Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

First page of Kangaroo mother care model Malawi article, including title, abstract, authors, and journal information

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Kangaroo mother care (KMC) is a critical strategy to care for preterm and low birth weight infants in resource-limited settings. Despite evidence of its effectiveness and low cost, coverage has remained low, largely due to sociocultural barriers. We aimed to better understand social norms and community perceptions of preterm infants and KMC (facility-initiated and community-continued) in Malawi, a country with a high preterm birth rate, to inform a pilot social and behavior change program.


In this qualitative study, we conducted 11 focus group discussions and 20 in-depth interviews. Participants were identified through purposive and snowball sampling and included pregnant women, parents engaged in KMC, health workers, community members, and religious leaders. Audio recordings were transcribed and translated into English. An inductive thematic analysis was applied.

Key Findings

  • This analysis identified 3 major injunctive norms that influence behavior at the community, family, household, and individual levels, and have both positive and negative effects on parent engagement with kangaroo mother care (KMC) in Malawi.
  • Proposed areas for intervention to promote KMC include (1) emphasizing the value of life and working to shift community attitudes about preterm infants, (2) encouraging family and community support systems, (3) highlighting the discrepancy between perceived and actual male KMC involvement, (4) sharing strategies that support collaborative participation in KMC among both parents, and (5) developing or strengthening efforts to provide economic relief to KMC parents

Key Implications

  • Because KMC requires significant caregiver involvement, a well-informed, context-specific social behavior change strategy is critical to increasing uptake and continuation.
  • Successful promotion efforts will build upon social norms that support KMC and aim to shift those that limit it, with actions focusing on multiple social levels.

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