Kangaroo mother care: EN-BIRTH multi-country validation study

Abstract

Background Kangaroo mother care (KMC) reduces mortality among stable neonates ≤2000 g. Lack of data tracking coverage and quality of KMC in both surveys and routine information systems impedes scale-up. This paper evaluates KMC measurement as part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. Methods The EN-BIRTH observational mixed-methods study was conducted in five hospitals in Bangladesh, Nepal and Tanzania from 2017 to 2018. Clinical observers collected time-stamped data as gold standard for mother-baby pairs in KMC wards/corners. To assess accuracy, we compared routine register-recorded and women’s exit survey-reported coverage to observed data, using different recommended denominator options (≤2000 g and ≤ 2499 g). We analysed gaps in quality of provision and experience of KMC. In the Tanzanian hospitals, we assessed daily skin-to-skin duration/dose and feeding frequency. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine register design, filling and use. Results Among 840 mother-baby pairs, compared to observed 100% coverage, both exit-survey reported (99.9%) and register-recorded coverage (92.9%) were highly valid measures with high sensitivity. KMC specific registers outperformed general registers. Enablers to register recording included perceptions of data usefulness, while barriers included duplication of data elements and overburdened health workers. Gaps in KMC quality were identified for position components including wearing a hat. In Temeke Tanzania, 10.6% of babies received daily KMC skin-to-skin duration/dose of ≥20 h and a further 75.3% received 12–19 h. Regular feeding ≥8 times/day was observed for 36.5% babies in Temeke Tanzania and 14.6% in Muhimbili Tanzania. Cup-feeding was the predominant assisted feeding method. Family support during admission was variable, grandmothers co-provided KMC more often in Bangladesh. No facility arrangements for other family members were reported by 45% of women at exit survey. Conclusions Routine hospital KMC register data have potential to track coverage from hospital KMC wards/corners. Women accurately reported KMC at exit survey and evaluation for population-based surveys could be considered. Measurement of content, quality and experience of KMC need consensus on definitions. Prioritising further KMC measurement research is important so that high quality data can be used to accelerate scale-up of high impact care for the most vulnerable.

Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

“…These findings highlight an urgent requirement for improved evidence to support an expanded typology of respectful care that intentionally includes newborns [19], and highlights the importance of disaggregating data by mode of birth. This was a recurrent theme across the EN-BIRTH study [49][50][51][52].…”

Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

“…Cord cutting and drying or clamping are universally practiced for most births; quality of care improvement requires data on timing, and hygienic practices which are better assessed via audit, and other facility-level clinical quality improvement approaches. As such, we do not recommend inclusion of questions in surveys regarding cord clamping, drying, or immediate skin-to-skin for all babies (which differs from kangaroo mother care) [57].…”

Impact of early kangaroo mother care versus standard care on survival of mild-moderately unstable neonates <2000 grams: A randomised controlled trial

“…The halving of baseline CFR in our cohort was likely influenced by both improvements to small and sick newborn care during the trial preparation phase (e.g. KMC implementation for stable newborns, increasing use of bCPAP) and enhanced clinical monitoring necessary for ethical trial conduct [25] , protocol compliance and avoidance of performance bias.…”