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Background: Kangaroo mother care (KMC) is an effective intervention for preterm and low birth weight infants. Effective implementation of KMC relies on a multidisciplinary team centering on the newborn’s caregiver, who delivers care with support from health care workers. This study explored the experiences of caregivers on the implementation of KMC. Methods: We conducted a descriptive qualitative study in the phenomenological tradition, an interpretative approach to describe the caregivers’ lived experience with KMC at four health facilities in Malawi from April and June 2019 through 10 non-participatory observations and 24 face-to-face interviews. We drew a purposive sample of 14 mothers, six fathers, three grandmothers, and one grandfather of infants receiving KMC in three secondary and one tertiary level hospitals. Data were analyzed following a thematic approach. Results: Caregivers had limited information on KMC before admission with most of the information learned from peers rather than medical professionals. Stories of positive outcomes following KMC contributed to a shift in perceptions of premature babies and acceptability of KMC as an effective intervention. Unintended consequences resulting from admission due to KMC disrupts responsibilities around the home and disrupts economic activities. Gender division of roles exists with the implementation of KMC and a mother’s support networks are crucial. Conclusion: Kangaroo mother care is feasible and acceptable among caregivers. KMC babies are described more positively with the potential to grow into strong and healthy children. KMC remains focused on the mother, which undervalues the important roles of her support network. A change in the nomenclature from kangaroo mother care to kangaroo care would include fathers and others delivering care.
This was a descriptive qualitative study in the phenomenological tradition, an interpretative approach that emphasizes understanding meanings people make of their experiences [17, 18], and aimed to describe the caregivers’ lived experience with KMC at four health facilities in Malawi. Our explorations of KMC are part of the larger project, “Integrating a neonatal healthcare package for Malawi”, funded as part of the Innovating for Maternal and Child Health in Africa initiative by the Canadian International Development Research Centre, Global Affairs Canada, and the Canadian Institutes for Health Research. We conducted the study at one tertiary (urban) and three secondary-level (district) hospitals in southern Malawi. Two district hospitals were government facilities while the third was a faith-based facility under a government service agreement to provide essential health services free of cost to patients. The selection of these health facilities was in liaison with the Malawi Ministry of Health and has been reported elsewhere [19]. Preterm and low birth weight (< 2500 g) newborns are admitted to KMC when determined to be in stable condition (no signs of fever, hyperthermia, weight loss, sunken eyes, protruding fontanel, or failure to feed). The timing of clinical assessment and KMC initiation varied depending on the infant’s health status and availability of staff at the time of birth. Prior to data collection, project staff briefed the clinical management teams at each of the hospitals. We employed a purposive sampling approach to select four to six caregivers of infants receiving KMC in each hospital, caregivers included mothers, fathers, and grandmothers. Our sample size was guided by the size of KMC wards (2–8 beds in each) and Guest et al’s argument that data saturation is often achieved by the 12th interview [20]. With the support of nursing officers at each hospital, we approached mothers providing KMC during their hospital stay. We prioritized caregivers of infants who had spent at least one night in the KMC ward. Those with less than five hours in the KMC ward had limited experience in the ward and were not approached for recruitment. Researchers also asked mothers if the baby’s father or other caregivers would be interested in participating in the study. Fathers rarely stayed at the hospital and were approached during the visiting hours and recruited irrespective of whether their wife had been interviewed or not. Of all women approached, two refused to take part, citing that they were busy with the care of the babies. We collected the data between April and June 2019 through non-participatory observations and face-to-face interviews of 30–60 minutes at each of the four health facilities after written consent was obtained from each participant. We piloted the topic guide at the tertiary hospital to ascertain its ability to capture the desired information and the appropriateness of the questions in local settings. A team of five Malawian researchers collected the data after intensive training in qualitative research methods. Researchers had no prior relationships with research participants. They first introduced themselves as members of IMCHA, a research group at the College of Medicine University of Malawi (CoM), and explained the study in detail. Observations were conducted in the KMC ward in each of the four hospitals following a guide covering the description of the room and infrastructure, clinical staff and patient interactions, the process of KMC practice, peer interactions, and anything else of note to the experience of KMC. Observations took on average 45–60 minutes and all observations were made during weekday day shifts. Interviews were conducted in a private setting within the health facility, in the local language (Chichewa) and audio recorded with permission. Data collectors compiled field notes after interviews and the qualitative team had multiple discussions to reflect the process and emerging themes, to discuss the dependability of our findings and the context of our research [21]. There were no repeat interviews. Data were stored in locked cabinets at CoM and in password-protected computers with access limited to lead researchers. Audio recordings were transcribed verbatim, translated into English, and managed using NVivo 12 software (QSR International, Melbourne, Australia). Participants were assigned codes that were used throughout the data collection and management process to maintain confidentiality. We employed a thematic approach in analyzing the data. Pilot data underwent preliminary analysis to develop the coding framework (MWK, MA in Medical Anthropology, and ALMN, Ph.D in Health Systems and Policy). Considering the exploratory approach of qualitative research and the value of shared patient stories, all data collected were analyzed including the pilot interviews. SS conducted the primary coding using the framework under the supervision of MWK and ALNM and the three discussed the data at intervals to reflect and refine the coding framework as necessary. We verified the themes against the audios to ensure that they were representative of the data.
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