Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada.
Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.
PLoS One. 2020 Dec 17;15(12):e0243770. doi: 10.1371/journal.pone.0243770. eCollection 2020.
Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother's chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of this study is to understand barriers and facilitators to KMC practice at tertiary and secondary health facilities in southern Malawi from the perspective of health workers.
This study is part of the "Integrating a neonatal healthcare package for Malawi" project in the Innovating for Maternal and Child Health in Africa initiative. In-depth interviews were conducted between May-Aug 2019 with a purposively drawn sample of service providers and supervisors working in newborn health at a large tertiary hospital and three district-level hospitals in southern Malawi. Data were analyzed using a thematic approach using NVivo 12 software (QSR International, Melbourne, Australia).
A total of 27 nurses, clinical officers, paediatricians and district health management officials were interviewed. Staff attitudes, inadequate resources and reliance on families emerged as key themes. Health workers from Malawi described KMC practice positively as a low-cost, low-technology solution appropriate for resource-constrained health settings. However, staff perceptions that KMC babies were clinically stable was associated with lower prioritization in care and poor monitoring practices. Neglect of the KMC ward by medical staff, inadequate staffing and reliance on caregivers for supplies were associated with women self-discharging early.
Though routine uptake of KMC was policy for stable low birthweight and preterm infants in the four hospitals, there were gaps in monitoring and maintenance of practice. While conceptualized as a low-cost intervention, sustainable implementation requires investments in technologies, staffing and hospital provisioning of basic supplies such as food, bedding, and KMC wraps. Strengthening hospital capacities to support KMC is needed as part of a continuum of care for premature infants.
袋鼠式护理（KMC）涉及婴儿在母亲胸前的持续皮肤接触，以提供温暖、频繁的母乳喂养、识别疾病的危险信号以及早期出院。尽管 KMC 是安全、有效且得到世界卫生组织推荐的，但在实践中，其实施仍然有限。本研究的目的是从卫生工作者的角度了解马拉维南部三级和二级卫生机构实施 KMC 的障碍和促进因素。
本研究是非洲创新母婴健康倡议中“为马拉维整合新生儿保健包”项目的一部分。2019 年 5 月至 8 月，我们对在马拉维南部一家大型三级医院和三家区县级医院从事新生儿保健工作的服务提供者和主管进行了有针对性的深入访谈。使用 NVivo 12 软件（澳大利亚墨尔本 QSR 国际公司）采用主题方法进行数据分析。
共访谈了 27 名护士、临床医生、儿科医生和区县级卫生管理人员。工作人员态度、资源不足和对家庭的依赖是关键主题。马拉维的卫生工作者积极描述 KMC 实践是一种低成本、低技术的解决方案，适用于资源有限的卫生环境。然而，工作人员认为 KMC 婴儿临床稳定与护理优先级较低和监测实践不佳有关。医护人员忽视 KMC 病房、人员配备不足以及依赖照顾者提供用品与妇女提前出院有关。
尽管四家医院的政策规定稳定的低出生体重和早产儿常规接受 KMC，但在监测和维持实践方面存在差距。虽然 KMC 被概念化为一种低成本干预措施，但可持续实施需要投资于技术、人员配备以及医院提供基本用品，如食物、被褥和 KMC 包裹。需要加强医院能力，以支持 KMC，作为早产儿连续护理的一部分。
