Selamawit Mengesha Bilal1, Henok Tadele2,3, Teshome Abuka Abebo4, Birkneh Tilahun Tadesse2, Mekonnen Muleta5, Fitsum W/Gebriel2, Akalewold Alemayehu4, Yusuf Haji4, Dejene Hailu Kassa4, Ayalew Astatkie4, Anteneh Asefa4, Million Teshome6, Aknaw Kawza7, Shemels Wangoro8, Thomas Brune9, Nalini Singhal10, Bogale Worku11, Khalid Aziz12. 1. College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia. Selamhunu@gmail.com. 2. Department of Paediatrics, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia. 3. Department of Pediatrics and Child Health, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia. 4. College of Medicine and Health Sciences, Faculty of Health Sciences, School of Public Health, Hawassa University, Hawassa, Ethiopia. 5. Independent Consultant, Addis Ababa, Ethiopia. 6. Department of Obstetrics and Gynaecology, College of Medicine and Health Sciences, Faculty of Medicine, Hawassa University, Hawassa, Ethiopia. 7. South Nations and Nationalities Regional Health Bureau Head, Hawassa, Ethiopia. 8. South Nations and Nationalities Regional Health Bureau, Maternal and Child Health Director, Hawassa, Ethiopia. 9. Sachs' Children and Youth Hospital, Stockholm, Sweden. 10. Paediatrics, University of Calgary, Calgary, Canada. 11. School of Medicine, Addis Ababa University, Ethiopian Paediatrics Society, Addis Ababa, Ethiopia. 12. Paediatrics, University of Alberta, Edmonton, Canada.
Abstract
BACKGROUND: Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. METHODS: A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. RESULTS: Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. CONCLUSIONS: Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.
BACKGROUND: Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. METHODS: A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. RESULTS: Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. CONCLUSIONS: Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.
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