Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Megan M. Lydon; Victoria Lwesha; Dyson Likomwa; Lydia Chimtembo; Tanya Guenther; Monica Longwe

doi:10.9745/GHSP-D-21-00727

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A Socioecological Model of KMC Engagement in 2 Districts in Malawi
Abbreviations: KMC, kangaroo mother care.

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TABLE 1.

KMC Study Participants From 2 Districts in Malawi, by Category

Participant Category	Sample Size, No.
Focus group discussions	Individuals	Groups
Pregnant women	48	4
KMC mothers	36	3
Community members	48	4
Total	132	11
In-depth interviews	Individuals
KMC fathers	6
Religious leaders	3
Community leaders	4
Nurses	3
Health surveillance assistants	4
Total	20

Abbreviations: KMC, kangaroo mother care.

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TABLE 2.

Areas for KMC Programmatic Intervention in Malawi

Social Norm	Insight for Implementation	Possible Actions
1. Although preterm infants are abnormal, they should still be cared for.	Build upon the existing shared value for life, including the lives of preterm infants.	Partner with faith and community gatekeepers or influencers to help reinforce message.
	Work to shift community attitudes about preterm infants towards positive perceptions.	Implement a community awareness and advocacy campaign to increase the value of preterm infants and awareness of the effectiveness of KMC. Highlight examples of preterm infants who have grown up to lead fruitful lives and contribute to family life.
2. Men should provide for their families, while women should care for their families.	Highlight the discrepancy between perceived and actual male behavior regarding KMC practices to normalize male involvement.	Engage male champions; popularize male involvement in KMC through interactive community dramas, radio shows, or other mechanisms; reward male KMC engagement in the public sphere.
	Share strategies that support and encourage both KMC parents to engage in the practice collaboratively.	Create a network of KMC alumni parents to share experiences with new KMC parents; impart learnings about KMC role-sharing in initial KMC counseling and ongoing household visits.
	Develop or strengthen efforts to provide economic relief to KMC parents.	Strengthen financial management training or messaging offered with antenatal care to prepare families for the costs related to childbirth, possible complications, and extended hospital stays. Offer families income-generating opportunities in the KMC ward and/or shorten hospital stays and supplement with community follow-up; consider disbursements to KMC families to offset economic losses and/or income-generating activities that can be accomplished while the infant is in the KMC position.
3. Families and communities should support one another.	Encourage existing family and community support systems and link vulnerable families to additional support.	Collaborate with community health workers, local leaders, and Community Action Groups to identify new KMC families that may need additional social support (such as families of twins or those where partner is absent) and link them to formal networks; establish peer mentoring among experienced and new KMC families.
3. Families and communities should support one another.	Strengthen linkages between the health facility and community-based care to ensure continued KMC support at the community level.	Provide an enabling environment for community health workers to support their ongoing KMC follow-up visits (e.g., ensuring transport for household visits, materials, supervision, regular salary). Strengthen the counter-referral system (referral back to the community level from the health facility) to allow for timely community follow-up of KMC families post-discharge.