Barriers and Enablers of KMC Implementation in Health Facility and Community of Tigray Region, Northern Ethiopia: Formative Research

Abstract

Background

Kangaroo mother care (KMC) is an evidence-based approach to reducing morbidity and mortality in low-birth-weight and preterm newborns. Barriers for KMC and its effective practice at a larger scale are highly affected by contextual factors. The purpose of this study is to explore barriers and enablers in the community and health facilities for implementation and continuation of KMC.

Methods

This formative study employed a qualitative exploratory approach using focus group discussions and in-depth interviews in five zones of Tigray region, Northern Ethiopia. A total of 16 focus group discussions and 46 in-depth interviews were conducted with health workers and community members. The whole process of data collection took an iterative approach. An inductive thematic analysis was done by going through the transcribed data using ATLAS.ti software.

Results

The current study found that problems of infrastructure and equipment for KMC practice, shortage of staff, and absence of trained health workers as the most frequently mentioned barriers by health workers. Low level of awareness, lack of support, mother being responsible for the rest of the family, holding babies in the front being traditionally unacceptable, and preference of incubators for better care of small babies were among the barriers identified in the community. Presence of community health workers and the positive attitude of the community towards them, as well as antenatal and postnatal care were among the favorable conditions for the implementation of KMC at health facilities and continuation of KMC at home.

Conclusion

Empowering health workers through training to identify preterm and low-birth-weight babies, to do follow-ups after discharge, and creating awareness in the community to change the perception of kangaroo mother care are necessary.

Keywords:

• kangaroo mother care
• KMC
• implementation research
• low birth weight
• Ethiopia
• newborn care
• preterm birth
• KMC implementation
• enablers and barriers to KMC

Abbreviations

ANC, antenatal care; CHW, community health workers; ERC, ethical review committee; FGD, focus group discussion; HEW, health extension workers; IDI, in-depth interview; KMC, kangaroo mother care; LBW, low birth weight; NICU, neonatal intensive care unit; PNC, postnatal care; WDG, women development group; WHO, World Health Organization.

Data Sharing Statement

Data will be available upon official request. Please contact MYH.

Ethics Approval and Consent to Participate

Ethical approval to conduct the assessment was obtained from the institutional review board of Mekelle University and by World Health Organization (WHO) Ethical Review Committee ERC 0740/2016. Support letter was obtained and written to each district health offices from the Tigray regional health bureau. A verbal consent which was recorded on audio was taken from every participant. The study complies with the Declaration of Helsinki.

Acknowledgments

We would like to thank Dr. Rajiv Bahil, Dr. Jose Martines, and Dr. Anayda Portella from World Health Organization for their technical support and guidance. We are thankful to all key informant researchers and study participants for taking part in the study. We would also like to thank Mekelle University, Tigray Regional Health Bureau, and Federal Ministry of Health for the support that was provided to us in undertaking the study.

Disclosure

The authors declare that they have no conflicts of interest in relation to this work.

Additional information

Funding

This formative research was conducted as part of the “KMC Implementation Research for Accelerating Scale Up project in Tigray region, Ethiopia”. The project was financially supported by Bill and Melinda Gates Foundation and technical Supported by World Health Organization. The funding organization didn’t have any role in influencing the interpretation of the research findings and their implication.