Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County, Kenya

Abstract

Purpose: Kangaroo Mother Care (KMC) entails infants and mothers having constant skin-to-skin contact. KMC is done in the hospital after delivery to preterm infants or after early discharge. Mothers or caregivers are sensitized on proper positioning, breastfeeding, hygiene, and preventive measures to protect infants from infections. Proper follow-up is critical to ensure effective results are achieved. The use of KMC was endorsed by the World Health Organization (WHO) as routine care for preterm infants with a birth weight of ≤2000 grams, especially the clinically stable infants. This recommendation was based on the available moderate-quality evidence that it works by providing warmth (thermal care) and increasing breastfeeding opportunities irrespective of setting, birth weight, or gestational age. Also, KMC has been strongly acclaimed and used as a natural thermoregulator, infection prevention, and nutrition for preterm infants, which are critical for physiological functions that are strongly affected by physical immaturity. Although this technique offers quality care to these babies, its implementation is low. There is a need to determine the suitable methods to improve its implementation in Kenya's healthcare facilities. This study aimed to determine factors influencing the implementation of KMC in Makueni County health facilities.
 Methodology: The study was conducted in maternity units of six sub-county hospitals (Makueni county referral hospital, Makindu sub-county hospital, Kibwezi sub-county hospital, Mbooni sub-county hospital, Kilungu sub-county hospital, and Sultan-Hamud sub-county hospital) in Makueni County. Cross-sectional study design with mixed methods was used. Semi-structured questionnaires and KMC checklist were filled by the researcher and research assistants. The convenience sampling technique was carried out, and 90 healthcare providers and 6 Key Informants were interviewed. Data was analyzed using version 23 of a statistical package for social sciences using descriptive and inferential statistics.
 Findings: The study results reveal that young health care providers portrayed better KMC implementation compared to the old (r=-.210, p=0.047). In relation to gender, female health care providers had better KMC implementation compared to the male (r= -.290, p=0.006).Knowledge (r=.282, p=0.007) and health workers' perception of KMC (r=.245, p=0.02) had a positive and significant relationship with implementing KMC. Perception (β=1.149, p=0.05) and funds (β=0.958, p=0.05) had a positive and significant effect on implementing KMC. R squared indicated that jointly, age, gender, perception, and budget accounted for 29.4% of the overall variation in the KMC implementation. Results demonstrated a high level of KMC (33.3%) implementation among the health facilities. The study concluded that funds and collaboration had a positive and significant effect on implementing KMC.
 Unique Contribution to Theory, Practice and Policy: The study recommends that the hospital management should ensure there is provision of adequate resources to support KMC implementation. In particular, the hospital management should focus on strengthening physical and human resources. There is also a need to link all relevant programs, such as essential newborn care and Integrated Management of Neonatal and Childhood Illnesses (IMNCI), to support KMC implementation.