Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future

Abstract

BackgroundGlobally, complications of prematurity are the leading cause of death in children under five. Preterm infants who survive their first month of life are at greater risk for various diseases and impairments in infancy, childhood and later life, representing a heavy social and economic burden for families, communities and health and social systems. Kangaroo mother care (KMC) is recommended as a beneficial and effective intervention for improving short- and long-term preterm birth outcomes in low- and high-income settings. Nevertheless, KMC is not as widely used as it should be. The International Network on KMC runs biennial workshops and congresses to help improve the coverage and quality of KMC worldwide. This paper reports the results of the two-day workshop held in November 2016, where 92 participants from 33 countries shared experiences in a series of round tables, group work sessions and plenaries.FindingsBarriers to and enablers of KMC are discussed with regard to parents, health workers and the health system. Key factors for effective implementation and uptake relate to appropriate training for health staff, adherence to protocols and the creation of a welcoming environment for families. Recommendations for planning for national programmes are made according to a six-stage change model. Resources and the cost of making progress are discussed in terms of investment, maintenance, and acceleration and scaling-up costs. KMC training requirements are presented according to three levels of care. To ensure quality KMC, key requisites are proposed for the different KMC components and for sensitive communication with caregivers. The group attending to the monitoring and evaluation of KMC at a national and subnational level highlight the lack of standard indicator definitions. Key priorities for investment include health services research, harmonisation of indicators, development of a costing tool, programming and scaling up, and the follow-up of preterm infants.ConclusionIt is hoped that this report will help to further scale-up and sustain KMC through a systematic approach that includes raising commitment, identifying key strategies to address the main barriers and using existing facilitators, ensuring training and quality, agreeing on indicators for monitoring and evaluation, and advancing implementation research.

Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study

“…KMC was initially proposed as an alternative to the conventional contemporary method of care for lowbirthweight infants and was introduced to some lowincome countries including Bangladesh, Malawi, Nepal, etc. in the 1980s and 1990s [3]. In these countries, the prevalence of prematurity/low birth weight is high while medical resources are limited, KMC was performed as an alternative to incubators or warmers [4].…”

“…The main facilitators to the practice of KMC included "support from hospital management", "mother-infant attachment" and "support from family, friends and other mentors" [21][22][23][24]. Despite there are studies published on barriers and facilitators of implementing KMC in many Asian countries including Nepal, India, Pakistan, Bangladesh, Vietnam, Philippines and Indonesia [3,22,25,26], we believe that China may have some unique barriers and facilitators to the practice of KMC due to its specific policies, resources and traditional culture and we are not aware of any prior published studies in China examining these barriers and facilitators.…”

Barriers and Facilitators of Kangaroo Mother Care Adoption in Five Chinese Hospitals: a Qualitative Study

“…Despite there are studies published on barriers and facilitators of implementing KMC in many Asian countries including Nepal, India, Pakistan, Bangladesh, Vietnam, and Indonesia [3,22,25], we believe that China may have some unique barriers and facilitators to the practice of KMC due to its speci c policies, resources and traditional culture and we are not aware of any prior published studies in China examining these barriers and facilitators.…”

“…Studies from other countries have found that at hospital and health system level, the absence of leadership, in exible visitation policies for parents, insu cient sta ng levels, and insu cient training were barriers to KMC [3]. Evidence from other Asian countries shows that leadership and governance, the presence of essential medical products, the health workforce and health nancing were important factors in uencing the adoption of KMC [22,25,36].…”

“…KMC also has multiple bene ts for newborns and their families, including improved duration of breastfeeding, weight gain and physiological response [5], supporting maternal-infant bonding and child development, improving longer term neuro-behavioural, psychomotor development and brain maturation [6][7][8]. Currently, KMC is considered one of the most cost-effective interventions to promote the well-being of preterm infants, and has been widely adopted in many countries, such as in Africa, Asia, America, Europe, and Latin American and the Caribbean [3]. It was estimated that KMC was practiced in some form (mostly intermittent) in 82% of all neonatal intensive care units (NICUs) in the United States [9].…”