Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study

Abstract

ObjectivesKangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.DesignThis study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measuresThe primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.ResultsKey barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).ConclusionsThis study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbersISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.

Increased breastfeeding; an educational exchange program between India and Norway improving newborn health in a low- and middle-income hospital population

“…Endeavours were focused on customisation to location and time. This adaptable strategy to improve implementation has proved successful in similar projects [ 13 ]. Less hierarchal distribution of authoritative knowledge, as advocated by implementation strategists, was achieved by involvement of all levels and links in the decision chains and focus on mutual accommodation of knowledge [ 14 ].…”

Improving Post-discharge Practice of Kangaroo Mother Care: Perspectives From Communities in East-Central Uganda

“…This recommendation is supported by previous research. Having a linkage and referral system between communities and providers via CHWs was identified as a potential enabler of KMC practice in Pakistan ( 1 , 10 , 20 ). In rural Malawi, a better follow-up of LBW babies after discharge was done through community follow-ups ( 21 ).…”

Centering and humanising health systems: empowerment through Kangaroo Mother Care

“…It’s proven effectiveness, however, is rooted in the undeniable power of human nature itself. Since fascination with technology has contributed to, yet has had bounded impact in curbing neonatal mortality [ 1 ], it is time to look within for solutions that engage the power of our humanity. Modern medicine must stop circumventing humanity in trying to solve public health problems.…”

“…We have published studies and statistics in an effort to demonstrate the benefits of this practice for newborn infants [ 2 - 5 , 7 ] as well as for mothers [ 11 ] and fathers [ 12 ] and its feasibility for scaling up [ 1 , 13 ]. But for anyone still skeptical, we recommend they try it.…”

“…Women often are marginalised in the care of their infants, as global health programmes tend to neglect the innate abilities women possess to enable their babies to survive and thrive. We report on the profoundly empowering experience that one of us (MW) had in providing skin-to-skin care for a preterm newborn infant in the context of programmatic efforts to transform Kangaroo Mother Care (KMC) provision in Uttar Pradesh (UP), India [ 1 ]. The Government of UP has recognised the scientific evidence and powerful humanity inherent in this practice and has constructed KMC units throughout the state with lounges designed to provide empathetic spaces in which women are dignified and rightfully recognised as possessing the ability to save newborn lives.…”