Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions

BMC Pregnancy and Childbirth

Research

Severin Ritter von Xylander¹  Gary L Darmstadt²  Kim E Dickson³  Linda Vesel⁴  Anne-Marie Bergh⁵  Bina Valsangkar⁶  Kate J Kerber⁶  Hannah Blencowe⁷  Joy E Lawn⁷  Sarah G Moxon⁷  Joseph de Graft Johnson⁸  Juan Gabriel Ruiz Peláez⁹  Goldy Mazia^1,10 

[1] Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland;Department of Pediatrics, Stanford University School of Medicine, 94305, Stanford, CA, USA;Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, 10017, New York, NY, USA;Innovations for Maternal, Newborn and Child Health, Concern Worldwide US, 355 Lexington Avenue, 10017, New York, NY, USA;Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, 10017, New York, NY, USA;On behalf of the KMC Research Acceleration Group, USA;MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, 0007, Arcadia, Pretoria, South Africa;Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, 20036, Washington, DC, USA;Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, 20036, Washington, DC, USA;Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, 20036, Washington, DC, USA;USAID's Maternal and Child Survival Program, 455 Massachusetts Avenue NW, Suite 1000, 20001, Washington, DC, USA;School of Medicine, Pontificia Universidad Javeriana, Carrera 7 No 40-62, Bogotá, Colombia;Fundación Canguro, Calle 56A No 50-36 - Bloque A13, Apto 416, Pablo VI Azul, Bogotá, Colombia;Hospital Universitario San Ignacio, Carrera 7 No 40-62, Bogotá, Colombia;USAID's Maternal and Child Survival Program, 455 Massachusetts Avenue NW, Suite 1000, 20001, Washington, DC, USA;

关键词: Neonatal;    newborn;    preterm;    kangaroo mother care;    skin-to-skin care;    health systems;    mortality;    quality;   

DOI  :  10.1186/1471-2393-15-S2-S5

来源: Springer

【 摘 要 】

BackgroundPreterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up.MethodsThe bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC.ResultsMarked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks.ConclusionsThere are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.

【 授权许可】

CC BY   
© Vesel et al. 2015