342
Views
202
PDF Downloads
3
XML Views
Open Access
Practice of Kangaroo Mother Care: Unveiling Implementation Among Healthcare Providers in Sokoto, North-Western Nigeria
Main Article Content
Abstract
Purpose – To assess the proportion of Health Care Providers (HCPs) in Sokoto practicing Kangaroo Mother Care (KMC) in their various health facilities and identify barriers to KMC practice among HCPs in Sokoto. The purpose of this research is to evaluate the extent of KMC adoption and uncover the obstacles that hinder its effective implementation.
Design/methods/approach – A cross-sectional descriptive study was conducted among 80 Health Care Providers (HCPs) who attended the World Prematurity Day celebration in 2022. The program was held at the Medical and Health Workers Union office, Tamaje, Sokoto, on December 2, 2022. A structured questionnaire comprising both open and close-ended questions was used. Data obtained were analyzed using SPSS version 25.
Findings – The mean age of the HCPs was 32.9±7.6 years, with the majority, 30 (37.5%), having less than five years of working experience. Of the 80 respondents, 41 (51.3%) were nurses, 9 (11.2%) were doctors, and 16 (20.0%) were midwives. Forty-three (53.7%) of the HCPs practiced KMC. The most common barriers to implementing KMC among the HCPs were lack of privacy for the mothers (23, 28.8%), lack of space for the mothers (21, 26.3%), cultural reasons (19, 23.8%), and lack of skills on KMC (16, 20.0%). The factors associated with the practice of KMC were previous training on KMC and working in tertiary hospitals (p<0.05).
Research implications/limitations – This research implies that to mitigate barriers to KMC practice in hospitals, HCPs need to be trained to acquire skills for KMC, and rooms for KMC that ensure privacy for mothers should be available in health facilities.
Practical implications –By identifying and addressing the barriers to KMC, such as lack of privacy, space, and skills, health facilities can improve the adoption and effectiveness of KMC practices.
Originality/value – Kangaroo Mother Care reduces morbidity and mortality in Low Birth Weight (LBW) infants, making it crucial for countries with scarce resources to adopt this practice. Healthcare providers play a vital role in educating, supporting, and assisting mothers to practice KMC in the hospital and continue it at home after discharge.
Paper type Research paper
Keywords:
Downloads
1. Introduction
Preterm birth accounts for approximately 15 million babies born annually worldwide, indicating a global preterm birth rate of about 11%, with 1 million children dying due to preterm birth before the age of 5 years(Rahmatika et al., 2022). Sub-Saharan Africa, including Nigeria, accounts for up to 60% of these cases, with over one million deaths due to complications of prematurity(Mullany et al., 2010). Nigeria currently has the highest number of newborn deaths in Africa and the second highest in the world after India(Mullany et al., 2010). In Nigeria, the leading causes of neonatal mortality are preterm births and intrapartum-related events, with 15% of babies born as low birth weight babies(Mustapha et al., 2020). The Nigeria Demographic and Health Survey (NDHS) 2013 and 2018 estimated birth weight based on numerical values from written records and mother reports, showing 16% and 24% of newborns respectively were low birth weight.
These alarming statistics highlight the urgent need for effective interventions to address preterm and low birth weight (LBW) complications. Implementing practices like Kangaroo Mother Care (KMC) could significantly improve neonatal outcomes by providing a cost-effective and evidence-based method to support the health and development of preterm and LBW infants. Enhancing healthcare provider training and ensuring adequate facilities for KMC are crucial steps in reducing neonatal mortality and improving the overall health of newborns in Nigeria and other resource-limited settings.
The Sustainable Development Goals (SDGs) recognize child mortality as a major global health problem and aim to end preventable neonatal and child deaths by 2030. Progress towards achieving these targets has been notably uneven across countries and regions, and the COVID-19 pandemic has reversed recent gains in child survival. Only a few countries are on track to reach the Neonatal Mortality Rate (NMR) and Under-5 Mortality Rate (U5MR) targets by 2030. If current trends persist, two-thirds of countries in sub-Saharan Africa will miss these targets(Yılmaz & Esenay, 2024).
Premature and low birth weight (LBW) infants are at the highest risk for hypothermia, as they have less brown fat, less subcutaneous fat, and inefficient metabolic heat production(Okoh & Onubogu, 2018). Hypothermia increases the risk of death five-fold. For every degree Celsius drop in neonatal body temperature, the risk of mortality increases by 80%(Mullany et al., 2010). Hypothermia in newborns is associated with a range of morbidities, such as hypoglycemia, hypoxia, metabolic acidosis, peri-intraventricular hemorrhage (PIVH), necrotizing enterocolitis, sepsis, and bronchopulmonary dysplasia, as well as increased mortality. The presence of hypothermia at admission to the Neonatal Intensive Care Unit increases the chance of death by 1.64 times(Cordeiro et al., 2021).
Kangaroo Mother Care (KMC) reduces morbidity and mortality in low birth weight infants. Countries with scarce resources should adopt KMC to minimize problems associated with the management of preterm and low birth weight infants(Azmeraw Getie et al., 2022)(Dhage et al., 2023). The every Newborn Action Plan, endorsed and launched by the World Health Assembly in 2014, envisages scaling up KMC to 50% of babies weighing under 2000g by 2020 and to 75% by 2025(Onalo, 2013).
In most countries, the use of incubators is standard for the thermal care of LBW babies(Mustapha et al., 2020). However, incubator care is not widely available in developing countries. Even in the limited cases where incubator care is available, the use of this method can be very challenging(Dalal et al., 2014). Problems such as poor maintenance, power outages, and lack of replacement parts reduce the number of available, functional incubators(Dalal et al., 2014). Additionally, in developed countries where incubator care is readily available, there are various disadvantages when incubators alone are used for the thermal care of newborns. These include a reduction in breastfeeding and reduced maternal-newborn bonding(Arya et al., 2023)(Wang et al., 2023). These risks can be mitigated if KMC is used alongside incubators for thermal care(Ibe et al., 2004).
Moreover, the reliance on incubators in developing countries poses significant financial and logistical challenges. High costs associated with purchasing and maintaining incubators can strain limited healthcare budgets, and logistical difficulties in transporting and installing these machines further complicate their use. The intermittent availability of electricity in many low-resource settings exacerbates these issues, making incubators an unreliable solution for thermal care.
In contrast, KMC provides a cost-effective and practical alternative that can be implemented even in resource-limited environments. KMC not only supports thermal regulation but also promotes breastfeeding, enhances maternal-infant bonding, and can improve overall neonatal outcomes. By integrating KMC with incubator use, healthcare systems can optimize the thermal care of LBW infants, ensuring more comprehensive support for both the infants and their mothers. This dual approach leverages the strengths of both methods, addressing the shortcomings of relying solely on incubators and creating a more resilient and adaptable neonatal care framework.
Several factors inhibit KMC practice, such as inadequate facilities, lack of skills among health workers, and social norms(DURMAZ et al., 2023)(Organization, 2014). To mitigate some of the barriers to KMC practice, training on Kangaroo Mother Care can be included in the training curriculum of health workers(Organization, 2014). This study aims to assess the proportion of Health Care Providers (HCPs) in Sokoto practicing KMC in their various health facilities and identify barriers to KMC practice among HCPs in Sokoto.
2. Methods
This
Article Details
How to Cite
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) before and during the submission process. It can lead to productive exchanges and earlier and greater citation of published work.
References
Anjur, K. I., & Darmstadt, G. L. (2023). Separation of Maternal and Newborn Care in US Hospitals: A Systemic Threat to Survival, Health and Well-Being. Health Systems & Reform, 9(1), 2267255. https://doi.org/10.1080/23288604.2023.2267255
Arya, S., Chhabra, S., Singhal, R., Kumari, A., Wadhwa, N., Anand, P., Naburi, H., Kawaza, K., Newton, S., Adejuyigbe, E., Westrup, B., Bergman, N., Rettedal, S., Linner, A., Chauhan, R., Rani, N., Minckas, N., Yoshida, S., Rao, S., & Chellani, H. (2023). Effect on neonatal sepsis following immediate kangaroo mother care in a newborn intensive care unit: a post-hoc analysis of a multicentre, open-label, randomised controlled trial. EClinicalMedicine, 60, 102006. https://doi.org/https://doi.org/10.1016/j.eclinm.2023.102006
Asmare, M. G., Murugan, R., & Adimasu, M. (2021). Perceived Enablers and Barriers of Kangaroo Mother Care among Mothers and Nurses in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Qualitative Study. Iranian Journal of Neonatology, 12(4), 63–69. https://doi.org/10.22038/ijn.2021.53431.1976
Azmeraw Getie, B., Engida Yismaw, A., & Eskezia Tiguh, A. (2022). Kangaroo mother care knowledge and practice among mothers who gave birth to preterm and low birth weight babies in Amhara regional state referral hospitals, North West Ethiopia. International Journal of Africa Nursing Sciences, 17, 100470. https://doi.org/https://doi.org/10.1016/j.ijans.2022.100470
Campanha, P. de P. A., de Magalhães-Barbosa, M. C., Prata-Barbosa, A., Rodrigues-Santos, G., & da Cunha, A. J. L. A. (2024). Exclusive breastfeeding and length of hospital stay in premature infants at a Brazilian reference center for kangaroo mother care. Jornal de Pediatria, 100(4), 392–398. https://doi.org/https://doi.org/10.1016/j.jped.2024.01.004
Cordeiro, R. C. O., Ferreira, D. M. de L. M., Reis, H. Dos, Azevedo, V. M. G. de O., Protázio, A. D. S., & Abdallah, V. O. S. (2021). Hypothermia and neonatal morbimortality in very low birth weight preterm infants. Revista Paulista de Pediatria : Orgao Oficial Da Sociedade de Pediatria de Sao Paulo, 40, e2020349. https://doi.org/10.1590/1984-0462/2022/40/2020349
Dalal, A., Bala, D. V, & Chauhan, S. (2014). A Cross-Sectional Study on Knowledge and Attitude Regarding Kangaroo Mother Care Practice Among Health Care Providers in Ahmedabad District. International Journal of Medical Science and Public Health, 3, 253–256. https://api.semanticscholar.org/CorpusID:2579004
Dhage, V. D., Rannaware, A., & Choudhari, S. G. (2023). Kangaroo Mother Care for Low-Birth-Weight Babies in Low and Middle-Income Countries: A Narrative Review. Cureus, 15(4), e38355. https://doi.org/10.7759/cureus.38355
DURMAZ, A., SEZICI, E., & AKKAYA, D. D. (2023). The effect of kangaroo mother care or skin-to-skin contact on infant vital signs: A systematic review and meta-analysis. Midwifery, 125, 103771. https://doi.org/https://doi.org/10.1016/j.midw.2023.103771
Ibe, O. E., Austin, T., Sullivan, K., Fabanwo, O., Disu, E., & Costello, A. M. de L. (2004). A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants < 2000 g in Nigeria using continuous ambulatory temperature monitoring. Annals of Tropical Paediatrics, 24(3), 245–251. https://doi.org/10.1179/027249304225019082
İnan Yurdagül, N., & Esenay, F. I. (2023). Effect of kangaroo care applied by mothers and fathers in premature infants: A crossover study. Journal of Neonatal Nursing, 29(3), 501–505. https://doi.org/https://doi.org/10.1016/j.jnn.2022.08.008
Kaoje, A. U., Labaran, S., Magashi, A. G., & Ango, J. T. (2018). Improving maternal and child health: a situational analysis of primary health care centres of Sokoto state, Nigeria. International Journal Of Community Medicine And Public Health, 5(12), 5052–5062. https://doi.org/10.18203/2394-6040.ijcmph20184777
Mehrpisheh, S., Doorandish, Z., Farhadi, R., Ahmadi, M., & Moafi, M. (2023). The effectiveness of Kangaroo Mother Care (KMC) on depression, anxiety, and stress of mothers with premature infants. Journal of Neonatal Nursing, 29(5), 786–790. https://doi.org/https://doi.org/10.1016/j.jnn.2023.03.002
Mehrpisheh, S., Doorandish, Z., Farhadi, R., Ahmadi, M., Moafi, M., & Elyasi, F. (2022). The Effectiveness of Kangaroo Mother Care (KMC) on attachment of mothers with premature infants. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 15, 100149. https://doi.org/https://doi.org/10.1016/j.eurox.2022.100149
Mimani Minuta, W., Lera, T., Haile, D., Badacho, A. S., Bekele, B., Gezume Ganta, A., Nigussie Bolado, G., & Bashe, B. (2023). Lived Experience of Mothers Having Preterm Newborns in a Neonatal Intensive Care Unit at Wolaita Sodo University Comprehensive Specialized Hospital Southern Ethiopia: A Phenomenological Study. Research and Reports in Neonatology, 13(null), 1–14. https://doi.org/10.2147/RRN.S417173
Mustapha, B., Simon, P., Abdullahi, B. I., & Abubakar, H. I. (2020). Prevalence and associated morbidities of preterm neonatal admissions at the University of Maiduguri Teaching Hospital, North-Eastern Nigeria. Nigerian Journal of Paediatrics, 47(3), 264–269. https://doi.org/10.4314/njp.v47i3.12
Okoh, B., & Onubogu, U. (2018). Knowledge and Attitude of Nigerian Health Workers Concerning Kangaroo Mother Care. International Journal of TROPICAL DISEASE & Health, 31(4), 1–10. https://doi.org/10.9734/ijtdh/2018/42974
Onalo, R. (2013). Neonatal hypothermia in sub-Saharan Africa: a review. Nigerian Journal of Clinical Practice, 16(2), 129–138. https://doi.org/10.4103/1119-3077.110120
Organization, W. H. (2014). Every Newborn: an action plan to end preventable deaths. World Health Organization.
Paradillah, I., Martha, E., Ramadhan, F. A., Tenriana, I., Syahbana, L. R., Lubis, I. A. P., & Pratomo, H. (2022). The Analysis of Kangaroo Mother Care Implementation at Public Health Center in Indonesia. PLACENTUM: Jurnal Ilmiah Kesehatan Dan Aplikasinya, 10(3), 180–188. https://doi.org/10.20961/placentum.v10i3.58384
Parikh, L., Manerkar, S., Kalamdani, P., Kalathingal, T., Patra, S., & Mondkar, J. (2023). Feasibility and acceptability of breast pumping during provision of kangaroo mother care in mothers of preterm infants - A cross-sectional survey. Journal of Neonatal Nursing, 29(3), 486–489. https://doi.org/https://doi.org/10.1016/j.jnn.2022.09.007
Pratomo, H., Uhudiyah, U., Sidi, I., Rustina, Y., Suradi, R., Bergh, A.-M., Rogers-Bloch, Q., & Gipson, R. (2012). Supporting factors and barriers in implementing kangaroo mother care in Indonesia. Paediatrica Indonesiana, 52(1), 43–50. https://doi.org/10.14238/pi52.1.2012.43-50
Rahmatika, Q. T., Aditya, R. S., Yusuf, A., Almutairi, R. L., Al Razeeni, D. M., Kotijah, S., & Sulistyorini, A. (2022). We are facing some barriers: A qualitative study on the implementation of kangaroo mother care from the perspectives of healthcare providers. Journal of Public Health in Africa, 13(2), 2412. https://doi.org/10.4081/jphia.2022.2412
Walani, S. R. (2020). Global burden of preterm birth. International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics, 150(1), 31–33. https://doi.org/10.1002/ijgo.13195
Wang, W., Wang, Y., Zhang, H., Yang, G., Lin, Y., Wang, C., Huang, X., Tian, X., Xiao, A. Y., Xu, T., & Tang, K. (2023). A pilot study of Kangaroo mother care in early essential newborn care in resource-limited areas of China: the facilitators and barriers to implementation. BMC Pregnancy and Childbirth, 23(1), 451. https://doi.org/10.1186/s12884-023-05720-4
Yılmaz, A., & Esenay, F. I. (2024). The effect of kangaroo mother care of newborns with indirect hyperbilirubinemia on breastfeeding. Journal of Neonatal Nursing. https://doi.org/https://doi.org/10.1016/j.jnn.2024.03.002
You, D., Hug, L., Ejdemyr, S., Idele, P., Hogan, D., Mathers, C., Gerland, P., New, J. R., & Alkema, L. (2015). Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet (London, England), 386(10010), 2275–2286. https://doi.org/10.1016/S0140-6736(15)00120-8
Yue, J., Liu, J., Williams, S., Zhang, B., Zhao, Y., Zhang, Q., Zhang, L., Liu, X., Wall, S., Wetzel, G., Zhao, G., & Bouey, J. (2020). Barriers and facilitators of kangaroo mother care adoption in five Chinese hospitals: a qualitative study. BMC Public Health, 20(1), 1234. https://doi.org/10.1186/s12889-020-09337-6
Zengin, H., Suzan, O. K., Hur, G., Kolukısa, T., Eroglu, A., & Cinar, N. (2023). The effects of kangaroo mother care on physiological parameters of premature neonates in neonatal intensive care unit: A systematic review. Journal of Pediatric Nursing, 71, e18–e27. https://doi.org/https://doi.org/10.1016/j.pedn.2023.04.010
