Readiness of Hospitals to Provide Kangaroo Mother Care (KMC) and Documentation of KMC Service Delivery: Analysis of Malawi 2014 EmONC Survey Data

Presenter: Kondwani Chavula, Save the Children

Background: Malawi introduced Kangaroo Mother Care (KMC) in 1999 as part of its efforts to address newborn morbidity and mortality and has continued to expand KMC services across the country.  Yet, data on availability of KMC services and routine service provision are limited.

Methods: We analyzed data from the EmONC survey conducted in September-October 2014, which was a census of all 87 hospitals in Malawi.  We used the WHO SARA domains to generate indicators for KMC service readiness (staffing & guidelines, equipment & infrastructure, diagnostics, and medicines & commodities) and added a domain for documentation of KMC services provided.  Levels of KMC service delivery were quantified using data extracted from a 12 month register review and calculating a KMC initiation rate for each facility, dividing the reported number of babies initiated on KMC by the number of live births at facility.

Results: 77% of hospitals reported that they provided inpatient KMC services.  Among facilities reporting KMC, 75% met the most basic definition of readiness (staff, space for KMC and functional scale), 42% met an expanded definition of readiness (guidelines, staff, space, scale and register in use).  Only 60% of hospitals reporting KMC had documentation of providing KMC in the last 12 months and just 23% had a KMC initiation rate of 5 or more per 100 live births.  Overall, just 17% of hospitals met the basic readiness criteria and had a KMC initiation rate of 5 or more per 100 live births.

Conclusions: We found large differences between reported levels of KMC services and documented levels of KMC readiness and service provision among hospitals in Malawi. We recommend that facility assessments of services such as KMC include record reviews to better estimate service availability and delivery.  Further efforts to strengthen capacity of Malawian hospitals to deliver KMC are needed.