Barriers and enablers for practicing kangaroo mother care (KMC) in rural Sindh, Pakistan

PLoS One. 2019 Jun 17;14(6):e0213225. doi: 10.1371/journal.pone.0213225. eCollection 2019.


Background: More than 2.5 million newborns die each year, accounting for 47% of children dying worldwide before their age of five years. Complications of preterm birth are the leading cause of death among newborns. Pakistan is amongst the top ten countries with highest preterm birth rate per 1000 live births. Globally, Every Newborn Action Plan (ENAP) has emphasized on Kangaroo Mother Care (KMC) as an essential component of neonatal health initiatives.

Materials and methods: We conducted this qualitative study with 12 in-depth interviews (IDIs) and 14 focus group discussion (FGD) sessions, in two health facilities of Sindh, Pakistan during October-December 2016, to understand the key barriers and enablers to a mother's ability to practice KMC and the feasibility of implementing and improving these practices.

Results: The findings revealed that community stakeholders were generally aware of health issues especially related to maternal and neonatal health. Both the health care providers and managers were supportive of implementing KMC in their respective health facilities as well as for continuous use of KMC at household level. In order to initiate KMC at facility level, study respondents emphasized on ensuring availability of equipment, supplies, water-sanitation facility, modified patient ward (e.g., curtain, separate room) and quality of services as well as training of health providers as critical prerequisites. Also in order to continue practicing KMC at household level, engaging the community and establishing functional referral linkage between community and facilities were focused issues in facility and community level FGDs and IDIs.

Conclusion: The study participants considered it feasible to initiate KMC practice at health facility and to continue practicing at home after returning from facility. Ensuring facility readiness to initiate KMC, improving capacity of health providers both at facility and community levels, coupled with focusing on community mobilization strategy, targeting specific audiences, may help policy makers and program planners to initiate KMC at health facility and keep KMC practice continued at household level.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Female
  • Focus Groups
  • Health Facilities / standards*
  • Health Personnel / standards*
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Newborn
  • Infant, Premature
  • Interviews as Topic
  • Kangaroo-Mother Care Method / methods*
  • Pakistan
  • Premature Birth / prevention & control
  • Rural Population
  • Young Adult

Grants and funding

This publication was made possible through support provided by the US Agency for International Development (USAID), under the terms of Associate Cooperative Agreement No. AID-391-LA-13-00001; Maternal, Newborn and Child Health Services Project. Also we received partial support from the Australian Government for this study. The opinions expressed herein are those of the authors and do not necessarily reflect either the views of USAID or the Australian Government. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.