evaluation of kangaroo mother care in malawi n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Evaluation of Kangaroo Mother Care in Malawi PowerPoint Presentation
Download Presentation
Evaluation of Kangaroo Mother Care in Malawi

Loading in 2 Seconds...

play fullscreen
1 / 13

Evaluation of Kangaroo Mother Care in Malawi - PowerPoint PPT Presentation


  • 184 Views
  • Uploaded on

Evaluation of Kangaroo Mother Care in Malawi. Reuben Ligowe, 1 Anne-Marie Bergh, 2 Elise van Rooyen, 2 Joy Lawn, 3 Evelyn Zimba, 1 George Chiundu 1.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Evaluation of Kangaroo Mother Care in Malawi' - gay-holt


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
evaluation of kangaroo mother care in malawi

Evaluation of Kangaroo Mother Care in Malawi

Reuben Ligowe,1 Anne-Marie Bergh,2

Elise van Rooyen,2 Joy Lawn,3

Evelyn Zimba,1 George Chiundu1

1 Save the Children Malawi Country Office; 2 MRC Unit for Maternal and Infant Health Care Strategies and University of Pretoria; 3 Save the Children/Saving Newborn Lives

background newborn deaths
Background - Newborn deaths
  • 1.2 million newborn deaths in Sub-Saharan Africa per year
    • 60-90% in low birth weight infants
    • 27% of deaths are directly due to preterm birth complications
  • Malawi (2006):
    • Under five mortality has been reduced by 30% in 5 years, but neonatal is not reducing so fast
    • 14,900 newborns die every year (NMR 31/1000 live births)
    • Newborn LBW rate of 20%
    • Preterm births are the leading cause of newborn deaths
    • 57% of births are in facilities

Source: Opportunities for Africa’s Newborns. Eds Lawn and Kerber. 2007

background kangaroo mother care
Background – Kangaroo Mother Care

Benefits of Kangaroo Mother Care are well known:

  • To the mother
  • To the baby
  • To the hospital and the health system
background kmc in malawi
Background – KMC in Malawi
  • 1999:Establishment of KMC unit in Zomba Central Hospital (ZCH) with European Union funding
  • 2000-2005: Introduction of KMC in 6 more hospitals with the support of Save the Children, and KMC was introduced as part of Essential Newborn Care (ENC) in Malawi
      • 3 central hospitals (tertiary, public)
      • 4 secondary (1 public, 3 mission)
      • Training: Zomba as training centre – 5-10 days’ training
  • 2005: National guidelines for KMC
  • 2007:Evaluation of the state of KMC implementation – purpose:
    • What had worked and what not?
    • Scaling-up to all district hospitals? Community links?
    • How to deal with lack of human resources and long off site training time?
methods for the evaluation
Methods for the evaluation
  • Use of South African standardised progress-monitoring tool to get a sense of the nature of quality of KMC practice
  • Qualitative data collected through discussions with key informants
  • Visit to 6 hospitals supported by Save the Children for KMC
  • Telephone conference with 7th supported hospital
  • Visit to 3 other health care facilities for comparison
results
Results
  • Successful & sustainable KMC implementation:
    • 5 of 7 supported hospitals
    • 3 central hospitals & 2 mission hospitals
    • Other 2 supported hospitals have KMC wards, but problems sustaining services (partly human resource challenges)
  • 3 of supported hospitals have trained providers from other sites
  • High awareness of KMC outside study hospitals
  • Not all health workers have sufficient information and confidence to start KMC in other facilities
achievements and strengths
Achievements and strengths

National:

  • National KMC policy - 2004
  • KMC included in pre-service training for nurses
  • High degree of awareness of KMC

Institutional:

  • Dedication of staff despite hardships
  • Good use of visual material (posters and cards)
  • Availability of KMC register
challenges
Challenges

Human resources – management and perceptions:

  • Health workers not perceiving newborn care as a priority in health system
  • Insufficient nursing and clinical supervision in some units
  • Staff shortages
  • Staff rotations – staff with skills in KMC are lost
  • Long off-site training, and limited on-site follow-up, especially if started in “project mode”
  • Resistance to on site training by other trained staff – perceived loss of remuneration during off-site training
  • Limited orientation of new health care staff in KMC
challenges1
Challenges

Implementation and follow-up:

  • Perception that KMC can not be implemented without a special unit, special beds and heaters
  • Improvement in quality of records, especially on feeding
  • Simple feeding job aids needed to calculate and record volumes for expressed breast milk
  • Variation in discharge criteriabetween hospitals
  • Lack of appropriate follow-up systems, and major challenges in follow up and access
missed opportunities
Missed opportunities

Recommendations for immediate attention:

  • Introduce intermittent KMC for stable infants in neonatal unit
    • Do not wait for establishment of a KMC unit
    • Do not wait until the criteria is met for continuous KMC

(2) Strengthening current feeding practices for all babies in KMC:

    • Misunderstanding of “feeding on demand”—>
    • Scheduled feeding times needed for LBW infants
    • Supervision, using patient attendants to support mothers

(3) Use of KMC (skin-to-skin position) to transport babies between home and facilities or between facilities

potential for scaling up kmc
Potential for scaling up KMC

Recommendations:

  • Shorter, integrated off-site training & on-site facilitation/ support
  • 1-day workshops for district officials
  • 2-day workshops for key implementers in district hospitals

Factors crucial for sustainability:

  • Active support of management at all levels
  • Experienced person needed to drive the process
  • Good communication and consultative participation
  • Sending the right people for training – ongoing support essential
  • Sensitisation of community health structures and local leaders
  • Integration of KMC into current services –not project mentality
  • Establishment of a community follow-up system essential
conclusion
Conclusion
  • There are awareness of the benefits of KMC in Malawi, even in hospitals and health centres not practising KMC
  • Strong support from Ministry of Health, good partnerships
  • Possible to design and implement a scale-up programme for Malawi to involve all district hospitals
  • Tracking of practices and quality advisable
  • Leadership and enough personnel are crucial
final conclusion
Final Conclusion
  • Extreme lack of medical staff in Malawi - Only 3 national paediatricians in the country
  • Novel approaches are therefore required - e.g. use of patient attendants

Thank you