Mothers’ perceptions on the barriers and facilitators of practicing kangaroo mother care: an exploratory interview study with mothers admitted to NICU of SPHMMC, Addis Ababa, Ethiopia 2023 G.C

Abstract

Abstract Background: Kangaroo Mother Care (KMC) is defined as early, continuous, and prolonged skin-to skin contact between the mother (or other caregiver) and the baby, and exclusive breastfeeding. It is recommended for the routine care of preterm or low-birth-weight (LBW) newborns weighing 2000 g or less at birth. It can be initiated in the health-care facility or at home and should be given for 8–24 hours per day (as many hours as possible). It decreases mortality of premature and LBW infants by decreasing risk of hypothermia, and infection. While global experts now recognize KMC as an essential component of newborn care, its implementation and adherence to quality standards continue to pose challenges. Despite its significant impact and apparent feasibility, achieving the desired coverage of KMC for preterm and low-birth-weight newborns in low-income countries remains difficult. Objective: To explore the perceived barriers and facilitators affecting the implementation of KMC among mothers admitted to the NICU of SPHMMC, Addis Ababa, Ethiopia. Methods: Qualitative phenomenological research design was used in the study. A semi- structured in depth interview was applied to explore the perceived barriers and facilitators of KMC. A total of 20 mothers were included in the study with in-depth interview from Sep 2023 - Jan 2024 and thematic analysis was conducted. Result: The study explored various barriers and facilitators related to KMC adoption among mothers. These factors encompassed community support, family support, cultural and religious considerations, hospital setting challenges, and maternal and neonatal factors. Mothers reported that their lack of prior knowledge about KMC, coupled with poor understanding of KMC within their families and communities, acted as barriers to practicing KMC. Additionally, crowded KMC rooms with restricted access and limited family support within the KMC ward were also reported as barriers. Poor supervision and follow-up, along with limited resources (especially for rest after discharge from the maternity ward and during intermittent KMC periods), were major hospital-related barriers. Furthermore, maternal and neonatal factors, such as surgical site infection, fatigue during kangaroo care, managing twin and triplet babies, and dealing with ill newborns, posed additional challenges. Conclusion and recommendation: This study examines the impact of various factors on KMC utilization among mothers with preterm and low birth weight infants in the NICU. The findings highlight a complex interplay of barriers and facilitators that influence a mother’s ability to provide KMC. To enhance maternal performance and promote the well-being of preterm and LBW infants, comprehensive support from family, community, and healthcare professionals is crucial. Addressing these factors through policy adjustments and hospital interventions is essential for optimizing neonatal care services. Key words: kangaroo mother care, facilitator, barriers, low birth weight, preterm, Neonatal intensive care unit