Barriers for kangaroo mother care (KMC) acceptance, and practices in southern Ethiopia: a model for scaling up uptake and adherence using qualitative study

BMC Pregnancy Childbirth. 2021 Jan 7;21(1):25. doi: 10.1186/s12884-020-03409-6.


Background: Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum.

Methods: A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation.

Results: Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities.

Conclusions: Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.

Keywords: Formative research; Implementation model; Kangaroo mother care; Low birth weight; Low-income country; Preterm.

MeSH terms

  • Adult
  • Community Health Workers
  • Culture
  • Ethiopia
  • Family / psychology
  • Female
  • Focus Groups
  • General Practitioners
  • Grounded Theory
  • Health Knowledge, Attitudes, Practice*
  • Home Childbirth / psychology
  • Humans
  • Infant
  • Infant Mortality
  • Infant, Low Birth Weight*
  • Infant, Newborn
  • Infant, Premature*
  • Kangaroo-Mother Care Method / psychology*
  • Models, Theoretical
  • Mothers
  • Patient Preference
  • Pediatricians
  • Qualitative Research
  • Referral and Consultation