An integrative review of parent-partnerships within neonatal care facilities in low- and lower-middle-income countries

Tom Coghlan; Tracey  Mills; Carol Bedwell

doi:10.51496/jogm.v4.151

Authors

Tom Coghlan BAO Queen’s University Belfast, Belfast, UK; and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
Tracey Mills Centre for Childbirth, Women’s and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK https://orcid.org/0000-0002-2183-7999
Carol Bedwell Centre for Childbirth, Women’s and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK https://orcid.org/0000-0001-8031-7793

DOI:

https://doi.org/10.51496/jogm.v4.151

Keywords:

Health Facilities, Infant, Kangaroo Mother Care, Neonatology, Newborn

Abstract

Background: Neonatal deaths in low-income countries account for a disproportionate percentage of all-mortality rates of children under 5. Parental-participation in neonatal care has been proven to improve outcomes for key developmental factors that influence morbidity and mortality of infants.

Objectives: This review aims to explore the current models of parent-partnership used in neonatal care facilities and identify factors that influence effective utilisation in low-resource nations.

Methods: This Integrative Review was performed by searching the databases of CINAHL, Medline and Global Health. The search was conducted using key-terms relating to Neonatology, Kangaroo Mother Care and Parent-Partnerships. Papers published between 2011 and 2021, from lower- and lower-middle-income countries, were included.

Results: The search identified 336 publications. Following screening and full-text review, 24 studies were identified that satisfied the inclusion criteria. Data were quality-appraised using the Mixed-Methods Appraisal Tool and extracted utilising the framework described by Whittemore and Knafl.

The analysis produced nine key themes – KMC as the predominant model of parent-partnership; the positive impact parent-partnerships have upon infants; the positive impact for parents; positive impact for nursing staff; enabling and limiting factors that influence implementation; pre-existing social and cultural barriers; task-sharing between staff and family; and how education influences perceptions.

Conclusions: Economic, social and cultural factors have been identified that strongly influence and inhibit the widespread use of parent-partnerships in neonatal care facilities. KMC is the predominant model of parent-partnership. A future or adapted form of healthcare in these facilities should include a structured approach of education, empowerment, enhanced male and community involvement that simultaneously accommodates to the psychosocial needs of the family unit.

References

UNICEF. Neonatal Mortality Unicef.org: Unicef; 2023. Available from: https://data.unicef.org/topic/child-survival/neonatal-mortality/ [cited 27 October 2023].

World bank. Neonatal Mortaility rate; 2023. Available from: https://data.worldbank.org/indicator/SH.DYN.MORT [cited 26 June 2023].

World Health Organization. Every newborn action plan; 2023. Available from: https://www.who.int/initiatives/every-newborn-action-plan [cited 26 June 2023].

Tasker RC, McClure RJ, Acerini CL. Oxford handbook of paediatrics. 2nd ed. Oxford, United Kingdom: Oxford University Press; 2013. DOI: https://doi.org/10.1093/med/9780199608300.001.0001

Institute-for-Health-Metrics-and-Evaluation. Local burden of disease – Under 5 mortality; 2023. Available from: https://vizhub.healthdata.org/lbd/under5.

WHO. SURVIVE and THRIVE: Transforming care for every small and sick newborn. who.int: Geneva, Switzerland: WHO; 2019.

Flacking R, Lehtonen L, Thomson G, Axelin A, Ahlqvist S, Moran VH, et al. Closeness and separation in neonatal intensive care. Acta Paediatr 2012;101(10):1032–7. doi: 10.1111/j.1651-2227.2012.02787.x DOI: https://doi.org/10.1111/j.1651-2227.2012.02787.x

Fernandez M, Maria I, Granero-Molina J, Fernandez-Sola C, Manuel Hernandez-Padilla, Camacho Avila M, et al. Bonding in neonatal intensive care units: experiences of extremely preterm infants’ mothers. Women Birth 2018;31(4):325–30. doi: 10.1016/j.wombi.2017.11.008 DOI: https://doi.org/10.1016/j.wombi.2017.11.008

Klawetter S, Greenfield JC, Speer SR, Brown K, Hwang SS. An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents. AIMS Public Health 2019;6(2):160–83. doi: 10.3934/publichealth.2019.2.160 DOI: https://doi.org/10.3934/publichealth.2019.2.160

Waddington C, O’ Brien K, Patel N. Family integrated care: supporting parents as primary caregivers in the neonatal intensive care unit. Pediatr Investig 2021;5(2):148–54. doi: 10.1002/ped4.12277 DOI: https://doi.org/10.1002/ped4.12277

Franck LS, O’Brien K. The evolution of family-centered care: from supporting parent-delivered interventions to a model of family integrated care. Birth Defects Res 2019;111(15):1044–59. doi: 10.1002/bdr2.1521 DOI: https://doi.org/10.1002/bdr2.1521

Benzies KM, Aziz K, Shah V, Faris P, Isaranuwatchai W, Scotland J, et al. Effectiveness of Alberta family integrated care on infant length of stay in level II neonatal intensive care units: a cluster randomized controlled trial. BMC Pediatr 2020;20(1):535. doi: 10.1186/s12887-020-02438-6 DOI: https://doi.org/10.1186/s12887-020-02438-6

O’Brien K, Bracht M, Macdonell K, McBride T, Robson K, O’Leary L, et al. A pilot cohort analytic study of family integrated care in a Canadian neonatal intensive care unit. BMC Pregnancy and Childbirth. 2013;13(suppl 1):S12. doi: 10.1186/1471-2393-13-S1-S12 DOI: https://doi.org/10.1186/1471-2393-13-S1-S12

Church PT, Grunau RE, Mirea L, Petrie J, Soraisham AS, Synnes A, et al. Family Integrated Care (FICare): Positive impact on behavioural outcomes at 18 months. Early Hum Dev 2020;151: 105196. doi: 10.1016/j.earlhumdev.2020.105196 DOI: https://doi.org/10.1016/j.earlhumdev.2020.105196

O’Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018;2(4):245–54. doi: 10.1016/S2352-4642(18)30039-7 DOI: https://doi.org/10.1016/S2352-4642(18)30039-7

Martinez HR, E. Manejo racional del niño prematuro. Bogota, Colombia: Curso de Medicina Fetal; 1983.

WHO. Kangaroo Mother Care: a practical guide: WHO; 2003. Available from: https://apps.who.int/iris/bitstream/handle/10665/42587/9241590351.pdf;jsessionid=1111F89F92580217FF6D25A7A5768BC8?sequence=1 [cited 09 August 2023].

Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Glob Health 2023;8(6). doi: 10.1136/bmjgh-2022-010728 DOI: https://doi.org/10.1136/bmjgh-2022-010728

Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, et al. Enhanced kangaroo mother care for heel lance in preterm neonates: a crossover trial. J Perinatol 2009;29(1):51–6. doi: 10.1038/jp.2008.113 DOI: https://doi.org/10.1038/jp.2008.113

Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, et al. Kangaroo mother care and neonatal outcomes: a meta-analysis. PEDIATRICS 2016;137(1):e20152238. doi: 10.1542/peds.2015-2238 DOI: https://doi.org/10.1542/peds.2015-2238

Karimi FZ, Sadeghi R, Maleki-Saghooni N, Khadivzadeh T. The effect of mother-infant skin to skin contact on success and duration of first breastfeeding: a systematic review and meta-analysis. Taiwanese J Obstet Gynecolo 2019;58(1):1–9. doi: 10.1016/j.tjog.2018.11.002 DOI: https://doi.org/10.1016/j.tjog.2018.11.002

Sinha B, Sommerfelt H, Ashorn P, Mazumder S, Taneja S, More D, et al. Effect of community-initiated kangaroo mother care on postpartum depressive symptoms and stress among mothers of low-birth-weight infants: a randomized clinical trial. JAMA Netw Open 2021;4(4):e216040. doi: 10.1001/jamanetworkopen.2021.6040 DOI: https://doi.org/10.1001/jamanetworkopen.2021.6040

Mörelius E, Örtenstrand A, Theodorsson E, Frostell A. A ran domised trial of continuous skin-to-skin contact after preterm birth and the effects on salivary cortisol, parental stress, depression, and breastfeeding. Early Hum Dev 2015;91(1):63–70. doi: 10.1016/j.earlhumdev.2014.12.005 DOI: https://doi.org/10.1016/j.earlhumdev.2014.12.005

Bergh A-M, Kerber K, Abwao S, Johnson Jd-G, Aliganyira P, Davy K, et al. Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa. BMC Health Serv. Res 2014;14:293. doi: 10.1186/1472-6963-14-293 DOI: https://doi.org/10.1186/1472-6963-14-293

Kinshella M-LW, Hiwa T, Pickerill K, Vidler M, Dube Q, Goldfarb D, et al. Barriers and facilitators of facility-based kangaroo mother care in sub-Saharan Africa: a systematic review. BMC Pregnancy Childb 2021;21(1):176. doi: 10.1186/s12884-021-03646-3 DOI: https://doi.org/10.1186/s12884-021-03646-3

Chan G, Bergelson I, Smith E, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health Policy Plann 2017;32(10):1466–75. https://doi.org/10.1093/heapol/czx098 DOI: https://doi.org/10.1093/heapol/czx098

Phiri PGMC, Chan CWH, Wong CL. The scope of family-centred care practices, and the facilitators and barriers to implementation of family-centred care for hospitalised children and their families in developing countries: an integrative review. J Pediatr Nurs 2020;55:10–28. doi: 10.1016/j.pedn.2020.05.018 DOI: https://doi.org/10.1016/j.pedn.2020.05.018

Arya S, Naburi H, Kawaza K, Newton S, Anyabolu CH, Bergman N, et al. Immediate ‘Kangaroo Mother Care’ and survival of infants with low birth weight. New Engl J Med 2021;384(21):2028–38. doi: 10.1056/NEJMoa2026486 DOI: https://doi.org/10.1056/NEJMoa2026486

Maniago JD, Almazan JU, Albougami AS. Nurses’ kangaroo mother care practice implementation and future challenges: an integrative review. Scand J Caring Sci 2020;34(2):293–304. doi: 10.1111/scs.12755 DOI: https://doi.org/10.1111/scs.12755

Reiter A, De Meulemeester J, Kenya-Mugisha N, Tagoola A, Kabajaasi O, Wiens MO, et al. Parental participation in the care of hospitalized neonates in low- and middle-income countries: a systematic review and meta-analysis. Front Pediatr 2022;10:987228. doi: 10.3389/fped.2022.987228 DOI: https://doi.org/10.3389/fped.2022.987228

Ridley DD. The literature review: a step-by-step guide for students. 2nd ed. London, United Kingdom: SAGE; 2012.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs 2005;52(5):546–53. doi: 10.1111/j.1365-2648.2005.03621.x DOI: https://doi.org/10.1111/j.1365-2648.2005.03621.x

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J 2021;372:n71. doi: 10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71

Worldbank. Low and lower-middle income nations. 2023. Available from: https://data.worldbank.org/country/XN [cited 26 June 2023].

Hong Q, Gonzalez-Reyes A, Pluye P. Improving the usefulness of a tool for appraising the quality of qualitative, quantitative and mixed methods studies, the Mixed Methods Appraisal Tool (MMAT). J Eval Clin Prac 2018;24(3):459–67. doi: 10.1111/jep.12884 DOI: https://doi.org/10.1111/jep.12884

Mathias CT, Mianda S, Ginindza TG. Facilitating factors and barriers to accessibility and utilization of kangaroo mother care service among parents of low birth weight infants in Mangochi District, Malawi: a qualitative study. BMC Pediatr 2020;20(1):355. doi: 10.1186/s12887-020-02251-1 DOI: https://doi.org/10.1186/s12887-020-02251-1

Jamali QZ, Shah R, Shahid F, Fatima A, Khalsa S, Spacek J, et al. Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan. PloS One 2019;14(6):e0213225. doi: 10.1371/journal.pone.0213225 DOI: https://doi.org/10.1371/journal.pone.0213225

Morgan MC, Nambuya H, Waiswa P, Tann C, Elbourne D, Seeley J, et al. Kangaroo mother care for clinically unstable neonates weighing ≤2000 g: is it feasible at a hospital in Uganda?. J Glob Health 2018;8(1):010701. doi: 10.7189/jogh.06.0207028.010701 DOI: https://doi.org/10.7189/jogh.06.0207028.010701

Ndiaye S, Bosowski J, Tuyisenge L, Penn-Kekana L, Thorogood N, Moxon SG, et al. Parents as carers on a neonatal unit: qualitative study of parental and staff perceptions in a low-income setting. Early Hum Dev 2020;145:105038. doi: 10.1016/j.earlhumdev.2020.105038 DOI: https://doi.org/10.1016/j.earlhumdev.2020.105038

Mbwele B, Ide NL, Reddy E, Ward SAP, Melnick JA, Masokoto FA, et al. Quality of neonatal healthcare in Kilimanjaro region, northeast Tanzania: learning from mothers’ experiences. BMC Pediatr 2013;13:68. doi: 10.1186/1471-2431-13-68 DOI: https://doi.org/10.1186/1471-2431-13-68

Ghavane S, Eklare D, Mohammad H. Long term outcomes of kangaroo mother care in very low birth weight infants. J Clin Diagn Res 2016;10(12):SC13–SC5. doi: 10.7860/JCDR/2016/23855.9006 DOI: https://doi.org/10.7860/JCDR/2016/23855.9006

Musabyemungu JA, Willson A, Batenhorst S, Webbe J, Cartledge PT. What topics should we teach the parents of admitted neonates in the newborn care unit in the resource-limited setting – a Delphi study. Matern Health Neonatol Perinatol 2019;5:11. DOI: https://doi.org/10.1186/s40748-019-0106-8

Omondi GB, Serem G, Abuya N, Gathara D, Stanton NA, Agedo D, et al. Neonatal nasogastric tube feeding in a low-resource African setting – using ergonomics methods to explore quality and safety issues in task sharing. BMC Nurs 2018;17:46. doi: 10.1186/s12912-018-0314-y DOI: https://doi.org/10.1186/s12912-018-0314-y

Gallagher K, Colin P, Hoang TT, Suzanna L, Duncan M. Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study. BMC Pediatr 2017;17(1):1–11. doi: 10.1186/s12887-017-0909-6

Mazumder S, Upadhyay R, Hill Z, Taneja S, Dube B, Kaur J, et al. Kangaroo mother care: using formative research to design an acceptable community intervention. BMC Public Health 2018;18:1–. doi: 10.1186/s12889-018-5197-z DOI: https://doi.org/10.1186/s12889-018-5197-z

Bergh AM, Manu R, Davy K, Rooyen Ev, Asare GQ, Awoonor-Williams JK, et al. Progress with the implementation of kangaroo mother care in four regions in Ghana. Ghana Med J 2013;47(2):57–63.

Jesmin P, Gustafsson FE, Moran AC, Suchismita R, Persson LÅ, Anisur R. Implementing kangaroo mother care in a resource-limited setting in rural Bangladesh. Acta Paediatr 2015;104(5):458–65. doi: 10.1111/apa.12929 DOI: https://doi.org/10.1111/apa.12929

Dandekar RH, Muhammed S. Kangaroo mother care technology as a boon to tertiary care hospital in western Maharashtra. Int J Biomed Adv Res 2013;4(10):731–4. doi: 10.7439/ijbar.v4i10.502 DOI: https://doi.org/10.7439/ijbar.v4i10.502

Lydon M, Longwe M, Likomwa D, Lwesha V, Chimtembo L, Donohue P, et al. Starting the conversation: community perspectives on preterm birth and kangaroo mother care in southern Malawi. J Glob Health 2018;8(1):010703. doi: 10.7189/jogh.08.010703 DOI: https://doi.org/10.7189/jogh.08.010703

Mazumder S. Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial. Lancet (British edition) 2019;394(10210):1724–36. doi: 10.1016/S0140-6736(19)32223-8 DOI: https://doi.org/10.1016/S0140-6736(19)32223-8

Kampekete GSM, Ngoma C, Masumo M. Acceptance of kangaroo mother care by mothers of premature babies. Afr J Midwifery Women’s Health 2018;12(4):178–88. doi: 10.12968/ajmw.2018.12.4.178 DOI: https://doi.org/10.12968/ajmw.2018.12.4.178

Chavula K, Likomwa D, Valsangkar B, Luhanga R, Chimtembo L, Dube Q, et al. Readiness of hospitals to provide Kangaroo Mother Care (KMC) and documentation of KMC service delivery: analysis of Malawi 2014 Emergency Obstetric and Newborn Care (EmONC) survey data. J Glob Health 2017;7(2):020802. doi: 10.7189/jogh.07.020802 DOI: https://doi.org/10.7189/jogh.07.020802

Bilal SM, Tadele H, Abebo TA, Tadesse BT, Muleta M, W/Gebriel F, et al. Barriers for kangaroo mother care (KMC) acceptance, and practices in southern Ethiopia: a model for scaling up uptake and adherence using qualitative study. BMC Pregnancy Childbirth 2021;21(1):25. doi: 10.1186/s12884-020-03409-6 DOI: https://doi.org/10.1186/s12884-020-03409-6

Ghavane S, Murki S, Subramanian S, Gaddam P, Kandraju H, Thumalla S. Kangaroo mother care in kangaroo ward for improving the growth and breastfeeding outcomes when reaching term gestational age in very low birth weight infants. Acta paediatr 2012;101(12):e545–e9. doi: 10.1111/apa.12023 DOI: https://doi.org/10.1111/apa.12023

Dawar R, Nangia S, Thukral A, Chopra S, Khanna R. Factors impacting practice of home kangaroo mother care with low birth weight infants following hospital discharge. J Trop Pediatr 2019;65(6):561–8. doi: 10.1093/tropej/fmz007 DOI: https://doi.org/10.1093/tropej/fmz007

Kapoor R, Verma A, Dalal P, Gathwala G, Dalal J. Enhancing kangaroo mother care uptake through implementation of an education protocol. Indian J Pediatr. 2021;88(6):544–9. doi: 10.1007/s12098-020-03537-z DOI: https://doi.org/10.1007/s12098-020-03537-z

Mousumi A, Salamat K, Mohammad S, Nadira M, Akhtar A. Management of preterm low birth weight infants in Dhaka: a comparison between standard care and kangaroo mother care. J Pediatr Neonat Individualized Med 2020;10(1):e100111–e.

Obaid Ur Rehman M, Hayat S, Gul R, Irfan Waheed KA, Victor G, Khan MQ. Impact of intermittent kangaroo mother care on weight gain of neonate in nicu: Randomized control trial. J Pak Med Association 2020;70(6):973–7.

Acharya N, Singh R, Bhatta N, Poudel P. Randomized control trial of kangaroo mother care in low birth weight babies at a tertiary level hospital. J Nepal Paediatr Soc 2014;34(1):18–23. doi: 10.3126/jnps.v34i1.8960 DOI: https://doi.org/10.3126/jnps.v34i1.8960

Gallagher K, Partridge C, Tran HT, Lubran S, Macrae D. Nursing & parental perceptions of neonatal care in Central Vietnam: a longitudinal qualitative study. BMC Pediatr 2017;17:1–11. doi: 10.1186/s12887-017-0909-6 DOI: https://doi.org/10.1186/s12887-017-0909-6

Seidman G, Unnikrishnan S, Kenny E, Myslinski S, Cairns-Smith S, Mulligan B, et al. Barriers and enablers of kangaroo mother care practice: a systematic review. PloS One 2015;10(5):e0125643. doi: 10.1371/journal.pone.0125643 DOI: https://doi.org/10.1371/journal.pone.0125643

Smith ER, Bergelson I, Constantian S, Valsangkar B, Chan GJ. Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives. BMC Pediatr 2017;17:35. doi: 10.1186/s12887-016-0769-5 DOI: https://doi.org/10.1186/s12887-016-0769-5

Sripad P, Peterson S, Idrissou D, Kamanga M, Kezembe A, Ndwiga C, et al. Applying a power and gender lens to understanding health care provider experience and behavior: a multicountry qualitative study. Glob Health Sci Pract 2023;11(Suppl 1):e2200420. doi: 10.9745/GHSP-D-22-00420 DOI: https://doi.org/10.9745/GHSP-D-22-00420