New mother Christine Mutinda performs KMC at Kibera South hospital with Kibera Slum in the background. The slum is the second largest in Africa. Save the Children is strengthening the skills and capacity of health providers in seven hospitals located in the Langata area of Nairobi, Kenya, so that they can deliver higher quality care to preterm and low-birth-weight babies. The project is targeting to reach 2,200 new born babie each year. Kangaroo Mother Care (KMC) is the current recommended practice to care for stable preterm babies in Kenya. For babies, KMC promotes faster weight gain due to better thermoregulation and improved breastfeeding and therefore shorter hospital stay. KMC improves bonding between mother and baby and empowers mothers to play an active role in care for the newborn. KMC reduces dependency on incubators, does not require additional nursing staff and reduces cost per patient due to shorter hospital stays providing benefits for the health facility.
Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. This article presents a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities.
Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities.
Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.