Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi

Gondwe, Austrida; Munthali, Alister; Ashorn, Per

doi:10.1007/s10995-016-1942-z

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Study participants highlighted that having a dedicated KMC ward facilitated the practice, which is aligned with other studies in sub-Saharan Africa that described insufficient space as a critical challenge [19,26,28,29,35,36]. However, beyond a sufficient space, there is a need for family-centered care to support mothers and their companions during their extended stay at the hospital.…”

Section: Investment In Basic Needssupporting

confidence: 69%

“…Participants in this study highlighted the multiple roles that nurse midwives played from counselling caregivers on initiation to being the main medical provider monitoring infants during KMC as well as supporting labour, delivery and nursery wards during emergencies. The challenge of adequate staffing and workload especially during night, weekend and holiday shifts has been reported in studies in sub-Saharan Africa as a key barrier to KMC practice [17,18,21,[24][25][26][27][28][29][30][31]. Investments in staffing can help to move beyond basic practice of initiating and educating caregivers on danger signs to continued support.…”

Section: Investment In Staffingmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Investment In Basic Needssupporting

confidence: 69%

Section: Investment In Staffingmentioning

confidence: 99%

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

et al. 2020

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“…However, the findings of this study revealed that there was lack of adequate radiant warmers, incubators and KMC rooms were overcrowded. Insufficient KMC rooms is common in most low income countries [26]. Preterm babies were found to be suffering from RDS which is a condition related to prematurity and accounts for 15% morbidity in infants born at 34 weeks and 3.2% in those born at 36 weeks [22].…”

Section: Discussion Of Findingsmentioning

confidence: 99%

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa

Mahwasane

Maputle

Simane-Netshisaulu

et al. 2020

Annals of Global Health

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Background: Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life. Purpose: The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa. Methods: Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method. Findings: Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision. Conclusion: Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

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“…Previous studies in developing countries such as Uganda [ 38 ], Ethiopia [ 39 ] and Ghana [ 40 ] have shown that government or hospital investments aimed at improving the privacy and comfort of the delivery environment have improved KMC implementation. With regards to labour resources, uneven and inadequate regional allocation of medical staff may negatively affect KMC implementation [ 41 , 42 ]. As for equipment, ensuring the supply of standardised, safe and comfortable equipment and consumables can enhance parental compliance with KMC implementation [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation

Wen

Wang

Zhang

et al. 2023

BMC Pregnancy Childbirth

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Background Implementation of Kangaroo Mother Care (KMC) in resource-limited areas of China may face unique barriers, such as a lack of resources, geographic location and more traditional culture among others. This qualitative study analyses the facilitators and barriers to implementing KMC in county-level health facilities in resource-limited areas of China for the promotion of KMC on a larger scale. Methods Participants from 4 of the 18 pilot counties where early essential newborn care was implemented through the Safe Neonatal Project and 4 control counties not enrolled in Safe Neonatal Project were selected using purposive sampling. A total of 155 participants were interviewed, including stakeholders of the Safe Neonatal Project such as national maternal health experts, relevant government officials and medical staff. Thematic analysis was used to process and analyse the interview content in order to summarise the facilitators and barriers to implementing KMC. Results KMC was accepted in the pilot areas but still faced certain challenges due to institutional regulation, resource provision and the perceptions of health staff, postpartum mothers and their families as well as COVID-19 prevention and control regulations. The facilitators identified were government officials and medical staff acceptance and the incorporation of KMC into routine clinical care. The barriers identified were a lack of dedicated funding and other resources, the present scope of health insurance and KMC cost-sharing mechanism, providers’ knowledge and practical abilities, parental awareness, postpartum discomfort, fathers’ inadequate involvement, and the impact from COVID-19. Conclusion The Safe Neonatal Project pilot experience indicated the feasibility of implementing KMC in more areas of China. Optimising institutional regulations, providing necessary supporting resources and enhancing education and training may help to refine the implementation and scale-up of KMC practice in China.

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Investigating Preterm Care at the Facility Level: Stakeholder Qualitative Study in Central and Southern Malawi

Cited by 7 publications

References 19 publications

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

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

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa

A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation

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