“We All Join Hands”: Perceptions of the Kangaroo Method Among Female Relatives of Newborns in The Gambia

Brotherton, Helen; Daly, Maura; Johm, Penda; Jarju, Bintou; Schellenberg, Joanna; Penn‐Kekana, Loveday; Lawn, Joy E

doi:10.1177/1049732320976365

Cited by 13 publications

(14 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many previous studies have observed these same challenges, noting a need for behavior change among primary caregivers as well as sufficient social support to overcome such barriers. 9 , 12 , 14 , 26 The results from this study agree that social support and behavior change are essential for KMC success; however, this study also highlights the critical need for economic support. Parents face competing priorities that underpin the time-commitment barrier described so often.…”

Section: Discussionsupporting

confidence: 65%

See 1 more Smart Citation

Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Lydon

Lwesha²,

Likomwa³

et al. 2022

Glob Health Sci Pract

View full text Add to dashboard Cite

This analysis identified 3 major injunctive norms that influence behavior at the community, family, household, and individual levels, and have both positive and negative effects on parent engagement with kangaroo mother care (KMC) in Malawi.n Proposed areas for intervention to promote KMC include (1) emphasizing the value of life and working to shift community attitudes about preterm infants, (2) encouraging family and community support systems, (3) highlighting the discrepancy between perceived and actual male KMC involvement, (4) sharing strategies that support collaborative participation in KMC among both parents, and (5) developing or strengthening efforts to provide economic relief to KMC parents.

show abstract

Section: Discussionsupporting

confidence: 65%

“…9,11 Numerous studies have underscored the role of gender norms with respect to KMC engagement. 9,11,14 Parent experiences of postpartum medical conditions and navigating other time commitments have also proven to be impediments to KMC. 9 As the benefits of KMC are striking, advocates continue working to overcome implementation challenges.…”

Section: Introductionmentioning

confidence: 99%

Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Lydon

Lwesha²,

Likomwa³

et al. 2022

Glob Health Sci Pract

View full text Add to dashboard Cite

show abstract

“…Involving other family members as alternative KMC providers may mitigate early maternal unavailability, as identified by HCW in this study and as per the eKMC trial in which 46% of the intervention arm received first KMC from a female relative (14). Female relatives are willing to support mothers in this role (36) and are influential newborn care decision makers in many African communities (37,38). Hence, involving female relatives, especially elders, in policy and programs may assist with delivery of this complex intervention.…”

Section: Discussionmentioning

confidence: 99%

“…The adoption system refers to the key actors involved in provision of the intervention and their interests, values and interactions (33). As both HCW and KMC providers (mothers and families) are important actors in this complex intervention (36), this theme was sub-divided to enable consideration of factors related to each actor.…”

Section: Adoption System (Health Care Workers and Kmc Providers)mentioning

confidence: 99%

Barriers and enablers to kangaroo mother care prior to stability from perspectives of Gambian health workers: A qualitative study

et al. 2022

Self Cite

View full text Add to dashboard Cite

AimsKangaroo mother care (KMC) is an evidence-based intervention recommended for stable newborns <2,000 g. Recent trials have investigated survival benefits of earlier initiation of KMC, including prior to stability, with WHO's iKMC trial showing 25% relative risk reduction for mortality of neonates 1–1.8 kg at tertiary Indian and African neonatal units (NNU). However, evidence is lacking about how to safely deliver this intervention to the most vulnerable neonates in resource limited settings (RLS). Our study aimed to understand barriers and enablers for early KMC prior to stability from perspectives of neonatal health care workers (HCW) in a high neonatal mortality RLS.MethodsThis qualitative study was conducted at Edward Francis Small Teaching Hospital (EFSTH), the main neonatal referral unit in The Gambia. It was ancillary study to the eKMC clinical trial. Ten semi-structured interviews were conducted with all neonatal HCW cadres (4 nurses; 1 nurse attendant; 5 doctors; all Gambian). Study participants were purposively selected, and saturation was reached. Thematic analysis was conducted using Atun's conceptual framework for evaluation of new health interventions with methods to ensure data reliability and trustworthiness.ResultsHCW's perceptions of early KMC prior to stability included recognition of potential benefits as well as uncertainty about effectiveness and safety. Barriers included: Unavailability of mothers during early neonatal unit admission; safety concerns with concomitant intravenous fluids and impact on infection prevention control; insufficient beds, space, WASH facilities and staffing; and lack of privacy and respectful care. Enablers included: Education of HCW with knowledge transfer to KMC providers; paternal and community sensitization and peer-to-peer support.ConclusionsAddressing health systems limitations for delivery of KMC prior to stability is foundational with linkage to comprehensive HCW and KMC provider education about effectiveness, safe delivery and monitoring. Further context specific research into safe and respectful implementation is required from varied settings and should include perceptions of all stakeholders, especially if there is a shift in global policy toward KMC for all small vulnerable newborns.

show abstract

“…Other challenges to providing prolonged KMC duration included mothers being absent due to maternal illness, post-caesarean section or delivery at another health facility. This is reflected in nearly half of our intervention arm receiving first KMC contact from a female relative (aunt/grandmother) and highlights the importance of family support for KMC [ 29 ]. The high proportion of twins (17% of our cohort were twins both enroled) may have also affected provision of prolonged KMC, due to the reticence of KMC providers to perform KMC with unstable twins simultaneously.…”

Section: Discussionmentioning

confidence: 99%

Impact of early kangaroo mother care versus standard care on survival of mild-moderately unstable neonates <2000 grams: A randomised controlled trial

Brotherton¹,

Gai²,

Kebbeh³

et al. 2021

EClinicalMedicine

Self Cite

View full text Add to dashboard Cite

Background Understanding the effect of early kangaroo mother care on survival of mild-moderately unstable neonates <2000 g is a high-priority evidence gap for small and sick newborn care. Methods This non-blinded pragmatic randomised clinical trial was conducted at the only teaching hospital in The Gambia. Eligibility criteria included weight <2000g and age 1–24 h with exclusion if stable or severely unstable. Neonates were randomly assigned to receive either standard care, including KMC once stable at >24 h after admission (control) versus KMC initiated <24 h after admission (intervention). Randomisation was stratified by weight with twins in the same arm. The primary outcome was all-cause mortality at 28 postnatal days, assessed by intention to treat analysis. Secondary outcomes included: time to death; hypothermia and stability at 24 h; breastfeeding at discharge; infections; weight gain at 28d and admission duration. The trial was prospectively registered at www.clinicaltrials.gov (NCT03555981). Findings Recruitment occurred from 23rd May 2018 to 19th March 2020. Among 1,107 neonates screened for participation 279 were randomly assigned, 139 (42% male [ n = 59]) to standard care and 138 (43% male [ n = 59]) to the intervention with two participants lost to follow up and no withdrawals. The proportion dying within 28d was 24% (34/139, control) vs. 21% (29/138, intervention) (risk ratio 0·84, 95% CI 0·55 – 1·29, p = 0·423). There were no between-arm differences for secondary outcomes or serious adverse events (28/139 (20%) for control and 30/139 (22%) for intervention, none related). One-third of intervention neonates reverted to standard care for clinical reasons. Interpretation The trial had low power due to halving of baseline neonatal mortality, highlighting the importance of implementing existing small and sick newborn care interventions. Further mortality effect and safety data are needed from varying low and middle-income neonatal unit contexts before changing global guidelines.

show abstract

“We All Join Hands”: Perceptions of the Kangaroo Method Among Female Relatives of Newborns in The Gambia

Cited by 13 publications

References 35 publications

Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Barriers and enablers to kangaroo mother care prior to stability from perspectives of Gambian health workers: A qualitative study

Impact of early kangaroo mother care versus standard care on survival of mild-moderately unstable neonates <2000 grams: A randomised controlled trial

Contact Info

Product

Resources

About