Health facilities struggle to implement 'kangaroo care'

Reuters Health - Making sure mothers have skin-to-skin contact with newborns is known to benefit babies, especially premature infants, but the practice is slow to catch on in healthcare facilities, researchers say.

Known as “Kangaroo Mother Care,” or skin-to-skin, this simple strategy can reduce newborn deaths and sickness, but hospitals often struggle to implement it due to time constraints, lack of staff training, cultural norms and lack of government support, a research review concludes in Health Policy and Planning, online August 24.

“Globally, newborn mortality continues to be very significant. Although the global community has made progress, we have many challenges in the first 28 days of life,” said lead study author Dr. Grace Chan of Boston Children’s Hospital in Massachusetts.

Preterm birth complications are the leading cause of death among children under age 5, according to the World Health Organization. Babies born preterm, in particular, face higher susceptibility to infections, lung complications and hypothermia. Studies predict kangaroo mother care can reduce mortality by 40%, Chan added.

“Not many of the current interventions we have are cost-effective and scalable,” Chan told Reuters Health in a phone interview. “If we could achieve high coverage of kangaroo mother care across the globe, we could significantly reduce newborn mortality.”

Chan and colleagues analyzed 86 studies about kangaroo care and skin-to-skin practices that encourage parents and babies to have as much skin contact as possible in the hours and days following birth. More than half were published since 2010.

The research team found six main reasons why healthcare workers and their facilities struggle to implement kangaroo care regularly: buy-in about the benefits, social support, time to train and provide the service, medical concerns such as the stability of the mother or baby after birth, access to training and resources, and cultural norms related to newborn care or facility policies.

For example, many healthcare staff said newborn care wasn’t a high priority at their workplace. In some locations, kangaroo mother care was seen as the “poor man’s alternative” to higher-tech postpartum care and was believed to be associated with developing countries, the study authors note.

“We’ve found that doing what’s natural seems to work,” Chan said. “Healthcare systems tend to separate parents and babies initially, but do they really need to be? There’s no better caretaker than the mother or father.”

Staff shortages, high turnover and a lack of training in preterm care also slowed buy-in for kangaroo mother care, Chan and colleagues found. If one or two healthcare workers are the main champions for kangaroo care, they are often saddled with the responsibility of training. When they move to a new location, the training and buy-in often leaves with them.

“We’re still kind of stumbling a little bit because of our lack of manpower to move forward with a lot of our things,” one healthcare worker said in a 2012 study. “I think the intent and the will is there, just we require more team members.”

In healthcare settings in Ghana and Uganda, for example, workers increased buy-in by putting up posters that explain kangaroo mother care and its benefits, and nurses signed up for workshops and text reminders to encourage the practice with parents.

In some hospitals, nurses worried about hurting the preterm baby while moving it for skin contact, especially if they had to maneuver cords and wires. Healthcare workers also had varying beliefs about whether to do skin-to-skin contact immediately after birth, what clothing preterm babies should wear for certain temperatures, and how soon mothers and babies should be discharged from the hospital after birth.

“I was surprised by how often lack of time and resources was cited,” said Debi Ferrarello, director of family education for the University of Pennsylvania Health System in Philadelphia, who wasn’t involved with the study.

“The reality is that kangaroo mother care is inexpensive, easy to implement, and can create an environment for babies that actually reduces the workload of healthcare workers,” she said by email.


Health Policy Plan 2017.