Evaluation of the implementation of the Kangaroo Mother Care after the DIB project in three health facilities in the central Cameroon region

Abstract

<title>Abstract</title> Background Neonatal mortality remains high in Cameroon and stagnant since 2014 at 28‰ according to DHS 2018. In the strategy to reduce this mortality, the project named “Development Impact Bond” (DIB) was set up in ten health facilities in Cameroon. Our objective was to determine the level of implementation of KMC as well as its effect on neonatal mortality in three health facilities in the central region. Methods We carried out a cross-sectional study using a mixed (quantitative and qualitative) approach with simultaneous triangulation and retrospective data collection. To assess the level of KMC implementation, we chose the progress monitoring model proposed by Bergh et al in 2005. Qualitatively, we used an observation grid and a semi-structured interview guide to collect their verbatims according to the different phases of KMC implementation. Results After the DIB project, our evaluation showed a level of achievement in the institutionalization stage and progress towards sustainable KMC practice, with scores of 24.5, 25 and 27.5 out of 30 points respectively for YGOPH, YUTH and BDH. During the project, there was a 1.6-fold, 2-fold and 4-fold reduction in mortality for YGOPH, YUTH and BDH respectively, followed by a trend towards increased mortality in 2 first-rate facilities, notably YUTH and YGOPH. The causes of this post-project performance appear to be difficulties in involving administrators, in communicating with mothers and in reducing the motivation of caregiver’s staff. Conclusion The level of implementation of the KMC after the DIB project was high, notwithstanding a rebound in mortality that may be explained by continuing managerial, social and technical difficulties.