Facilitating factors and barriers to kangaroo mother care utilisation in low- and middle-income countries: A scoping review

Abstract

Background: Kangaroo mother care (KMC) has been widely adopted in low-and middle-income countries (LMICs) to minimise low birthweight infants’ (LBWIs) adverse outcomes. However, the burden of neonatal and child mortality remains disproportionately high in LMICs.Aim: Thus, this scoping review sought to map evidence on the barriers, challenges and facilitators of KMC utilisation by parents of LBWIs (parent of low birthweight infant [PLBWI]) in LMICs.Methods: We searched for studies conducted in LMICs and published in English between January 1990 and August 2020 from SciELO, Google Scholar, JSTOR, LILACS, Academic search complete, PubMed, CINAHL with full text, and Medline databases. We adopted Arksey and O’Malley’s framework for conducting scoping reviews. Potential studies were exported to Endnote X7 reference management software for abstract and full article screening. Two independent reviewers did a parallel abstract and full article screening using a standardised form. The results were analysed using thematic content analysis.Results: We generated 22 040 studies and after duplicate removal, 42 studies were eligible for full-text screening and 22 studies, most form sub-Saharan Africa, were included in the content analysis. Eight themes emerged from the analysis: access, buy-in, co-ordination and collaboration, medical issues, motivation, social support-gender obligation and empowerment, time and timing and traditional/cultural norms.Conclusion: Identifying factors affecting KMC may optimise KMC utilisation. Additional studies aiming at identifying influencing factors that affect KMC utilisation amongst PLBWIs’ in LMICs need to be conducted to provide evidence-based strategies to enhance practice, inform policy and decision-makers in KMC utilisation amongst the PLBWIs in LMICs and beyond.

What influences the implementation of kangaroo mother care? An umbrella review

“…Table 1 provides an overview of five systematic reviews and one scope review related to KMC implementation as of July 1, 2022, all of which were published in 2015 and later, indicating this topic is relatively fresh. Two of the six articles described barriers and facilitators of KMC implementation from the perspective of caregivers of preterm infants [ 27 , 39 ]; one article explored these influencing factors from the the perspective of healthcare workers [ 28 ]; and the remaining articles discussed the factors affecting KMC implementation from both the perspectives of healthcare workers and parents of preterm infants [ 29 , 38 , 40 ].…”

“…mothers, fathers, and families) perspective Chan et al (2017) [ 28 ] Systematic review January 1, 1960 to August 19, 2015 86 Americas, Africa, Europe, Southeast Asia, Eastern Mediterranean, Western Pacific, and multiple regions Health facility, NICU or stepdown unit, Community or population-based surveillance To further explore the barriers and enablers of KMC implementation specifically from the perspective of health systems, with a focus on HCWs and health facilities Perspective of healthcare workers (HCWs) and/or facilities Seidman et al (2015) [ 38 ] Systematic review Before August 13, 2013 103 Sweden, United States, Sub-Saharan Africa, South Africa, North Africa/the Middle East, Latin America/Caribbean, Eastern Europe, East Asia/ Southeast Asia/Pacific and multiple regions Health facility, community-initiated setting To identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. Mothers, fathers, and health practitioners Kinshella et al (2021) [ 29 ] Systematic review From database inception to December 2019 30 Sub-Saharan Africa (Ghana, Nigeria, Malawi, Mozambique, South Africa, Zambia, Zimbabwe, Ethiopia, Tanzania, Uganda) Health facilities in sub-Saharan Africa To understand the barriers and facilitators of kangaroo mother care implementation in health facilities in sub-Saharan Africa, where there are the highest rates of neonatal mortality in the world Health worker, mothers and their families Mathias et al (2021) [ 39 ] Scoping review January 1990 to August 2020 22 Low-and middle income countries (Bangladesh, Brazil, Ethiopia, Ghana, India, Indonesia, Malawi, Mozambique, Nigeria, Pakistan and South Africa) Health facility, community-based surveillance To map evidence on the barriers, challenges and facilitators of KMC utilisation by parents of LBWIs (parent of low birthweight infant [PLBWI]) in LMICs. Parents of low birthweight infant Chan et al (2016) [ 40 ] Systematic review January 1, 1960 to 19 August, 2015 112 Americas, African, European, South-East Asia, Eastern Mediterranean, Western Pacific and Multiple regions Health facility, NICU or stepdown unit, Community or population-based surve...…”

Strengthening Kangaroo Mother Care at a tertiary level hospital in Zambia: A prospective descriptive study

“…Despite the several barriers identified in facility-based implementation of KMC in literature, such as lack of adequate staff, resources and community structures, our model was introduced into routine standard of care and leveraged student nurses at UTH [ 36 , 37 ]. Our findings suggest that student nurses serving as champions, in settings where experienced staff are unavailable can ensure longevity of KMC at an organisational level.…”

“…KMC is a proven, low-cost, and effective intervention that was developed by Dr. E. Rey in 1978 for preterm (born before 37 weeks of gestation) and/or low birthweight infants (<2500g) [ 9 – 11 ]. It is a method for parents or guardians to provide warmth to their newborns through continuous skin-to-skin contact, in which the newborn is placed (naked) in a reclined position between the mother or guardians’ breasts and covered with a blanket [ 13 , 37 ]. The KMC position encourages early and exclusive breastfeeding, infant weight gain as well as promotes mother-infant bonding [ 12 ].…”

Improving Post-discharge Practice of Kangaroo Mother Care: Perspectives From Communities in East-Central Uganda

“…It is important that the progress in improved infant survival and long-term health and developments that have been made through the implementation of KMC in hospitals are not lost after discharge. Indeed, many researchers have highlighted that community care must be linked to facility care in order to have successful KMC implementation ( 17 – 19 ).…”