Background Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d’Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d’Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. Method This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. Results A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father’s resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers’ perceived value of KMC, mothers−healthcare providers’ relationship, mothers’ adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. Conclusion Our study highlighted the challenges to implement KMC in Cote d’Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.

Background The World Health Organization Safe Childbirth Checklist tool was specifically designed for developing countries such as sub-Saharan African countries, to ensure safety and security of the couple mother and newborn around the time of childbirth. However, the implementation of the Safe Childbirth Checklist tool requires a good knowledge of the context setting to face challenges. Our study objectives were (1) to assess the acceptability of the WHO SCC tool and (2) to identify conditions and strategies for a better introduction and use of the WHO SSC tool. Methods This was a pilot multi-country study conducted from January to March 2019 in Burkina Faso and Côte d’Ivoire, respectively, in the health regions of central-North and Agnéby-Tiassa-Mé. In each health region, 5 health facilities of different levels within the health system pyramid were selected through a purposive sampling. The study was conducted in 2 phases: 38 healthcare providers and 15 managers were first trained to use the Safe Childbirth Checklist tool; secondly, the trained providers were allowed to use the tool in real-life conditions for 2 weeks. Then, semi-structured interviews were conducted among healthcare providers and managers. The topics covered by the interview guides were acceptability of the tool, barriers and facilitators to its use, as well as strategies for better introduction and use within the healthcare system. Analysis was carried out using the Nvivo 12 software. Results Respondents reported an overall good acceptance of using the tool. However, they suggested minor content adaptation. The design of the tool and increased workload were the main barriers to its use. Potential facilitators to its introduction were managers’ commitment, healthcare providers’ motivation, and the availability of supplies. The best strategies for optimal use were its attachment to existing tool such as partograph or/and its display in the maternity ward. Conclusions The findings showed that the implementation of the Safe Childbirth Checklist tool is acceptable in Burkina Faso and Côte d’Ivoire. These findings are important and will help to design a trial aiming at assessing the effectiveness of the tool WHO SCC tool in these two countries.

Background. Kangaroo Mother Care (KMC) is a low-tech, highimpact intervention for preterm and low-birth-weight newborns. In 2019, Côte d’Ivoire opened its first KMC unit. We wanted to determine KMC’s acceptability in Côte d’Ivoire after a year. Methods. This qualitative study used semi-structured interviews in September 2020 at the Teaching Hospital of Treichville’s first KMC unit. Mothers of preterm and low birth weight babies who received KMC were studied. Deductive (TFA-driven) framework analysis was performed. Coded using Nvivo 12. Results. KMC was acceptable overall. Mothers knew KMC’s goal and benefits, including self-confidence and breastfeeding benefits. Most women reported that the method was easy to implement and were confident in implementing KMC at the unit or in the household, even though some of them found KMC not aligned with their cultural values. Some mothers, especially housewives and self-employed, highlighted the benefits of KMC, but they must have given up. Conclusions. Our study highlighted the need to increase KMC awareness, advocacy, education, and training for pregnant women and the community to reduce preterm and low birth weight infant mortality and morbidity.

Introduction : En Côte d’Ivoire, la prévalence contraceptive moderne nationale reste faible. Elle était de 21 % en 2017. But de l’étude : L’objectif de cette étude était d’identifier les obstacles socioculturels liés à l’utilisation de la contraception moderne chez les femmes en âge de se reproduire. Méthodes : Nous avons mené une étude qualitative descriptive dans le quartier Dallas dans la commune d’Adjamé, située au centre de la ville d’Abidjan. L’enquête s’est déroulée du 9 juin au 7 juillet 2018. Quatre focus groups ont été réalisés avec des hommes de plus de 20 ans, des femmes en âge de se reproduire de 15 à 49 ans et deux leaders religieux recrutés selon un échantillonnage raisonné. Les guides de discussion de groupe et d’entretien individuel étaient les outils de collecte de données. Les données ont été analysées après enregistrement et retranscription, suivant une analyse thématique du contenu. Résultats : Trente personnes dont 14 hommes, 14 femmes et deux guides religieux ont été interrogés. Les principaux obstacles décrits étaient : le manque d’information fiable et adéquate, les fausses idées sur la contraception, la crainte des effets secondaires, l’analphabétisme, le pouvoir décisionnel de l’homme, les interdictions religieuses et les contradictions socioculturelles. Pour contourner ces obstacles, les femmes utilisaient secrètement les contraceptifs, s’exposant ainsi à des risques sociaux. Conclusion : Notre étude a mis en exergue la persistance de pratiques socioculturelles. La prise en compte des perceptions des populations s’avère nécessaire pour améliorer l’utilisation de la contraception moderne au niveau communautaire.

These results could help to elaborate effective strategies for the attraction and maintenance of healthcare workers in underserved areas in Ivory Coast.