Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research

Abstract

Background Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC. Methods This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software. Results The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home. Conclusion Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Feasibility and acceptability of a novel biomedical device to prevent neonatal hypothermia and augment Kangaroo Mother Care in Kenya: Qualitative analysis of focus group discussions and key Informant Interviews

“…Poor infrastructure and inadequate logistics within healthcare facilities is a particularly challenging barrier to KMC/STS, since hospitals often do not have space, privacy, or a comfortable environment to support continuous KMC. [16,19,36,[59][60][61][62] In some settings, units such as the NICU have limited visitation policies that interfere with adult-baby dyads engaging in KMC/STS. [63] In contexts where lack of a formal KMC ward, or limited space, lack of privacy, or hospital policy limits mother and baby contact, Kenyan interviewees suggested NeoWarm can be a viable way to augment thermal care.…”

Barriers and enablers of quality high-acuity neonatal care in sub-Saharan Africa: protocol for a synthesis of qualitative evidence

“…There are a number of potential barriers that hinder the quality of care and enablers that foster it in the NICU. Barriers related to the provider, the caregiver and the health system include inadequate knowledge and training, rigid division of roles and responsibilities, poor leadership, lack of effective communication, human resource constraints, inadequate equipment and clinical guidelines, poor documentation and infrastructure, and economic insecurity of the parents 12–22. On the other hand, barriers related to the sociocultural environment include the patterns of interaction between the staff and the parents and among the staff, and power structure of the staff and the leaders 23–25.…”

“…Barriers related to the provider, the caregiver and the health system include inadequate knowledge and training, rigid division of roles and responsibilities, poor leadership, lack of effective communication, human resource constraints, inadequate equipment and clinical guidelines, poor documentation and infrastructure, and economic insecurity of the parents. [12][13][14][15][16][17][18][19][20][21][22] On the other hand, barriers related to the…”

The NeoRoo mobile app: Initial design and prototyping of an Android-based digital health tool to support Kangaroo Mother Care in low/middle-income countries (LMICs)

“…Kangaroo Mother Care/Skin-to-skin care (KMC/STS) is an evidence-based method of newborn care involving skin-to-skin contact between an adult caregiver and infant, which has been shown to significantly reduce the incidence of neonatal hypothermia within LMICs [17], and greatly improve rates of survival among premature infants. [18][19][20][21][22][23][24]Challenges and barriers to adopting and implementing KMC/STS have been identified to exist for all the key adult stakeholders within a premature baby's environment, including among parents. [25][26][27] and healthcare providers.…”