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Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi.
J Glob Health. 2018 Jun; 8(1):010703.JG

Abstract

Background

Despite introduction of Kangaroo Mother Care (KMC) in Malawi over a decade ago, preterm birth remains the leading cause of neonatal mortality. Although KMC is initiated in the health care facility, robust community follow-up is critical for survival and optimal development of preterm and low birth weight infants post-discharge. The objective of this qualitative study was to gain insight into community and health worker understanding, attitudes, beliefs and practices around preterm and low birth weight babies and KMC in Malawi.

Methods

A total of 152 participants were interviewed in two districts in southern Malawi, Machinga and Thyolo, in April 2015. Focus group discussions (groups = 11, n = 132) were conducted with pregnant women, community members and women who have practiced KMC. In-depth interviews (n = 20) were conducted with fathers who have practiced KMC, community and religious leaders, and health workers. Purposive and snowball sampling were employed to identify participants. Thematic content analysis was conducted.

Findings

KMC mothers and fathers only learned about KMC and care for preterm newborns after delivery of a child in need of this care. Men typically were not included in KMC counseling due to societal gender roles. Health facilities were the main source of information on KMC, however informal networks among women provided some degree of knowledge exchange. Community leaders were regarded as major facilitators of health information, conveners, key influencers, and policy-makers. Religious leaders were regarded as advocates and emotional support for families with preterm infants. Finally, while many participants initially had negative feelings towards preterm births and KMC, the large majority saw a shift in their perceptions through health counseling, peer modeling, and personal success with KMC.

Conclusions

The findings offer several opportunities to improve KMC implementation including 1) earlier introduction of KMC to pregnant women and their families that are at-risk for preterm birth, 2) greater involvement of men in KMC counselling, practice and care for preterm infants, and 3) strengthening and defining partnerships with community and religious leaders. Finally, as parental perceptions of preterm infants and KMC improved with successful KMC practice, it is hopeful that KMC itself can positively affect social norms surrounding preterm infants, leading to a virtuous cycle of improved perceptions of preterm infants and increased uptake of KMC.

Authors+Show Affiliations

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.Save the Children, Malawi.Save the Children, Malawi.Save the Children, Malawi.Save the Children, Malawi.Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.Save the Children - US, Fairfield, Connecticut, USA.Save the Children - US, Fairfield, Connecticut, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29904606

Citation

Lydon, Megan, et al. "Starting the Conversation: Community Perspectives On Preterm Birth and Kangaroo Mother Care in Southern Malawi." Journal of Global Health, vol. 8, no. 1, 2018, p. 010703.
Lydon M, Longwe M, Likomwa D, et al. Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi. J Glob Health. 2018;8(1):010703.
Lydon, M., Longwe, M., Likomwa, D., Lwesha, V., Chimtembo, L., Donohue, P., Guenther, T., & Valsangar, B. (2018). Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi. Journal of Global Health, 8(1), 010703. https://doi.org/10.7189/jogh.08.010703
Lydon M, et al. Starting the Conversation: Community Perspectives On Preterm Birth and Kangaroo Mother Care in Southern Malawi. J Glob Health. 2018;8(1):010703. PubMed PMID: 29904606.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi. AU - Lydon,Megan, AU - Longwe,Monica, AU - Likomwa,Dyson, AU - Lwesha,Victoria, AU - Chimtembo,Lydia, AU - Donohue,Pamela, AU - Guenther,Tanya, AU - Valsangar,Bina, PY - 2018/6/16/entrez PY - 2018/6/16/pubmed PY - 2018/6/21/medline SP - 010703 EP - 010703 JF - Journal of global health JO - J Glob Health VL - 8 IS - 1 N2 - Background: Despite introduction of Kangaroo Mother Care (KMC) in Malawi over a decade ago, preterm birth remains the leading cause of neonatal mortality. Although KMC is initiated in the health care facility, robust community follow-up is critical for survival and optimal development of preterm and low birth weight infants post-discharge. The objective of this qualitative study was to gain insight into community and health worker understanding, attitudes, beliefs and practices around preterm and low birth weight babies and KMC in Malawi. Methods: A total of 152 participants were interviewed in two districts in southern Malawi, Machinga and Thyolo, in April 2015. Focus group discussions (groups = 11, n = 132) were conducted with pregnant women, community members and women who have practiced KMC. In-depth interviews (n = 20) were conducted with fathers who have practiced KMC, community and religious leaders, and health workers. Purposive and snowball sampling were employed to identify participants. Thematic content analysis was conducted. Findings: KMC mothers and fathers only learned about KMC and care for preterm newborns after delivery of a child in need of this care. Men typically were not included in KMC counseling due to societal gender roles. Health facilities were the main source of information on KMC, however informal networks among women provided some degree of knowledge exchange. Community leaders were regarded as major facilitators of health information, conveners, key influencers, and policy-makers. Religious leaders were regarded as advocates and emotional support for families with preterm infants. Finally, while many participants initially had negative feelings towards preterm births and KMC, the large majority saw a shift in their perceptions through health counseling, peer modeling, and personal success with KMC. Conclusions: The findings offer several opportunities to improve KMC implementation including 1) earlier introduction of KMC to pregnant women and their families that are at-risk for preterm birth, 2) greater involvement of men in KMC counselling, practice and care for preterm infants, and 3) strengthening and defining partnerships with community and religious leaders. Finally, as parental perceptions of preterm infants and KMC improved with successful KMC practice, it is hopeful that KMC itself can positively affect social norms surrounding preterm infants, leading to a virtuous cycle of improved perceptions of preterm infants and increased uptake of KMC. SN - 2047-2986 UR - https://www.unboundmedicine.com/medline/citation/29904606/Starting_the_conversation:_community_perspectives_on_preterm_birth_and_kangaroo_mother_care_in_southern_Malawi_ L2 - https://doi.org/10.7189/jogh.08.010703 DB - PRIME DP - Unbound Medicine ER -