Mothers’ perceptions of the practice of kangaroo mother care for preterm neonates in sub-Saharan Africa: a systematic review of qualitative evidence

Abstract

Objective: The objective of this review was to explore the experiences of mothers with the practice of kangaroo mother care for preterm neonates at home in sub-Saharan Africa. Introduction: Newborn deaths globally have remained high despite the significant reductions in deaths among under-fives over the past few decades. More than 7000 deaths occur daily around the globe, but mostly in sub- Saharan Africa. Of these deaths, 60% to 80% are due to preterm birth and low birth weight. Kangaroo mother care is known to offer a cheap and effective way to care for low birth weight, preterm neonates; however, its practice is still low. There is limited evidence on the factors that hinder or facilitate the practice of kangaroo mother care at the community level. Inclusion criteria: The review considered studies conducted in sub-Saharan Africa on the perceptions and experiences of mothers who had given birth to preterm babies and had practiced kangaroo mother care wholly or in part at home. Qualitative studies in English and French conducted from January 1979 to March 2019 were considered for inclusion if they exclusively used qualitative research methods including, but not limited to, phenomenology, grounded theory, ethnography, action research, or feminist research. Methods: PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Academic Search Complete, CINAHL Complete, Education Source, and Health Source: Nursing/Academic Edition were searched in March 2019. Eligible studies were critically appraised using the standardized JBI tool. Findings were pooled using the metaaggregative approach, and confidence was assessed according to the ConQual approach. Results: Following the systematic search and critical appraisal process, six studies were included in the review for data extraction and synthesis of findings. Three of the six studies were based on in-depth individual interviews, while two employed both individual interviews and focus group discussions, and one study used only focus group discussions. Twenty-six primary findings were generated from the review process that were aggregated into 10 categories, which generated four meta-synthesized findings: i) Cultural and contextual factors: The traditional way of carrying babies on the back and providing them warmth through lighting lamps or charcoal make kangaroo mother care appear odd and shameful (level of confidence: low). ii) The technical content of the intervention: The practice of kangaroo mother care is perceived to be technically cumbersome, especially because it has to be continuous; there is fear of making the baby’s cord bleed; it creates difficulty in positioning for breastfeeding; and there is difficulty in maintaining the position while sleeping and doing other household chores (level of confidence: moderate). iii) Health system factors: The health care systems have no clear strategies to promote kangaroo mother care at the community level. Most mothers learned about the practice for the first time from health care workers only after birthing; however, peer-to-peer information sharing was noted to be a powerful source of trusted information about kangaroo mother care. Community leaders and religious leaders could be used to promote use of kangaroo mother care (level of confidence: moderate). iv) Individual and family factors: Although mothers realize the importance of kangaroo mother care for their infants’ recovery, their individual and family conditions affect their decision to practice the intervention (level of confidence: moderate). Conclusions: There is a link between the perceptions and experiences of kangaroo mother care that influences its practice in sub-Saharan Africa. The health care systems have failed to create awareness among communities before the birth of a preterm neonate. The traditional practices make kangaroo mother care stigmatizing at the community level, and the practice is perceived to be difficult and cumbersome, requiring substantial social support. Strategies to make the practice less cumbersome need to be devised, focusing on the comfort of mothers. Further qualitative studies are needed to explore community-level experiences of kangaroo mother care in sub-Saharan Africa.