Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study

• Authors: Prem K Mony, St John's Medical College and Research Institute; Henok Tadele, Addis Ababa University; Abebe Gobezayehu, Emory University; Grace J Chan, Boston Childrens Hospital; Aarti Kumar, Community Empowerment Lab, Lucknow; Sarmila Mazumder, Center for Health Research and Development, Society for Applied Studies, New Delhi; Selemawit Asfaw Beyene, Mekelle University; Krishnamurthy Jayanna, Karnataka Health Promotion Trust, Bangalore; Dejene H Kassa, Hawassa University; Hajira A Mohammed, Emory Ethiopia-Country Office; Abiy S Estifanos, Addis Ababa University; Pankaj Kumar, National Health Mission, Government of Uttar Pradesh, Lucknow; Arun Singh Jadaun, Center for Health Research and Development; Tedros H Abay, Mekelle University; Maryann Washington, St John’s Medical College, Bangalore; Fitsum W Gebriel, Hawassa University; Lamesgin Alamineh, Emory Ethiopia-Amhara Regional Office; Addisalem Fikre, St. Paul’s Hospital Millennium Medical College; Alok Kumar, Governent of Uttar Pradesh, Lucknow, Uttar Pradesh; Sonia Trikha, State Health Systems Resource Center, India; Fisseha A Gebregizabher, Tigray Regional Health Bureau, Mekelle; Arin Kar, Karnataka Health Promotion Trust, Rajajinagar, India; Selamawit Mengesha Bilal, Hawassa University; Mulusew L Belew, Emory Ethiopia-Amhara Regional Office; Mesfin K Debere, Addis Ababa University; Raghav Krishna, Community Empowerment Lab, Lucknow, India; Suresh Kumar Dalpath, State Health Systems Resource Center; Samson Y Amare, Mekelle University; HL Mohan, Karnataka Health Promotion Trust; Thomas Brune, Sachs’ Children and Youth Hospital; Lynn Sibley, Emory University; Abraham Tariku, Federal Ministry of Health, Addis Ababa; Arti Sahu, Community Empowerment Lab, Lucknow; Tarun Kumar, Society for Applied Studies, New Delhi, India; Marta Yemane Hadush, Mekelle University; Prabhu D Gowda, Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore; Khalid Aziz, University of Alberta, Edmonton; Dereje Duguma, Federal Ministry of Health, Addis Ababa; Pramod Kumar Singh, Community Empowerment Lab, Lucknow; Gary L Darmstadt, Stanford University; Ramesh Agarwal, All India Institute of Medical Sciences; Dawit Seyoum Gebremariam, Mekelle University; Jose Martines, World Health Organization, Geneva; Anayda Portela, World Health Organization, Geneva; Harsh Vardhan Jaiswal, Center for Health Research and Development, Society for Applied Studies, New Delhi; Rajiv Bahl, World Health Organization, Geneva; Suman PN Rao, St John's Medical College Hospital, Bangalore; Birkneh Tilahun Tadesse, Hawassa University; John Crammer, Emory University; Damen Hailemariam, Addis Ababa University; Vishwajeeet Kumar, Community Empowerment Lab, Lucknow; Nita Bhandari, Center for Health Research and Development, Society for Applied Studies, New Delhi; Araya A Medhanyie, Mekelle University
• Journal Title: BMJ GLOBAL HEALTH
• Volume: Volume 6, Number 9
• Publisher: BMJ PUBLISHING GROUP | 2021-09-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjgh-2021-005905
• Subjects: Health Sciences, Epidemiology; Health Sciences, Human Development
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; paediatrics; health systems; other study design; BIRTH-WEIGHT INFANTS

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.