PT  - JOURNAL ARTICLE
AU  - Maryann Washington
AU  - Leah Macaden
AU  - Annetta Smith
AU  - Sumithra Selvam
AU  - Prem K. Mony
TI  - Determinants of Kangaroo Mother Care Uptake for Small Babies Along the Health Facility to Community Continuum in Karnataka, India
AID  - 10.9745/GHSP-D-22-00457
DP  - 2023 May 25
TA  - Global Health: Science and Practice
4099  - http://www.ghspjournal.org/content/early/2023/05/24/GHSP-D-22-00457.short
4100  - http://www.ghspjournal.org/content/early/2023/05/24/GHSP-D-22-00457.full
AB  - Key FindingsPlace of hospitalization determines the early initiation and duration of kangaroo mother care (KMC).The competence of health care workers (HCWs) enables KMC initiation and optimal duration before discharge and at least until the seventh day after discharge.Support for mothers at the health facility to initiate and maintain KMC determines its early initiation and longer duration.Key ImplicationsHealth facility managers need to invest in contextual, supportive capacity-building strategies for HCWs and community health workers (CHWs) to facilitate the uptake of KMC along the health facility to community continuum.Health facility managers and implementers (HCWs and CHWs) need to find ways to support mothers along the health facility to community continuum to initiate and maintain KMC uptake for as long as required.Introduction:Kangaroo mother care (KMC) scale-up is a proposed strategy to accelerate reduction in neonatal mortality rates. We aimed to identify determinants of KMC uptake for small babies (less than 2,000 g birth weight) along the health facility to community continuum in Karnataka, India.Methods:From June 2017 to March 2020, data on characteristics of health facilities and health care workers (HCWs) from 8 purposively selected health facilities were assessed. Knowledge, attitude, and support the mothers received for KMC uptake were assessed once between 4 weeks and 8 weeks unadjusted age of the cohort of babies. Secondary data on KMC were obtained from the district-wide implementation research project database. Bivariate analysis was used to assess the association of characteristics of health facilities, HCWs, mothers, and small babies with the day of KMC initiation and its duration. Log-binomial regression analysis was then computed to identify determinants of KMC.Results:We recruited 227 (91.5%) of 248 babies eligible to participate with a mean unadjusted age of 35.6 days (±7.5) and 1,693.9 g (±263.1 g) birth weight. KMC was initiated for 95.2% of 227 babies at the health facility; initiated at 3 days or earlier of life for 59.6% of 226 babies; and babies continued to receive KMC for more than 4 weeks (30.2 days [±8.4]) at home. Determinants of KMC initiation were HCWs’ attitudes, initiation support at the health facility, and place of hospitalization. Determinants of KMC maintenance at the health facility were HCWs’ skills and support the mother received at the facility after initiating KMC. Place of hospitalization and HCWs’ knowledge determined KMC duration at home 1 week after discharge.Conclusion:These findings emphasize the importance of competent HCWs and support for mothers at the health facility for initiation and maintenance of KMC within the health facility and 1 week after discharge.