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Background

Kangaroo Mother Care (KMC) is an evidence-based intervention recommended by the World Health Organization (WHO) to reduce preterm mortality and morbidity. The aim of this study was to explore caregivers’ experiences of providing KMC in hospital settings and after continuation at home in Bangladesh in order to assess enablers and barriers to optimal implementation.

Methods

Interviews with fifteen caregivers were conducted using an interview guide with semi-structured questions in August 2019 and March 2020. Convenience sampling was used to select hospitals and participants for the study. The inclusion criteria were being a caregiver currently performing KMC in the hospital or having been discharged one week earlier from the KMC ward. The interviews were audio recorded, transcribed verbatim, and translated. The data were analyzed using thematic analysis with an inductive approach.

Results

Three themes were identified as regards the caregivers’ experiences of providing KMC: conducive conditions, an empowering process, and suboptimal implementation. The results showed that there are supporting circumstances for caregivers performing KMC in Bangladesh, including social support structures and positive attitudes to the method of care. It also appeared that the caregivers felt strengthened in their roles as caregivers by learning and performing KMC. However, the implementation of KMC was suboptimal due to late initiation of KMC, difficulties with keeping the baby skin-to-skin, and pain after cesarean section hampering skin-to-skin practice.

Conclusions

The social and cultural conditions for the caregivers to perform KMC as well as the empowerment the parents felt in their roles as caregivers when performing KMC are facilitating factors for this method of care. Initial separation and late initiation of KMC, as well as disregard for the mothers’ needs for care and support, were barriers to optimal practice leading to missed opportunities. These facilitators and barriers need to be addressed in order to succeed in scaling up the national KMC program.

Aim: To explore healthcare providers' experiences of facility-initiated KMC in Bangladesh.

Methods: An explorative qualitative study based on 11 semi-structured interviews with health care providers (HCPs) from two hospitals in Dhaka was conducted. Nurses, senior nurses, medical officers, and pediatric consultants were representing the HCPs. Qualitative content analysis was used.

Results: Supporting KMC needs to be a continuous process that requires a high level of commitment from healthcare staff. Optimal implementation is however challenged by structural conditions such as shortage of staff, separation of mother and child, and incomplete follow-up, which need to be addressed to support KMC.

Conclusion: Findings from this formative research can aid in designing interventions for scaling up KMC in Bangladesh by paying attention to the crucial role of healthcare providers, and giving them training on the importance of continuous and repeated counseling to both mother and family. To enhance motivation, involving nurses in follow-up care is essential, alongside strengthening the health system for families living far away and tracking those not attending follow-up.  Furthermore, this study highlights the need to adapt clinical practice in Bangladesh to the recently updated WHO recommendations for KMC.