Bergh Anne-Marie, Kerber Kate, Abwao Stella, de-Graft Johnson Joseph, Aliganyira Patrick, Davy Karen, Gamache Nathalie, Kante Modibo, Ligowe Reuben, Luhanga Richard, Mukarugwiro Béata, Ngabo Fidèle, Rawlins Barbara, Sayinzoga Felix, Sengendo Naamala Hanifah, Sylla Mariam, Taylor Rachel, van Rooyen Elise, Zoungrana Jeremie
MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa.
BMC Health Serv Res. 2014 Jul 8;14:293. doi: 10.1186/1472-6963-14-293.
Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda.
A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress.
Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care.
The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
一些国家已开展了包括扩大袋鼠式护理规模在内的项目。本研究的目的是系统评估马拉维、马里、卢旺达和乌干达这四个非洲国家基于机构的袋鼠式护理服务的实施状况。
采用横断面混合方法研究设计。利益相关者在国家会议和个人访谈中提供了背景信息。通过先前在其他环境中应用的标准化工具，对这些国家的39家医疗机构进行半结构化关键信息访谈和观察，从而对机构进行评估。根据实施进展的六个阶段，每个机构获得的总分最高为30分。
在这四个国家中，95%接受评估的医疗机构都有一些袋鼠式护理实践的证据。表现较好的机构开展袋鼠式护理的历史较长，或者已发展成为卓越中心，或者有强有力的领导者支持实施过程。不同机构之间以及不同国家之间在实施质量上存在差异。实施过程中确定的重要因素包括：培训与指导；支持性监督；将袋鼠式护理纳入质量改进；连续护理；对袋鼠式护理实施的高层认可与支持；以及以客户为导向的护理。
将袋鼠式护理纳入常规新生儿护理服务应成为所有孕产妇和新生儿护理举措及套餐的一部分。从一开始就让卫生部和其他实施伙伴参与进来，可能会促进认可并有助于调动资源以扩大袋鼠式护理服务。监测这些服务的机制应纳入现有的卫生管理信息系统。
