Integration of Kangaroo Mother Care in Health Systems: a Systematic Review of Barriers and Enablers

Session: Scale-up of Kangaroo Mother Care: What Works, What Doesn’t, and What’s Next

Presenter: Grace Chan, Harvard T. H. Chan School of Public Health
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Background: Kangaroo mother care (KMC) has been shown to prevent newborn mortality and morbidities. Despite its benefits, country-level adoption and implementation have been limited and coverage of KMC remains low. We discuss how health systems and contextual factors influence the scale-up of KMC.

Methods: We searched PubMed, Embase, Scopus, Web of Science, and the World Health Organization Regional Databases for studies with ‘kangaroo mother care’, ‘kangaroo care’ or ‘skin to skin care’ from January 1, 1960 to April 2014. We included programmatic reports and hand searched references of published reviews. Two independent reviewers screened articles and abstracted data on KMC, adoption systems, health system characteristics, and contextual factors. We developed a conceptual model to analyze the integration of KMC in health systems using NVivo.

Results: We screened 2544 studies and included 94 studies that contained qualitative data on KMC implementation. KMC was variously applied in different contexts and influenced by behavioral change. The complexity of KMC affected the speed and likelihood of its uptake. Adopters of KMC – parents, health care workers, and health facilities – faced challenges with buy-in and bonding, social support, time, medical concerns, access, and cultural norms. Health systems level key barriers included organization, financing, and service delivery. In the broad context, cultural norms influenced the perceptions and success of adoption.

Conclusions:  KMC is a complex intervention that is behavior driven and includes multiple elements. Success of integration requires high user engagement and stakeholder involvement. Future research includes designing and testing models of interventions to improve KMC uptake.