Quality improvement initiative to improve the duration of Kangaroo Mother Care in tertiary care neonatal unit of South India

Jegannathan, Sathya; Natarajan, Muthukumaran; Solaiappan, Manikumar; Shanmugam, Ramya; Tilwani, Sandeep Ajit

doi:10.1136/bmjoq-2021-001775

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…A study across seven sites in Ethiopia and India reported that 60% of eligible infants received KMC with ≥ 8 h of skin-to-skin contact and exclusive breastfeeding in the 24 h preceding discharge, and that this coverage was achieved with government engagement and financial resources to establish and maintain KMC units with supportive policies for mothers, including beds, food, bathing, and toilets [ 40 ]. In contrast, the WHO trial and a related quality improvement study reported a median daily duration of skin-to-skin contact of 17 h among babies who received iKMC, following the establishment of mother-neonatal intensive care units with adult beds for KMC in six tertiary-level hospitals in Ghana, India, Malawi, Nigeria, and Tanzania [ 17 , 41 ], illustrating the importance of providing infrastructure and advanced newborn care and equipment, including CPAP.…”

Section: Discussionmentioning

confidence: 99%

Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda

Medvedev

Tumukunde

Kirabo-Nagemi

et al. 2023

BMC Health Serv Res

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Background Preterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000–1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings. Methods We describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children’s Fund. Results Following the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m2 to 212 m2. Costs of improvements were lowest at the national referral hospital (financial: $31,354; economic: $45,051; 2020 USD) and varied across the four smaller hospitals (financial: $68,330-$95,796; economic: $99,430-$113,881). In a standardised 20-bed neonatal unit offering a level of care comparable to the four smaller hospitals, the total financial cost could be in the range of $70,000 to $80,000 if an existing space could be repurposed or remodelled, or $95,000 if a new unit needed to be constructed. Even after improvements, the facility assessments demonstrated broad variability in laboratory and pharmacy capacity as well as the availability of essential equipment and supplies. Conclusions These five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable. Trial registration ClinicalTrials.gov, NCT02811432. Registered: 23 June 2016.

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Section: Discussionmentioning

confidence: 99%

Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda

Medvedev

Tumukunde

Kirabo-Nagemi

et al. 2023

BMC Health Serv Res

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“…In the study by Ramachandrappa et al, using three PDSA cycles, the duration of KMC at the institute was increased from 2.7 hours/baby/day to 7.8 hours/baby/day [ 15 ]. In the study by Jegannathan et al, the duration of KMC was improved from 4.6 hours/baby/day to 16.6 hours/baby/day by implementing seven PDSA cycles [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mother/alternative KMC provider-Baby dyads were classified as A, B, C, and D based on the last 48 hours of KMC performance. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC provided 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day respectively [ 13 ]. Before embarking on the study, we carried out a fishbone analysis, and a series of plan-do-study-act (PDSA) cycles were planned based on the needs analysis (Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study

Patawat¹,

Choudhary²,

Jain³

et al. 2023

Cureus

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IntroductionKangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methodsWe conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant. ResultsOne hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. ConclusionSets of intervention packages based on needs analysis using the PDSA cyc...

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“…A qualitative study by Jegannathan et al showed improvement from 4.6 hours/day to an impressive 16.6 hours/ day with these interventions. 26 Longer duration of KMC sessions achieved by practicing milk expression in the KMC position and doing simple procedures during skin-to-skin contact are associated with reduced mortality and better growth. 27,28 The current survey revealed 40.4% NICUs have supported mothers for expressing milk in KMC position.…”

Section: (Table 2 Continued) (Table 2 Continued)mentioning

confidence: 99%

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

Rao Kodhati,

RR,

Vamsi Krishna

et al. 2024

Journal of Neonatology

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Background: KMC is a global standard for LBW and preterm neonates, supported by evidence for reducing morbidities and mortality. Integrated into India’s Newborn Action Plan since 2014, aiming for single-digit neonatal mortality by 2030, KMC practices in India have not reached the optimal levels. Hence, we attempted to study the KMC practices in tertiary care NICUs across India. Methods: A cross-sectional online national survey among neonatologists in level III NICUs in India was conducted. Utilizing Google Forms and a structured questionnaire of 30 questions on KMC, one respondent per unit participated. Results: Of the 110 NICUs invited to participate, a total of 52 units responded (47.3%). All units have a written KMC policy and conventionally provide KMC to neonates with BW < 2000 g, while 36.5% units provide KMC for neonates with BW between 2000 and 2500 g. Though 86.5% of NICUs provide KMC to infants on respiratory support, only 13.5% practice KMC for mechanically ventilated neonates. The time to initiate KMC within 48–72 hours is prevalent in 44.2% of NICUs, with 54% of NICUs providing an average KMC duration of 4–8 hours/day. A significantly lower percentage of NICUs (28.9%) have a KMC follow-up program. Conclusion: The study highlights the need to boost the ongoing KMC training programs for HCWs to increase the coverage of KMC for LBWs and sick preterm neonates. This includes requiring more uniform and structured KMC practices across the country, especially upscaling of infrastructure, earlier initiation and longer duration of KMC, better monitoring of neonates in KMC, and strengthening the follow-up program.

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Quality improvement initiative to improve the duration of Kangaroo Mother Care in tertiary care neonatal unit of South India

Cited by 7 publications

References 13 publications

Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda

Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda

Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study

Kangaroo Mother Care Practices in Tertiary Care NICUs Across India: A Cross-sectional Questionnaire-based Survey

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