The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison
Abstract Background Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment). In US studies, H-HOPE increased mothe...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-04-01
|
| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-023-04015-z |
| _version_ | 1797840887576788992 |
|---|---|
| author | Esnath M. Kapito Ellen M. Chirwa Elizabeth Chodzaza Kathleen F. Norr Crystal Patil Alfred O. Maluwa Rosemary White-Traut |
| author_facet | Esnath M. Kapito Ellen M. Chirwa Elizabeth Chodzaza Kathleen F. Norr Crystal Patil Alfred O. Maluwa Rosemary White-Traut |
| author_sort | Esnath M. Kapito |
| collection | DOAJ |
| description | Abstract Background Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care. Method This pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC). Results The final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96). Conclusion This study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide. |
| first_indexed | 2024-04-09T16:22:04Z |
| format | Article |
| id | doaj.art-ddeb5f3851f44ab6bc9512f4fb70f362 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-09T16:22:04Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-ddeb5f3851f44ab6bc9512f4fb70f3622023-04-23T11:28:22ZengBMCBMC Pediatrics1471-24312023-04-0123111110.1186/s12887-023-04015-zThe H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparisonEsnath M. Kapito0Ellen M. Chirwa1Elizabeth Chodzaza2Kathleen F. Norr3Crystal Patil4Alfred O. Maluwa5Rosemary White-Traut6School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health SciencesSchool of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health SciencesSchool of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health SciencesChildren’s Hospital of Wisconsin, Children’s Research InstituteCollege of Nursing, University of Illinois ChicagoMalawi University of Science and TechnologyChildren’s Hospital of Wisconsin, Children’s Research InstituteAbstract Background Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care. Method This pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC). Results The final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96). Conclusion This study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide.https://doi.org/10.1186/s12887-023-04015-zMother-infant responsivityPreterm birthKangaroo Mother Care (KMC)Early behavioral interventionH-HOPEMalawi |
| spellingShingle | Esnath M. Kapito Ellen M. Chirwa Elizabeth Chodzaza Kathleen F. Norr Crystal Patil Alfred O. Maluwa Rosemary White-Traut The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison BMC Pediatrics Mother-infant responsivity Preterm birth Kangaroo Mother Care (KMC) Early behavioral intervention H-HOPE Malawi |
| title | The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison |
| title_full | The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison |
| title_fullStr | The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison |
| title_full_unstemmed | The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison |
| title_short | The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison |
| title_sort | h hope behavioral intervention plus kangaroo mother care increases mother preterm infant responsivity in malawi a prospective cohort comparison |
| topic | Mother-infant responsivity Preterm birth Kangaroo Mother Care (KMC) Early behavioral intervention H-HOPE Malawi |
| url | https://doi.org/10.1186/s12887-023-04015-z |
| work_keys_str_mv | AT esnathmkapito thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT ellenmchirwa thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT elizabethchodzaza thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT kathleenfnorr thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT crystalpatil thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT alfredomaluwa thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT rosemarywhitetraut thehhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT esnathmkapito hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT ellenmchirwa hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT elizabethchodzaza hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT kathleenfnorr hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT crystalpatil hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT alfredomaluwa hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison AT rosemarywhitetraut hhopebehavioralinterventionpluskangaroomothercareincreasesmotherpreterminfantresponsivityinmalawiaprospectivecohortcomparison |