“We All Join Hands”: Perceptions of the Kangaroo Method Among Female Relatives of Newborns in The Gambia

listen audio

Study Justification:
– Limited research on perceptions of female relatives regarding kangaroo mother care (KMC)
– No published studies from West African contexts
– Family support is essential for KMC
Study Highlights:
– In-depth interviews conducted with 11 female relatives of preterm neonates in The Gambia
– Female relatives willing to support mothers by providing KMC and assisting with domestic chores and agricultural labor
– Three themes identified: collective family responsibility for newborn care, balance between traditional practices and acceptance of KMC, and gendered expectations of women’s responsibilities postnatally
Study Recommendations for Lay Reader:
– Female relatives are influential stakeholders and could play important roles in KMC programs
– Encourage community ownership of KMC
– Contribute to improved outcomes for vulnerable newborns
Study Recommendations for Policy Maker:
– Include female relatives in KMC programs and policies
– Provide resources and support for female relatives to participate in KMC
– Promote community engagement and ownership of KMC programs
Key Role Players:
– Female relatives of newborns
– Mothers
– Healthcare providers
– Community leaders
– Policy makers
Cost Items for Planning Recommendations:
– Training and education for female relatives on KMC
– Transportation expenses for female relatives to participate in KMC programs
– Resources for KMC implementation (e.g., kangaroo care units, educational materials)
– Community engagement activities
– Monitoring and evaluation of KMC programs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on in-depth interviews conducted with a purposive sample of 11 female relatives of preterm neonates admitted to The Gambia’s referral hospital. Thematic analysis was conducted using an inductive framework. The study is part of the formative phase for a randomized controlled trial investigating Kangaroo Mother Care (KMC) before stabilization in neonates weighing <2,000 g. The abstract provides information on the study setting, participant characteristics, data collection methods, and analysis approach. However, the sample size is small, and the abstract does not provide information on the generalizability of the findings or the limitations of the study. To improve the strength of the evidence, future research could consider increasing the sample size, including participants from diverse backgrounds, and providing a more comprehensive discussion of the study's limitations.

Family support is essential for kangaroo mother care (KMC), but there is limited research regarding perceptions of female relatives, and none published from West African contexts. In-depth interviews were conducted from July to August 2017 with a purposive sample of 11 female relatives of preterm neonates admitted to The Gambia’s referral hospital. Data were coded in NVivo 11, and thematic analysis was conducted applying an inductive framework. Female relatives were willing to support mothers by providing KMC and assisting with domestic chores and agricultural labor. Three themes were identified: (a) collective family responsibility for newborn care, with elder relatives being key decision makers, (b) balance between maintaining traditional practices and acceptance of KMC as a medical innovation, and (c) gendered expectations of women’s responsibilities postnatally. Female relatives are influential stakeholders and could play important roles in KMC programs, encourage community ownership, and contribute to improved outcomes for vulnerable newborns.

Based on the concept that perceptions of newborns and their care are influenced by social phenomena, we aimed to construct accounts of participants’ experience, which were collected using in-depth interviews, observations, and reflexive field notes. The study formed part of the formative phase for a randomized controlled trial investigating KMC before stabilization in neonates weighing 18 years) female relatives of newborns weighing ≤2,000 g who were admitted to the study site between April and July 2017. We used purposive sampling to identify participants by approaching mothers of currently hospitalized neonates or those discharged within the preceding month. They were contacted by the interviewers in person or by phone, and invitations were extended to their female relatives. Women who were willing to participate contacted the interviewers to arrange a convenient time, and transport expenses were provided. Because different generations and family lines may have different perspectives, we aimed to include maternal and paternal relatives from a range of generations. All participants interviewed were from different families and represented a different neonate. Sample size was based on the availability of participants within the study period. Semi-structured interviews were conducted over a 5-week period from July to August 2017 by the interviewers: a non-Gambian female midwife researcher and a multilingual Gambian female field worker. The Gambian interviewer enhanced the credibility of the interviewing team and was able to elucidate and interpret participants’ comments within the cultural context in which they were intended (Guba & Lincoln, 2005). Neither interviewer was involved in the clinical care of the participants or their newborn relatives. A semi-structured interview guide was used with open-ended questions concerning knowledge and perceptions of newborns, care of small newborns, and KMC (Supplementary File I). Written informed consent, including for audio-recording, was obtained in the participants’ preferred language, with impartial witnesses present for illiterate participants. Informed consent documents were in English, with verbal translation to local languages during the consent process, as per standard local consenting practice in view of the most common local languages having no formal written standard in routine use. Interviews were then conducted in Wolof or Mandinka, as preferred by the participant, in a private, nonclinical room at the hospital. A pictorial information sheet was used to assist the discussion (Supplementary File II). The interviews lasted between 30 and 40 minutes (average 37 minutes) and were recorded on an ICDPX 440 Sony digital recorder. The interviews were conducted by the same interviewers with the Gambian interviewer leading the interview and the non-Gambian interviewer present for observation of the interview process and reflexivity. The interviewers worked closely together to ensure understanding of the interview guide, and both were experienced in conducting interviews, including on similar topics. The interviewers were aware that as interviews were conducted in the hospital, participants possibly associated the study with the hospital and despite assurances of confidentiality and independence, this may have led to participants sharing what they thought the interviewers wanted to hear. To try and address this, we attempted to build rapport using a warmup session, and the semi-structured interview style allowed participants to lead portions of the interview. As only one interviewer conducted interviews, we were confident that internal validity of the questions was maintained between sessions. A pilot of two interviews was used to refine the interview guide and to ensure that the Gambian interviewer was familiar with the guide and able to readily translate into the spoken language. After each interview, the interviewers debriefed, which helped maintain reflexivity, improved interview technique, and challenged established assumptions during the analysis and writing. A field diary was kept to document the context and reflections from the interviews, informal conversations with hospital staff and insights into potential findings. Interviews were translated and transcribed into written English text by the same interviewers to ensure consistency and dependability (Tuckett, 2005). Three randomly selected transcripts underwent validation by an independent research nurse fluent in the local languages and English to monitor for accuracy of translation, and no major discrepancies were identified. The use of these research strategies contributed to the rigor of the data collection, especially the reliability and internal validity of data collected (Guba & Lincoln, 2005). All participants’ data were pseudonymized from the time of enrollment with unique study identification codes for confidentiality. All recordings were deleted from the recorder after transcription. Recordings and transcripts were securely stored on an access-restricted, central server at London School of Hygiene & Tropical Medicine (LSHTM). Ethical approval was obtained from the ethics committees at LSHTM (Ref. 12398) and The Gambia Government/Medical Research Council Joint Ethics Committee (Ref. 1535). Thematic analysis was conducted using an inductive framework (Braun & Clarke, 2006), allowing codes and themes to develop directly from the data. Due to time constraints, the full transcripts were read and coded by one researcher (the non-Gambian midwife interviewer), who then worked in a cell of qualitative researchers to map, reflect, and refine codes and interpretations of themes. This process was used to help strengthen the reliability of the coding (Guba & Lincoln, 2005). Transcripts were read twice with line-by-line coding on the third reading using NVivo 11 qualitative data analysis software (QSR International Pty Ltd.). The fourth reading focused on merging and reorganizing codes and examining unexpected findings and discrepancies. Codes were then collated into themes, which were refined through iterative analysis and thematic mapping. Themes evolved both directly from the data on a semantic level from explicit meanings and a latent level from interpretation of underlying patterns and ideas (Braun & Clarke, 2006). Quotes were selected to reflect the refined themes. This article was prepared in consultation with Standards for Reporting Qualitative Research (O’Brien et al., 2014).

The provided text appears to be a research article describing a study conducted in The Gambia on the perceptions of female relatives regarding kangaroo mother care (KMC) for preterm neonates. The study aimed to explore the role of female relatives in supporting mothers and their acceptance of KMC as a medical innovation. The research used in-depth interviews, observations, and reflexive field notes to collect data from a purposive sample of 11 female relatives. Thematic analysis was conducted using NVivo 11 software.

However, it seems that you are looking for innovations to improve access to maternal health. Unfortunately, the text you provided does not explicitly mention any innovations or recommendations in this regard. If you have any specific questions or need assistance with a different topic, please let me know.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health is to involve female relatives in Kangaroo Mother Care (KMC) programs. The study mentioned in the description found that female relatives were willing to support mothers by providing KMC and assisting with domestic chores and agricultural labor. This indicates that female relatives can play important roles in KMC programs and contribute to improved outcomes for vulnerable newborns.

To implement this recommendation, healthcare providers and policymakers can:

1. Raise awareness: Conduct educational campaigns to inform female relatives about the benefits of KMC and their role in supporting mothers. This can be done through community meetings, workshops, and distribution of informational materials.

2. Training programs: Provide training to female relatives on how to perform KMC and provide postnatal care. This can include hands-on training sessions, demonstrations, and interactive workshops.

3. Community engagement: Involve female relatives in the planning and implementation of KMC programs. This can be done through community meetings, focus groups, and consultations to ensure their perspectives and needs are considered.

4. Supportive environment: Create a supportive environment for female relatives to actively participate in KMC programs. This can include providing transportation assistance, flexible visiting hours, and designated spaces for KMC within healthcare facilities.

5. Peer support networks: Establish peer support networks for female relatives to share experiences, provide emotional support, and exchange knowledge and skills related to KMC. This can be done through support groups, online forums, and mentorship programs.

By involving female relatives in KMC programs, access to maternal health can be improved as they can provide valuable support to mothers and contribute to better outcomes for newborns.
AI Innovations Methodology
The provided text describes a study conducted in The Gambia to explore the perceptions of female relatives regarding the Kangaroo Mother Care (KMC) method for preterm neonates. The study aimed to understand the role of female relatives in supporting mothers and their willingness to participate in KMC programs. The methodology involved in-depth interviews with a purposive sample of 11 female relatives of preterm neonates admitted to The Gambia’s referral hospital. The data collected were coded and analyzed thematically using NVivo 11 software.

To improve access to maternal health, here are some potential recommendations:

1. Community Education and Awareness: Implement educational programs to raise awareness about maternal health, including the importance of antenatal care, skilled birth attendance, and postnatal care. This can be done through community health workers, local leaders, and mass media campaigns.

2. Mobile Health (mHealth) Solutions: Utilize mobile technology to provide maternal health information, reminders for appointments, and access to teleconsultations with healthcare providers. This can help overcome geographical barriers and improve access to healthcare services.

3. Transportation Support: Establish transportation services or subsidies to ensure pregnant women can easily access healthcare facilities, especially in remote areas. This can involve partnerships with local transport providers or the use of ambulances for emergency cases.

4. Maternal Waiting Homes: Set up maternal waiting homes near healthcare facilities to accommodate pregnant women who live far away. These homes can provide a safe and comfortable place for women to stay during the final weeks of pregnancy, ensuring they are close to the facility when labor begins.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data Collection: Gather baseline data on the current state of maternal health access, including indicators such as antenatal care coverage, skilled birth attendance, and postnatal care utilization. This can be done through surveys, interviews, and analysis of existing health records.

2. Modeling: Develop a mathematical model or simulation tool that incorporates the recommended interventions and their potential impact on improving access to maternal health. This model should consider factors such as population demographics, geographical distribution, healthcare infrastructure, and resource availability.

3. Parameter Estimation: Collect data on key parameters needed for the model, such as population size, distance to healthcare facilities, transportation costs, and the effectiveness of the interventions. This can be done through surveys, interviews, and literature review.

4. Simulation and Analysis: Run the simulation using the collected data and assess the impact of the recommended interventions on improving access to maternal health. Analyze the results to identify the most effective interventions and their potential outcomes in terms of increased access to maternal health services.

5. Sensitivity Analysis: Conduct sensitivity analysis to test the robustness of the model and assess the impact of uncertainties or variations in the input parameters. This will help understand the potential range of outcomes and identify areas where additional data or interventions may be needed.

6. Policy Recommendations: Based on the simulation results, develop policy recommendations for implementing the recommended interventions to improve access to maternal health. Consider factors such as feasibility, cost-effectiveness, and sustainability.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different interventions on improving access to maternal health and make informed decisions on implementing the most effective strategies.

Partilhar isto:
Facebook
Twitter
LinkedIn
WhatsApp
Email