC positioning (n = 15) or Vertical SSC positioning (n = 15). OUTCOME MEASURES Amiel-Tison Neurological Assessment at Term (ATNAT) and observation of the spontaneous motor activity were assessed at term corrected age. RESULTS Infants in the SDF group had less dolichocephaly (adj. p = .014) and arms in candlestick position (adj. p = .048). Only 3 in the SDF group against 11 in the vertical group showed nonoptimal spontaneous motor activity. Infants in the SDF group had more positive signs such as foot-to-foot contact (adj. p = .047) or arms movements toward midline (adj. p = .046 and 0.011). CONCLUSIONS The present study shows that nonoptimal spontaneous motor activity was increased and dolichocephaly was more common in the vertical group. Consistently with current guidelines, it is critical to consider preterm infants' postures during SSC or while in incubators or cradles.
Collapse
Affiliation(s)
- Aude Buil
- Centre de Recherche Clinique_Service de réanimation et médecine néonatale, CHI Créteil, France; Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé (LPPS ER4057), France.
| | - Nelly Thomas
- Service de Réanimation et Médecine Néonatale, CHI Créteil, France.
| | - Benoît Chevalier
- Laboratoire Cognition Humaine et Artificielle, Ecole Pratique des Hautes Etudes, Paris_Luciole Formation, Angers, France
| | - Emmanuel Devouche
- Université Paris Cité, Laboratoire de Psychopathologie et Processus de Santé (LPPS ER4057), France
| |
Collapse
|
9
|
Govindarajan V, Devadas S, Shah PA, Diggikar S. Impact of Kangaroo Mother Care on Skin Microbiome of Very Preterm Infants - A Pilot Study. Indian J Pediatr 2024; 91:229-234. [PMID: 37040016 DOI: 10.1007/s12098-023-04562-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/10/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To test whether Kangaroo mother care (KMC) aids in transfer of favourable skin microbiome from mother to infant by comparing the microbiome composition before and after KMC. METHODS A prospective cohort pilot study was conducted in a Level III neonatal intensive care unit (NICU) in South India, recruiting 30 preterm infants with gestation <32 wk from October 2020 through December 2020. Neonatal skin involving the area in contact with the mother during KMC i.e., axilla, chest and abdomen was swabbed at the end of first week of life, prior to initiation of KMC. The 2nd swab involving the same areas was taken following KMC for 7 d for at least 6 h a day. The swabs were analysed using Next Generation Sequencing (NGS) - 16sRNA and abundance of organisms isolated were mapped. Statistical analyses using t-test and PERMANOVA were performed to compare phyla and genera of bacterial abundance pre-KMC and post-KMC. RESULTS KMC at phyla level increased the relative abundance of Firmicutes (p=0.52) and significantly decreased Proteobacteria (p=0.02). At species level, KMC decreased pathogenic bacterial count of Escherichia (p=0.05), while counts of S. hemolyticus (p=0.01) and S. hominis (p=.002) significantly increased post KMC. CONCLUSIONS KMC has a potential role in altering the neonatal skin microbiota towards a more favourable microenvironment. The clinical significance of these novel findings needs to be validated with larger studies.
Collapse
Affiliation(s)
- Varun Govindarajan
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sahana Devadas
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Pritik A Shah
- Undergraduate (MBBS), Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Shivashankar Diggikar
- Department of Pediatrics, Oyster Woman and Child Hospital, Bengaluru, Karnataka, India.
| |
Collapse
|
10
|
Galván Núñez YC, Florez Suaza A, Sánchez Rojo LC, Lombo Lievano ÁM. [Factors associated with abandoning from the Kangaroo Mother Program between years 2019 and 2021]. Rev Esp Salud Publica 2024; 98:e202402012. [PMID: 38385555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
OBJECTIVE The abandonment of the Kangaroo Mother Program is a public health problem that affects the health of premature infants. The objective of this study was to determine the factors associated with the abandonment of mothers or caregivers of premature infants in the first stage of the Kangaroo Mother Program of a Health Promoting Company (EPS) in the department of Antioquia (Colombia), between 2019 and 2021. METHODS An observational, cross-sectional, and analytical study was carried out, where information was collected on admissions to the program (N=1,344) between 2019 and 2021. The Chi-Square likelihood ratio test was performed with crude prevalence ratio, a generalized linear model of robust variance was applied with the adjusted prevalence ratio. RESULTS When adjusting for dropout with the independent variables, a higher probability of dropout was evidenced: with respect to the year 2020 (PR 2.44, 95% CI: 1.94-3.08, p-value=0.0001), marital status alone with support (PR 1.60, 95% CI: 0.84-3.04, p-value=0. 147), primary school completed or incomplete (PR 1.48, 95% CI 1.11-1.97, p-value=0.006), monthly income less than the current legal monthly minimum wage (CLMMW) (PR 1.26, 95% CI: 1.00-1.59, p-value=0.004) and area of residence living outside Medellin (PR 1.25, 95% CI: 1.06-1.46, p-value=0.006). CONCLUSIONS The findings of this study can be very useful to carry out interventions in families belonging to Kangaroo Programs, with the aim of intervening risk factors associated with program dropout.
Collapse
|
11
|
Tesfie TK, Anlay DZ, Abie B, Chekol YM, Gelaw NB, Tebeje TM, Animut Y. Nomogram to predict risk of neonatal mortality among preterm neonates admitted with sepsis at University of Gondar Comprehensive Specialized Hospital: risk prediction model development and validation. BMC Pregnancy Childbirth 2024; 24:139. [PMID: 38360591 PMCID: PMC10868119 DOI: 10.1186/s12884-024-06306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Mortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians. OBJECTIVE We aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions. METHODS A three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model. RESULT The nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions. CONCLUSION The developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk.
Collapse
Affiliation(s)
- Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Degefaye Zelalem Anlay
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhanu Abie
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Science, Mizan Aman, Ethiopia
| | - Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
12
|
Manzar S. Kangaroo mother care and its effects on the digestive system of preterm infants. J Trop Pediatr 2024; 70:fmae006. [PMID: 38515250 DOI: 10.1093/tropej/fmae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Affiliation(s)
- Shabih Manzar
- Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| |
Collapse
|
13
|
Lee MS, Lee S. Exploring the Knowledge Structures of Korean and International Nursing Research on Premature Infants Using Text Network Analysis. Comput Inform Nurs 2024; 42:109-117. [PMID: 37276432 DOI: 10.1097/cin.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study aimed to identify the knowledge structures of Korean and international nursing studies on premature infants using text network analysis, which represents a text as a network graph that describes how keywords are linked. This network graph refers to a knowledge structure. International and Korean journal databases were searched to extract nursing studies regarding premature infants published in academic journals from 1998 to 2020. Abstracts from the selected studies were analyzed using the following four steps: word extraction and refinement, keyword extraction, co-occurrence matrix generation, and text network visualization. The results demonstrated that 182 Korean and 2502 international studies were published. The common keywords of Korean and international studies were "kangaroo mother care," "stress," and "child." The keywords of the international studies had more branches linking to other keywords than those of the Korean studies. Thus, the knowledge structure of international studies included diverse concepts. These findings will serve as important guidance for future research worldwide. Furthermore, studies to develop a more comprehensive knowledge structure of international research on premature infants are needed. The knowledge structure of Korean studies mainly included concepts related to mothers. Korean studies regarding hospitalized premature infants and communication with parents need to be conducted.
Collapse
Affiliation(s)
- Myeong Seon Lee
- Author Affiliations: Department of Nursing (M. S. Lee), Nambu University; and College of Nursing (S. Lee), Chonnam National University, Gwangju, South Korea
| | | |
Collapse
|
14
|
Freccero A, Scala M, McLeod KA, Donahue B, Webb M, Briggs M, Najm I, Sinha M, Santagata L, Dahlen A, Nasr A. The Safety of Body Wraps on Skin-to-Skin Care in the Neonatal Population: A Pilot Study. Adv Neonatal Care 2024; 24:E11-E19. [PMID: 38127581 DOI: 10.1097/anc.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Despite well-established benefits of skin-to-skin care (SSC) for preterm infants and parents, standardized guidelines for implementation do not exist. Furthermore, the literature offers little evidence-based information to guide best practice. PURPOSE To discover whether SSC using a body wrap to hold preterm infants would increase the duration of SSC, decrease parental stress during SSC, and minimize adverse events to ensure that body wraps are safe and feasible. METHODS Twenty-nine dyads of parents and preterm infants younger than 34 weeks postmenstrual age were enrolled. The first 15 dyads to meet inclusion criteria were assigned to a standard of care group for SSC with no body wrap. The remaining 14 dyads were assigned to an experimental group for SSC with a body wrap. Each dyad performed 2 SSC holds. Parents completed the Parental Stressor Scale and Parent Feedback Form. Adverse events were also documented. RESULTS No statistically significant differences were found between the 2 groups in total SSC time ( P = .33), the number of adverse events ( P = .31 for major events; P = .38 for minor events), average parental stress ( P = .22), and parental confidence performing SSC ( P = .18). IMPLICATIONS FOR PRACTICE AND RESEARCH This study found that SSC with a body wrap is safe for preterm infants in a neonatal intensive care unit (NICU). This is the first study to explore the use, safety, and effectiveness of body wraps during SSC with preterm infants in an NICU. Future research should be conducted with larger sample sizes to further evaluate the safety and efficacy.
Collapse
Affiliation(s)
- Allison Freccero
- Departments of Rehabilitation Services (Drs Freccero, McLeod, Donahue, and Webb and Ms Briggs) and Nursing (Mss Najm, Sinha, and Santagata), Lucile Packard Children's Hospital Stanford, Palo Alto, California; Departments of Neonatology (Dr Scala) and Pediatrics (Dr Nasr), School of Medicine, Stanford University, Lucile Packard Children's Hospital Stanford, Palo Alto, California; and Quantitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, California (Dr Dahlen)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Kebede BF, Biyazin Tesfa T, Yetwale Hiwot A, Mulu KK, Adugnaw E, Mihretu E, Sewmehone E, Genie YD. Time to death and predictors of mortality among asphyxiated neonates in southwest Ethiopia, 2022: prospective cohort study. BMJ Open 2024; 14:e077943. [PMID: 38238169 PMCID: PMC10806697 DOI: 10.1136/bmjopen-2023-077943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE This study aimed to determine the time to death and predictors of mortality among asphyxiated neonates admitted to public hospitals in the southwest region of Ethiopia. DESIGN An institution-based prospective cohort study was conducted. SETTING Public hospitals in southwest Ethiopia. PARTICIPANTS A total of 144 asphyxiated neonates, who were admitted to the neonatal intensive care unit, and their mothers participated from March 2022 to 30 September 2022. Data were entered into EpiData V.4.4.2.1 and exported to STATA V.16 for analysis. The Cox proportional hazards model using bivariate (p<0.25) and multivariate (p<0.05) analyses was used to identify the predictors of mortality. The median survival time was estimated using Kaplan-Meier survival estimates. PRIMARY OUTCOME Time to death from asphyxia and its predictors in neonates. RESULTS The mortality incidence rate of asphyxiated neonates was 9.1 deaths per 1000 person-days of observation (95% CI: 7.11 to 11.52) with a median survival time of 8 days, and 45.83% (95% CI: 37.81% to 54.08%) of asphyxiated neonates died. Being male (adjusted HR (AHR) 0.32 (95% CI: 0.14 to 0.76)), neonatal sepsis (AHR 0.321 (95% CI: 0.13 to 0.77)), not receiving kangaroo mother care (AHR 0.16 (95% CI: 0. 07 to 0.39)) and vaginal delivery (AHR 0.39 (95% CI: 0.16 to 0.95)) were independent predictors of mortality of asphyxiated neonates. CONCLUSIONS In this study, asphyxiated neonates had a higher incidence of mortality with a median survival time of only 8 days. Being male, vaginal delivery, not receiving kangaroo mother care and comorbidities such as neonatal sepsis were independent predictors of mortality among asphyxiated neonates. Therefore, healthcare providers and other stakeholders should provide timely initiation of advanced diagnosis and appropriate therapeutic interventions for neonates with asphyxia to reduce neonatal mortality.
Collapse
Affiliation(s)
| | | | | | | | - Emebet Adugnaw
- Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia
| | - Esmelalem Mihretu
- Pediatrics and Child Health, Debre Markos University, Debre Markos, Ethiopia
| | | | | |
Collapse
|
16
|
Lusambili A, Kovats S, Nakstad B, Filippi V, Khaemba P, Roos N, Part C, Luchters S, Chersich M, Hess J, Kadio K, Scorgie F. Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya. BMC Pediatr 2024; 24:36. [PMID: 38216969 PMCID: PMC10787431 DOI: 10.1186/s12887-023-04517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/29/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi. DESIGN Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16). SETTINGS We conducted our research in Kilifi County in Kenya's Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C. DATA ANALYSIS Data were analyzed in NVivo 12, using both inductive and deductive approaches. RESULTS High ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate's skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as "having no peace". Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care. CONCLUSIONS High ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings.
Collapse
Affiliation(s)
- Adelaide Lusambili
- Environmental Health and Governance Center, Leadership and Governance Hub, School of Business, Africa International University, Nairobi, Kenya.
| | - Sari Kovats
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Britt Nakstad
- Division of Pediatric and Adolescent Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Khaemba
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
| | - Nathalie Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Cherie Part
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Stanley Luchters
- Department of International Public Health, Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeremy Hess
- Emergency Medicine, Env & Occ Health Sciences, and Global Health, University of Washington, Washington, USA
| | - Kadidiatou Kadio
- Institute de Recherche en Siences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
17
|
Eckermann HA, Meijer J, Cooijmans K, Lahti L, de Weerth C. Daily skin-to-skin contact alters microbiota development in healthy full-term infants. Gut Microbes 2024; 16:2295403. [PMID: 38197254 DOI: 10.1080/19490976.2023.2295403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
The gut microbiota is vital for human body development and function. Its development in early life is influenced by various environmental factors. In this randomized controlled trial, the gut microbiota was obtained as a secondary outcome measure in a study on the effects of one hour of daily skin-to-skin contact (SSC) for five weeks in healthy full-term infants. Specifically, we studied the effects on alpha/beta diversity, volatility, microbiota maturation, and bacterial and gut-brain-axis-related functional abundances in microbiota assessed thrice in the first year. Pregnant Dutch women (n = 116) were randomly assigned to the SSC or care-as-usual groups. The SSC group participants engaged in one hour of daily SSC from birth to five weeks of age. Stool samples were collected at two, five, and 52 weeks and the V4 region was sequenced. We observed significant differences in the microbiota composition, bacterial abundances, and predicted functional pathways between the groups. The SSC group exhibited lower microbiota volatility during early infancy. Microbiota maturation was slower in the SSC group during the first year and our results suggested that breastfeeding duration may have partially mediated this relation. Our findings provide evidence that postpartum SSC may influence microbiota development. Replication is necessary to validate and generalize these results. Future studies should include direct stress measurements and extend microbiota sampling beyond the first year to investigate stress as a mechanism and research SSC's impact on long-term microbiota maturation trajectories.
Collapse
Affiliation(s)
- Henrik Andreas Eckermann
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Jennifer Meijer
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| | - Kelly Cooijmans
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Leo Lahti
- Department of Computing, University of Turku, Turku, Finland
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience, Radboud university medical center, Nijmegen, The Netherlands
| |
Collapse
|
18
|
Anjur KI, Darmstadt GL. Separation of Maternal and Newborn Care in US Hospitals: A Systemic Threat to Survival, Health and Well-Being. Health Syst Reform 2023; 9:2267255. [PMID: 37890078 DOI: 10.1080/23288604.2023.2267255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Through greater understanding of past social, cultural, economic, political, scientific and technological forces which shaped our current health systems to separate mothers and newborn infants, we can begin to devise effective approaches to reshape these systems to meet the needs of mothers and newborn infants today. Medical science and technology have evolved vastly in the last century; however, effects of historical factors persist in our current health care systems, reflected in separate maternal and neonatal care in different departments with distinct guidelines, providers, and treatment locations. This separation prevents maternal-infant skin-to-skin contact and bonding, which significantly affects infant development, well-being, and that of their caregivers. We explore historical precedents for the separation of maternal-newborn care, including the transition from midwifery home care to hospital obstetric care, reasons for the increase in hospital births and hospital nursery development, and the effects of world wars, federal acts, health insurance, rooming-in practices, and the development of medical advances such as antibiotics, on hospital infrastructure. This information is evaluated in the context of modern scientific advancements to show that the conditions which shaped health systems to separate mothers and newborns in the past no longer hold. The insights gained will help to identify strategic actions to reshape health care systems to enable more integrated maternal-newborn care and the practice of Kangaroo Mother Care, and to improve survival outcomes and well-being for mothers, families, and their newborn infants.
Collapse
Affiliation(s)
- Kavya I Anjur
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
19
|
Randa MB, Malesela JM. Women's experiences providing kangaroo mother care in an academic hospital in Tshwane, Gauteng. Afr J Reprod Health 2023; 27:101-105. [PMID: 38158890 DOI: 10.29063/ajrh2023/v27i12.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Preterm birth can be stressful for mothers and have negative consequences for the natural establishment of the mother-infant relationship. A high-impact, economical, and potentially life-saving strategy for the care of preterm and low-birthweight babies is kangaroo mother care (KMC). The literature suggests challenges to and enablers of KMC implementation in low-resource environments. The aim was to explore and describe women's experiences of providing KMC to their preterm babies. A qualitative, exploratory and descriptive approach was adopted. An unstructured interview guide was used to collect data during a focus group interview with mothers who provided kangaroo care. Data were analyzed using Braun and Clarke's method. Four main themes emerged from the analyzed data. The results reflected on participants' positive experiences, parenting skills and challenges. The participants suggested measures to enhance their encounters while providing KMC. Nurses need to support mothers who provide KMC; continuous education and guidance can enhance the implementation of this evidence-based practice to improve health outcomes for both preterm babies and their mothers. There is a need for continued training and support for mothers practising KMC, along with the consideration for healthcare providers to offer postpartum services for the mothers.
Collapse
Affiliation(s)
- Moreoagae B Randa
- School of Health Care Sciences, Department of Public Health, Sefako Makgatho Health Sciences University
| | - Jacobeth M Malesela
- School of Health Care Sciences, Department of Nursing Science, Sefako Makgatho Health Sciences University
| |
Collapse
|
20
|
Mandu R, Miller L, Namazzi G, Twum-Danso N, Achola KJA, Cooney I, Butrick E, Santos N, Masavah L, Nyakech A, Kirumbi L, Waiswa P, Walker D. Quality improvement collaboratives as part of a quality improvement intervention package for preterm births at sub-national level in East Africa: a multi-method analysis. BMJ Open Qual 2023; 12:e002443. [PMID: 38135302 DOI: 10.1136/bmjoq-2023-002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Quality improvement collaboratives (QIC) are an approach to accelerate the spread and impact of evidence-based interventions across health facilities, which are found to be particularly successful when combined with other interventions such as clinical skills training. We implemented a QIC as part of a quality improvement intervention package designed to improve newborn survival in Kenya and Uganda. We use a multi-method approach to describe how a QIC was used as part of an overall improvement effort and describe specific changes measured and participant perceptions of the QIC. METHODS We examined QIC-aggregated run charts on three shared indicators related to uptake of evidence-based practices over time and conducted key informant interviews to understand participants' perceptions of quality improvement practice. Run charts were evaluated for change from baseline medians. Interviews were analysed using framework analysis. RESULTS Run charts for all indicators reflected an increase in evidence-based practices across both countries. In Uganda, pre-QIC median gestational age (GA) recording of 44% improved to 86%, while Kangaroo Mother Care (KMC) initiation went from 51% to 96% and appropriate antenatal corticosteroid (ACS) use increased from 17% to 74%. In Kenya, these indicators went from 82% to 96%, 4% to 74% and 4% to 57%, respectively. Qualitative results indicate that participants appreciated the experience of working with data, and the friendly competition of the QIC was motivating. The participants reported integration of the QIC with other interventions of the package as a benefit. CONCLUSIONS In a QIC that demonstrated increased evidence-based practices, QIC participants point to data use, friendly competition and package integration as the drivers of success, despite challenges common to these settings such as health worker and resource shortages. TRIAL REGISTRATION NUMBER NCT03112018.
Collapse
Affiliation(s)
- Rogers Mandu
- School of Public Health, Makerere University, Kampala, Kampala, Uganda
| | - Lara Miller
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Gertrude Namazzi
- School of Public Health, Makerere University, Kampala, Kampala, Uganda
| | | | | | - Isabella Cooney
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Butrick
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Nicole Santos
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | | | - Leah Kirumbi
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Kampala, Uganda
- Karolinska Institutet, Stockholm, Stockholm, Sweden
| | - Dilys Walker
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
- Department of Obstetrics and Gynecology and Global Health Sciences, University of California San Francisco Medical Center at Parnassus, San Francisco, California, USA
| |
Collapse
|
21
|
Yildirim F, Büyükkayaci Duman N, Şahin E, Vural G. The Effect of Kangaroo Care on Paternal Attachment: A Randomized Controlled Study. Adv Neonatal Care 2023; 23:596-601. [PMID: 37884013 DOI: 10.1097/anc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND During the first interaction between the father and the infant, touch can be very important especially father-infant skin-to-skin contact. Few studies have focused on the effect of kangaroo care (KC) on paternal attachment. PURPOSE This randomized controlled study was conducted to determine the effect of KC on paternal attachment. METHODS A total of 90 fathers of healthy newborns, including 45 in the intervention group and 45 in the control group who met the inclusion criteria, were included randomly in the study. Data were collected using the Introductory Information Form at study admission and the Father-Infant Attachment Scale (FIAS) at 3 months of age. T test, Mann-Whitney U test, and Kruskal-Wallis test were used for statistical analysis. RESULTS The mean FIAS scores for the intervention group (I) were higher than for the control group (C) (I: 80.57 ± 13.70; C: 56.76 ± 13.23) ( P < .05). Patience and tolerance (I: 13.70 ± 1.18; C: 11.57 ± 2.30), pleasure in interaction (I: 29.50 ± 2.86; C: 17.13 ± 5.93), and love and pride (I: 37.37 ± 2.85; C: 28.06 ± 5.82) mean scores for FIAS subdimensions in the intervention group were also higher than in the control group ( P < .05). IMPLICATIONS FOR PRACTICE AND RESEARCH Findings of this study demonstrate that KC has the potential to increase paternal attachment. Healthcare providers should provide discharge education for fathers on KC to increase father-infant attachment. There is a need for studies with larger samples in different cultures on the factors related to parents that affect father-infant attachment and evidence-based practices that increase attachment.
Collapse
Affiliation(s)
- Fatma Yildirim
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Hitit University, Çorum, Turkey (Drs Yildirim and Duman); Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Ordu University, Ordu, Turkey (Dr Şahin); and Yüksek I˙htisas University, Faculty of Health Sciences, Obstetrics and Gynecology Department, Ankara, Turkey (Dr Vural)
| | | | | | | |
Collapse
|
22
|
Pallás-Alonso C, Montealegre A, Hernández-Aguilar MT, Muñoz-Amat B, Collados-Gómez L, Jiménez-Fernández L, García-Lara N, Cabrera-Lafuente M, Moral-Pumarega MT, López-Maestro M, Charpak N. XIII International Conference on Kangaroo Mother Care - Different opinions, experiences and related KMC issues: Good practices, stabilisation concept, nutrition and basic respiratory support. Acta Paediatr 2023; 112:2478-2485. [PMID: 37667990 DOI: 10.1111/apa.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
AIM This study aimed to summarise the views and experiences of the participants in the workshop of the XIII International Conference on Kangaroo Mother Care (KMC). METHODS The results of the discussions held during the workshop of the XIII International Conference on KMC were summarised. There were 152 participants from 47 countries. Four main KMC topics were discussed: good practices, immediate implementation, nutrition and basic ventilation. RESULTS Several agreements were reached, namely that professional societies and governments should develop official recommendations to promote KMC as standard care for preterm and low birth weight infants and that parents should be involved as active caregivers in neonatal care units. Moreover, the criteria for referring community-born infants to KMC require standardisation. Important inequalities in resource availability among high-, middle- and low-income countries were recognised for all topics. Specific needs were identified for parenteral nutrition and fortifiers, nasal continuous positive airway pressure (nCPAP) and oxygen blenders, which are rarely available in low- and middle-income countries. Immediate implementation of KMC was discussed as a new concept. Its benefits were recognised, but its application has some variability. CONCLUSION Adequate preterm care requires a basic neonatal package, including KMC, nCPAP, immediate management protocols and adequate nutrition and feeding strategies. The differences in resources among high-, middle- and low-income countries highlight the wide disparities in neonatal care according to the place of birth.
Collapse
Affiliation(s)
- Carmen Pallás-Alonso
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Adriana Montealegre
- Fundación Canguro Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Bárbara Muñoz-Amat
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Laura Collados-Gómez
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
- Nursing and Nutrition Department, Faculty of Biomedicine, Universidad Europea, Madrid, Spain
| | | | - Nadia García-Lara
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - Marta Cabrera-Lafuente
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
- Spanish Neonatal BFHI Coordinator, Madrid, Spain
| | - María Teresa Moral-Pumarega
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | - María López-Maestro
- Department of Neonatology, 12 de Octubre University Hospital, Madrid, Spain
- i+12 Research Institute, Madrid, Spain
| | | |
Collapse
|
23
|
Wigglesworth H, Huddy V, Knowles R, Millings A. Evaluating the impact of sling provision and training upon maternal mental health, wellbeing and parenting: A randomised feasibility trial. PLoS One 2023; 18:e0293501. [PMID: 37948400 PMCID: PMC10637655 DOI: 10.1371/journal.pone.0293501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Close body contact interventions such as Kangaroo Mother Care have been shown to improve maternal mental health following birth. Infant carriers ('slings') facilitate hands-free close body contact. No studies have specifically examined whether sling use improves maternal mental health. A full-scale efficacy study is needed to examine whether sling use is beneficial to maternal mental health. The current study is a feasibility study designed to gather information to support the design of a future RCT, such as acceptability and study parameters, including recruitment rates, consent rate and attrition. METHOD Mothers of infants aged 0-6 weeks were randomised to one of two conditions: intervention (n = 35) vs. waitlist control (n = 32). Intervention participants received sling training, support, and free sling hire for 12 weeks. Participants completed self-report measures of mood, wellbeing and parenting at baseline (Time 1), and 6- (Time 2) and 12- (Time 3) weeks post-baseline. RESULTS Eligibility and consent rates met feasibility objectives, though there were some difficulties with retention of participants in the study. Preliminary effectiveness analyses showed a non-significant improvement with a small effect size in postnatal depression from T1 to T3, and a significant improvement with a medium effect size in maternal self-efficacy from T1 to T3. Qualitative feedback indicated acceptability of the intervention and study participation. Intervention participants attributed greater autonomy, bonding with their baby, and parental self-confidence, to the intervention. CONCLUSIONS These findings indicate a randomised study of the impact of a sling and related support intervention upon maternal mental health is feasible. These findings should be interpreted within the context of sampling bias (due to the use of volunteer sampling methods), an absence of feedback from those who discontinued participation in the study, and the study not being adequately powered. TRIAL REGISTRATION Registration number ISRCTN88575352.
Collapse
Affiliation(s)
| | - Vyv Huddy
- Clinical Psychology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Rosie Knowles
- Sheffield Sling Surgery and Library, Carrying Matters, Sheffield, United Kingdom
| | - Abigail Millings
- Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, Sheffield, United Kingdom
| |
Collapse
|
24
|
Tran HT, Luu HM, Le TD, Pham NTQ, Sobel HL, Murray JCS. Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study. J Glob Health 2023; 13:04121. [PMID: 37934970 PMCID: PMC10630854 DOI: 10.7189/jogh.13.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC). Methods To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed. Results Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9). Conclusions Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.
Collapse
Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Hanh My Luu
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Thao Dieu Le
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Nga Thi Quynh Pham
- World Health Organization Representative Office in Viet Nam, Ha Noi, Vietnam
| | - Howard L Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - JCS Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| |
Collapse
|
25
|
Heine E, Trautmann-Villalba P, Schoemig C, Hucklenbruch-Rother E, Kribs A, Mehler K. Delivery room skin-to-skin contact brings mother-child-interaction of preterm infants close to normal. Acta Paediatr 2023; 112:2381-2383. [PMID: 37463073 DOI: 10.1111/apa.16909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 07/17/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Eva Heine
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Charlotte Schoemig
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Eva Hucklenbruch-Rother
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Angela Kribs
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katrin Mehler
- Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| |
Collapse
|
26
|
Erduran B, Yaman Sözbir Ş. Effects of intermittent kangaroo care on maternal attachment, postpartum depression of mothers with preterm infants. J Reprod Infant Psychol 2023; 41:556-565. [PMID: 35129000 DOI: 10.1080/02646838.2022.2035703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To reveal the effect of intermittent kangaroo care on maternal attachment, postpartum depression of mothers with preterm infants. METHODS The study was conducted as a single centre randomised controlled study with sixty mothers whose newborns were hospitalised in the NICU due to prematurity. The data were collected by the questionnaire form, Edinburgh Postnatal Depression Scale (EPDS) and the Maternal Attachment Inventory (MAI). 'Intermittent kangaroo care' was applied for 30 minutes once a day for 10 days to the experimental group. Women were completed the EPDS and the MAI in postpartum 30-40th days. RESULTS The median of the total score of EPDS in the experimental group was 7, and in the control group was 9 (p > 0.05). The median of the total score of MAI in the experimental group was 99, and in the control group was 97 (p <0.05) and it was determined that the effect size of the difference between the groups was medium (1-β: 0.65, Cohen's d: 0.532). CONCLUSION It was determined that mothers who received intermittent kangaroo care had higher scores that can be interpreted as higher maternal attachment than others and the postpartum depression scores did not differ between experimental and control group.
Collapse
Affiliation(s)
- Burcu Erduran
- Institute of Health Sciences, Ob/Gyn Nursing, Akdeniz University, Antalya, Turkey
| | - Şengül Yaman Sözbir
- Faculty of Health Sciences, Nursing Department, Ob/Gyn Nursing, Gazi University, Ankara, Turkey
| |
Collapse
|
27
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
28
|
Huka AE, Oljira L, Weldesenbet AB, Bushra AA, Ahmed IA, Tura AK, Tuluka AA. Predictors of time to death among preterm neonates admitted to neonatal intensive care units at public hospitals in southern Ethiopia: A cohort study. PLoS One 2023; 18:e0283143. [PMID: 37824535 PMCID: PMC10569587 DOI: 10.1371/journal.pone.0283143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Although the survival of preterm neonates has improved, thanks to advanced and specialized neonatal intensive care, it remains the main reason for neonatal admission, death, and risk of lifelong complication. In this study, we assessed time to death and its predictors among preterm neonates admitted to neonatal intensive care units (NICU) at public hospitals in southern Ethiopia. METHODS A hospital based retrospective cohort was conducted among preterm neonates admitted to NICU at public hospitals in west Guji and Borena zones, Oromia National Regional State, southern Ethiopia. Simple random sampling technique was used to select records of preterm neonates admitted to both major hospitals in the study area. Data on neonatal condition, obstetric information, and status at discharge were collected from admission to discharge by trained research assistant through review of their medical records. Kaplan Meir curve and Log rank test were used to estimate the survival time and compare survival curves between variables. Cox-Proportional Hazards model was used to identify significant predictors of time to death at p<0.05. RESULT Of 510 neonates enrolled, 130(25.5%; 95% CI: 22-29) neonates died at discharge or 28days. The median survival time was 18 days with an interquartile range of (IQR = 6, 24). The overall incidence of neonatal mortality was 47.7 (95% CI: 40.2-56.7) per 1000 neonatal days. In the multivariable cox-proportional hazard analysis, lack of antenatal care (AHR: 7.1; 95%CI: 4-12.65), primipara (AHR: 2.3; 95% CI: 1.16-4.43), pregnancy complications (AHR: 3.4; 95% CI: 1.94-6.0), resuscitation at birth (AHR: 2.1, 95% CI: 0.28-0.77) and not receiving Kangaroo mother care (AHR: 9.3, 95% CI: 4.36-19.9) were predictors of preterm neonatal death. CONCLUSION Despite admission to NICU for advanced care and follow up, mortality of preterm neonates was found to be high in the study settings. Addressing major intrapartum complications is required to improve survival of neonates admitted to NICU.
Collapse
Affiliation(s)
- Alo Edin Huka
- Department of Epidemiology, School of Public Health, Institute of Health, Bule Hora University Bule Hora, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulmalik Abdela Bushra
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ibsa Abdusemed Ahmed
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abera Kenay Tura
- School of Nursing and Midwifery, Collage of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Angefa Ayele Tuluka
- Department of Epidemiology, School of Public Health, Institute of Health, Bule Hora University Bule Hora, Ethiopia
| |
Collapse
|
29
|
Patel DV, Sameer K, Pujara RK, Nimbalkar SM, Patel PY, Makwana JB, Patel SN. Kangaroo mother care utilization at stepdown ward of a tertiary care teaching hospital: a quality improvement study. J Trop Pediatr 2023; 69:fmad041. [PMID: 38006294 DOI: 10.1093/tropej/fmad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
PURPOSE India has the highest burden of preterm/low birth weight newborns. To tackle this, Kangaroo Mother Care (KMC) needs to be scaled up. We did a quality improvement (QI) study to increase KMC coverage to 80% and its utilization to at least 4 h/infant/day. METHODS This study was conducted at a stepdown ward (KMC ward) of a tertiary care teaching institute over a period of four months. All babies with birth weight <2.5 kg were eligible. The QI team included faculty in-charge, one senior resident and three senior staff nurses. Potential barriers were listed using fish-bone analysis. Four possible interventions were identified (daily documentation of total KMC hours by doctor, providing KMC during all the nursing duty shifts, counseling and education to mothers and family members), introduced, and then subsequently tested by four Plan-Do-Study-Act (PDSA) cycles and sustenance was assessed over three months. RESULTS A total of 93 infants were included in this QI study. During baseline phase, the KMC coverage was 50% which increased to 100% by the end of fourth PDSA cycle and remained 100% during the sustenance phase. During baseline period, KMC was given for ≥ 4 h in 18.8% (28 of 149) patient days which increased to 88.96% (137 of 154) during the sustenance phase. The mean KMC utilization increased from 1.97 (1.57) h/infant/day to 5.65 (1.20) h/infant/day in the sustenance phase. CONCLUSION QI study incorporating PDSA cycles helped improve coverage and utilization of KMC.
Collapse
Affiliation(s)
- Dipen V Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325, India
| | - K Sameer
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325, India
| | - Reshma K Pujara
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325, India
| | - Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat 388325, India
| | - Paresha Y Patel
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, 388325, India
| | - Jayshreeben B Makwana
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, 388325, India
| | - Smita N Patel
- Department of Neonatology, Shree Krishna Hospital, Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, 388325, India
| |
Collapse
|
30
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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).
Collapse
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
| |
Collapse
|
31
|
Murthy R, Kallesh A, Somasekhara Aradhya A, Bharadwaj SK, Venkatagiri P, Jagadish M, Rao P, Chandramouli D, Hema D, Chaithra SN, Glory H, Purkayastha J. Sustaining extended Kangaroo mother care in stable low birthweight babies in NICU: a quality improvement collaborative of six centres of Karnataka. BMJ Open Qual 2023; 12:e002307. [PMID: 37863504 PMCID: PMC10603408 DOI: 10.1136/bmjoq-2023-002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) is a proven intervention for intact survival in preterms. Despite evidence, its adoption has been low. We used a point of care quality improvement (QI) approach to implement and sustain KMC in stable low birthweight babies from a baseline of 1.5 hours/baby/day to above 4 hours/baby/day through a series of plan-do-study-act (PDSA) cycles over a period of 53 weeks. METHODS All babies with birth weight <2000 g not on any respiratory support or phototherapy and or umbilical lines were eligible. The key quantitative outcome was KMC hours/baby/day. A QI collaborative was formed between six centres of Karnataka mentored by a team with a previous QI experience on KMC. The potential barriers for extended KMC were evaluated using fishbone analysis. Baseline data were collected over 3 weeks. A bundled approach consisting of a variety of parent centric measures (such as staff awareness, making KMC an integral part of treatment order, foster KMC, awareness sessions to parents weekly, recognising KMC champions) was employed in multiple PDSA cycles. The data were aggregated biweekly and the teams shared their implementation experiences monthly. RESULTS A total of 1443 parent-baby dyads were enrolled. The majority barriers were similar across the centres. Bundled approach incorporating foster KMC helped in the quick implementation of KMC even in outborns. Parental involvement and empowering nurses helped in sustaining KMC. Two centres had KMC rates above 10 hours/baby/day, while remaining four centres had KMC rates sustained above 6 hours/baby/day. Cross-learnings from team meetings helped to sustain efforts. Extended KMC could be implemented and sustained by low intensity training and QI collaboration. CONCLUSIONS Formation of a QI collaborative with mentoring helped in scaling implementation of extended KMC. Extended KMC could be implemented by parent centric best practices in all the centres without any additional need of resources.
Collapse
Affiliation(s)
| | - Anil Kallesh
- Pediatrics, Sarji Hospital, Shimoga, Karnataka, India
| | | | | | | | | | | | - Divya Chandramouli
- Pediatrics, Ovum Woman & Child Speciality Hospital Banaswadi, Bangalore, Karnataka, India
| | | | - S N Chaithra
- Pediatrics, Sarji Hospital, Shimoga, Karnataka, India
| | - Hellan Glory
- Pediatrics, Ovum Woman & Child Speciality Hospital Banaswadi, Bangalore, Karnataka, India
| | | |
Collapse
|
32
|
Costa S, Menzella N, Vento G, Barnea ER. FIGO good practice recommendations: Bundle of care to reduce neonatal mortality and improve outcomes after preterm and term delivery. Int J Gynaecol Obstet 2023; 163 Suppl 2:68-73. [PMID: 37807586 DOI: 10.1002/ijgo.15116] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
An integrated approach is lacking for the management of childbirth and newborn care, even though their codependence is critical for improving maternal and newborn outcomes. FIGO's Prep-for-Labor rapid triage methods for women arriving at a clinical facility are addressed in earlier papers in this Supplement, but do not include newborn care. Immediate postpartum rapid triage using established Apgar score helps determine whether standard of care can be followed on site with available staff/tools. If not, newborn transfer alone or with the mother to a higher-level center as soon as feasible may be required. Updated newborn management tools with special emphasis on pragmatic steps that are applicable for any clinical setting including low- and middle-income countries (LMICs) are presented in this article. Given that more than 80% of newborn care can be managed at the birthing facility, transfer to a higher-level center for care is required only in selected cases. Management steps for healthy newborns are described and the actions needed for those requiring resuscitation are summarized. The simple noninvasive kangaroo mother care approach-universally applicable for both term and preterm newborns-is associated with a significant reduction in morbidity and mortality. Kangaroo mother care involves continuous maternal skin-to skin contact from birth, exclusive breastfeeding, and home support after discharge. Hence, hypothermia, hypoglycemia, and acquired infections are frequently prevented. It is anticipated that implementing simple noninvasive management steps will have a substantial positive impact on improving maternal and newborn outcomes.
Collapse
Affiliation(s)
- Simonetta Costa
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicoletta Menzella
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eytan R Barnea
- Society for the Investigation of Early Pregnancy (SIEP), New York, New York, USA
- Department of Obstetrics Gynecology & Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
33
|
Clarkson G. Commentary on a Turkish kangaroo care study. Evid Based Nurs 2023; 26:133. [PMID: 37045560 DOI: 10.1136/ebnurs-2022-103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Gina Clarkson
- Division of Health Sciences, School of Nursing, Idaho State University, Pocatello, Idaho, USA
| |
Collapse
|
34
|
Durmaz A, Sezici E, Akkaya DD. The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis. Midwifery 2023; 125:103771. [PMID: 37454580 DOI: 10.1016/j.midw.2023.103771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND It has been reported that kangaroo mother care/skin-to-skin contact immediately after birth facilitates the newborn's physiological and psychological adaptation to extrauterine life. OBJECTIVE To examine the effect of kangaroo mother care/skin-to-skin contact on infants' body temperature, oxygen saturation, respiratory rate and heart rate. DESIGN Systematic review and meta-analysis. METHODS PubMed, ScienceDirect, SpringerLink, Wiley Online Library and Taylor & Francis Online were searched for the period 1 January 2015 to 30 November 2021 for studies published in the English language. The methodological quality of articles was assessed using the modified Jadad scale and the Newcastle-Ottawa scale. Effect size calculations were made using the fixed effects and random effects models. FINDINGS This meta-analysis included 13 studies, with a total of 891 infants. Kangaroo mother care/skin-to-skin contact was effective for maintaining infants' body temperature (p = 0.000). Infants' heart rate decreased (p = 0.015) and oxygen saturation was higher (p = 0.040) following kangaroo mother care/skin-to-skin contact. Kangaroo mother care/skin-to-skin contact did not affect infants' respiratory rate (p = 0.896), but infants' respiratory rate decreased after kangaroo mother care/skin-to-skin contact (p = 0.047). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Kangaroo mother care/skin-to-skin contact is effective for improving the vital signs of newborns. Kangaroo mother care/skin-to-skin contact is recommended for all neonates, and standardization of this approach would be beneficial.
Collapse
Affiliation(s)
- Aysegul Durmaz
- Department of Midwifery, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye.
| | - Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
| | - Deniz Done Akkaya
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Türkiye
| |
Collapse
|
35
|
Salam SS, Ameen S, Balen J, Nahar Q, Jabeen S, Ahmed A, Gillespie B, Chauke L, Mannan A, Hoque M, Dey SK, Islam J, Ashrafee S, Alam HMS, Saberin A, Saha PK, Sarkar S, Alim A, Islam MS, Gray C, El Arifeen S, Rahman AE, Anumba DOC. Research prioritisation on prevention and management of preterm birth in low and middle-income countries (LMICs) with a special focus on Bangladesh using the Child Health and Nutrition Research Initiative (CHNRI) method. J Glob Health 2023; 13:07004. [PMID: 37651640 PMCID: PMC10472017 DOI: 10.7189/jogh.13.07004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Background Fifteen million babies are born preterm globally each year, with 81% occurring in low- and middle-income countries (LMICs). Preterm birth complications are the leading cause of newborn deaths and significantly impact health, quality of life, and costs of health services. Improving outcomes for newborns and their families requires prioritising research for developing practical, scalable solutions, especially in low-resource settings such as Bangladesh. We aimed to identify research priorities related to preventing and managing preterm birth in LMICs for 2021-2030, with a special focus on Bangladesh. Methods We adopted the Child Health and Nutrition Research Initiative (CHNRI) method to set research priorities for preventing and managing preterm birth. Seventy-six experts submitted 490 research questions online, which we collated into 95 unique questions and sent for scoring to all experts. A hundred and nine experts scored the questions using five pre-selected criteria: answerability, effectiveness, deliverability, maximum potential for burden reduction, and effect on equity. We calculated weighted and unweighted research priority scores and average expert agreement to generate a list of top-ranked research questions for LMICs and Bangladesh. Results Health systems and policy research dominated the top 20 identified priorities for LMICs, such as understanding and improving uptake of the facility and community-based Kangaroo Mother Care (KMC), promoting breastfeeding, improving referral and transport networks, evaluating the impact of the use of skilled attendants, quality improvement activities, and exploring barriers to antenatal steroid use. Several of the top 20 questions also focused on screening high-risk women or the general population of women, understanding the causes of preterm birth, or managing preterm babies with illnesses (jaundice, sepsis and retinopathy of prematurity). There was a high overlap between research priorities in LMICs and Bangladesh. Conclusions This exercise, aimed at identifying priorities for preterm birth prevention and management research in LMICs, especially in Bangladesh, found research on improving the care of preterm babies to be more important in reducing the burden of preterm birth and accelerating the attainment of Sustainable Development Goal 3 target of newborn deaths, by 2030.
Collapse
Affiliation(s)
| | - Shafiqul Ameen
- The University of Sheffield, Sheffield, UK
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Julie Balen
- The University of Sheffield, Sheffield, UK
- Canterbury Christ Church University, Canterbury, UK
| | - Quamrun Nahar
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisuddin Ahmed
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Abdul Mannan
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Sanjoy Kumer Dey
- Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Jahurul Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Sabina Ashrafee
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Husam Md Shah Alam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Ashfia Saberin
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Palash Kumar Saha
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Supriya Sarkar
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Azizul Alim
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Muhammad Shariful Islam
- Directorate General of Health Services (DGHS), Government of Bangladesh, Ministry of Health and Family Welfare, Bangladesh
| | - Clive Gray
- Stellenbosch University, Stellenbosch, South Africa
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | |
Collapse
|
36
|
Ciochetto CR, Bolzan GDP, Gonçalves DDS, da Silveira FPH, Weinmann ARM. Effects of Kangaroo Care on the development of oral skills and achievement of exclusive oral feeding in preterm infants. Codas 2023; 35:e20220070. [PMID: 37556686 PMCID: PMC10449087 DOI: 10.1590/2317-1782/20232022070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 08/22/2022] [Indexed: 08/11/2023] Open
Abstract
PURPOSE analyze the effects of hospitalization in the Kangaroo Neonatal Intermediate Care Unit (UCINCa), the second stage of the Kangaroo Care (KC), on the development of oral feeding skills in preterm neonates. METHODS an analytical observational study of the prospective longitudinal type, carried out in a public hospital in Southern Brazil, where infants were accompanied until hospital discharge. The sample consisted of 20 preterm neonates hospitalized at the UCINCa and 26 preterm neonates at the Conventional Neonatal Intermediate Care Unit (UCINCo), that were periodically evaluated through the levels of oral skill, in a bottle, according to the criteria of proficiency and milk transfer rate. The outcomes considered were a progression of the oral skill level, days of transition to obtain the full oral route, and days of hospital stay. RESULTS the duration of transition to exclusive oral feeding was shorter for preterm neonates at the UCINCa (4.5 vs. 10 days) relative to those at the UCINCo (p = 0.041). By the third assessment, all preterm neonates at the UCINCa had reached level 4, while participants at the UCINCo only achieved this level of performance on the fifth assessment. The average number of days of hospitalization was four days shorter in UCINCa participants (p=0.098). CONCLUSION the admission to the UCINCa had been a further acceleration in the maturation of oral skills, which allowed for a faster transition to exclusive oral feeding as compared to neonates admitted in UCINCo.
Collapse
Affiliation(s)
- Carla Ribeiro Ciochetto
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Faculdade de Fonoaudiologia, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.
| | - Geovana de Paula Bolzan
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.
| | - Daniela da Silva Gonçalves
- Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.
| | | | - Angela Regina Maciel Weinmann
- Programa de Pós-Graduação em Distúrbios da Comunicação Humana, Faculdade de Fonoaudiologia, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brasil.
| |
Collapse
|
37
|
Gobezayehu AG, Lijalem M, Endalamaw LA, Mohammad H, Beyene T, Mekonnen TB, Abay GG, Sibley LM, Cranmer JN. Creation of a globally informed and locally relevant KMC implementation model for population-impact in Amhara, Ethiopia. Acta Paediatr 2023; 112 Suppl 473:42-55. [PMID: 36544262 DOI: 10.1111/apa.16587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
AIM As part of a multi-country implementation trial, we tested a regionally specific model of kangaroo mother care (KMC). Effective KMC was defined as ≥8 h of newborn-caregiver skin-to-skin contact daily plus exclusive breast feeding. The study was designed to achieve ≥80+% effective KMC coverage at the population level. METHODS The Amhara KMC model was designed using global evidence, formative research in the region and input from government officials, clinicians, newborn families and global scientists. We optimised the initial model using continuous quality improvement with process feedback, outcome measurement and collaborative re-design. Outcomes from the evaluation period are reported. RESULTS At discharge, the final model resulted in a median of 16 h per day of skin-to-skin contact with 63% effective KMC coverage. Fifty-three percent sustained effective KMC to 7 days post-discharge. CONCLUSIONS It is possible to achieve high coverage (63%), high-quality KMC at public hospitals without prior KMC services using government-owned, multisectoral collaborative design. Targeted co-design, real-time data and customisation of KMC interventions with input from impacted stakeholders was critical in achieving high coverage and sustained quality.
Collapse
|
38
|
Tadele H, Kassa DH, Gebriel FW, Bilal SM, Gedefaw A, Teshome M, Kawza A, Wangoro S, Muleta M, Abebo TA, Asefa A, Astatkie A, Haji Y, Alemayehu A, Aziz K, Brune T, Singhal N, Worku B, Tadesse BT. Development and evaluation of a kangaroo mother care implementation model in South Ethiopia. Acta Paediatr 2023; 112 Suppl 473:65-76. [PMID: 37519118 DOI: 10.1111/apa.16812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 08/01/2023]
Abstract
AIM To develop a model for increasing the coverage of kangaroo mother care (KMC), which involved ≥8 h of skin-to-skin contact per day and exclusive breastfeeding, for small babies with birth weight < 2000 g in South Ethiopia. METHODS A mixed methods study was conducted between June 2017 and January 2019 at four hospitals and their catchment areas. Iterative cycles of implementation, program learning and evaluation were used to optimise KMC implementation models. The study explored the community-facility continuum of care and assessed the proportion of neonates with a birth weight less than 2000 g receiving effective KMC. RESULTS Three KMC implementation models were tested with Model 2 being the final version. This model included enhanced identification of home births, improved referral linkages, immediate skin-to-skin care initiation in facilities and early contact after discharge. These improvements resulted in 86% coverage of effective facility-based KMC initiation for eligible babies. The coverage was 81.5% at discharge and 57.5% 7 days after discharge. The mean age of babies at KMC initiation was 8.2 days (SD = 5.7). CONCLUSION The study found that the KMC implementation model was feasible and can lead to substantial population-level KMC coverage for small babies.
Collapse
Affiliation(s)
- Henok Tadele
- Department of Paediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Fitsum W Gebriel
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aknaw Kawza
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | - Shemels Wangoro
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | | | - Teshome Abuka Abebo
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yusuf Haji
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Khalid Aziz
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bogale Worku
- Ethiopian Paediatrics Society, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
39
|
Martines JC, Portela A, Bahl R. Developing context-specific models to achieve high coverage and quality of KMC in India and Ethiopia: Learnings from implementation research. Acta Paediatr 2023; 112 Suppl 473:3-5. [PMID: 37519119 DOI: 10.1111/apa.16862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Jose Carlos Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| |
Collapse
|
40
|
Kumar A, Tiwari M, Krishna R, Singh PK, Sahu A, Singh V, Mishra A, Kumar P, Kumar A, Darmstadt GL, Kumar V. A scalable health system model to achieve high coverage and quality of Kangaroo mother care in Uttar Pradesh, India. Acta Paediatr 2023; 112 Suppl 473:27-41. [PMID: 36184883 DOI: 10.1111/apa.16534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
AIM To design a health system model for scaling-up Kangaroo mother care (KMC) and assess its impact on the population-level coverage and quality of KMC in Uttar Pradesh, India. METHODS We co-developed the model with mothers and health system stakeholders using human-centred design over multiple cycles of implementation, learning and data-driven refinement. Infants with birthweight <2000 g in the study district were prospectively followed to assess the 'effective coverage' of KMC. Effective coverage referred to the proportion of eligible infants receiving ≥8 h of daily skin-to-skin contact and exclusive breastfeeding. RESULTS High delivery load facilities were equipped with a KMC Lounge to ensure comfort, respectful care of mothers and high-quality KMC over prolonged periods. Systems to ensure weighing at birth, referral of infants with birthweight <2000 g to KMC facilities, initiation of KMC for all stable low birthweight infants, improving quality of care within KMC facilities and supporting families to continue KMC at home post discharge, were integrated into existing services. KMC was initiated in 93.3% of eligible infants with effective coverage of 52.7% and 64.8% at discharge and 7 days post discharge, respectively. CONCLUSION The model addressed critical barriers to KMC implementation and adoption, contributing to its scale-up across the state.
Collapse
Affiliation(s)
- Aarti Kumar
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Madhuri Tiwari
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Raghav Krishna
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Pramod Kumar Singh
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Arti Sahu
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Vivek Singh
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | - Aman Mishra
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| | | | - Alok Kumar
- Government of Uttar Pradesh, Lucknow, India
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Vishwajeet Kumar
- Global Center for KMC Acceleration, Community Empowerment Lab, Lucknow, India
| |
Collapse
|
41
|
Estifanos AS, Haile Mariam D, Fikre A, Kote M, Tariku A, Chan GJ. Implementation science to design, test and scale up effective Kangaroo Mother Care in Oromia region, Ethiopia. Acta Paediatr 2023; 112 Suppl 473:56-64. [PMID: 35691617 DOI: 10.1111/apa.16413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
AIM To develop a locally tested and optimised Kangaroo Mother Care (KMC) scale-up model to achieve high population-based effective coverage of KMC in Oromia region. METHOD We conducted an implementation research study to design and test KMC scale-up models from March 2017 to March 2019 in five hospitals and 39 health centres covering a population of 1.1 million in Oromia region, Ethiopia. We evaluated the models by measuring effective KMC coverage (at least 8 hours of skin-to-skin care plus exclusive breastfeeding) for newborns weighing <2000 g in the 24 hours before discharge from the KMC facility and on the 7th-day post-discharge. RESULTS After three cycles of iterative model implementation, we developed a KMC scale-up model that resulted in increased population-based effective KMC coverage. We enhanced the existing health system by strengthening the health system, reinforcing the linkages between the health system and communities and improving community engagement. Our final model achieved effective KMC coverage of 54%: 95% CI [49, 60] in the 24 hours before discharge from the facility and 38%: 95% CI [32, 43] on the 7th-day post-discharge. CONCLUSION Through iterative testing and adaptations, a model to scale up KMC that achieves 54% population-based effective coverage of KMC can be developed.
Collapse
Affiliation(s)
- Abiy Seifu Estifanos
- Department of Reproductive, Family, and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen Haile Mariam
- Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisalem Fikre
- HaSET Maternal, Neonatal, and Child Health Research Program, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesfin Kote
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Grace J Chan
- Division of Medical Critical Care, Department of Paediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
42
|
Sharma D, Khera S. Consideration of Regional Differences While using Kangaroo Mother Care During Neonatal Transport. Indian Pediatr 2023; 60:598-599. [PMID: 37424129 DOI: 10.1007/s13312-023-2948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Affiliation(s)
- Divyanshi Sharma
- Department of Pediatrics, Army Hospital Research and Referral, Delhi
| | - Sanjeev Khera
- Department of Pediatrics, Army Hospital Research and Referral, Delhi.
| |
Collapse
|
43
|
Nimbalkar SM. Consideration of Regional Differences While using Kangaroo Mother Care During Neonatal Transport: AUTHORS' REPLY. Indian Pediatr 2023; 60:598-599. [PMID: 37424130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat.
| |
Collapse
|
44
|
Darmstadt GL, Kirkwood B, Gupta S. WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal-infant care. Lancet 2023; 401:1751-1753. [PMID: 37207686 DOI: 10.1016/s0140-6736(23)01000-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
45
|
Nimbalkar SM, Patel VT, Patel DV, Phatak AG. Impact of hypothermia alert device (BEMPU) on improvement of duration of Kangaroo Mother Care (KMC) provided at home: parallel-group randomized control trial. Sci Rep 2023; 13:4368. [PMID: 36928063 PMCID: PMC10020158 DOI: 10.1038/s41598-023-29388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/03/2023] [Indexed: 03/18/2023] Open
Abstract
The objective of the study was to determine if using the hypothermia-detecting bracelet (named BEMPU) improves the duration of Kangaroo Mother Care (KMC) at home by one hour. This parallel-group randomized controlled trial was conducted at a step-down nursery of a teaching hospital. Neonates between 1000 and 2000 g were randomized to BEMPU and control groups at the time of discharge. BEMPU was applied at the wrist of each newborn in the BEMPU (intervention) group. Parents were advised to keep the BEMPU in place till 4 weeks post-discharge. The BEMPU generates a beep sound as an alarm when a newborn's temperature drops below 36.5 °C. Parents in both groups were trained to provide KMC at home. Parents in the BEMPU group received the "KMC chart" and "BEMPU beep chart," while the control group received the "KMC chart" only. In the "KMC chart," parents entered information about KMC hours on a real-time basis, and in the "BEMPU beep chart," they entered information about alarm beeps from BEMPU on a real-time basis till 4 weeks post-discharge. Independent samples t-test was used to compare mean KMC hours between the two groups. A total of 128 neonates participated in the study (64 in BEMPU and 64 in Control groups). The mean(SD) gestational age for the BEMPU group was 34.04(2.84) weeks vs 34.75(2.70) weeks for the control group. In BEMPU group, mean(SD) daily time spent doing KMC was significantly higher in 1st week [4.78(2.93) vs. 3.22(2.44) h, p = 0.003], in 2nd week [4.52(3.43) vs. 2.84(2.95) h, p = 0.008], in 3rd week [4.23(3.71) vs. 2.30(2.70) h, p = 0.003], in 4th week [3.72(3.30) vs. 1.95(2.65) h, p = 0.003] as compared to control group. BEMPU improved the daily duration of KMC hours at home compared to the control group over four weeks. Clinical Trial Registration: This trial is registered at Clinical Trials Registry India with registration number: CTRI/2018/08/015154 and accessible at http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=27600&EncHid=&modid=&compid=%27,%2727600det%27 Registered on 01/08/2018.
Collapse
Affiliation(s)
- Somashekhar Marutirao Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, 388325, India.
- Central Research Services, Bhaikaka University, Karamsad, Gujarat, 388325, India.
| | - Viral Thakorbhai Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, 388325, India
| | - Dipen Vasudev Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat, 388325, India
| | - Ajay Gajanan Phatak
- Central Research Services, Bhaikaka University, Karamsad, Gujarat, 388325, India
| |
Collapse
|
46
|
Stierman EK, Maliqi B, Mary M, Dohlsten MA, Katwan E, Moran AC, Creanga AA. Changes in the health systems and policy environment for maternal and newborn health, 2008-2018: An analysis of data from 78 low-income and middle-income countries. Soc Sci Med 2023; 321:115765. [PMID: 36801755 PMCID: PMC10024243 DOI: 10.1016/j.socscimed.2023.115765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/31/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Political, social, economic, and health system determinants play an important role in creating an enabling environment for maternal and newborn health. This study assesses changes in health systems and policy indicators for maternal and newborn health across 78 low- and middle-income countries (LMICs) during 2008-2018, and examines contextual factors associated with policy adoption and systems changes. METHODS We compiled historical data from WHO, ILO, and UNICEF surveys and databases to track changes in ten maternal and newborn health systems and policy indicators prioritized for tracking by global partnerships. Logistic regression was used to examine the odds of systems and policy change based on indicators of economic growth, gender equality, and country governance with available data from 2008 to 2018. RESULTS From 2008 to 2018, many LMICs (44/76; 57·9%) substantially strengthened systems and policies for maternal and newborn health. The most frequently adopted policies were national guidelines for kangaroo mother care, national guidelines for use of antenatal corticosteroids, national policies for maternal death notification and review, and the introduction of priority medicines in Essential Medicines Lists. The odds of policy adoption and systems investments were significantly greater in countries that experienced economic growth, had strong female labor participation, and had strong country governance (all p < 0·05). CONCLUSIONS The widespread adoption of priority policies over the past decade is a notable step in creating an environment supportive for maternal and newborn health, but continued leadership and resources are needed to ensure robust implementation that translates into improved health outcomes.
Collapse
Affiliation(s)
- Elizabeth K Stierman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.
| | - Blerta Maliqi
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Meighan Mary
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA
| | - Martin Aj Dohlsten
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Elizabeth Katwan
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Allisyn C Moran
- Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland
| | - Andreea A Creanga
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA; International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA; Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| |
Collapse
|
47
|
Abstract
OBJECTIVE Feeding intolerance (FI) is a common condition in preterm infants because they have an immature gastrointestinal tract. There are studies on the effects of the position on gastric residual volume (GRV) in preterm infants. Kangaroo mother care (KMC) may be an instrument for reducing FI by providing an upright position to infants. Moreover, numerous studies conducted with this therapeutic position applied by putting an infant on the mother's chest have indicated its positive effects on the infant's weight gain, growth and development, and vital signs. Therefore, this study aimed to reveal the impact of KMC on FI in preterm infants. METHODS The population of the study, designed as a randomized trial, consisted of 168 preterm infants [KMC: 84, Standart Care (SC): 84] hospitalized in the neonatal intensive care unit of a university hospital between June and November 2020. Infants were randomly selected and divided into two groups. After the vital signs of the infants in both groups became stable, the infants were fed in the same position. KMC was applied to the infants in the intervention group for 1 h by preparing a suitable environment after feeding. Infants in the SC group were placed in the prone position after feeding. The GRVs of the infants in both groups were recorded on the Infant Follow-up Form before the next feeding. RESULTS No statistically significant difference was detected between the groups upon comparing them in terms of demographic and clinical characteristics. The body temperatures and O2 saturations of the participants in the KMC group were statistically significantly higher, and their respiratory and heart rates were lower than the SC group. The transition time to full enteral feeding was statistically significantly shorter, and FI was experienced significantly less in the KMC group infants than in the SC group (p < 0.05). There was no statistically significant difference between the groups in terms of the infants' weight gain and length of hospital stay (p > 0.05). CONCLUSION The present study demonstrated that KMC had a positive impact on FI in preterm infants. KMC is not only a safe care model providing the earliest contact between parents and infants but also a practice whose positive effect on the functioning of the digestive system in preterm infants we can use.
Collapse
Affiliation(s)
- Sinem Yalnızoğlu Çaka
- Department of Pediatric Nursing, Faculty of Health Sciences, Kocaeli University, Kocaeli 41001, Turkey
| | - Sümeyra Topal
- Department of Pediatric Nursing, Faculty of Health Sciences, Kahramanmaraş İstiklal University, Kahramanmaraş 46100, Turkey
| | - Sadık Yurttutan
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş 46040, Turkey
| | - Selin Aytemiz
- Department of Neonatal Intensive Care Unit, Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, Kahramanmaraş 46040, Turkey
| | - Yasemin Çıkar
- Department of Neonatal Intensive Care Unit, Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, Kahramanmaraş 46040, Turkey
| | - Murat Sarı
- Department of Neonatal Intensive Care Unit, Kahramanmaras Sutcu Imam University Health Practice and Research Hospital, Kahramanmaraş 46040, Turkey
| |
Collapse
|
48
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
49
|
Cristóbal-Cañadas D, Parrón-Carreño T, Nievas-Soriano BJ. 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. Int J Environ Res Public Health 2022; 19:16432. [PMID: 36554312 PMCID: PMC9778417 DOI: 10.3390/ijerph192416432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Delia Cristóbal-Cañadas
- Neonatal and Pediatric Intensive Care Unit, Torrecárdenas University Hospital, 04009 Almeria, Spain
| | - Tesifón Parrón-Carreño
- Nursing, Physiotherapy and Medicine Department, University of Almeria, 04120 Almeria, Spain
- Andalusian Council of Health at Almeria Province, 04005 Almeria, Spain
| | | |
Collapse
|
50
|
Chanie ES, Engedaw D, Eyayu T, Admasu FT, Amera ED, Azanaw KA, Kassaw A, Feleke DG, Ayehu GW, Jimma MS, GebreEyesus FA, Moges N, Woelile TA, Kerebeh G, Birrie E. Escalating the limit of median survival time and predictors of mortality among preterm neonates in Northwest Ethiopia, 2021: a 1-year prospective follow-up study. BMJ Open 2022; 12:e061385. [PMID: 36576181 PMCID: PMC9723894 DOI: 10.1136/bmjopen-2022-061385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To examine the survival rate and predictors of mortality among preterm neonates in the neonatal intensive care unit at South Gondar public hospitals, 2021. DESIGN Prospective follow-up study. SETTING South Gondar public hospitals, Northwest, Ethiopia. PARTICIPANTS We recruited 283 preterm neonates who were admitted at neonatal intensive care unit at selected hospitals from 15 February 2020 to 22 January 2021. OUTCOME MEASURES The primary outcome measure of this study was the survival rate of preterm neonates in the neonatal intensive care unit. Moreover, the study assessed the predictors for the occurrence of mortality by the Cox-proportional hazard model. Data were entered into Epi data V.4.2 and exported to Stata V.14 statistical software for analysis. The log-rank test determines the survival difference between predictor variables. RESULTS A total of 283 preterm neonates, 61 died during the follow-up. Born from antepartum haemorrhage mother (adjusted HR (AHR)=2.2 (95% CI 1.10 to 4.37)), being small weight for gestational age (AHR=4.6 (95% CI 2.22 to 9.53)), not having kangaroo mother care practice initiated (AHR=2.7 (95% CI 1.39 to 7.74)), hypothermia (AHR=4.0 (95% CI 1.96 to 8.30)) and perinatal asphyxia (AHR=3.9 (95% CI 1.97 to 7.94)) were significant predictors of preterm neonate mortality. CONCLUSION In this study, the preterm neonates survival rate (78.4%) and the median survival time (21 days) were found to be low. Preventing and managing the predictors, including an antepartum haemorrhagic mother, small weight for gestational age, hypothermia and prenatal asphyxia, is crucial. In addition, more emphasis should be placed on initiating universal kangaroo mother care practice soon after birth to increase the survival of preterm neonates.
Collapse
Affiliation(s)
- Ermias Sisay Chanie
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Destaw Engedaw
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tahir Eyayu
- Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | - Eninur Dejen Amera
- Department of Medical Laboratory Sciences, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | - Amare Kassaw
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Gashaw Walle Ayehu
- Biomedical Science, Debre Tabor University, Debre Tabor, Amhara, Ethiopia
| | | | | | - Natnael Moges
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Gashaw Kerebeh
- Pedatric and Neonatal Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | | |
Collapse
|