Tumukunde Victor S, Katongole Joseph, Namukwaya Stella, Medvedev Melissa M, Nyirenda Moffat, Tann Cally J, Seeley Janet, Lawn Joy E
Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2024 Jul 31;4(7):e0002856. doi: 10.1371/journal.pgph.0002856. eCollection 2024.
Kangaroo mother care (KMC) is an evidence-based method to improve newborn survival. However, scale-up even for stable newborns has been slow, with reported barriers to implementation. We examined facilitators and barriers to initiating KMC before stabilisation amongst neonates recruited to the OMWaNA study in Uganda. The OMWaNA study was a randomised controlled trial that examined the mortality effect of KMC prior to stabilisation amongst newborns weighing ≤2000 grams. At the four trial hospitals, we conducted focus group discussions (FGD) separately with caregivers and healthcare providers, in-depth interviews (IDI) with caregivers and key informant interviews (KII) with hospital administrators and healthcare providers. The World Health Organisation (WHO) Health Systems Building Blocks were used to guide thematic analysis. Eight FGDs (4 caregivers, 4 healthcare providers), 41 caregiver IDIs (26 mothers, 8 grandmothers, 7 fathers), and 23 KIIs were conducted. Key themes based on the building blocks were; family and community support/ involvement, health workforce, medical supplies and commodities, infrastructure and design, financing, and health facility leadership. We found that the presence of a family member in the hospital, adequate provision of healthcare workers knowledgeable in supporting KMC prior to stability, and adequate space for KMC beds where neonatal care is being delivered, can enable implementation of KMC before stability. Implementation barriers included fear of inadvertently causing harm to the newborn, inadequate space to practice KMC in the neonatal unit, and a limited number of trained healthcare workers coupled with insufficient medical supplies.
袋鼠式护理（KMC）是一种基于证据的提高新生儿存活率的方法。然而，即使对于情况稳定的新生儿，扩大该护理模式的应用进展缓慢，且存在实施障碍的报道。我们在乌干达招募参加OMWaNA研究的新生儿中，调查了在病情稳定前启动袋鼠式护理的促进因素和障碍。OMWaNA研究是一项随机对照试验，研究对象为体重≤2000克的新生儿，该试验考察了在病情稳定前实施袋鼠式护理对死亡率的影响。在四家试验医院，我们分别与护理人员和医护人员进行了焦点小组讨论（FGD），与护理人员进行了深入访谈（IDI），并与医院管理人员和医护人员进行了关键 informant 访谈（KII）。世界卫生组织（WHO）的卫生系统构建模块被用于指导主题分析。共进行了8次焦点小组讨论（4次护理人员、4次医护人员）、41次护理人员深入访谈（26位母亲、8位祖母、7位父亲）以及23次关键 informant 访谈。基于这些构建模块的关键主题包括：家庭和社区支持/参与、卫生人力、医疗用品和商品、基础设施和设计、融资以及卫生设施领导。我们发现，医院中有家庭成员在场、有足够的熟悉在病情稳定前支持袋鼠式护理的医护人员，以及在提供新生儿护理的地方有足够的空间放置袋鼠式护理床位，能够使在病情稳定前实施袋鼠式护理成为可能。实施障碍包括担心无意中对新生儿造成伤害、新生儿病房中进行袋鼠式护理的空间不足，以及训练有素的医护人员数量有限且医疗用品不足。
