Barriers and enabling factors for introducing Kangaroo mother care in the rural setting of Sindh : a case study in district Dadu, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


The Kangaroo Mother Care is a recognized strategy for care of preterm and low birth weight babies across the world. Naked babies with covered heads, diaper and socks are placed on the chest of mothers for a skin-to-skin contact. It is easy to do, cheaper and effective as incubator care. It provides warmth, initiates breastfeeding, helps for early discharge of newborn babies from hospitals and decreases the chances of hospital acquired infections. Resultantly, 30% to 40% mortality among preterm and low birth weight babies is reduced. Pakistan is a resource poor country and facing high neonatal mortality since decades. The introduction and implementation of Kangaroo Mother Care could be a key strategy for reducing high mortality of preteen and low birth weight babies. Methodology: The qualitative study was used to assess the barriers and enabling factors for introducing Kangaroo Mother Care in the rural setting of Sindh. The study was conducted in District Dadu, Pakistan during July to September 2017. Five in-depth interviews were conducted with healthcare providers working in maternal and child health services and providing care to newborn babies. Seven in depth interviews were conducted with District and Taluka level health managers of public and private sector health facilities. Seven Focus Group Discussions were conducted, one was conducted from Lady Health Workers, while rest of the six FGDs were conducted from the community (mothers/grandmothers, fathers/grandfathers). Purposive sampling was used for selection of participants and health facilities; whereas, semi structured questionnaires were used among all 52 participants of the study. Data collected by each method was transcribed and codes, categories, sub-themes, and themes were generated. Results: Six themes emerged from the qualitative analysis of data. These were; Care of newborn baby, Care of preterm and low birth weight babies, Community practices for preterm and low birth weight babies, Accessing healthcare, Environment at health facilities and Acceptance for Kangaroo Mother Care. Majority of the participants were aware of the newborn care. However, HCPs and health managers had the knowledge of components of Kangaroo Mother Care, while, rest of the participants were unaware of the Kangaroo Mother Care. The major barriers for utilization of healthcare were the non-availability and poor attitude of health care providers, lack of guidelines for management of preterm and low birth weight babies, long distance and lack of transportation, insufficient number of the available and functional incubators, lack of space for mothers/families and lack of waiting areas for attendants and long hours of electricity load shedding. However, among the enabling factors, the infrastructure of health facilities on the supply side and social support from the demand side, were significant. The study has identified that the preterm and low birth weight babies received attention during complications, while, they were not provided preventive measures and follow up checkup. Furthermore, all participants including mothers/grandmothers and fathers/grandfathers were willing to do Kangaroo Mother Care for the benefit of their babies. Conclusion: The study has identified the major gaps for the care of preterm and low birth weight babies in public sector health facilities; these include: lack of guidelines for care of preterm and low birth weight babies, the insufficient number of available and functional incubators as compared to the number of babies admitted to the nursery. This study, therefore, signifies the need of introduction and implementation of Kangaroo Mother Care at health facilities and then trickle down to community. As well as, it has highlighted the need for training and awareness of Kangaroo Mother Care for all health care providers. Awareness and involvement of the community (mothers/grandmothers, fathers/grandfathers) and community health workers (Lady Health Workers, Community Midwives, and Traditional Birth Attendants/dais) have been identified as a key step for the introduction and continuation of Kangaroo Mother Care in health facilities as well as among the community.

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