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

Abstract

BackgroundKangaroo mother care, an evidence based practice and a national policy for management of low birth weight newborns in Nepal, is not widely practiced. This implementation research study aimed to explore the consumer preference and acceptability of the traditional and a new ergonomic wrap on the continuation of kangaroo mother care in the facility and community following discharge.MethodsA mixed method feasibility study was done from May to October 2015. Ninety-six families of stable low birth weight newborns weighing 1800 to 2499 grams were counseled and taught to practice kangaroo mother care using both wraps. They were randomized into two groups of 48 with one group trying out the traditional wrap for the first six hours and the new wrap for the next six, and vice versa. Mothers were allowed to choose between the wraps for continuation of kangaroo mother care at the facility and post discharge. They were followed up telephonically weekly over 28 days postpartum to ascertain practice of kangaroo mother care. In-depth interviews with mothers (n = 12) and focus group discussions with health workers (n = 16) further evaluated the intervention. Descriptive statistics are presented for the quantitative part of the study.ResultsMothers in the two groups chose the new wrap with no significant difference (81.3% vs 89.6%, p = 0.24). Of the 96 randomized mothers, 85% chose the new wrap. During the hospital stay, six mothers dropped out and remaining 90 mothers who were discharged with the intention of continuing Kangaroo Mother Care, 78 and 12 mothers did so with the new and traditional wrap respectively. New wrap users (429.1 hours, 95% confidence interval [CI]: 351.7–470.3) performed skin-to-skin contact for an extra 77.4 hours overall than traditional wrap (351.7 hours, 95%CI: 259.3–444) users from first day to 28 day postpartum. Health workers and mothers reported positive experience with the new wrap as it was easy to wear without assistance, secure and flexible to move around in kangaroo mother care position.ConclusionsInvolvement of mothers and families with provision of ergonomic wraps showed improvement in kangaroo mother care practice during hospital stay and at home.

Knowledge, attitude and issues in practicing kangaroo mother care at home after discharge from a kangaroo mother care ward of a tertiary care hospital in central Lahore

“…Thapa K showed 85% mothers chose new band instead of their customary clothing. 19 On the contrary, studies done in Bangladesh, Tanzania and Nepal depicted only 13.2% usage of KMC wrap by mothers and rest used their traditional cloths for securing the baby. 17 In this study, 73.7% mothers were confident to handle preterm infant which is in concordance with Purbasary and…”

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

“…We found that women reported higher levels of satisfaction with the customized wrap than the traditional wrap; however, we did not test preference between wraps; rather, the acceptability of a customized wrap. Feasibility research in Nepal assessing the CarePlus Wrap compared to a traditional wrap found women preferring the customized wrap [20,21]. A study from Indonesia exploring perceptions of using different types of KMC wraps found no difference in preference between wraps [19].…”

“…In addition to the studies included in the Cochrane review, an observational study in Uganda found a mean of only three hours of skin-to-skin contact over the first week of life [18]. The feasibility study from Nepal found that all reported practicing skin-to-skin contact was for 10 hours or more daily in the first month, regardless of wrap (longer duration was reported among mothers using the customized wrap, though this was not statistically significant) [21]. As a strong recommendation, the most recent WHO guidelines indicate that newborns weighing 2,000g or less at birth should be provided "as close to continuous Kangaroo mother care as possible" and "intermittent" KMC if continuous care is not possible.…”

“…This finding is consistent with other studies. The Nepal feasibility study found that all women reported continuing KMC at home at the 28-day postnatal visit [21]. A descriptive study from India reported that 82.5% of mothers were continuing with skin-to-skin contact at the 45-day post discharge visit [7].…”

Kangaroo Mother Care and Swaddling Methods In Low Born Weight Babies In Community Settings: A Systematic Review

“…The as well as members of other families who become caregivers baby just born with low weight. The application of the kangaroo mother care method at home is carried out to maintain the stability of the body temperature of infants who are prone to hypothermia (Thapa et al, 2018). Baby just born with low birth weight are treated in the community have a risk of more high against the incidence of hypothermia (Daga, 2018).…”