FACILITATORS AND BARRIERS TO IMPLEMENTATION OF FACILITY-BASED KANGAROO MOTHER CARE IN EAST AFRICA: WHAT IS THE EVIDENCE?

Abstract

Abstract

Background: Globally, Neonatal Mortality Rate (NMR) is19 deaths per 1000 live births with African region having the highest (28 per 1000 live births).  Sub-Saharan Africa accounts for 38% of the global neonatal deaths, while Kenya’s NMR is at 22 per 1000 live births. Largest direct cause of neonatal mortality globally is prematurity and Low Birth Weight. Many neonatal deaths are preventable through healthcare interventions and Kangaroo Mother Care has been recommended as an alternative method to conventional care that reduces neonatal mortality by a half. Despite strong evidence that KMC is safe, easy to use, cost-effective and high impact intervention for preterm and LBW babies, the uptake is very low globally and in Africa, especially developing countries.

Methods: This was a systematic review. Database search limited to full text articles published in English, from 1986 to October 2017 was conducted using Google Scholar, SCOPUS, CINAHL, PubMed, African Journals Online (AJOL) and Web of Science.  Hand searching and search through grey literature was also done.

Results: Sixteen studies that met the inclusion criteria were identified comprising:  Six evaluation studies, two qualitative studies, four mixed methods studies, one unblinded randomized clinical trial, one cross-sectional survey, one descriptive cross-sectional survey and one observational study. Findings show that there were variations and similarities regarding KMC implementation among the six East African countries namely; Kenya, Uganda, Tanzania, Rwanda, Ethiopia and Sudan. Findings also showed that implementation and scale-up of KMC is dependent on factors within health facilities, community and the health system.

Conclusion: Successful implementation of KMC is facilitated by a well laid down framework that incorporates prior preparation of the health facilities, community sensitization and health system strengthening.