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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.
PLoS One. 2020; 15(12):e0243770.Plos

Abstract

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.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi.Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi.Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi.Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.

Pub Type(s)

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

Language

eng

PubMed ID

33332395

Citation

Kinshella, Mai-Lei Woo, et al. ""So Sometimes, It Looks Like It's a Neglected Ward": Health Worker Perspectives On Implementing Kangaroo Mother Care in Southern Malawi." PloS One, vol. 15, no. 12, 2020, pp. e0243770.
Kinshella MW, Salimu S, Chiwaya B, et al. "So sometimes, it looks like it's a neglected ward": Health worker perspectives on implementing kangaroo mother care in southern Malawi. PLoS One. 2020;15(12):e0243770.
Kinshella, M. W., Salimu, S., Chiwaya, B., Chikoti, F., Chirambo, L., Mwaungulu, E., Banda, M., Newberry, L., Njirammadzi, J., Hiwa, T., Vidler, M., Molyneux, E. M., Dube, Q., Mfutso-Bengo, J., Goldfarb, D. M., Kawaza, K., & Nyondo-Mipando, A. L. (2020). "So sometimes, it looks like it's a neglected ward": Health worker perspectives on implementing kangaroo mother care in southern Malawi. PloS One, 15(12), e0243770. https://doi.org/10.1371/journal.pone.0243770
Kinshella MW, et al. "So Sometimes, It Looks Like It's a Neglected Ward": Health Worker Perspectives On Implementing Kangaroo Mother Care in Southern Malawi. PLoS One. 2020;15(12):e0243770. PubMed PMID: 33332395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "So sometimes, it looks like it's a neglected ward": Health worker perspectives on implementing kangaroo mother care in southern Malawi. AU - Kinshella,Mai-Lei Woo, AU - Salimu,Sangwani, AU - Chiwaya,Brandina, AU - Chikoti,Felix, AU - Chirambo,Lusungu, AU - Mwaungulu,Ephrida, AU - Banda,Mwai, AU - Newberry,Laura, AU - Njirammadzi,Jenala, AU - Hiwa,Tamanda, AU - Vidler,Marianne, AU - Molyneux,Elizabeth M, AU - Dube,Queen, AU - Mfutso-Bengo,Joseph, AU - Goldfarb,David M, AU - Kawaza,Kondwani, AU - Nyondo-Mipando,Alinane Linda, Y1 - 2020/12/17/ PY - 2020/10/06/received PY - 2020/11/27/accepted PY - 2020/12/17/entrez PY - 2020/12/18/pubmed PY - 2021/1/30/medline SP - e0243770 EP - e0243770 JF - PloS one JO - PLoS One VL - 15 IS - 12 N2 - 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33332395/"So_sometimes_it_looks_like_it's_a_neglected_ward":_Health_worker_perspectives_on_implementing_kangaroo_mother_care_in_southern_Malawi_ L2 - https://dx.plos.org/10.1371/journal.pone.0243770 DB - PRIME DP - Unbound Medicine ER -