Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study
Abstract Background Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and p...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Implementation Science Communications |
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| Online Access: | https://doi.org/10.1186/s43058-021-00215-9 |
| _version_ | 1818391061541683200 |
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| author | Saima Mehjabeen Mowtushi Matin Rajat Das Gupta Ipsita Sutradhar Yameen Mazumder Minjoon Kim Shamina Sharmin Jahurul Islam Malabika Sarker |
| author_facet | Saima Mehjabeen Mowtushi Matin Rajat Das Gupta Ipsita Sutradhar Yameen Mazumder Minjoon Kim Shamina Sharmin Jahurul Islam Malabika Sarker |
| author_sort | Saima Mehjabeen |
| collection | DOAJ |
| description | Abstract Background Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and prolonged skin-to-skin contact between an infant and caregiver, exclusive breastfeeding, early discharge from the hospital, and post-discharge follow-up. The purpose of this study was to investigate the fidelity of this intervention’s implementation according to national guidelines across all tiers of government (public) health facilities of Bangladesh. Methods We adopted a triangulation mixed-methods approach of both quantitative and qualitative components in this research to support and explain the information obtained from quantitative observation with the help of qualitative interviews on the fidelity of KMC practice. We used an observation checklist to find the fidelity of KMC practice and used semi-structured guidelines to explain and understand the moderators of fidelity through key informant interviews and in-depth interviews. We undertook eight facility visits in four districts, observed twenty-three neonates and their caregivers during KMC practice at those facilities, and conducted twenty-seven key informant interviews with facility managers, health care providers, and five in-depth interviews with caregivers. Extracted information was triangulated and arranged under the themes of the fidelity framework. Results Despite being a low-cost intervention, findings exhibit some adherence to the national guideline with several gaps in practice. Leadership played a critical role in ensuring the KMC practice. Specific components of KMC practice, like duration, nutrition maintenance, discharge criteria, and follow-up, were not consistent as recommended. Infrastructure, human resources, developmental partner support, and the demand-side and supply-side responsiveness played a critical role in enacting this human-centric approach’s fidelity. The observed interruption found in the implementation process posed threats to achieve the intended outcome as these caused violations of the basic principles of KMC. Conclusions The study findings will help find ways to effectively deliver this intervention so that fidelity of practice is maintained, enhancing KMC services’ quality and advocating towards the successful scale-up of this program. |
| first_indexed | 2024-12-14T05:07:32Z |
| format | Article |
| id | doaj.art-9f1f406c3227412587fe4dc76632cc5f |
| institution | Directory Open Access Journal |
| issn | 2662-2211 |
| language | English |
| last_indexed | 2024-12-14T05:07:32Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj.art-9f1f406c3227412587fe4dc76632cc5f2022-12-21T23:16:04ZengBMCImplementation Science Communications2662-22112021-10-012111310.1186/s43058-021-00215-9Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method studySaima Mehjabeen0Mowtushi Matin1Rajat Das Gupta2Ipsita Sutradhar3Yameen Mazumder4Minjoon Kim5Shamina Sharmin6Jahurul Islam7Malabika Sarker8Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityCenter of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityCenter of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityCenter of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityCenter of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityHealth Section, United Nations Children’s Fund (UNICEF)Health Section, United Nations Children’s Fund (UNICEF)MNCAH, Directorate General of Health Services (DGHS)Center of Excellence for Science of Implementation & Scale-Up (CoE-SISU), BRAC James P Grant School of Public Health, BRAC UniversityAbstract Background Kangaroo mother care (KMC) is a proven low-cost intervention to prevent neonatal mortality of pre-term and low birth weight babies and is very relevant to Bangladesh. KMC provides thermal regulation and thus directly avert neonatal mortality. KMC includes early, continuous, and prolonged skin-to-skin contact between an infant and caregiver, exclusive breastfeeding, early discharge from the hospital, and post-discharge follow-up. The purpose of this study was to investigate the fidelity of this intervention’s implementation according to national guidelines across all tiers of government (public) health facilities of Bangladesh. Methods We adopted a triangulation mixed-methods approach of both quantitative and qualitative components in this research to support and explain the information obtained from quantitative observation with the help of qualitative interviews on the fidelity of KMC practice. We used an observation checklist to find the fidelity of KMC practice and used semi-structured guidelines to explain and understand the moderators of fidelity through key informant interviews and in-depth interviews. We undertook eight facility visits in four districts, observed twenty-three neonates and their caregivers during KMC practice at those facilities, and conducted twenty-seven key informant interviews with facility managers, health care providers, and five in-depth interviews with caregivers. Extracted information was triangulated and arranged under the themes of the fidelity framework. Results Despite being a low-cost intervention, findings exhibit some adherence to the national guideline with several gaps in practice. Leadership played a critical role in ensuring the KMC practice. Specific components of KMC practice, like duration, nutrition maintenance, discharge criteria, and follow-up, were not consistent as recommended. Infrastructure, human resources, developmental partner support, and the demand-side and supply-side responsiveness played a critical role in enacting this human-centric approach’s fidelity. The observed interruption found in the implementation process posed threats to achieve the intended outcome as these caused violations of the basic principles of KMC. Conclusions The study findings will help find ways to effectively deliver this intervention so that fidelity of practice is maintained, enhancing KMC services’ quality and advocating towards the successful scale-up of this program.https://doi.org/10.1186/s43058-021-00215-9Kangaroo mother careKMCFidelityImplementation researchBangladesh |
| spellingShingle | Saima Mehjabeen Mowtushi Matin Rajat Das Gupta Ipsita Sutradhar Yameen Mazumder Minjoon Kim Shamina Sharmin Jahurul Islam Malabika Sarker Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study Implementation Science Communications Kangaroo mother care KMC Fidelity Implementation research Bangladesh |
| title | Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study |
| title_full | Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study |
| title_fullStr | Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study |
| title_full_unstemmed | Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study |
| title_short | Fidelity of kangaroo mother care services in the public health facilities in Bangladesh: a cross-sectional mixed-method study |
| title_sort | fidelity of kangaroo mother care services in the public health facilities in bangladesh a cross sectional mixed method study |
| topic | Kangaroo mother care KMC Fidelity Implementation research Bangladesh |
| url | https://doi.org/10.1186/s43058-021-00215-9 |
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