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Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation.
BMJ Open. 2019 11 21; 9(11):e025879.BO

Abstract

INTRODUCTION

Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it.

METHODS AND ANALYSIS

This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge.

ETHICS AND DISSEMINATION

Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination.

STUDY STATUS

WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019.

TRIAL REGISTRATION NUMBER

Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698).

Authors+Show Affiliations

School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.Urban Health, John Snow Inc, Addis Ababa, Ethiopia.School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.School of Public Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.Tigray Regional Health Bureau, Mekelle, Ethiopia.Department of Neonatology, University of Alberta, Edmonton, Alberta, Canada.Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.Southern Nations, Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia.Department of Neonatology, Karloniska Institute, Calgary, Alberta, Canada.Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.Oromia Regional Health Bureau, Addis Ababa, Ethiopia.Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia.Amhara National Regional Health Bureau, Bahir Dar, Ethiopia.Emory Ethiopia, Addis Ababa, Ethiopia.Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia.Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.Community Mobilization, Karnataka Health Promotion Trust, Bangalore, India.Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.Quality Improvement, Karnataka Health Promotion Trust, Bangalore, India. Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada.National Health Mission, Indian Administrative Service, Lucknow, India.Karnataka Health Promotion Trust, Bangalore, India.Global Health, Community Empowerment Lab, Lucknow, India.Global Health, Community Empowerment Lab, Lucknow, India.Global Health, Community Empowerment Lab, Lucknow, India.Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.Amhara Regional Office, Emory Ethiopia, Bahirdar, Ethiopia.Department of Health and Family Welfare, Government of Karnataka, Bangalore, India.Centre for Intervention Science in Maternal and Child Health, Universitetet i Bergen Senter for internasjonal helse, Bergen, Norway.Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.Emory Ethiopia, Addis Ababa, Ethiopia.Division of Epidemiology and Population Health, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India.Private Consultant, Addis Ababa, Ethiopia.Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.Department of Neonatology, St John's Medical College Hospital, Bangalore, India.Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia.Global Health, Emory University School of Public Health, Atlanta, Georgia, USA.Department of Neonatology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.Federal Ministry of Health, Addis Ababa, Ethiopia.Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia.Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia. Pediatrics Society, Addis Ababa, Ethiopia.Department of Pediatrics and Child Health, Mekelle University College of Health Sciences, Mekelle, Ethiopia.Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland bahlr@who.int.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31753865

Citation

Medhanyie, Araya Abrha, et al. "Kangaroo Mother Care Implementation Research to Develop Models for Accelerating Scale-up in India and Ethiopia: Study Protocol for an Adequacy Evaluation." BMJ Open, vol. 9, no. 11, 2019, pp. e025879.
Medhanyie AA, Alemu H, Asefa A, et al. Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation. BMJ Open. 2019;9(11):e025879.
Medhanyie, A. A., Alemu, H., Asefa, A., Beyene, S. A., Gebregizabher, F. A., Aziz, K., Bhandari, N., Beyene, H., Brune, T., Chan, G., Cranmer, J. N., Darmstadt, G., Duguma, D., Fikre, A., Andualem, B. G., Gobezayehu, A. G., Mariam, D. H., Abay, T. H., Mohan, H. L., ... Bahl, R. (2019). Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation. BMJ Open, 9(11), e025879. https://doi.org/10.1136/bmjopen-2018-025879
Medhanyie AA, et al. Kangaroo Mother Care Implementation Research to Develop Models for Accelerating Scale-up in India and Ethiopia: Study Protocol for an Adequacy Evaluation. BMJ Open. 2019 11 21;9(11):e025879. PubMed PMID: 31753865.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kangaroo Mother Care implementation research to develop models for accelerating scale-up in India and Ethiopia: study protocol for an adequacy evaluation. AU - Medhanyie,Araya Abrha, AU - Alemu,Hibret, AU - Asefa,Anteneh, AU - Beyene,Selemawit Asfaw, AU - Gebregizabher,Fisseha Ashebir, AU - Aziz,Khalid, AU - Bhandari,Nita, AU - Beyene,Habtamu, AU - Brune,Thomas, AU - Chan,Grace, AU - Cranmer,John N, AU - Darmstadt,G, AU - Duguma,Dereje, AU - Fikre,Addisalem, AU - Andualem,Bizuayehu Gashaw, AU - Gobezayehu,Abebe Gebremariam, AU - Mariam,Damen Haile, AU - Abay,Tedros Hailu, AU - Mohan,H L, AU - Jadaun,Arun, AU - Jayanna,K, AU - Kajal,F N U, AU - Kar,Arin, AU - Krishna,Raghav, AU - Kumar,Aarti, AU - Kumar,Vishwajeet, AU - Madhur,Tarun Kumar, AU - Belew,Mulusew Lijalem, AU - M,Rajini, AU - Martines,Jose, AU - Mazumder,Sarmila, AU - Amin,Hajira, AU - Mony,Prem K, AU - Muleta,Mekonnen, AU - Pileggi-Castro,Cynthia, AU - Pn Rao,Suman, AU - Estifanos,Abiy Seifu, AU - Sibley,Lynn M, AU - Singhal,Nalini, AU - Tadele,Henok, AU - Tariku,Abraham, AU - Lemango,Ephrem Tekle, AU - Tadesse,Birkneh Tilahun, AU - Upadhyay,Ravi, AU - Worku,Bogale, AU - Hadush,Marta Yemane, AU - Bahl,Rajiv, AU - ,, Y1 - 2019/11/21/ PY - 2019/11/23/entrez PY - 2019/11/23/pubmed PY - 2020/10/23/medline KW - kangaroo-mother care method KW - low birth weight KW - newborn KW - research protocol SP - e025879 EP - e025879 JF - BMJ open JO - BMJ Open VL - 9 IS - 11 N2 - INTRODUCTION: Kangaroo Mother Care (KMC) is the practice of early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding. Despite clear evidence of impact in improving survival and health outcomes among low birth weight infants, KMC coverage has remained low and implementation has been limited. Consequently, only a small fraction of newborns that could benefit from KMC receive it. METHODS AND ANALYSIS: This implementation research project aims to develop and evaluate district-level models for scaling up KMC in India and Ethiopia that can achieve high population coverage. The project includes formative research to identify barriers and contextual factors that affect implementation and utilisation of KMC and design scalable models to deliver KMC across the facility-community continuum. This will be followed by implementation and evaluation of these models in routine care settings, in an iterative fashion, with the aim of reaching a successful model for wider district, state and national-level scale-up. Implementation actions would happen at three levels: 'pre-KMC facility'-to maximise the number of newborns getting to a facility that provides KMC; 'KMC facility'-for initiation and maintenance of KMC; and 'post-KMC facility'-for continuation of KMC at home. Stable infants with birth weight<2000 g and born in the catchment population of the study KMC facilities would form the eligible population. The primary outcome will be coverage of KMC in the preceding 24 hours and will be measured at discharge from the KMC facility and 7 days after hospital discharge. ETHICS AND DISSEMINATION: Ethics approval was obtained in all the project sites, and centrally by the Research Ethics Review Committee at the WHO. Results of the project will be submitted to a peer-reviewed journal for publication, in addition to national and global level dissemination. STUDY STATUS: WHO approved protocol: V.4-12 May 2016-Protocol ID: ERC 2716. Study implementation beginning: April 2017. Study end: expected March 2019. TRIAL REGISTRATION NUMBER: Community Empowerment Laboratory, Uttar Pradesh, India (ISRCTN12286667); St John's National Academy of Health Sciences, Bangalore, India and Karnataka Health Promotion Trust, Bangalore, India (CTRI/2017/07/008988); Society for Applied Studies, Delhi (NCT03098069); Oromia, Ethiopia (NCT03419416); Amhara, SNNPR and Tigray, Ethiopia (NCT03506698). SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31753865/Kangaroo_Mother_Care_implementation_research_to_develop_models_for_accelerating_scale_up_in_India_and_Ethiopia:_study_protocol_for_an_adequacy_evaluation_ DB - PRIME DP - Unbound Medicine ER -