'Kangaroo Mother Care (KMC) improves survival, health, somatic growth, neurodevelopment, psychoemotional well-being of stable newborns, even preterm infants, positively impacts family relationships and is cost-effective compared with incubator use. Although it is used routinely in low-income settings, no study has explored its use at scale in the UK'
CITATION: Stefani G, Skopec M, Battersby C, et al. Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care. BMJ Innovations Published Online First: 22 October 2021. doi: 10.1136/bmjinnov-2021-000828
ABSTRACT
Objective: Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.
Design: This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.
Data: source OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.
Eligibility criteria: Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.
Results: The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.
Conclusion: The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.
COMMENT (NPW): This is a good example of a proven intervention in LMICs that would have benefits also in high income countries. The authors note that a few other HICs, notably Sweden, have incorporated KMC into routine care. It would be interesting to hear from other HICs such as the United States and Canada.
Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org
