Objectives
Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.
Design
This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.
Results
Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).
What is already known?
- Preterm births and low birth weight contribute to 80% of neonatal deaths.
- Kangaroo Mother Care (KMC) reduces mortality in stable babies <2000 g in hospital settings.
- WHO and national policies exist to support KMC, yet global coverage remains low.
What are the new findings?
- High population-based coverage of KMC can be achieved using a model derived through implementation research.
- The model includes strong government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy and practice.
- Key to success are KMC units, ecosystems that keep mother and baby together, provide basic amenities and services for the mother–baby pair, effective counselling and technical support.