Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India.
Institute for Global Health, Faculty of Population Health Sciences, University College of London, London, UK.
BMC Public Health. 2018 Mar 2;18(1):307. doi: 10.1186/s12889-018-5197-z.
Low and middle income countries (LMICs), including India, contribute to a major proportion of low birth weight (LBW) infants globally. These infants require special care. Kangaroo Mother Care (KMC) in hospitals is a cost effective and efficacious intervention. In institutional deliveries, the duration of facility stay is often short. In LMICs, a substantial proportion of deliveries still occur at home and access to health care services is limited. In these circumstances, a pragmatic choice may be to initiate KMC at home for LBW babies. However, evidence is lacking on benefits of community-initiated KMC (cKMC). Promoting KMC at home without an understanding of its acceptability may lead to limited success.
We conducted formative research to assess the feasibility, acceptability and adoption of cKMC with the aim of designing an intervention package for a randomised controlled trial in LBW infants in Haryana, India. Qualitative methods included 40 in-depth interviews with recently delivered women and 6 focus group discussions, two each with fathers and grandfathers, grandmothers, and community health workers. A prototype intervention package to promote cKMC was developed and tested in 28 mother-infant pairs (of them, one mother had twins), using Household (HH) trials.
We found that most mothers in the community recognized that babies born small required special care. In spite of not being aware of the practice of KMC, respondents felt that creating awareness of KMC benefits will promote practice. They expressed concerns about doing KMC for long periods because mothers needed rest after delivery. However, the cultural practice of recently delivered women not expected to be doing household chores and availability of other family members were identified as enablers. HH trials provided an opportunity to test the intervention package and showed high acceptability for KMC. Most mothers perceived benefits such as weight gain and increased activity in the infant.
Community-initiated KMC is acceptable by mothers and adoption rates are high. Formative research is essential for developing a strategy for delivery of an intervention.
Trial registration number CTRI/2015/10/006267 . Name of Registry: Clinical Trials Registry - India. URL of Registry: http://ctri.nic.in/Clinicaltrials/login.php Date of Registration: 15/10/2015. Date of enrolment of the first participant to the trial: 18/04/2015.
包括印度在内的中低收入国家（LMICs）在全球范围内贡献了很大比例的低出生体重（LBW）婴儿。这些婴儿需要特别护理。医院中的袋鼠式护理（KMC）是一种具有成本效益和疗效的干预措施。在机构分娩中，产妇在医院的停留时间往往很短。在 LMICs 中，仍有很大一部分分娩是在家里进行的，而且获得医疗保健服务的机会有限。在这种情况下，为 LBW 婴儿选择在家庭中开始 KMC 可能是一个明智的选择。然而，对于社区发起的 KMC（cKMC）的益处，目前还缺乏证据。在不了解其可接受性的情况下，在家庭中推广 KMC 可能会导致有限的成功。
我们进行了形成性研究，以评估 cKMC 的可行性、可接受性和采用情况，目的是为印度哈里亚纳邦 LBW 婴儿的随机对照试验设计一个干预包。定性方法包括对最近分娩的妇女进行 40 次深入访谈和 6 次焦点小组讨论，每次讨论各有父亲和祖父、祖母以及社区卫生工作者参加。使用家庭（HH）试验，开发并测试了一个促进 cKMC 的原型干预包。
我们发现，社区中的大多数母亲都认识到出生体重较小的婴儿需要特殊护理。尽管不知道 KMC 的做法，但受访者认为，提高对 KMC 益处的认识将促进这种做法。他们对长时间进行 KMC 表示担忧，因为母亲在分娩后需要休息。然而，最近分娩的妇女不需要做家务的文化习俗和其他家庭成员的存在被认为是促进因素。HH 试验为测试干预包提供了机会，并显示出对 KMC 的高度可接受性。大多数母亲认为 KMC 有增加婴儿体重和活动的好处。
社区发起的 KMC 被母亲接受，采用率很高。形成性研究对于制定干预措施的实施策略至关重要。
临床试验注册号 CTRI/2015/10/006267。注册机构名称：印度临床试验注册中心。注册网址：http://ctri.nic.in/Clinicaltrials/login.php。注册日期：2015 年 10 月 15 日。试验首例参与者入组日期：2015 年 4 月 18 日。
