Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi

Abstract

BackgroundDespite introduction of Kangaroo Mother Care (KMC) in Malawi over a decade ago, preterm birth remains the leading cause of neonatal mortality. Although KMC is initiated in the health care facility, robust community follow-up is critical for survival and optimal development of preterm and low birth weight infants post-discharge. The objective of this qualitative study was to gain insight into community and health worker understanding, attitudes, beliefs and practices around preterm and low birth weight babies and KMC in Malawi.MethodsA total of 152 participants were interviewed in two districts in southern Malawi, Machinga and Thyolo, in April 2015. Focus group discussions (groups = 11, n = 132) were conducted with pregnant women, community members and women who have practiced KMC. In-depth interviews (n = 20) were conducted with fathers who have practiced KMC, community and religious leaders, and health workers. Purposive and snowball sampling were employed to identify participants. Thematic content analysis was conducted.FindingsKMC mothers and fathers only learned about KMC and care for preterm newborns after delivery of a child in need of this care. Men typically were not included in KMC counseling due to societal gender roles. Health facilities were the main source of information on KMC, however informal networks among women provided some degree of knowledge exchange. Community leaders were regarded as major facilitators of health information, conveners, key influencers, and policy-makers. Religious leaders were regarded as advocates and emotional support for families with preterm infants. Finally, while many participants initially had negative feelings towards preterm births and KMC, the large majority saw a shift in their perceptions through health counseling, peer modeling, and personal success with KMC.ConclusionsThe findings offer several opportunities to improve KMC implementation including 1) earlier introduction of KMC to pregnant women and their families that are at-risk for preterm birth, 2) greater involvement of men in KMC counselling, practice and care for preterm infants, and 3) strengthening and defining partnerships with community and religious leaders. Finally, as parental perceptions of preterm infants and KMC improved with successful KMC practice, it is hopeful that KMC itself can positively affect social norms surrounding preterm infants, leading to a virtuous cycle of improved perceptions of preterm infants and increased uptake of KMC.

Facilitating factors and barriers to accessibility and utilization of kangaroo mother care service among parents of low birth weight infants in Mangochi District, Malawi: a qualitative study

“…Messages/guidelines in the Malawi antenatal counselling standard operating procedures (SOPs) does not integrate KMC awareness at the ANC service delivery point [ 32 , 33 ], which is aiding inconsistency in KMC message acquisition amongst mothers at ANC clinics in various health facilities, although,. Lydon et al , observed that the ANC clinic was the important arena to disseminate KMC messages to the targeted population, who are at risk of LBWI delivery [ 34 ]. This study indicated increased number of pregnancies as one of the high risk factors of LBWIs deliveries in MD catchment area, which serves as the indicators to dissemination of KMC messages at ANC clinics and strengthening strategies of family planning methods uptake.…”

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

“…Previous studies have identified other factors beyond the wrap influencing KMC practices, including inadequate staffing levels and capacity, limited provision of information about KMC to mothers during antenatal care/shortly after birth, inadequate equipment and supplies to support mothers' adherence to recommended KMC practices, dedicated space, addressing the pain and fatigue of mothers in facilities and support to the mothers post-discharge, and weak recording and reporting on KMC [5,[10][11][12]15]. These other challenges also warrant further examination to improve the quality of KMC implementation in Malawi.…”

“…The study also found little engagement of husbands in the support of skin-to-skin, contact, regardless of the wrap used. The level of family and social support has been previously identified as an important enabler for KMC practices in Malawi [6,11,27]. Though there is not enough evidence on the involvement of fathers in increasing adherence to KMC [3], several studies report that stigma around male involvement in child care prevents KMC uptake [27,28].…”

“…Some studies have shown that the level of adherence of post-discharge KMC practice remain high [7,8](Ghana, India), yet studies from Malawi have found lower levels of adherence post-discharge [9]. Studies assessing women's perceptions in Malawi on KMC following discharge have found women being overwhelmed with responsibilities at home, developing anxiety and fatigue discouraging them from continuing KMC, and experiencing financial difficulties, lack of support, and stigma, ultimately resulting in following unhealthy, traditional care practices of LBW babies [10][11][12][13]. Mothers in Malawi have also identified positioning of the infant and discomfort among the main barriers to KMC practice when using the traditional wrap called a chitenje, which is a piece of fabric normally two meters long by one meter wide [10].…”

<p>Qualitative assessment of knowledge transfer regarding preterm birth in Malawi following the implementation of targeted health messages over 3 years</p>

“…We did not query its acceptability in this present study, but other investigators have found it to be well received and generally acceptable, particularly after the benefits are explained. [74][75][76][77][78][79][80] Additional responses referenced the theme of help being available for the baby at these centers, including keeping the baby warm and giving oxygen. One respondent referenced corticosteroids for fetal maturity.…”