Kangaru Mother Care Info-graphic Book

INFOGRAPHIC ON KANGAROO MOTHER CARE CREATED BY: Centre of Excellence for Science of implementation and Scale-up(CoE-SISU) BRAC James P Grant school of Public Health, BRAC University And UNICEF Bangladesh

Kangaroo Mother Care (KMC) Kangaroo Mother Care (KMC) is an effective intervention for low birth weight babies suitable for implementing in the community and resource-limited health facility.

Bangladesh has declared KMC as a feasible intervention to be introduced and scaled-up nationwide.

•

Early, continuous, and prolonged skin-to-skin contact

•

Between infant and caregiver

•

Exclusive breastfeeding

•

Early discharge from hospital

•

Adequate support for caregiver and infant at home

Infographic on Kangaroo Mother Care 3

Preterm babies comprise the highest percentage of newborn death in Bangladesh.

0.4

7.2 Source: WHO and Maternal and Child Epidemiology, Estimation Group (MCEE) 2017

22.7 29.8 20.2

0.6

6

12.9

Why Implementation Research on Kangaroo Mother Care?

Benefits of Kangaroo Mother Care Increase bonding between baby and the care giver

Regulates baby's heart rate, breathing and body temperature

Increase mother's milk production

Promotes healthy sleep for brain growth

Strengthen immunity of the baby

Improves baby's weight gain

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To see readiness of the selected health facilities to provide KMC

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To identify enabling factors and barriers of KMC practice

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To see health system bottlenecks of KMC practice and implementation bottlenecks of KMC in selected health facilities

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To assess and recommend any policy level change and modification of operational strategies for quality scale-up

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To develop an evidence-based model for implementation and scale up of KMC in

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Bangladesh in order to reduce the burden of neonatal mortality due to LBW and prematurity.

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Research questions Implementation Research for Introducing Kangaroo Mother Care Services in Bangladesh

What are the drivers and barriers to implementing KMC in Bangladesh ?

What is the progress of selected health facilities towards implementation of KMC ?

What is the ďŹ delity of the KMC practices in selected health facilities?

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KURIGRAM

STUDY DESIGN EMBEDDED MIXED METHOD DESIGN

TANGAIL

QUALITATIVE KUSHTIA

QUANTITATIVE

DHAKA

SURVEY

STUDY SITES

KEY INFORMANT INTERVIEW(KII)

IN DEPTH INTERVIEW(IDI)

OBSERVATION

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Management owchart of LBW and preterm babies observed in all selected facilities

Out patient department (OPD) or Emergency

Labor ward (delivery)

Pediatric ward (refered to SCANU or KMC room)

SCANU room (unstable baby)

KMC room (stable baby)

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Implementation Drivers and Barriers: Consolidated Framework for Implementation Research (CFIR) INTERVENTION CHARACTERISTICS

INNER SETTING

EVIDENCE STRENGTH & QUALITY • KMC reduces neonatal mortality related to prematurity and LBW ADAPTABILITY • Skin to skin care aligned with the local culture • Suitable for existing health facility setting COMPLEXITY • Human centric approach • Needs intensive counseling • Post discharge follow-up COST

Implementation driver

Implementation barrier

STRUCTURAL CHARACTERISTICS

• Well equipped facilities with adequate staff

IMPLEMENTATION CLIMATE

• Structured supervision system

• Increased workload and shortage of staff

READINESS FOR IMPLEMENTATION

• Leadership engagement • Dedicated Space • KMC training

• No refresher training

• Cheaper Infographic on Kangaroo Mother Care 3

Implementation Drivers and Barriers: Consolidated Framework for Implementation Research (CFIR) OUTER SETTING

PATIENT NEED & SUPPORT

EXTERNAL POLICY AND INCENTIVES

INDIVIDUAL CHARACTERISTICS

Implementation driver

Implementation barrier

• Community demand • Suitable for health facility with available resource

• No dedicated service providers and Budget

• National guideline

• No performance based incentives • Inadequate logistics

KNOWLEDGE AND BELIEF ABOUT INTERVENTION

Implementation driver

Implementation barrier

• Motivation from personal experience

• Perceived advantage of Special Care Newborn Unit(SCANU) over KMC

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Implementation Drivers and Barriers: Consolidated Framework for Implementation Research (CFIR) IMPLEMENTATION PROCESS

Progress of health facilities towards implementation of KMC 30 28

Implementation barrier

6. SUSTAIN NEW PRACTICES

24

5. INTREGRATE INTO ROUTINE PRACTICE

• Leadership engagement • Development partner support

• No separate budget for KMC

16

4. IMPLEMENT

ENGAGING

• Poor counseling and communication with the beneficiaries

• Quality improvement system

78%

MOTHERS MAINRAINED KMC POSTION

87%

MOTHERS WERE COUNSELLED

10

4 2

65%

3. PREPARE TO IMPLEMENT TEMPARATURE WERE MEASURED FOR CONSECUTIVE 3 DAYS

8 6

REFLECTING AND EVALUATING

NEONATS MET KMC POSTION

14 12

• Engagement of stuffs as opinion leader and champion

78%

20 18

PLANNING AND EXECUTION

NEONATES MET ALL CRITERIA FOR STARTING KMC

26

22

Implementation driver

COMULATIVE SCORE

Fidelity of the KMC practices in selected health facilities

30%

2. COMMITE TO IMPLEMENT 1. CREATE AWARENESS

ALL DISCHARGE CRITERIA MET

11%

0

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A separate room with adequate privacy is a prerequisite for KMC

“

The mother who agrees, we refer her for KMC. For their benefit, we have built a separate noise free room, attached latrine, separate bed along with food with improved nutritional value

“

- SENIOR STAFF NURSE

Refresher training is necessary for provision of quality care: “I do feel that refresher training is essential. Without practice service providers tends to forget the procedure.”

- PHYSICIAN

Capacity building through training on Kangaroo Mother Care (KMC) “I participated in a three-day training on KMC at BSMMU. At that time, I came to know about KMC. After learning from there, I attempted several mothers to give KMC, and I found that the babies got improved.”

- SENIOR STAFF NURSE

Effective counseling is the key to successful implementation

Inadequate human resource affects the quality of service

“Their education and way of understanding are completely different from that of ours. It is our accomplishment if we can make them understand what is good for them… … Previously, when I used to work at IMCI corner, I counseled many patients. Now, I counsel and explain the necessity and benefits of KMC to relevant patient party at my chamber. Till now, no one refused me in this regard.”

-PHYSICIAN

“We required 128 nurses, but we have 68 nurses. By default, we are in lack of workforce, so it hampers the quality of service, but we have nothing to do.

We are overburden already. We need more workforce.”

–SUPERINTENDENT OF A SECONDARY LEVEL HOSPITAL

Ensuring post discharge follow up is still a challenge We ask the mother to come back for follow-up when they leave the hospital. But we could not start and establish the follow-up card yet. They come at their wish, then sometimes visit doctors and nurses… …

I think the area is very poor. They need money for transport purpose, so they do not come. If we could provide them with some money, they could have come for it, and thus KMC visit could have been increased.”

- SENIOR STAFF NURSE

Out of pocket expenditure is hampering the service “It is good if the duration of KMC is at least seven days. But we have few beds here, and patients come from distant places, a real problem. Two or three persons are needed for KMC because a mother cannot continue for 20 hours, who will give them food? So they have to bring food from home. For these reasons, patients don’t want to stay longer than two-three days. They say, sir our home is far away, financial problem, not having food” - PHYSICIAN

Recommendations: • Health care professionals should be trained through inclusion of KMC in the medical and nursing curriculum.

• Specific job description with clear roles and responsibilities of service providers of different levels for KMC activities, provision of structured, supportive supervisory programme and visit by KMC experts to health facilities.

• Identification of effective leadership and encouragement through performance based rewarding • Introducing a separate budget line for KMC in the facility budget and finding out local resources and means to self-sustain the practice.

• Ensuring retention of trained staff and proper placement of them.

DEVELOPED BY Centre of Excellence for Science of Implementation and Scale-Up (CoE-SISU) BRAC James P Grant School of Public Health, BRAC University and UNICEF Bangladesh CONTRIBUTORS Mowtushi Matin, Saima Mehjabeen, Yameen Mazumder, Atonu Rabbani Rajat Das Gupta, Shams Shabab Haider, Carlos Acosta Bermúdez, Juanita Vasquez Escallon GUIDED AND SUPERVISED BY Professor Malabika Sarker DESIGN BY Nuruzzaman Lucky PRINTED BY Color line, Mohakhali, Dhaka 1212