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Abstract：
Introduction Kangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children\'s Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methods We conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant. Results One hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. Conclusion Sets of intervention packages based on needs analysis using the PDSA cycle were able to improve the rate and duration of KMC in the hospital and at home.
摘要：
介绍袋鼠母亲护理(KMC)是基于证据的，简单,经过时间考验,低成本,医院和社区对新生儿生存的高影响干预，特别是在资源有限的地区。这对患病和稳定的低出生体重婴儿有许多有益的影响，哺乳期的母亲,家庭,社会,还有政府.然而,尽管世界卫生组织（世卫组织）和联合国国际儿童紧急基金（儿童基金会）对KMC的建议，在社区和设施中都没有令人满意的实施。这项研究旨在改善家庭袋鼠母亲护理（HBKMC）的持续时间。材料和方法我们进行了基于医院的前后干预，在III级新生儿重症监护病房（NICU）进行单中心研究，以改善HBKMC的持续时间。KMC持续时间分为四类：短，扩展,长,连续提供KMC4小时/天，5-8小时/天,9-12小时/天,超过12小时/天，分别。在2021年4月至2021年7月的五个月内，印度一家三级医院的所有出生体重<2.0公斤的新生儿及其母亲/替代KMC提供者都被认为符合这项研究的条件。我们通过使用计划-做-研究-行动周期（PDSA周期）测试了三组干预措施。第一组干预措施是通过教育讲座对母亲和其他家庭成员进行全面咨询，提高父母和医护人员对KMC益处的敏感性，视频,图表，和海报。第二组干预措施是通过提供更多的女性员工和教授适当的礼服穿着技术来减少产妇的焦虑/压力，同时保持产妇的隐私。第三套干预措施是通过提供产前和产后哺乳咨询以及托儿所的温暖来解决泌乳和环境温度问题。采用配对T检验和单因素方差分析(ANOVA)进行统计学分析,P<0.05为显著。结果180名新生儿与他们的母亲/替代KMC提供者一起分四个阶段登记，并实施了三个PDSA循环。在180名LBW婴儿中，21例（11.67%）婴儿接受KMC<4小时/天。根据KMC分类，31%的人在该机构中有连续的KMC，其次是24%长的KMC，26%扩展KMC，和18%的短KMC。三个PDSA循环后,HBKMC为38.88%连续KMC，其次是24.22%的KMC，20.55%延长KMC，和16.11%的短KMC。在三个PDSA周期中实施三套干预措施后，从研究的第一阶段到第四阶段，连续KMC从研究所的21％提高到46％，在家的16％提高到50％。应用PDSA循环后，逐相KMC速率和持续时间得到了改善，这也在HBKMC中维护，但在统计学上并不显着。结论使用PDSA循环基于需求分析的干预包集能够提高医院和家庭中KMC的发生率和持续时间。
