scholarly journals Scaling up kangaroo mother care in the Philippines using policy, regulatory and systems reform to drive changes in birth practices

2021 ◽  
Vol 6 (8) ◽  
pp. e006492
Author(s):  
Anthony Patrick Calibo ◽  
Socorro De Leon Mendosa ◽  
Maria Asuncion Silvestre ◽  
John Charles Scott Murray ◽  
Zhao Li ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Environmental Changes ◽  
Scale Up ◽  
Newborn Care ◽  
The Philippines ◽  
Kangaroo Mother Care ◽  
Multidisciplinary Teams ◽  
Local Data ◽  
Skin Contact ◽  
Low Middle Income Countries

The WHO recommends kangaroo mother care (KMC) for stable preterm and low birthweight babies because it has been demonstrated to reduce mortality by up to half compared with conventional incubator-based care. Uptake of KMC in low/middle-income countries has been limited, despite its suitability for low-resource environments. This paper reviews factors that contributed to the adoption and expansion of KMC in the Philippines. Early introduction began in 1999 but national scale-up was slow until 2014 after which a significant improvement in national adoption was observed. The proportion of target hospitals implementing KMC rose from 3% to 43% between 2014 and 2019, with 53% of preterm and low birthweight babies receiving KMC by the end of this period. Expansion was led by the government which committed resources and formed partnerships with development partners and non-governmental organisations. Scale-up of KMC was built on the introduction of evidence-based newborn care practices around birth. Practice changes were promoted and supported by consensus-based policy, protocol, regulatory and health insurance changes led by multidisciplinary teams. A new approach to changing and sustaining clinical practice used hospital teams to conduct on-the-job clinical coaching and use local data to make environmental changes to support practices. Institutionalisation of early skin-to-skin contact, non-separation of mother and newborn and early initiation of exclusive breast feeding, with increased responsibility given to mothers, drove a cultural change among staff and families which allowed greater acceptance and uptake of KMC. Financial and programmatic support must be sustained and expanded to address ongoing challenges including staffing gaps, available space for KMC, willingness of some staff to adopt new practices and lack of resources for clinical coaching and follow-up.

Kangaroo mother care: Understanding community low birth weight baby care perceptions and practices for designing appropriate community based KMC implementation package: a formative research. (Preprint)

2021 ◽  
Author(s):  
Shabina Ariff ◽  
Ikram Maznani ◽  
Maria Bhura ◽  
Zahid Memon ◽  
Tayyaba Arshad ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Rural Areas ◽  
Healthcare Providers ◽  
Newborn Care ◽  
Formative Research ◽  
Kangaroo Mother Care ◽  
Community Members ◽  
Hospital Administrators ◽  
Skin Contact

BACKGROUND Low birth weight (LBW) is a common outcome of preterm birth and increases the risk of an infant’s morbidity and mortality. About 20 million infants are born with low birth weight globally. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of Kangaroo Mother Care (KMC) (skin-to-skin contact) in communities to prevent neonatal mortality and morbidity. OBJECTIVE We conducted a formative research in order to understand the context of communities and facilities with regards to neonatal care and KMC practice, inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC, in rural areas of district Dadu, in the Sindh province. METHODS We conducted focus group discussions, in-depth interviews and key informant interviews with families of LBW babies, community members, healthcare providers and hospital administrators to identify barriers, enablers and a knowledge base for KMC interventions. RESULTS Newborn care practices in communities were subpar. Although KMC practices are not commonly practiced in communities and facilities and the method is unknown to many, family members were willing to provide KMC to LBW babies to improve their health outcomes. Community members, hospital administrators and healthcare providers widely accepted the practice for neonatal health and found it feasible and convenient. CONCLUSIONS The KMC as a method of treating low birth weight babies is widely accepted in the community. This formative research provided strategically effective ways for developing effective implementation strategies by identifying common community practices for LBW babies, and barriers and enablers to KMC practice.

scholarly journals The Hammock as a Therapeutic Alternative at The Neonatal Intensive Care Unit

2020 ◽  
pp. 1-4 ◽  
Author(s):  
Silvana Alves Pereira ◽  
Gentil Gomes da Fonseca Filho ◽  
Norrara Scarlytt de Oliveira Holanda ◽  
Daniela Elizabeth de Castro Vieira ◽  
Cristiane Aparecida Moran
Keyword(s):  
Neonatal Intensive Care ◽  
Low Birthweight ◽  
Vestibular Stimulation ◽  
Kangaroo Mother Care ◽  
University Hospitals ◽  
Normal Birth ◽  
Skin Contact ◽  
Quasi Experimental ◽  
Maternal Presence ◽  
Collection Form

Background: Among the therapeutic alternatives complementary to humanized care, there is the vestibular stimulation. Provided by the gentle swing in a hammock, it simulates the containment and maternal movements found in the intrauterine environment and is considered a safe method that reduces stress levels in very low birthweight premature newborn (PTNB). Objective: To observe the time of hospitalization and the discharge weight of the PTNB that passed through the positioning in the hammock and kangaroo mother care. Methods: A quasi-experimental study involving two university hospitals including PTNB. The PTNB were allocated into two groups: Kangaroo Mother Care (KMC) composed by PTNB selected according to the maternal presence and vestibular stimulation (VS) composed by PTNB whose maternal presence was not possible. The KMC were kept in skin-to-skin contact with the mother. The VS were positioned in dorsal decubitus in a hammock of cotton adapted within the incubator. The time of hospitalization and weight monitoring were recorded daily by the nursing team in a collection form. Results: From the 40 PTNB included in this study, 47.5% were female and 40% had normal birth, 20 of them were allocated in the VS group and 20 in the KMC group. The time of hospitalization were not different between the groups (p=0.12), but the discharge weight were higher in the VS group (p<0.05). Conclusion: The data indicate that the hospitalization time is similar between the PTNB who received KMC and VS, and that the discharge weight is higher for the group that received the VS.

scholarly journals Kangaroo mother care: need of the day

2019 ◽  
Vol 12 (12) ◽  
pp. e228402
Author(s):  
Rubina Sohail ◽  
Noreen Rasul ◽  
Ammara Naeem ◽  
Humayun Iqbal Khan
Keyword(s):  
Developing Countries ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Kangaroo Mother Care ◽  
Preterm Baby ◽  
Mortality And Morbidity ◽  
Safe Delivery ◽  
Live Births ◽  
Skin Contact ◽  
Skin To Skin

Each year approximately 20 million low birthweight babies are born globally. Prematurity is a leading cause of neonatal mortality in developing countries and results in 60%–80% of neonatal deaths. Neonatal mortality is the major contributor to under-5 mortality. According to Pakistan Demographic and Health Survey 2017–2018, neonatal mortality in Pakistan is 42 per 1000 live births and under-5 mortality is 74 per 1000 live births. One out of every 22 newborns dies in Pakistan, which is an alarming figure. Majority of these deaths are preventable. They can be prevented by well-trained midwives, safe delivery, early initiation of breast feeding within an hour after birth and skin-to-skin contact. Pakistan is among the top 10 countries with the highest number of preterm births and with limited resources to manage the burden. Kangaroo mother care (KMC) is a safe and economical alternative to provide preterm care in developing countries. In babies at gestational age less than 37 weeks or with neonatal weight less than 2.5 kg, skin-to-skin contact prevents hypothermia and infection. Neonatal mortality and morbidity can be reduced by providing preterm care through KMC. This case report is of a preterm baby who was delivered at 33 weeks of gestation with a weight of 1.3 kg and was saved by KMC in the paediatric department of Services Hospital in Lahore.

scholarly journals “So sometimes, it looks like it’s a neglected ward”: Health worker perspectives on implementing kangaroo mother care in southern Malawi

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243770
Author(s):  
Mai-Lei Woo Kinshella ◽  
Sangwani Salimu ◽  
Brandina Chiwaya ◽  
Felix Chikoti ◽  
Lusungu Chirambo ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Service Providers ◽  
Health Workers ◽  
Health Management ◽  
Low Cost ◽  
Newborn Health ◽  
Kangaroo Mother Care ◽  
World Health ◽  
District Health ◽  
Skin Contact

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.

scholarly journals First Experience of Implementation of Kangaroo Mother Care in Punjab- Pakistan to Reduce Morbidity and Mortality in Preterm Infants

2018 ◽  
Vol 23 (4) ◽  
pp. 496-502 ◽  
Author(s):  
Noreen Rasul ◽  
Madeeha Rashid ◽  
Aqeela Abbas ◽  
Rubina Sohail
Keyword(s):  
Birth Weight ◽  
Neonatal Mortality ◽  
Breast Feeding ◽  
Newborn Care ◽  
Kangaroo Mother Care ◽  
Morbidity And Mortality ◽  
Essential Newborn Care ◽  
Exclusive Breast Feeding ◽  
Skin Contact

The study was planned to assess the effect of Kangaroo Mother Care on preterm and stable neonates in reducing neonatal morbidity and mortality. This is a case series design of 121preterm and low birth weight neonates, weighing less than 2500 gram, enrolled from 1 August 2016 till31 January 2017.Kangaroo Mother Care is initiated after birth, after performing early essential newborn care practices. Weight gain of 20-30 gram for three consecutive days, establishment of breast-feeding for 20-30 minutes every two hourly and maintenance of body temperature at 37 degree centigrade is the discharge criteria. During the periodof six months, total number of deliveries was 6459, out of them spontaneous vaginal deliveries were 52.2% (3372) and caesarean sections were 47.7% (3087). In 55.4%neonate’s(both preterm and term)early essential newborn care was practiced.Total preterm were 290 (4.5%), out of them 121 (2%) neonates were kept inKangaroo Mother Care position and 129 (44%) were shifted to neonatal intensive care unit. 14% parents refused for KMC position and discharged. Mortality in preterm newborn in neonatal unit was 29.4% (without KMC) but no mortality occurred after 3 months follow up in KMC babies. All the neonates from KMC unitwere discharged in satisfactory condition and called for follow up investigations. All Kangaroo Mother Care babies had exclusive breast-feeding. Taken together, the results indicate that prolonged skin-to-skin contact and exclusive breast feeding reduces neonatal mortality and morbidity in birth weight 1.5 to 2.5 kg in stable neonates in hospital. However KMC is limited to SHL at present. Workshops are being conducted to teach other doctors and nurses for early essential newborn care and kangaroo mother care. They are still facing controversies and challenges in initiation of KMC in many hospitals. However it is essential to strengthen KMC services in healthcare facilities as it significantly reduces neonatal mortality.

scholarly journals Respectful maternal and newborn care: measurement in one EN-BIRTH study hospital in Nepal

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Rejina Gurung ◽  
◽  
Harriet Ruysen ◽  
Avinash K. Sunny ◽  
Louise T. Day ◽  
...  
Keyword(s):  
Newborn Care ◽  
Verbal Abuse ◽  
Standards Of Care ◽  
Skin Contact ◽  
Mode Of Birth ◽  
Survey Interviews ◽  
Maternal And Newborn Care ◽  
Poor Care ◽  
Respectful Care ◽  
Maternal And Newborn

Abstract Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value < 0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (β = − 0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value < 0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR = 0.02, 95% CI, 0.01–0.05) of receiving skin-to-skin contact than those with vaginal births. Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

scholarly journals Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study

2021 ◽  
Vol 10 (3) ◽  
pp. e001089
Author(s):  
Hoang Thi Tran ◽  
John Charles Scott Murray ◽  
Howard Lawrence Sobel ◽  
Priya Mannava ◽  
Le Thi Huynh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Relative Risk ◽  
Caesarean Section ◽  
Environmental Changes ◽  
Newborn Care ◽  
Adverse Outcomes ◽  
National Guidelines ◽  
Post Intervention ◽  
Essential Newborn Care ◽  
Newborn Outcomes

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.

scholarly journals Barriers for kangaroo mother care (KMC) acceptance, and practices in southern Ethiopia: a model for scaling up uptake and adherence using qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Selamawit Mengesha Bilal ◽  
Henok Tadele ◽  
Teshome Abuka Abebo ◽  
Birkneh Tilahun Tadesse ◽  
Mekonnen Muleta ◽  
...  
Keyword(s):  
Research Study ◽  
Service Providers ◽  
Scale Up ◽  
Formative Research ◽  
Kangaroo Mother Care ◽  
Southern Ethiopia ◽  
Theory Approach ◽  
Structural Factors ◽  
Implementation Model ◽  
Health Service Providers

Abstract Background Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. Methods A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. Results Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity’s beliefs and valueswith respect to preterm and LBW babies;health professionals’ acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. Conclusions Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.

The evolution of the science of kangaroo (mother) care (skin‐to‐skin contact)

2019 ◽  
Vol 111 (15) ◽  
pp. 1032-1043 ◽  
Author(s):  
Raouth R. Kostandy ◽  
Susan M. Ludington‐Hoe
Keyword(s):  
Kangaroo Mother Care ◽  
Skin Contact ◽  
Skin To Skin
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