Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study.
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Mony Prem K, Tadele Henok, Gobezayehu Abebe Gebremariam, Chan Grace J, Kumar Aarti, Mazumder Sarmila, Beyene Selemawit Asfaw, Jayanna Krishnamurthy, Kassa Dejene Hailu, Mohammed Hajira Amin, Estifanos Abiy Seifu, Kumar Pankaj, Jadaun Arun Singh, Hailu Abay Tedros, Washington Maryann, W/Gebriel Fitsum, Alamineh Lamesgin, Fikre Addisalem, Kumar Alok, Trikha Sonia, Ashebir Gebregizabher Fisseha, Kar Arin, Bilal Selamawit Mengesha, Belew Mulusew Lijalem, Debere Mesfin Kote, Krishna Raghav, Dalpath Suresh Kumar, Amare Samson Yohannes, Mohan H L, Brune Thomas, Sibley Lynn M, Tariku Abraham, Sahu Arti, Kumar Tarun, Hadush Marta Yemane, Gowda Prabhu Deva, Aziz Khalid, Duguma Dereje, Singh Pramod Kumar, Darmstadt Gary L, Agarwal Ramesh, Gebremariam Dawit Seyoum, Martines Jose, Portela Anayda, Jaiswal Harsh Vardhan, Bahl Rajiv, Rao Pn Suman, Tadesse Birkneh Tilahun, Cranmer John N, Hailemariam Damen, Kumar Vishwajeet, Bhandari Nita, Medhanyie Araya Abrha, KMC Scale-Up Study Group
Аннотация
DESIGN: This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.
PARTICIPANTS: 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.
MAIN OUTCOME MEASURES: The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.
RESULTS: Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%-86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%-65% of infants in all sites, except Oromia (38%) and Karnataka (36%).
CONCLUSIONS: This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers' conviction that KMC is the standard of care, women's and families' acceptance of KMC, and changes in infrastructure, policy, skills and practice.
TRIAL REGISTRATION NUMBERS: ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.