The presence of physician champions improved Kangaroo Mother Care in rural western India

Abstract

Aim This study determined the effect of physician champions on the two main components of Kangaroo mother care (KMC): skin-to-skin care and breastfeeding. Methods KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between 5 January 2011 and 7 October 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models. Results In comparison to when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% Confidence Interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53% to 82%) and an average of 1.47 less hours of skin-to-skin care (95% CI −2.07 to −0.86). Breastfeeding practices were similar across the different champion environments. Conclusion Withdrawing physician champions from the NICU setting was associated with a decline in skin-to-skin care, but not breastfeeding. Training healthcare workers and community stakeholders to become champions could help to scale up and maintain KMC practices.

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

“…At health systems level [ 23 , 24 ], identified barriers include absence of leadership (leading to infrastructure shortages, lack of space and poor privacy in hospitals), lack of provision of transportation services to health facilities, inflexible visitation policies for parents, insufficient staff and leaders in the field, and an absence of KMC champions (e.g. in rural western India [ 25 ]). Perverse financial mechanisms that rewarded traditional incubator/warmer care instead of promoting prolonged skin-to-skin contact were also discussed.…”

Medical champions can make a difference in initiating culture change

“…Facilitators are crucial in translating the evidence into clinical practice, as shown by Soni et al. in this issue of Acta Paediatrica . They showed that two doctors were the key facilitators in promoting skin‐to‐skin contact in neonates admitted to an Indian neonatal intensive care unit.…”

“…Thereafter, the risk of regressing back to old practices becomes smaller, even if some individuals moved away. According to the study reported in this issue , breastfeeding remained at the same level even after the champion doctors had moved to other units. However, some of the elements required for sustainability in the everyday practice of skin‐to‐skin contact had not been reached, as there was a significant decrease in the skin‐to‐skin practice after the champions had moved away.…”

“…To learn more about successful culture change, the evaluation of complex interventions is needed together with follow‐up to evaluate the final patient outcomes. The quantification of the elements of Kangaroo care, that is skin‐to‐skin contact and breastfeeding separately, is a strength of this study and should be encouraged in future studies .…”

“…The paper by Soni et al. provides us with information about one mechanism that can be used to initiate culture change. The team work between the doctors, nurses and parents was shown to reach the desired goal when the champion doctors provided enthusiastic support for the team, in order to help the parents to provide skin–skin contact for their baby.…”