Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions

Abstract

BackgroundPreterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC.ResultsMarked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks.ConclusionsThere are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.

Observation study showed that the continuity of skin‐to‐skin contact with low‐birthweight infants in Uganda was suboptimal

“…Existing customs, such as carrying the infant on the back, stigma surrounding the birth of a preterm infant and general poor involvement and support from the community may affect KMC. Beliefs that incubator care is more effective than SSC and ambivalence by medical staff may also influence the duration of SSC .…”

“…Prolonged direct SSC between infants and caregivers is the cornerstone of KMC . Most studies of KMC have taken place in dedicated KMC wards , where staff were trained to care for both newborn infants and post‐partum women.…”

“…Lack of data on the duration of SSC in routine practice has been cited as a limitation in the current evidence , and poor‐quality data on low‐birthweight infants are a significant barrier to KMC success . This study aimed to address the knowledge gap surrounding the continuity of facility‐based KMC through direct observation of SSC in a busy newborn unit at a resource‐limited hospital in Uganda.…”

Nurses’ Kangaroo Mother Care practice implementation and future challenges: an integrative review

“…The principles are extensively recognised in hospitals, but their application into specific policies and practices involves challenges. For example, in Africa, this practice is considered conventional newborn quality care, but leadership and governance affected the KMC implementation of healthcare workers . An Indian study found that most maternal–child health nurses do not practice KMC, despite a positive attitude towards the method .…”

Evidence of the factors that influence the utilisation of Kangaroo Mother Care by parents with low-birth-weight infants in low- and middle-income countries (LMICs): a scoping review protocol

“…The measure of success of KMC not only depends on KMC implementation but also on the utilisation of the service by the beneficiaries, parents with LBWIs [20, 21]. As such, the success of service utilisation largely depends on the utilisation determinants, absence of challenges and barriers, perceived quality of care, cost of care, supportive factors, cultural factors, health system factors and provider factors [20].…”