Academic journal article Bulletin of the World Health Organization

Kangaroo Mother Care: A Systematic Review of Barriers and enablers/La Methode «Mere Kangourou»: Examen Systematique Des Obstacles et Des aides/El Metodo Madre Canguro: Una Revision Sistematica De Barreras Y Facilitadores

Academic journal article Bulletin of the World Health Organization

Kangaroo Mother Care: A Systematic Review of Barriers and enablers/La Methode «Mere Kangourou»: Examen Systematique Des Obstacles et Des aides/El Metodo Madre Canguro: Una Revision Sistematica De Barreras Y Facilitadores

Article excerpt

Introduction

More than 2.7 million newborns die each year, accounting for 44% of children dying before the age of five years worldwide. Complications of preterm birth are the leading cause of death among newborns. (1) Kangaroo mother care can include early and continuous skin-to-skin contact, breastfeeding, early discharge from the health-care facility and supportive care. (2) The clinical efficacy and health benefits of kangaroo mother care have been demonstrated in multiple settings. In low birthweight newborns (<2000 g) who are clinically stable, kangaroo mother care reduces mortality and if widely applied could reduce deaths in preterm newborns. (3,4) However, in spite of the evidence, country-level adoption and implementation of kangaroo mother care has been limited and global coverage remains low. Few studies have examined the reasons for the poor uptake of kangaroo mother care.

To understand factors influencing adoption of kangaroo mother care in different contexts, we did a systematic review. We created a narrative analysis of the articles and reports identified, guided by a conceptual framework (5) with five elements: (i) the problem being addressed--neonatal mortality; (ii) the intervention or innovation aimed at addressing the problem; (iii) the adoption system--those implementing the intervention, those benefiting from it and those affected by it; (iv) the health system--organization, financing and service delivery; and (v) the broad context--demographic, epidemiological, political, economic and sociocultural factors. These five elements interact to influence the extent, pattern and rate of adoption of interventions in health systems. (5)

Methods

We searched PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Literature (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR) and Western Pacific Region Index Medicus (WPRIM) without language restrictions, from 1 January 1960 to 19 August 2015 using the search terms "kangaroo mother care" or "kangaroo care" or "skin-to-skin care." We excluded studies without human subjects or without primary data collection. We screened studies for inclusion if they discussed barriers to kangaroo mother care implementation or enablers for successful implementation. Our population of interest included mothers, newborns or mother-newborn dyads who had practiced kangaroo mother care, and health-care providers, health facilities, communities and health systems that have implemented such care. We hand-searched the reference lists of published systematic reviews and references of the included articles. To search the grey literature for unpublished studies, we explored programmatic reports and requested data from programmes implementing kangaroo mother care.

Two reviewers independently extracted data from identified articles using standardized forms to identify potential determinants of kangaroo mother care uptake, including data on knowledge, attitudes and practices. Reviewers compared their results to reach consensus and ties were broken by a third party. To assess study quality, we evaluated each study in five quality domains: selection bias, appropriateness of data collection, appropriateness of data analysis, generalizability and ethical considerations. (6)

A deductive approach was used to fit the outputs of the analysis to the elements of the conceptual framework and explore emerging themes. (7) Using the qualitative analytical software NVivo (QSR International, Melbourne, Australia), two researchers indexed and annotated the data through several rounds of coding to analyse themes, viewpoints, ideas and experiences. Once major themes were established, we constructed narratives and categorized the data into matrices by theme. We highlighted quotes that summarized multiple perspectives from the articles. …

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