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Denge TT, Bam NE, Lubbe W, Rakhudu A. Essential components of an educational program for implementing skin-to-skin contact for preterm infants in intensive care units: an integrative literature review. BMC Pregnancy Childbirth 2024; 24:281. [PMID: 38627706 PMCID: PMC11022346 DOI: 10.1186/s12884-024-06447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Globally, prematurity is the primary factor behind the mortality of children under the age of 5 years, resulting in approximately 1 million children dying annually. The World Health Organization (WHO) recommends Skin-to-Skin Contact (SSC) as part of routine care for preterm infants. Evidence shows that SSC reduces mortality, possibly by improving thermoregulation, facilitating the earlier initiation of breastfeeding and reducing the risk of nosocomial infection. An educational program for implementing SSC has been demonstrated to enhance the knowledge and practice of parents and nurses in intensive care units. This study, the first of its kind in the North West Province (NWP), aims to identify the essential components of an educational program for implementing SSC for premature infants in intensive care units. OBJECTIVE This paper presents an integrative literature review that critically synthesizes research-based literature on essential components of an educational program for implementing SSC for preterm infants in intensive care units. METHODS A comprehensive search of electronic databases, such as CINAHL, MEDLINE, PsycINFO, ProQuest and Health Source: Nursing/Academic Edition and Health Source-Consumer Edition, was conducted using different keywords and references lists from the bibliography. RESULTS Twelve articles relevant to this review were identified, read and synthesized to answer the research question. Three essential components emerged from the findings of this review, namely (1) the necessity of policy and role players for implementing SSC, (2) the availability of education and training, and (3) counseling and support for parents of preterm infants. CONCLUSIONS The outcomes of this study have the potential to facilitate the implementation and expansion of SSC in intensive care units. This could aid program implementers, policymakers, and researchers to implement and scale up this important tool in intensive care units.
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Affiliation(s)
- Takalani T Denge
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Nokwanda Edith Bam
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Welma Lubbe
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Annah Rakhudu
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
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Kassaw MW, Abebe AM, Abate BB, Kassie AM, Tegegne KD. Health professional assisted Kangaroo mother care practice in Ethiopian health care facilities: evidence from the 2016 Ethiopian demographic and health survey. BMC Pediatr 2023; 23:417. [PMID: 37620779 PMCID: PMC10463399 DOI: 10.1186/s12887-023-04230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Worldwide, 15 million children born prematurely every year and over one million of them died because of prematurity caused complications. However, three-fourths of deaths from preterm related complications are preventable by using Kangaroo Mother Care (KMC). The Ethiopian government has been implementing a guideline that declares putting all low birth weight neonates at KMC. The aim of this study was to assess health professionals' assisted KMC practice and its associated factors among Ethiopian mothers who gave birth at health facilities. METHODOLOGY This study used the 2016Ethiopian Demographic and Health Survey data (EDHS). The 2016EDHS used a stratified two stage sampling method to select a representative sample using validated questioner. The sample we used in this study after cleaning the children's data set from the 2016EDHS was 2,960. Logistic regression model was used to assess the association of health professional assisted KMC practice and predictor variables. RESULTS Mothers who gave birth in health facilities and practiced kangaroo mother care were 1808(62.1%). In the multivariable logistic regression analysis, women from poorest (AOR, (95%CI)), (0.60, (0.43, 0.81)) and poorer (0.62, (0.46, 0.86)) socio-economic status were not practicing KMC. CONCLUSIONS The coverage of health professional assisted KMC practice was far lower than the expectation for mothers who gave birth in health facilities (100%). Low socio-economic status was associated with not practicing KMC. A further study on why mothers from low wealth index did not practicing KMC while they were in health facilities may be needed.
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Affiliation(s)
- Mesfin Wudu Kassaw
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia.
| | - Ayele Mamo Abebe
- Department of Nursing, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Biruk Beletew Abate
- Department of Nursing, College of Health Science, Woldia University, Woldia, Ethiopia
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Tadele H, Kassa DH, Gebriel FW, Bilal SM, Gedefaw A, Teshome M, Kawza A, Wangoro S, Muleta M, Abebo TA, Asefa A, Astatkie A, Haji Y, Alemayehu A, Aziz K, Brune T, Singhal N, Worku B, Tadesse BT. Development and evaluation of a kangaroo mother care implementation model in South Ethiopia. Acta Paediatr 2023; 112 Suppl 473:65-76. [PMID: 37519118 DOI: 10.1111/apa.16812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 08/01/2023]
Abstract
AIM To develop a model for increasing the coverage of kangaroo mother care (KMC), which involved ≥8 h of skin-to-skin contact per day and exclusive breastfeeding, for small babies with birth weight < 2000 g in South Ethiopia. METHODS A mixed methods study was conducted between June 2017 and January 2019 at four hospitals and their catchment areas. Iterative cycles of implementation, program learning and evaluation were used to optimise KMC implementation models. The study explored the community-facility continuum of care and assessed the proportion of neonates with a birth weight less than 2000 g receiving effective KMC. RESULTS Three KMC implementation models were tested with Model 2 being the final version. This model included enhanced identification of home births, improved referral linkages, immediate skin-to-skin care initiation in facilities and early contact after discharge. These improvements resulted in 86% coverage of effective facility-based KMC initiation for eligible babies. The coverage was 81.5% at discharge and 57.5% 7 days after discharge. The mean age of babies at KMC initiation was 8.2 days (SD = 5.7). CONCLUSION The study found that the KMC implementation model was feasible and can lead to substantial population-level KMC coverage for small babies.
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Affiliation(s)
- Henok Tadele
- Department of Paediatrics and Child Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dejene Hailu Kassa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Fitsum W Gebriel
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Abel Gedefaw
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Million Teshome
- Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Aknaw Kawza
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | - Shemels Wangoro
- Southern Nations, Nationalities, and Peoples' Regional State Health Bureau, Hawassa, Ethiopia
| | | | - Teshome Abuka Abebo
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Anteneh Asefa
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Yusuf Haji
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Akalewold Alemayehu
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Khalid Aziz
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Nalini Singhal
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Bogale Worku
- Ethiopian Paediatrics Society, Addis Ababa, Ethiopia
| | - Birkneh Tilahun Tadesse
- Department of Paediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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4
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Martines JC, Portela A, Bahl R. Developing context-specific models to achieve high coverage and quality of KMC in India and Ethiopia: Learnings from implementation research. Acta Paediatr 2023; 112 Suppl 473:3-5. [PMID: 37519119 DOI: 10.1111/apa.16862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Jose Carlos Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Washington M, Macaden L, Smith A, Selvam S, Mony PK. Determinants of Kangaroo Mother Care Uptake for Small Babies Along the Health Facility to Community Continuum in Karnataka, India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200457. [PMID: 37348942 DOI: 10.9745/ghsp-d-22-00457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Kangaroo mother care (KMC) scale-up is a proposed strategy to accelerate reduction in neonatal mortality rates. We aimed to identify determinants of KMC uptake for small babies (less than 2,000 g birth weight) along the health facility to community continuum in Karnataka, India. METHODS From June 2017 to March 2020, data on characteristics of health facilities and health care workers (HCWs) from 8 purposively selected health facilities were assessed. Knowledge, attitude, and support the mothers received for KMC uptake were assessed once between 4 weeks and 8 weeks unadjusted age of the cohort of babies. Secondary data on KMC were obtained from the district-wide implementation research project database. Bivariate analysis was used to assess the association of characteristics of health facilities, HCWs, mothers, and small babies with the day of KMC initiation and its duration. Log-binomial regression analysis was then computed to identify determinants of KMC. RESULTS We recruited 227 (91.5%) of 248 babies eligible to participate with a mean unadjusted age of 35.6 days (±7.5) and 1,693.9 g (±263.1 g) birth weight. KMC was initiated for 95.2% of 227 babies at the health facility; initiated at 3 days or earlier of life for 59.6% of 226 babies; and babies continued to receive KMC for more than 4 weeks (30.2 days [±8.4]) at home. Determinants of KMC initiation were HCWs' attitudes, initiation support at the health facility, and place of hospitalization. Determinants of KMC maintenance at the health facility were HCWs' skills and support the mother received at the facility after initiating KMC. Place of hospitalization and HCWs' knowledge determined KMC duration at home 1 week after discharge. CONCLUSION These findings emphasize the importance of competent HCWs and support for mothers at the health facility for initiation and maintenance of KMC within the health facility and 1 week after discharge.
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Affiliation(s)
- Maryann Washington
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India.
| | - Leah Macaden
- Nursing Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - Annetta Smith
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sumithra Selvam
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. Johns Research Institute, Bangalore, India
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Joshi A, Londhe A, Joshi T, Deshmukh L. Quality improvement in Kangaroo Mother Care: learning from a teaching hospital. BMJ Open Qual 2022; 11:bmjoq-2021-001459. [PMID: 35545277 PMCID: PMC9092177 DOI: 10.1136/bmjoq-2021-001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Kangaroo Mother Care (KMC) is a low-resource, evidence-based, high-impact intervention for low-birth weight (LBW) care. Quality improvement in KMC requires meso-level, macro-level and micro-level interventions. Our institution, a public teaching hospital, hosts a level-II/III neonatal intensive care unit (NICU). The average demand for beds typically exceeds available capacity, with 60% occupancy attributed to LBW patients. There was low uptake of KMC practice at our unit. AIM STATEMENT In the initial phase, we aimed to improve the coverage of KMC in admitted eligible neonates from a baseline of 20%-80% within 15 days. After a period of complacency, we revised the aim statement with a target of improving the percentage of babies receiving 6-hour KMC from 30% to 80% in 12 weeks. METHODS We report this quasi-experimental time-series study. With the Point of Care Quality Improvement methodology, we performed Plan-Do-Study-Act (PDSA) cycles to improve KMC practice. We involved all the healthcare workers, mothers and caregivers to customise various KMC tools (KMC book format, KMC bag, mother's gown) and minimise interruptions. Feedback from all levels guided our PDSA cycles. RESULTS The percentage of babies receiving at least 1-hour KMC increased from 20% to 100% within 15 days of August 2017. In the improvement phase, baseline 6-hour KMC coverage of 30% increased to 80% within 12 weeks (October-December 2017). It sustained for more than 2 years (January 2018 till February-2020) at 76.5%±2.49%. CONCLUSIONS Quality improvement methods helped increase the coverage and percentage of babies receiving 6-hour KMC per day in our NICU. The duration specified KMC coverage should be adopted as the quality indicator of KMC. The training of healthcare workers and KMC provider should include hands-on sessions involving the mother and the baby. Maintaining data and providing suitable KMC tools are necessary elements for improving KMC. Minimising interruption is possible with family support and appropriate scheduling of activities. Having a designated KMC block helps in peer motivation.
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Affiliation(s)
- Amol Joshi
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Atul Londhe
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Trupti Joshi
- Pediatrics, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
| | - Laxmikant Deshmukh
- Neonatology, Government Medical College and Hospital Aurangabad, Aurangabad, Maharashtra, India
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7
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Willson M, Kumar V, Darmstadt GL. Centering and humanising health systems: empowerment through Kangaroo Mother Care. J Glob Health 2021; 11:03105. [PMID: 34956631 PMCID: PMC8684780 DOI: 10.7189/jogh.11.03105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Mony PK, Tadele H, Gobezayehu AG, Chan GJ, Kumar A, Mazumder S, Beyene SA, Jayanna K, Kassa DH, Mohammed HA, Estifanos AS, Kumar P, Jadaun AS, Hailu Abay T, Washington M, W/Gebriel F, Alamineh L, Fikre A, Kumar A, Trikha S, Ashebir Gebregizabher F, Kar A, Bilal SM, Belew ML, Debere MK, Krishna R, Dalpath SK, Amare SY, Mohan HL, Brune T, Sibley LM, Tariku A, Sahu A, Kumar T, Hadush MY, Gowda PD, Aziz K, Duguma D, Singh PK, Darmstadt GL, Agarwal R, Gebremariam DS, Martines J, Portela A, Jaiswal HV, Bahl R, Rao Pn S, Tadesse BT, Cranmer JN, Hailemariam D, Kumar V, Bhandari N, Medhanyie AA. Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health 2021; 6:bmjgh-2021-005905. [PMID: 34518203 PMCID: PMC8438727 DOI: 10.1136/bmjgh-2021-005905] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/07/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives Kangaroo 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. Design This 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. Participants 3804 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 measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. Results Key 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%). Conclusions This 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 numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.
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Affiliation(s)
- Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College and Research Institute, Bangalore, India
| | - Henok Tadele
- College of Health Sciences, Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Grace J Chan
- Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Department of Epidemiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Aarti Kumar
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Sarmila Mazumder
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Selemawit Asfaw Beyene
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, Bangalore, India.,Ramaiah University of Applied Sciences, Bangalore, India
| | - Dejene Hailu Kassa
- College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia
| | | | | | - Pankaj Kumar
- National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Arun Singh Jadaun
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tedros Hailu Abay
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Maryann Washington
- St John's Research Institute, St John's Medical College, Bangalore, India
| | - Fitsum W/Gebriel
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | - Addisalem Fikre
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alok Kumar
- Governent of Uttar Pradesh, Lucknow, Uttar Pradesh, India
| | - Sonia Trikha
- State Health Systems Resource Center, Panchkula, Haryana, India
| | | | - Arin Kar
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Selamawit Mengesha Bilal
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | - Raghav Krishna
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | | | - Samson Yohannes Amare
- Department of Software Engineering, School of Computing, College of Science and Technology, Mekelle University, Mekelle, Ethiopia
| | - H L Mohan
- Karnataka Health Promotion Trust, Rajajinagar, India
| | - Thomas Brune
- Sachs' Children and Youth Hospital, Stockholm, Sweden
| | | | - Abraham Tariku
- Maternal & Child Health Department, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Arti Sahu
- Community Empowerment Lab, Lucknow, Uttar Pradesh, India
| | - Tarun Kumar
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Marta Yemane Hadush
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Prabhu Deva Gowda
- Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore, India
| | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Ramesh Agarwal
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Dawit Seyoum Gebremariam
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jose Martines
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Harsh Vardhan Jaiswal
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Suman Rao Pn
- Department of Neonatology, St John's Medical College Hospital, Bangalore, India
| | - Birkneh Tilahun Tadesse
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | | | | | | | - Nita Bhandari
- Center for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Araya Abrha Medhanyie
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.,School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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Ariff S, Habib A, Memon Z, Arshad T, Samejo T, Maznani I, Umer M, Hussain A, Rizvi A, Ahmed I, Soofi SB, Bhutta ZA. Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e28156. [PMID: 34170839 PMCID: PMC8386402 DOI: 10.2196/28156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. OBJECTIVE The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. METHODS We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. RESULTS The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. CONCLUSIONS This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. TRIAL REGISTRATION clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28156.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Atif Habib
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zahid Memon
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tayyaba Arshad
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Tariq Samejo
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Ikram Maznani
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Umer
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Amjad Hussain
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Arjumand Rizvi
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan.,Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Center of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan
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Rao SPN, Minckas N, Medvedev MM, Gathara D, Y N P, Seifu Estifanos A, Silitonga AC, Jadaun AS, Adejuyigbe EA, Brotherton H, Arya S, Gera R, Ezeaka CV, Gai A, Gobezayehu AG, Dube Q, Kumar A, Naburi H, Chiume M, Tumukunde V, Medhanyie AA, Plange-Rhule G, Shabini J, Ohuma EO, Tadele H, W/Gebriel F, Hadgu A, Alamineh L, Mehta R, Molyneux E, Lawn JE. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers' voices and experiences. BMJ Glob Health 2021; 6:e004347. [PMID: 33716220 PMCID: PMC7959239 DOI: 10.1136/bmjgh-2020-004347] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic is disrupting health systems globally. Maternity care disruptions have been surveyed, but not those related to vulnerable small newborns. We aimed to survey reported disruptions to small and sick newborn care worldwide and undertake thematic analysis of healthcare providers' experiences and proposed mitigation strategies. METHODS Using a widely disseminated online survey in three languages, we reached out to neonatal healthcare providers. We collected data on COVID-19 preparedness, effects on health personnel and on newborn care services, including kangaroo mother care (KMC), as well as disruptors and solutions. RESULTS We analysed 1120 responses from 62 countries, mainly low and middle-income countries (LMICs). Preparedness for COVID-19 was suboptimal in terms of guidelines and availability of personal protective equipment. One-third reported routine testing of all pregnant women, but 13% had no testing capacity at all. More than 85% of health personnel feared for their own health and 89% had increased stress. Newborn care practices were disrupted both due to reduced care-seeking and a compromised workforce. More than half reported that evidence-based interventions such as KMC were discontinued or discouraged. Separation of the mother-baby dyad was reported for both COVID-positive mothers (50%) and those with unknown status (16%). Follow-up care was disrupted primarily due to families' fear of visiting hospitals (~73%). CONCLUSION Newborn care providers are stressed and there is lack clarity and guidelines regarding care of small newborns during the pandemic. There is an urgent need to protect life-saving interventions, such as KMC, threatened by the pandemic, and to be ready to recover and build back better.
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Affiliation(s)
- Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Nicole Minckas
- Institute for Global Health, University College London, London, UK
| | - Melissa M Medvedev
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - David Gathara
- Kenya Medical Research Institute-, Wellcome Trust Research Program, Nairobi, Kenya
| | - Prashantha Y N
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, India
| | - Abiy Seifu Estifanos
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfrida Camelia Silitonga
- Department of Reproductive, Maternal, Newborn, Child and Adolescent Health, World Health Organization, Country Office Indonesia, Jakarta, Indonesia
| | - Arun Singh Jadaun
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Helen Brotherton
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sugandha Arya
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rani Gera
- Department of Pediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Chinyere V Ezeaka
- Department of Pediatrics, University of Lagos and Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Abdou Gai
- Medical Research Council Unit The Gambia, at London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | | | - Queen Dube
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Helga Naburi
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Victor Tumukunde
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Araya Abrha Medhanyie
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | - Gyikua Plange-Rhule
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Josephine Shabini
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamayo, Tanzania
| | - Eric O Ohuma
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Henok Tadele
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Amanuel Hadgu
- School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia
| | | | - Rajesh Mehta
- Regional Office, South East Asia, World Health Organisation, New Delhi, India
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, University of Malawi College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Abdalla S, Pair E, Mehta1, KM, Ward VC, Darmstadt GL. Geospatial variations in trends of reproductive, maternal, newborn and child health and nutrition indicators at block level in Bihar, India, during scale-up of Ananya program interventions. J Glob Health 2020; 10:021004. [PMID: 33425328 PMCID: PMC7758914 DOI: 10.7189/jogh.10.021004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Geographical variations in the levels and trajectory of health indicators at local level can inform the adaptation of interventions and development of targeted approaches for efficient scale-up of intervention impact. We examined the hypothesis that time trends of a set of reproductive, maternal, newborn, and child health and nutrition (RMNCHN) indicators varied at block-level during the statewide scale-up phase of the Ananya program in Bihar, India. METHODS We used data on 22 selected indicators from four rounds of the Community-based Household Survey carried out between 2014 and 2017. Indicator levels at each round were estimated for each block. We used hierarchical Bayesian spatiotemporal modelling to smooth the raw estimates for each block with the estimates from its neighbouring blocks, and to examine space-time interaction models for evidence of variations in trends of indicators across blocks. We expressed the uncertainty around the smoothed levels and the trends with 95% credible intervals. RESULTS There was evidence of variations in trends at block level in all but three indicators: facility delivery, public facility delivery, and age-appropriate initiation of complementary feeding. Fifteen indicators showed trends in opposite directions (increases in some blocks and declines in others). All blocks had at least 97.5% probability of a rise in immediate breastfeeding, early pregnancy registration, and having at least four antenatal care visits. All blocks had at least 97.5% probability of a decline in seeking care for pregnancy complications. CONCLUSIONS The findings underscore the value of monitoring and evaluation at local level for targeted implementation of RMNCHN interventions. There is a need for identifying systematic factors leading to universal trends, or variable contextual or implementation factors leading to variable trends, in order to optimise primary health care program impact. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Emma Pair
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kala M Mehta1,
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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