Observational Study

. 2021 Sep;6(9):e005905.

doi: 10.1136/bmjgh-2021-005905.

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

Prem K Mony¹, Henok Tadele^{2

3}, Abebe Gebremariam Gobezayehu⁴, Grace J Chan^{5

6}, Aarti Kumar⁷, Sarmila Mazumder⁸, Selemawit Asfaw Beyene⁹, Krishnamurthy Jayanna^{10

11}, Dejene Hailu Kassa¹², Hajira Amin Mohammed⁴, Abiy Seifu Estifanos¹³, Pankaj Kumar¹⁴, Arun Singh Jadaun⁸, Tedros Hailu Abay¹⁵, Maryann Washington¹⁶, Fitsum W/Gebriel³, Lamesgin Alamineh¹⁷, Addisalem Fikre¹⁸, Alok Kumar¹⁹, Sonia Trikha²⁰, Fisseha Ashebir Gebregizabher²¹, Arin Kar²², Selamawit Mengesha Bilal²³, Mulusew Lijalem Belew¹⁷, Mesfin Kote Debere¹³, Raghav Krishna⁷, Suresh Kumar Dalpath²⁰, Samson Yohannes Amare²⁴, H L Mohan²², Thomas Brune²⁵, Lynn M Sibley²⁶, Abraham Tariku²⁷, Arti Sahu⁷, Tarun Kumar⁸, Marta Yemane Hadush¹⁵, Prabhu Deva Gowda²⁸, Khalid Aziz²⁹, Dereje Duguma³⁰, Pramod Kumar Singh⁷, Gary L Darmstadt³¹, Ramesh Agarwal³², Dawit Seyoum Gebremariam¹⁵, Jose Martines³³, Anayda Portela³³, Harsh Vardhan Jaiswal⁸, Rajiv Bahl³⁴, Suman Rao Pn³⁵, Birkneh Tilahun Tadesse³, John N Cranmer²⁶, Damen Hailemariam³⁶, Vishwajeet Kumar⁷, Nita Bhandari⁸, Araya Abrha Medhanyie^{9

37}; KMC Scale-Up Study Group

Affiliations

¹ Division of Epidemiology & Population Health, St John's Medical College and Research Institute, Bangalore, India.
² College of Health Sciences, Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.
³ Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
⁴ Emory Ethiopia-Country Office, Addis Ababa, Ethiopia.
⁵ Boston Children's Hospital, Boston, Massachusetts, USA.
⁶ Department of Pediatrics, Department of Epidemiology, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Community Empowerment Lab, Lucknow, Uttar Pradesh, India.
⁸ Center for Health Research and Development, Society for Applied Studies, New Delhi, India.
⁹ School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
¹⁰ Karnataka Health Promotion Trust, Bangalore, India.
¹¹ Ramaiah University of Applied Sciences, Bangalore, India.
¹² College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia.
¹³ School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁴ National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India.
¹⁵ Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
¹⁶ St John's Research Institute, St John's Medical College, Bangalore, India.
¹⁷ Emory Ethiopia-Amhara Regional Office, Bahir Dar, Ethiopia.
¹⁸ St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
¹⁹ Governent of Uttar Pradesh, Lucknow, Uttar Pradesh, India.
²⁰ State Health Systems Resource Center, Panchkula, Haryana, India.
²¹ Tigray Regional Health Bureau, Mekelle, Ethiopia.
²² Karnataka Health Promotion Trust, Rajajinagar, India.
²³ School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
²⁴ Department of Software Engineering, School of Computing, College of Science and Technology, Mekelle University, Mekelle, Ethiopia.
²⁵ Sachs' Children and Youth Hospital, Stockholm, Sweden.
²⁶ Emory University, Atlanta, Georgia, USA.
²⁷ Maternal & Child Health Department, Federal Ministry of Health, Addis Ababa, Ethiopia.
²⁸ Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore, India.
²⁹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
³⁰ Federal Ministry of Health, Addis Ababa, Ethiopia.
³¹ Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
³² Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
³³ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
³⁴ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland bahlr@who.int.
³⁵ Department of Neonatology, St John's Medical College Hospital, Bangalore, India.
³⁶ Addis Ababa University, Addis Ababa, Ethiopia.
³⁷ School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.

PMID: 34518203
PMCID: PMC8438727
DOI: 10.1136/bmjgh-2021-005905

Observational Study

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

Prem K Mony et al. BMJ Glob Health. 2021 Sep.

. 2021 Sep;6(9):e005905.

doi: 10.1136/bmjgh-2021-005905.

Authors

Affiliations

¹ Division of Epidemiology & Population Health, St John's Medical College and Research Institute, Bangalore, India.
² College of Health Sciences, Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia.
³ Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
⁴ Emory Ethiopia-Country Office, Addis Ababa, Ethiopia.
⁵ Boston Children's Hospital, Boston, Massachusetts, USA.
⁶ Department of Pediatrics, Department of Epidemiology, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Community Empowerment Lab, Lucknow, Uttar Pradesh, India.
⁸ Center for Health Research and Development, Society for Applied Studies, New Delhi, India.
⁹ School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
¹⁰ Karnataka Health Promotion Trust, Bangalore, India.
¹¹ Ramaiah University of Applied Sciences, Bangalore, India.
¹² College of Medicine and Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia.
¹³ School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁴ National Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India.
¹⁵ Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
¹⁶ St John's Research Institute, St John's Medical College, Bangalore, India.
¹⁷ Emory Ethiopia-Amhara Regional Office, Bahir Dar, Ethiopia.
¹⁸ St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
¹⁹ Governent of Uttar Pradesh, Lucknow, Uttar Pradesh, India.
²⁰ State Health Systems Resource Center, Panchkula, Haryana, India.
²¹ Tigray Regional Health Bureau, Mekelle, Ethiopia.
²² Karnataka Health Promotion Trust, Rajajinagar, India.
²³ School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
²⁴ Department of Software Engineering, School of Computing, College of Science and Technology, Mekelle University, Mekelle, Ethiopia.
²⁵ Sachs' Children and Youth Hospital, Stockholm, Sweden.
²⁶ Emory University, Atlanta, Georgia, USA.
²⁷ Maternal & Child Health Department, Federal Ministry of Health, Addis Ababa, Ethiopia.
²⁸ Directorate of Health & Family Welfare Services, Government of Karnataka, Bangalore, India.
²⁹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
³⁰ Federal Ministry of Health, Addis Ababa, Ethiopia.
³¹ Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
³² Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
³³ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
³⁴ Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland bahlr@who.int.
³⁵ Department of Neonatology, St John's Medical College Hospital, Bangalore, India.
³⁶ Addis Ababa University, Addis Ababa, Ethiopia.
³⁷ School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.

PMID: 34518203
PMCID: PMC8438727
DOI: 10.1136/bmjgh-2021-005905

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.

Keywords: health systems; other study design; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Overview of the study design and implementation. KMC, Kangaroo Mother Care; LBW, low birth weight.

See this image and copyright information in PMC

References

1. United Nations . Special edition: progress towards the sustainable development goals. Report of the Secretary-General, 2020. Available: https://undocs.org/E/2019/68
1. Lawn JE, Davidge R, Paul VK, et al. . Born too soon: care for the preterm baby. Reprod Health 2013;10 Suppl 1:S5. 10.1186/1742-4755-10-S1-S5 - DOI - PMC - PubMed
1. Bhutta ZA, Das JK, Bahl R, et al. . Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? The Lancet 2014;384:347–70. 10.1016/S0140-6736(14)60792-3 - DOI - PubMed
1. Yoshida S, Martines J, Lawn JE, et al. . Setting research priorities to improve global newborn health and prevent stillbirths by 2025. J Glob Health 2016;6:010508. 10.7189/jogh.06.010508 - DOI - PMC - PubMed
1. Blencowe H, Krasevec J, de Onis M, et al. . National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 2019;7:e849–60. 10.1016/S2214-109X(18)30565-5 - DOI - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Associated data

Actions
- Search in PubMed
- Search in ClinicalTrials.gov
Actions
- Search in PubMed
- Search in ClinicalTrials.gov
Actions
- Search in PubMed
- Search in ClinicalTrials.gov

Grants and funding

001/WHO_/World Health Organization/International

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical