Quality of Kangaroo Mother Care services in Ethiopia: Implications for policy and practice

Autoři: Haftom Gebrehiwot Weldearegay aff001;  Araya Abrha Medhanyie aff001;  Mulugeta Woldu Abrha aff002;  Lisanu Tadesse aff003;  Ephrem Tekle aff004;  Bereket Yakob aff005;  Tsinuel Girma aff005;  Catherine Arsenault aff005
Působiště autorů: College of Health Sciences, Mekelle University, Mekelle, Ethiopia aff001;  Tigray Health Research Institute, Mekelle, Ethiopia aff002;  JSI, L10K and Federal Ministry of Health, Addis Ababa, Ethiopia aff003;  Maternal and Child Health Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia aff004;  Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225258



Providing high-quality kangaroo mother care (KMC) is a strategy proven to improve outcomes in premature babies. However, whether KMC is consistently and appropriately provided in Ethiopia is unclear. This study assesses the quality of KMC services in Ethiopia and the factors associated with its appropriate initiation among low birth weight neonates.


We used data from the 2016 national Emergency Obstetric and Newborn Care (EmONC) assessment which contains data on all health facilities providing delivery care services in Ethiopia (N = 3,804). We described the quality of KMC services provided to low-birth weight (LBW) babies in terms of infrastructure, processes and outcomes (survival status at discharge). We also explored the factors associated with appropriate KMC initiation using multivariable logistic regression models.


The quality of KMC services in Ethiopia was poor. The facilities included scored only 59.0% on average on a basic index of service readiness. KMC was initiated for only 46.4% of all LBW babies included in the sample. Among those who received KMC, 66.7% survived, 13.3% died and 20.4% had no data on survival status at discharge. LBW babies born in health centers were twice more likely to receive KMC compared to those born in hospitals (AOR = 2.0, 95% CI: 1.3–3.0). Public facilities, those with a staff rotation policy in place for newborn care, and those with separate newborn corners were also more likely to initiate KMC for LBW babies.


We found low levels of appropriate KMC initiation, inadequate infrastructure and staffing, and poor survival among LBW babies in Ethiopia. Efforts must be made to improve the adoption of this life saving technique, particularly in hospitals and in the private sector where KMC remains underutilized. Facilities should also dedicate specific spaces for newborn care that enables mothers to provide KMC. In addition, improving record keeping and data quality for routine health data is a priority.

Klíčová slova:

Birth weight – Ethiopia – Health care policy – Charts – Labor and delivery – Neonatal care – Neonates – Population density


1. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al., Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?. Lancet., 2014. 14(384:): p. 347–70.

2. World Health Organization, recommendations on interventions to improve preterm birth outcomes in Geneva. World Health Organization, 2015.

3. Lawn JE, Mwansa JK, Horta BL, Barros FC, Cousens S., Kangaroo mother care' to prevent neonatal deaths due to preterm birth complications International Journal of Epidemiology,2010.39 (SUPPL. 1): p. i144–i54.

4. Staff Of Mekelle University, KMC Implementation Research for Accelerating Scale-up: Generic Protocol–Version 4.0, working document. 2016/2017.

5. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et ‘al, Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet, 2015. 385(9966): p. 430–40. doi: 10.1016/S0140-6736(14)61698-6 25280870

6. Vesel L, Bergh AM, Kerber KJ, Valsangkar B, Mazia G, Moxon SG, et’al. Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions. BMC pregnancy and childbirth. 2015 Dec;15(2):S5.

7. Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Finley GA, Walker CDet’al, Kangaroo mother care diminishes pain from heel lance in very preterm neonates: A crossover trial, BMC Pediatrics 2008,8:13 doi: 10.1186/1471-2431-8-13 18435837

8. Conde‐ AA, Díaz‐Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2014 Apr 22;(4):CD002771. doi: 10.1002/14651858.CD002771.pub3 24752403

9. Chan GJ, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bulletin of the World Health Organization. 2016 Feb 1;94(2):130., doi: 10.2471/BLT.15.157818 26908962

10. Chan G, Bergelson I, Smith ER, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health policy and planning. 2017 Aug 24;32(10):1466–75., doi: 10.1093/heapol/czx098 28973515

11. World Health Organization, Service availability and readiness assessment, An annual monitoring system for service delivery reference manual, Geneva. WHO, 2015.

12. Ethiopian Public Health Institute Addis Ababa, Federal Ministry of Health of Ethiopia, and Averting Maternal Death and Disability (AMDD), Columbia University New York, USA, ETHIOPIAN Emergency Obstetric and Newborn Care (EmONC) Assessment 2016; Final Report. September 2017: p. 66–69.

13. FMoH, Ethiopia., Health Sector Transformation Plan, Annual Performance Report. EFY 2008 2015/16. ARM 18-Doc 02/16.

14. Donabedian A. Explorations in Quality Assessment and Monitoring: The Definition of Quality and Approaches to Its Assessment. Ann Arbor, MI. Health Administration Press., 1980. 1.

15. Averting Maternal Death and Disability, EmOC Needs Assessment Toolkit. New York: Columbia University Mailman School of Public Health, 2014.

16. WHO, Achieving the health-related MDGs. It takes a workforce: Density of doctors, nurses and midwives in 49 priority countries. IJIHCR-M, 2010.

17. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder- DS, et’al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018 Nov 1;6(11):e1196–252. doi: 10.1016/S2214-109X(18)30386-3 30196093

18. FDRE Demographic and Health Survey, 2016: Central Statistical Agency, Addis Ababa, Ethiopia,. July,2017.

19. Chavula K, Likomwa D, Valsangkar B, Luhanga R, Chimtembo L, Gobezie WA, 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. Journal of global health. 2017 Dec;7(2).

20. Seidman G, Unnikrishnan S, Kenny E, Myslinski S, Cairns-Smith S, Mulligan B, et al. (2015), Barriers and Enablers of Kangaroo Mother Care Practice: A Systematic Review. PLoS ONE 10(5): e0125643. doi: 10.1371/journal.pone.0125643 25993306

21. Emily RS, Ilana B, Stacie C, Bina V, Grace JC. Barriers and enablers of health system adoption of kangaroo mother care: a systematic review of caregiver perspectives. BMC Pediatr. 2017 Jan 25;17(1):35. doi: 10.1186/s12887-016-0769-5 28122592; PMCID: PMC5267363.

22. Mazumder S, Taneja S, Dalpath SK, Gupta R, Dube B, Norheim OF, et’al. Impact of community-initiated Kangaroo Mother Care on survival of low birth weight infants: study protocol for a randomized controlled trialTrials (2017) 18:262. doi: 10.1186/s13063-017-1991-7 28592313

23. Shrivastava SR, Shrivastava PS.,and Ramasamy J, Utility of kangaroo mother care in preterm and low birthweight infants. South African Family Practice, 2013. 55(4): p. 340–344. https://doi.org/10.1080/20786204.2013.10874373

24. Bergh AM, Kerber K, Abwao S, De-Graft JJ, Aliganyira P, Davy K, et’ al.:Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa. BMCHealth Services Research 2014 14:29

25. FDRE:MoH. Health Sector Transformation Plan. Addis Ababa: Ethiopia Ministry of Health; 2015. 2015/16-2019/20.

26. Bakar I, Ariff M, Noor S, Naz S, Jamal H, Maheshwary N., et al The Assessment of Mothers in Selecting Private and Public Hospital Care for their Child; An Observational Comparative Study to Determine the Motive Behind Predilection. EC Paediatrics 4.5 (2017): 130–137.

Článek vyšel v časopise


2019 Číslo 11