1
|
Pratik PP, Lakshminarayana SK, Devadas S, Kommalur A, Sajjan SV, Kariyappa M. Quality Improvement Study With Low-Cost Strategies to Reduce Neonatal Admission Hypothermia. Cureus 2023; 15:e40301. [PMID: 37448391 PMCID: PMC10337647 DOI: 10.7759/cureus.40301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Background Admission hypothermia is still an underappreciated major challenge for new-born survival in low-resource settings. The WHO recommends skin-to-skin contact as the simplest and safest way for maintaining the body temperature even during transportation. Quality improvement initiatives for hospitalised new-borns have shown benefits like a reduction in neonatal morbidity and mortality. This study was undertaken in a resource-constrained public hospital in southern India with an aim to reduce neonatal hypothermia at admission to <20%. Method It was a prospective, quality improvement study undertaken over 20 weeks. All neonates born in the selected delivery room (DR), requiring transportation to the neonatal intensive care unit, were included. The primary outcome indicators were the mean axillary temperature of neonates measured upon arrival at the neonatal intensive care unit and the percentage of neonates with hypothermia at admission. Improving the thermoregulatory practices and ambient DR temperature to >25˚C, transportation by the kangaroo method, and a portable infant warmer (PIW) were implemented in three successive Plan-Do-Study-Act (PDSA) cycles. Result In the third PDSA cycle, the mean admission temperature (36.51˚C ±0.82) was significantly (p<0.0001) higher when compared with the baseline phase (35.41˚C ±1.09), and there was a significant (p<0.001) reduction in hypothermia (33.33%). The aim was achieved in the last two weeks of the third cycle with a reduction in hypothermia to 17.6%. Conclusion Implementation of appropriate thermoregulatory practices and low-cost strategies like the kangaroo method and PIW using quality improvement methodology significantly reduced admission hypothermia.
Collapse
Affiliation(s)
- Pi Pragyan Pratik
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND
| | | | - Sahana Devadas
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Anitha Kommalur
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Sushma Veeranna Sajjan
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND
| | - Mallesh Kariyappa
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, IND
| |
Collapse
|
2
|
Mohammadi M, Bergh AM, Jahdi NS, Valizadeh L, Hosseini M, Hakimi S. Launching continuous kangaroo mother care through participatory action research in Iran. BMC Health Serv Res 2023; 23:436. [PMID: 37143074 PMCID: PMC10159671 DOI: 10.1186/s12913-023-09372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND This study describes the launching of a unit for continuous kangaroo mother care (KMC) in a teaching hospital (Taleghani) in Iran. METHODS We used a participatory three-stage action research approach to establish a unit for continuous KMC: design (needs identification and planning for change); implementation (and reflection); and evaluation (and institutionalization). As part of the design and implementation stages, individual and focus group interviews were conducted with mothers, physicians, nurses, other healthcare personnel and policy makers. The evaluation was done by means of a standardized tool specifically developed for monitoring progress with the implementation of KMC. RESULTS Four themes relating to potential barriers to implementation emerged from the analysis of the staff interviews, namely barriers associated with the mother, the father, the physician and the health system. Mothers' experiences of barriers were grouped into five themes: personal discomfort, fear, healthcare provider attitudes and actions, infrastructure constraints and family matters. An implementation progress score of 27.05 out of 30 was achieved, indicating that the continuous KMC unit was on the path to institutionalization. Some of the gaps identified related to policies on resource allocation, the discharge and follow-up system, and the transportation of infants in the KMC position. CONCLUSION The study findings indicated that participatory action research is a suitable method for studying the establishment of a continuous KMC unit. When action research is practiced, there is a prospect of turning knowledge into action in the real world.
Collapse
Affiliation(s)
- Marzieh Mohammadi
- Student's Research Committee, Tabriz University of Medical Science, Tabriz, Iran
| | - Anne-Marie Bergh
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
| | - Niloufar Sattarzadeh Jahdi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Leila Valizadeh
- Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Sevil Hakimi
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran.
- Department of Midwifery, Faculty of Nursing and Midwifery. Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran.
| |
Collapse
|
3
|
WHO KMC Scale Up Study Group. Incremental costs of scaling up kangaroo mother care: Results from implementation research in Ethiopia and India. Acta Paediatr 2022. [PMID: 35983749 DOI: 10.1111/apa.16490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022]
Abstract
AIM To estimate incremental costs of an implementation model for scaling up Kangaroo Mother Care (KMC) for neonates with birthweight <2000 g. METHODS Seven sites across Ethiopia and India collected data for 2018-19 to calculate incremental recurrent costs (of health worker time, supplies, and operations) and start-up costs for KMC scale up. The costs were estimated per live newborn <2000 g eligible for KMC identified in the study population. RESULTS Scaling up KMC in study districts required average incremental costs of US$59 (95% CI US$ 52-67) in Ethiopia and US$72 (95% CI US$ 41-103) in India per eligible newborn in the population. Most of these costs were recurrent; the annualised start-up costs per eligible newborn ranged from 12%-25% of total costs in Ethiopia and 9%-16% in India. The major cost driver was human resources, followed by initial and recurrent training, supplies, and communications costs. Incremental infrastructure costs were only 2%-6% of total costs in both countries. Most of the costs were for activities at the KMC implementing facility, accounting for 79%-88% of the total costs in Ethiopia and 89%-93% of those in India. CONCLUSION The costs for successful scale up of KMC seem affordable but must be included in programme budgets.
Collapse
|
4
|
Jadaun AS, Dalpath SK, Trikha S, Upadhyay RP, Bhandari N, Punia JS, Rawal M, Martines JC, Bahl R, Agarwal R, Mazumder S. Government-led initiative increased the effective use of Kangaroo Mother Care in a region of North India. Acta Paediatr 2022. [PMID: 35665961 DOI: 10.1111/apa.16376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
AIM To learn how to achieve high-quality, effective coverage of Kangaroo Mother Care (KMC), defined as 8 hours or more of skin-to-skin contact per day and exclusive breastfeeding in district Sonipat in North India, and to develop and evaluate an implementation model. METHODS We conducted implementation research using a mixed-methods approach, including formative research, followed by repeated, rapid cycles of implementation, evaluation and refinement until a model with the potential for high and effective coverage was reached. Evaluation of this model was conducted over a 12-month period. RESULTS Formative research findings informed the final implementation model. Programme learning was critical to achieve high coverage. The model included improving the identification of small babies, creating KMC wards, modification in hospitalisation criteria, private sector engagement and in-built programme learning to refine implementation progress. KMC was initiated in 87% of eligible babies. At discharge, 85% received skin-to-skin contact care, 60% effective KMC and 80% were exclusively breastfed. At home, 7-day post discharge, 81% received skin-to-skin care and 79% were exclusively breastfed in the previous 24 hours. CONCLUSION Achieving high KMC coverage is feasible in the study setting using a model responsive to the local context and led by the Government.
Collapse
Affiliation(s)
- Arun S. Jadaun
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Suresh K. Dalpath
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Sonia Trikha
- State Health Systems Resource Center, Haryana Panchkula Haryana India
| | - Ravi P. Upadhyay
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Nita Bhandari
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| | - Jaswant Singh Punia
- Department of Health District Hospital, Government of Haryana Sonipat Haryana India
| | - Manoj Rawal
- Bhagat Phool Singh Government Medical College Sonipat Haryana India
| | - Jose Carlos Martines
- Department of Global Public Health and Primary Care Centre for Intervention Science in Maternal and Child Health University of Bergen Bergen Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization Geneva Switzerland
| | - Ramesh Agarwal
- Department Pediatrics All India Institute of Medical Sciences New Delhi India
| | - Sarmila Mazumder
- Centre for Health Research and Development Society for Applied Studies New Delhi India
| |
Collapse
|
5
|
Cabrera-Lafuente M, Alonso-Díaz C, Pumarega MTM, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey. An Pediatr (Barc) 2022; 96:300-308. [PMID: 35523686 DOI: 10.1016/j.anpede.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
Collapse
Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Laura N Haiek
- Ministère de la santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Denmark
| | | |
Collapse
|
6
|
Collados-Gómez L, Esteban-Gonzalo L, López-López C, Jiménez-Fernández L, Piris-Borregas S, García-García E, Fernández-Gonzalo JC, Martínez-Miguel E. Lateral Kangaroo Care in Hemodynamic Stability of Extremely Preterm Infants: Protocol Study for a Non-Inferiority Randomized Controlled Trial CANGULAT. Int J Environ Res Public Health 2021; 19:293. [PMID: 35010554 PMCID: PMC8750690 DOI: 10.3390/ijerph19010293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION This study aims to assess the efficacy of the modified kangaroo care lateral position on the thermal stability of preterm neonates versus conventional kangaroo care prone position. MATERIAL AND METHODS A non-inferiority randomized parallel clinical trial. Kangaroo care will be performed in a lateral position for the experimental group and in a prone position for the control group preterm. The study will take place at the neonatal intensive care unit (NICU) of a University Hospital. The participants will be extremely premature infants (under 28 weeks of gestational age) along the first five days of life, hemodynamically stable, with mother or father willing to do kangaroo care and give their written consent to participate in the study. The sample size calculated was 35 participants in each group. When the premature infant is hemodynamically stable and one of the parents stays in the NICU, the patient will be randomized into two groups: an experimental group or a control group. The primary outcome is premature infant axillary temperature. Neonatal pain level and intraventricular hemorrhage are secondary outcomes. DISCUSSION There is no scientific evidence on modified kangaroo care lateral position. Furthermore, there is little evidence of increased intraventricular hemorrhage association with the lateral head position necessary in conventional or prone kangaroo care in extremely premature newborns. Kangaroo care is a priority intervention in neonatal units increasing the time of use more and more, making postural changes necessary to optimize comfort and minimize risks with kangaroo care lateral position as an alternative to conventional prone position kangaroo care. Meanwhile, it is essential to ensure that the conventional kangaroo care prone position, which requires the head to lay sideways, is a safe position in terms of preventing intraventricular hemorrhage in the first five days of life of children under 28 weeks of gestational age. Trial registration at clinicaltrials.gov: NCT03990116.
Collapse
Affiliation(s)
- Laura Collados-Gómez
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
| | - Laura Esteban-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Candelas López-López
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Care Research Group (Invecuid), Instituto de Investigación Sanitaria 12 de Octubre (imas12), 28041 Madrid, Spain
- Faculty of Nursing, Physiotherapy and Podiatry, Nursing Department, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Lucía Jiménez-Fernández
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
| | - Salvador Piris-Borregas
- Department of Neonatal Intensive Care, Hospital Universitario 12 de Octubre, (H12O), 28041 Madrid, Spain; (C.L.-L.); (L.J.-F.); (S.P.-B.)
- Researcher at the Maternity and Childhood Health Research Group (Area 4), 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Esther García-García
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Juan Carlos Fernández-Gonzalo
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| | - Esther Martínez-Miguel
- Faculty of Biomedicine, Nursing and Nutrition Department, Universidad Europea de Madrid, 28670 Madrid, Spain; (L.C.-G.); (E.G.-G.); (J.C.F.-G.); (E.M.-M.)
| |
Collapse
|
7
|
Mohammadi M, Sattarzadeh N, Heidarzadeh M, Hosseini MB, Hakimi S. Implementation Barriers for Practicing Continuous Kangaroo Mother Care from the Perspective of Neonatologists and Nurses. J Caring Sci 2021; 10:137-144. [PMID: 34849357 PMCID: PMC8609115 DOI: 10.34172/jcs.2021.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction: Kangaroo mother care (KMC), as a complement to incubator care, is one of the ten recommendations of the World Health Organization (WHO) for the care of preterm infants. The KMC stabilizes the heart rate, improves oxygen saturation, makes weight gain better, and reduces crying in the infant. In order to launch KMC unit, the barriers for implementing this type of care should be recognized.
Methods: This qualitative research was conducted using a focus group discussion and individual semi-structured interview with nurses, doctors, executive and management staff of a neonatal unit of a third level teaching hospital in Tabriz, northwest Iran. The participants were selected using purposeful sampling. Content analysis was used for analyzing data. Data were analyzed by MAXQDA 10 software.
Results: After analyzing data, four main themes were extracted including mother-related barriers, father-related barriers, physician- related barriers, and system-related barriers.
Conclusion: Based on the findings of the research, it seems that in order to facilitate practicing continuous KMC, much emphasis should be placed on training the parents and health care providers. Furthermore, in some cases, reforming the payment system for physicians, providing an instruction for performing continuous KMC, and continuous assessment of hospitals annually are necessary.
Collapse
Affiliation(s)
- Marzieh Mohammadi
- Student's Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Niloufar Sattarzadeh
- Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Heidarzadeh
- Pediatric Health Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammad Bagher Hosseini
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| | - Sevil Hakimi
- School of Nursing and Midwifery, Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science, Tabriz, Iran
| |
Collapse
|
8
|
Mehjabeen S, Matin M, Gupta RD, Sutradhar I, Mazumder Y, Kim M, Sharmin S, Islam J, Sarker M. Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study. Implement Sci Commun 2021; 2:115. [PMID: 34625121 PMCID: PMC8501568 DOI: 10.1186/s43058-021-00215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and prolonged skin-to-skin contact between an infant and caregiver, exclusive breastfeeding, early discharge from the hospital, and post-discharge follow-up. The purpose of this study was to investigate the fidelity of this intervention’s implementation according to national guidelines across all tiers of government (public) health facilities of Bangladesh. Methods We adopted a triangulation mixed-methods approach of both quantitative and qualitative components in this research to support and explain the information obtained from quantitative observation with the help of qualitative interviews on the fidelity of KMC practice. We used an observation checklist to find the fidelity of KMC practice and used semi-structured guidelines to explain and understand the moderators of fidelity through key informant interviews and in-depth interviews. We undertook eight facility visits in four districts, observed twenty-three neonates and their caregivers during KMC practice at those facilities, and conducted twenty-seven key informant interviews with facility managers, health care providers, and five in-depth interviews with caregivers. Extracted information was triangulated and arranged under the themes of the fidelity framework. Results Despite being a low-cost intervention, findings exhibit some adherence to the national guideline with several gaps in practice. Leadership played a critical role in ensuring the KMC practice. Specific components of KMC practice, like duration, nutrition maintenance, discharge criteria, and follow-up, were not consistent as recommended. Infrastructure, human resources, developmental partner support, and the demand-side and supply-side responsiveness played a critical role in enacting this human-centric approach’s fidelity. The observed interruption found in the implementation process posed threats to achieve the intended outcome as these caused violations of the basic principles of KMC. Conclusions The study findings will help find ways to effectively deliver this intervention so that fidelity of practice is maintained, enhancing KMC services’ quality and advocating towards the successful scale-up of this program. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00215-9.
Collapse
Affiliation(s)
- Saima Mehjabeen
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Mowtushi Matin
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Rajat Das Gupta
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,University of South Carolina, Columbia, USA
| | - Ipsita Sutradhar
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Yameen Mazumder
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Minjoon Kim
- Health Section, United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - Shamina Sharmin
- Health Section, United Nations Children's Fund (UNICEF), Dhaka, Bangladesh
| | - Jahurul Islam
- MNCAH, Directorate General of Health Services (DGHS), Dhaka, Bangladesh
| | - Malabika Sarker
- Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh. .,Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
10
|
Zhang B, Yue J, Duan Z, Zhao Y, Williams S, Huang L, Zhang X, Wu W, Zhang L, Liu J, Zhao G. Maternal experience of intermittent kangaroo mother care for late preterm infants: a mixed-methods study in four postnatal wards in China. BMJ Open 2021; 11:e050221. [PMID: 34493519 PMCID: PMC8424842 DOI: 10.1136/bmjopen-2021-050221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe how mothers of late preterm infants experienced the provision of intermittent kangaroo mother care (KMC) in four postnatal wards in different hospitals in China, under a pilot KMC project. DESIGN A concurrent mixed-methods approach incorporating quantitative maternal questionnaires and qualitative semistructured interviews. SETTING Four postnatal wards in level-III hospitals based in different provinces of Southeast and Northwest China. PARTICIPANTS All 752 mothers who provided intermittent KMC to their late preterm newborns in the four participating postnatal wards consented to participate in the study (quantitative component), as well as six nurses, two obstetricians and two mothers from two of the participating postnatal wards (qualitative component). OUTCOME MEASURES Maternal KMC experiences during a hospital stay, patients' perceptions of KMC initiation, processes, benefits and challenges. RESULTS Most mothers had not heard of KMC before being introduced to it in the postnatal ward. On average, mothers and newborns stayed in postnatal wards for 3.6 days; during their stay, mothers provided an average of 3.5 KMC sessions, which is an average of 1.1 sessions a day. Each KMC session lasted an average of 68 min, though there was much variation in the length of a session. Common reasons given for discontinuing a KMC session included restroom use, infant crying and perceived time limitations. Some mothers would have preferred to provide KMC for longer periods of time and nurses encouraged this. Most mothers experienced no difficulty providing KMC, received support from family and medical staff and intended to continue with KMC postdischarge. CONCLUSION In order to improve the maternal experience of KMC, it is recommended that raising awareness of KMC should be included in antenatal care and after birth. Longer periods of KMC provision should be encouraged, greater privacy should be provided for mothers providing KMC in postnatal wards and family members should be encouraged to support KMC.
Collapse
Affiliation(s)
- Bo Zhang
- Peking University First Hospital, Beijing, China
| | - Jieya Yue
- Peking University First Hospital, Beijing, China
| | - Zhiying Duan
- Peking University First Hospital, Beijing, China
| | - Yingxi Zhao
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Limin Huang
- Hunan Provincial Maternal and Child Health Hospital, Hunan, China
| | - Xiaoqin Zhang
- Northwest Women & Children Hospital Department of Obstetrics, Shaanxi, China
| | - Wenli Wu
- Linyi Maternity and Child Health Hospital, Shandong, China
| | | | - Jun Liu
- Peking University First Hospital, Beijing, China
| | - Gengli Zhao
- Peking University First Hospital, Beijing, China
| |
Collapse
|
11
|
Fahey N, Sadhwani N, Shethwala S, Allison J, Soni A, Nimbalkar S. Knowledge of Breastfeeding and Kangaroo Mother Care Practices Among General Practitioners in Rural Western India. Food Nutr Bull 2021; 42:460-463. [PMID: 34165020 PMCID: PMC10792493 DOI: 10.1177/03795721211026520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breastfeeding and Kangaroo Mother Care (KMC) are interventions to reduce neonatal mortality and undernutrition. We investigated the knowledge of allopathic and Ayurvedic, Yoga-naturopathy, Siddha, and Homeopathic (AYUSH) general practitioners in rural western India and identified attributes associated with awareness and knowledge on these topics. METHODS This cross-sectional study of general practitioners in the Anand district of Gujarat, India, used an anonymous self-reported survey. Multivariable regression models were used to identify practitioner attributes associated with awareness and knowledge. RESULTS Among the 158 respondents, a quarter (26.0%) were trained in allopathic medicine and 63.0% had practiced for 5 years or more. The average score of breastfeeding knowledge was 8.0 of 13. Most (79.1%) did not have any awareness of KMC. After adjusting for potential confounders, knowledge of breastfeeding practices among AYUSH practitioners was 4-fold greater than that of allopathic practitioners (incidence rate ratio: 3.9; 95% CI: 3.2-4.6). By contrast, AYUSH practitioners had 80% decreased odds of awareness about KMC compared with allopathic practitioners (odds ratio: 0.2; 95% CI: 0.1-0.3). DISCUSSION This study demonstrates distinct knowledge gaps among allopathic and AYUSH general practitioners regarding breastfeeding and KMC. There is a need for tailored continuing medical education among general practitioners to enhance their clinical knowledge of newborn care practices to achieve improvements in neonatal health.
Collapse
Affiliation(s)
- Nisha Fahey
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nitesh Sadhwani
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Smit Shethwala
- Department of Pediatrics, Pramukhswami Medical College, Karamsad, Gujarat, India
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Apurv Soni
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | | |
Collapse
|
12
|
Montealegre-Pomar ADP, Charpak N. Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants. Pediatr Pulmonol 2021; 56:1601-1608. [PMID: 33524247 DOI: 10.1002/ppul.25288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. OBJECTIVES (1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth. METHODS A prospective cohort study. Descriptive and multivariate analysis. RESULTS Recruited patients were 407 with 33 weeks median gestational age (GA). Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R2 = .49). CONCLUSIONS In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.
Collapse
Affiliation(s)
- Adriana Del Pilar Montealegre-Pomar
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Nathalie Charpak
- Kangaroo Foundation, Bogotá, Colombia.,Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
13
|
Cabrera-Lafuente M, Alonso-Díaz C, Moral Pumarega MT, Díaz-Almirón M, Haiek LN, Maastrup R, Pallás-Alonso C. [Breastfeeding practices in neonatal wards in Spain. Neo-BFHI international survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00178-8. [PMID: 34045162 DOI: 10.1016/j.anpedi.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). OBJECTIVE Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. MATERIAL AND METHODS Cross-sectional study through a survey on compliance with the Neo-BFHI ("Three basic principles", "Ten steps adapted to neonatal wards" and "the compliance with the International Code of Marketing of Breast-milk Substitutes" and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. RESULTS The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. CONCLUSIONS Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.
Collapse
Affiliation(s)
| | - Clara Alonso-Díaz
- Servicio de Neonatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Mariana Díaz-Almirón
- Sección de Bioestadística, IdiPAZ, Hospital Universitario La Paz, Madrid, España
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canadá; McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, University Hospital Rigshospitalet, Department of Neonatology, Blegdamsvej, Dinamarca
| | | |
Collapse
|
14
|
Salim N, Shabani J, Peven K, Rahman QSU, Kc A, Shamba D, Ruysen H, Rahman AE, Kc N, Mkopi N, Zaman SB, Shirima K, Ameen S, Kong S, Basnet O, Manji K, Kabuteni TJ, Brotherton H, Moxon SG, Amouzou A, Hailegebriel TD, Day LT, Lawn JE. Kangaroo mother care: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:231. [PMID: 33765950 PMCID: PMC7995571 DOI: 10.1186/s12884-020-03423-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) reduces mortality among stable neonates ≤2000 g. Lack of data tracking coverage and quality of KMC in both surveys and routine information systems impedes scale-up. This paper evaluates KMC measurement as part of the Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study. METHODS The EN-BIRTH observational mixed-methods study was conducted in five hospitals in Bangladesh, Nepal and Tanzania from 2017 to 2018. Clinical observers collected time-stamped data as gold standard for mother-baby pairs in KMC wards/corners. To assess accuracy, we compared routine register-recorded and women's exit survey-reported coverage to observed data, using different recommended denominator options (≤2000 g and ≤ 2499 g). We analysed gaps in quality of provision and experience of KMC. In the Tanzanian hospitals, we assessed daily skin-to-skin duration/dose and feeding frequency. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine register design, filling and use. RESULTS Among 840 mother-baby pairs, compared to observed 100% coverage, both exit-survey reported (99.9%) and register-recorded coverage (92.9%) were highly valid measures with high sensitivity. KMC specific registers outperformed general registers. Enablers to register recording included perceptions of data usefulness, while barriers included duplication of data elements and overburdened health workers. Gaps in KMC quality were identified for position components including wearing a hat. In Temeke Tanzania, 10.6% of babies received daily KMC skin-to-skin duration/dose of ≥20 h and a further 75.3% received 12-19 h. Regular feeding ≥8 times/day was observed for 36.5% babies in Temeke Tanzania and 14.6% in Muhimbili Tanzania. Cup-feeding was the predominant assisted feeding method. Family support during admission was variable, grandmothers co-provided KMC more often in Bangladesh. No facility arrangements for other family members were reported by 45% of women at exit survey. CONCLUSIONS Routine hospital KMC register data have potential to track coverage from hospital KMC wards/corners. Women accurately reported KMC at exit survey and evaluation for population-based surveys could be considered. Measurement of content, quality and experience of KMC need consensus on definitions. Prioritising further KMC measurement research is important so that high quality data can be used to accelerate scale-up of high impact care for the most vulnerable.
Collapse
Affiliation(s)
- Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania.
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Kimberly Peven
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Harriet Ruysen
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Naresh Kc
- Ministry of Health, Department of Health Services, Kathmandu, Nepal
| | - Namala Mkopi
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar es Salaam, Tanzania
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Stefanie Kong
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | | | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Theopista John Kabuteni
- Department of Maternal, Newborn, Child, Adolescent Health and Aging, World Health Organization (WHO), Dar Es Salaam, Tanzania
| | - Helen Brotherton
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah G Moxon
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Louise T Day
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive & Child Health (MARCH), London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
15
|
Kinshella MLW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Njirammadzi J, Hiwa T, Vidler M, Molyneux EM, Dube Q, Mfutso-Bengo J, Goldfarb DM, Kawaza K, Nyondo-Mipando AL. "So sometimes, it looks like it's a neglected ward": Health worker perspectives on implementing kangaroo mother care in southern Malawi. PLoS One 2020; 15:e0243770. [PMID: 33332395 PMCID: PMC7746165 DOI: 10.1371/journal.pone.0243770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/27/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers. Methods This study is part of the “Integrating a neonatal healthcare package for Malawi” project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia). Findings A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early. Conclusion Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.
Collapse
Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Sangwani Salimu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Brandina Chiwaya
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Chikoti
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lusungu Chirambo
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ephrida Mwaungulu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwai Banda
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Laura Newberry
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Jenala Njirammadzi
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Elizabeth M. Molyneux
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M. Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children’s and Women’s Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| |
Collapse
|
16
|
Charpak N, Angel MI, Banker D, Bergh A, María Bertolotto A, De Leon‐Mendoza S, Godoy N, Lincetto O, Lozano JM, Ludington‐Hoe S, Mazia G, Mokhachane M, Montealegre A, Ramirez E, Sirivansanti N, Solano JM, Day LT, Uy ME. Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale. Acta Paediatr 2020; 109:2278-2286. [PMID: 32027398 PMCID: PMC7687100 DOI: 10.1111/apa.15214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.
Collapse
Affiliation(s)
| | | | - Deepa Banker
- SMT NHL Municipal Medical College Ahmedabad India
| | - Anne‐Marie Bergh
- SAMRC Unit for Maternal and Infant Health Care Strategies University of Pretoria Pretoria South Africa
| | | | | | | | - Ornella Lincetto
- Maternal Newborn Child and Adolescent Health Department World Health Organization Geneva Switzerland
| | - Juan M. Lozano
- Department of Medical and Population Health Sciences Research Herbert Wertheim College of Medicine Florida International University Miami FL USA
| | - Susan Ludington‐Hoe
- FP Bolton School of Nursing Case Western Reserve University Cleveland OH USA
| | - Goldy Mazia
- Global Health Department Save the Children Washington D.C. USA
| | - Mantoa Mokhachane
- Unit of Undergraduate Medical Education (UUME) Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Adriana Montealegre
- Fundación Canguro Bogotá Colombia
- Department of Pediatrics Pontificia Universidad Javeriana Bogotá Colombia
| | - Erika Ramirez
- Department of Sexuality Sexual Rights and Reproductive Rights Ministry of Health Bogotá Colombia
| | - Nicole Sirivansanti
- Department of Maternal, Newborn and Child Health Bill and Melinda Gates Foundation Seattle WA USA
| | | | - Louise-Tina Day
- MARCH Centre for Maternal, Adolescent Reproductive & Child Health London School of Hygiene & Tropical Medicine London UK
| | - Maria Esterlita Uy
- Institute of Child Health and Human Development National Institutes of Health University of the Philippines Manila Manila Philippines
| |
Collapse
|