Kangaroo mother care: using formative research to design an acceptable community intervention

Abstract

BackgroundLow and middle income countries (LMICs), including India, contribute to a major proportion of low birth weight (LBW) infants globally. These infants require special care. Kangaroo Mother Care (KMC) in hospitals is a cost effective and efficacious intervention. In institutional deliveries, the duration of facility stay is often short. In LMICs, a substantial proportion of deliveries still occur at home and access to health care services is limited. In these circumstances, a pragmatic choice may be to initiate KMC at home for LBW babies. However, evidence is lacking on benefits of community-initiated KMC (cKMC). Promoting KMC at home without an understanding of its acceptability may lead to limited success.MethodsWe conducted formative research to assess the feasibility, acceptability and adoption of cKMC with the aim of designing an intervention package for a randomised controlled trial in LBW infants in Haryana, India. Qualitative methods included 40 in-depth interviews with recently delivered women and 6 focus group discussions, two each with fathers and grandfathers, grandmothers, and community health workers. A prototype intervention package to promote cKMC was developed and tested in 28 mother-infant pairs (of them, one mother had twins), using Household (HH) trials.ResultsWe found that most mothers in the community recognized that babies born small required special care. In spite of not being aware of the practice of KMC, respondents felt that creating awareness of KMC benefits will promote practice. They expressed concerns about doing KMC for long periods because mothers needed rest after delivery. However, the cultural practice of recently delivered women not expected to be doing household chores and availability of other family members were identified as enablers. HH trials provided an opportunity to test the intervention package and showed high acceptability for KMC. Most mothers perceived benefits such as weight gain and increased activity in the infant.ConclusionsCommunity-initiated KMC is acceptable by mothers and adoption rates are high. Formative research is essential for developing a strategy for delivery of an intervention.Trial registrationTrial registration number CTRI/2015/10/006267.Name of Registry: Clinical Trials Registry - India.URL of Registry: http://ctri.nic.in/Clinicaltrials/login.phpDate of Registration: 15/10/2015.Date of enrolment of the first participant to the trial: 18/04/2015.

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

“…A study from Indonesia exploring perceptions of using different types of KMC wraps found no difference in preference between wraps [19]. Besides these studies, other related KMC studies do not compare wraps, but rather they use customized wraps in all cases or do they not mention the type of wrap used [3,[22][23][24]. Some countries and facilities have institutionalized the use of a customized wrap, without testing its impact; e.g., South Africa uses the Kalafong KMC Thari PLOS ONE…”

Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

“…Infants unable to feed, with difficulty in breathing, with less than normal movements or gross congenital malformations, those for whom KMC was initiated in hospitals, and those whose mothers did not intend to stay in the study area for the next 6 months or did not consent to participate were excluded. The weight category was determined based on our formative research findings [22] that suggested most babies with birth weight > 2250 g wriggle out of KMC position before the neonatal period. The lower cut-off 1500 g was considered to avoid including infants who would have been at a high-risk of complications and would have required hospital care.…”

“…Visits continued till 28 days of age or until the baby wriggled out and no longer accepted SSC, whichever was earlier. The intervention delivery was designed based on previous formative research [22]. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers (Accredited Social Health Activists; ASHAs) as implemented through the health system [24].…”

Growth faltering in early infancy: highlights from a two-day scientific consultation

“…According to national guidelines, district level hospitals should establish a kangaroo mother care unit for low birth weight infants who do not require care in sick newborn care units (SNCU). The scale up of this has been limited though [22,23]. Integrating good infrastructure, treating mothers with respect, lactation support, kangaroo mother care (KMC) and counselling of mothers at the time of discharge are important.…”