Supporting factors and barriers in implementing kangaroo mother care in Indonesia
Keywords:
kangaroo mother care, implementation, barriers, supporting factors, Indonesian hospitals
Abstract
Background Kangaroo mother care (KMC) was introduced toIndonesia in the 1990s. Since then, KMC has not been widely
implemented and has not received national policy support.
Objective The objectives of this case study were to implement
KMC by an intervention that would ultimately benefit ten
hospitals in Java, Indonesia, as well as identify supporting factors
and barriers to KMC implementation.
Methods An intervention with four phases was conducted in
ten hospitals. Two teaching hospitals were supported to serve as
training centers, six hospitals were supported to implement KMC
and two other hospitals were supported to strengthen existing
KMC practices. The four phases were comprised of a baseline
assessment, a five-day training workshop, two supervisory visits
to each hospital, and an end-line assessment.
Results A total of 344 low birth weight infants received KMC
during the intervention period. Good progress with regards to
implementation was observed in most hospitals between the first
and second supervisory visits. Supporting factors for KMC were the
following: support received from hospital management, positive
attitudes ofhealthcare providers, patients, families and communities,
as well as the availability of resources. The most common challenges
were record keeping and data collection, human resources and staff
issues, infrastructure and budgets, discharge and follow-up, as well
as family issues. Challenges related to the family were the inability
of the mother or family to visit the infant frequently to provide
KMC, and the affordability of hospital user fees for the infant to
stay in the hospital for a sufficient period of rime.
Conclusion KM C appeared to be well accepted in most hospitals.
For an intervention to have maximum impact, it is important
to integrate services and maintain a complex network of
communication systems. [Paediatr lndones. 2012;52:43-50).
References
1. Nyqvist KH, Anderson CG, Bergman N, Cattaneo A, Charpak
N, Davanzo R, et al. Towards universal kangaroo mother
care: recommendations and report from the first European
conference and seventh international workshop on kangaroo
mother care. Acta Paediatr. 2010;99:820-6.
2. Conde-Agudelo A, Beliz:in JM, Diaz-Rosse llo J. Kangaroo
mother care to reduce morbidity and mortality in low
birthweight infants. Cochrane Database Syst Rev [Internet].
2011 [cited 2011]. Avalaible from: http://onlinelibrary.wiley.
com/doi/10.1002!14651858.CD002771.pub2/abstract
3. Ludington-Hoe SM, Morgan K, Abouelfettoh A. A
clinical guideline for implementation of kangaroo care with
premature infants of 30 or more weeks' postmenstrual age.
Adv Neonatal Care. 2008;8:3-23.
4. Ruiz JG, Charpak N. Evidence-based clinical guidelines
for an optimal use of the kangaroo moth er method in
preterm and/or low birthweight infants at birth. Bogota,
Colombia: Fundaci6n Canguro and Department of Clinical
Epidemiology and Biostatistics, Sch ool of Medicine,
Pontificia Universidad J averiana; 2007.
5. Lawn J, Mwan sa-Kambafwile J, Barros FC, Cousens S.
'Kangaroo mother care' to prevent neonatal deaths due
to preterm birth complications. Int J Epidemiol. 2010;39:
144-54.
6. Badan Pusat Statistik (Central Bureau of Statistics),
Badan Koordinasi Keluarga Berencana Pusat (National
Coordinating Board of Family Planning, Departemen
Kesehatan (Ministry of Health), & Macro International.
Survei Demografi clan Kesehatan Indonesia 2007 (Indonesia
Demographic and Health Survey 2007), Jakarta, BPS,
BKKBN Depkes; USAID, Dec. 2008. p. 119.
7. World Health Organization. Neonatal and Perinatal
Mortality: Country, Regional and Global Estimates. Geneva:
WHO; 2006. p. 31.
8. Kusharisupeni DS. Gizi maternal, langkah awal dalam meniti
daur kehidupan [Maternal nutrition: early step in passing the
life cycle]. Professional inauguration lecture in Public Health
Nutrition, Faculty of Public Health, University of Indonesia,
Depok, 12 November 2008.
9. DepKes RI [Ministry of Health]. Laporan Hasil Riser
Kesehatan Dasar RISKESDAS, Indonesia - Tahun 2007
[Report on Basic Health Research, Indonesia, 2007]. Jakarta:
Departemen Kesehatan RI, BPPK; 2008. p. 279.
10. DepKes RI [Ministry ofHealth]. Laporan Data Rumah Sakit
(Report of Hospital Data) . Jakarta: Departemen Kesehatan
RI, Dirjen Yanmedik (Director General Medical Services);
2004. p. 3.
11. Suradi R, Chair I, Thaha RM. Acceptance of the kangaroo
care method by mothers in rural areas. Paediatr lndonesiana.
1998;38:215 -23 .
12. Pratomo H. Pandangan clan kebiasaan perawatan bayi barn
lahir pada wanita di gugus pulau seram barat, Kabupaten
Maluku Tengah, Propinsi Maluku [Opinions and habits
of caring for low birth weight infants in Central Maluku
district, Maluku Province] . Jurnal Epidemiologi Indonesia
[Indonesian } Epidemiol] . 1998;2:1-12.
13. Haksari EI, Surjono A, Setyowireni D. Kangaroo-mother
care in low birthweight infants: a randomized controlled
trial. Paediatr Indonesiana. 2002;42:56-61.
14. Suradi R, Yanuarso PB, Sastroasmoro S, Dharmasetiawani
N. Early kangaroo mother care vs. conventional method in
stabilizing low birth weight infant: physiology parameters
(preliminary report). Paediatr Indones. 2002:42:273-9.
15. Endyarni B, Roeslani RD, Rohsiswatmo R, Soedjatmiko.
Mothers' response to kangaroo mother care intervention for
preterm infants. Paediatr Indonesiana. 2009;49:224-8.
16. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero
L, et al. Changing provider behavior: an overview of systematic
reviews of interventions. Med Care. 2001;39Suppl 2:II2-45.
17. Gruen RL, Weeramanthri TS, Knight SSE, Bailie RS.
Specialist outreach clinics in primary care and rural hospital
settings. Cochrane Database Syst Rev [Internet]. 2003
[cited 2003]. Available from: http: //onlinelibrary.wiley.com/
doi /10.1002!1 4651858.CD003 798.pub2 /abstract
18. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, OdgaardJ
ensen J, Kristoffersen DT, et al. Educational outreach
visits: effects on professional practice and health care
outcomes. Cochrane Database Syst Rev [Internet]. 2007
[cited 2007]. Available from: http: //onlinelibrary.wiley.com/
doi/10.1002 /1 4651858.CD000409.pub2 /abstract
19. Pattinson RC, Arsalo I, Bergh A-M, Malan AF, Patrick M,
Phillips N. Implementation of kangaroo mother care: a
randomised trial of two outreach strategies. Acta Paediatr.
2005;94:924-7.
20. Bergh A-M, Van Rooyen E, Pattinson RC. 'On-site' versus
'off-site' facilitation: a randomised trial of outreach strategies
for scaling up kangaroo mother care. Hum Resour Health.
2008;6:13.
21. Bergh A-M, Pattinson RC. Development of a conceptual
tool for the implementation of kangaroo mother care. Acta
Paediatr. 2003;92:709-14.
22. Charpak N, Ruiz JG. Resistance to implementing kangaroo
mother care in developing countries, and proposed solutions.
Acta Paediatr. 2006;95:529-34.
23. Bergh A-M, Van Rooyen E, Lawn J, Zimba E, Ligowe R,
Chiundu G. Retrospective evaluation of kangaroo mother
care practices in Malawian hospitals, July-August 2007
(report). Lilongwe: Malawi Ministry of Health; 2007. p. 7,
9, 13, 24.
24. Bergh A-M, Davy K, Van Rooyen E, Manu R, Greenfield
J, Ghana Health Service. Scaling up kangaroo mother
care in Ghana. Proceedings of the 28th Conference on
Priorities in Perinatal Care in South Africa, 10-13 March
2009; Champagne Sports Castle, KwaZulu-Natal, 2009.
p. 88-90.
25. Bergh A-M, Arsalo I, Malan AF, Patrick M, Pattinson RC,
Phillips N. Measuring implementation progress in kangaroo
mother care. Acta Paediatr. 2005;94:1102-8.
N, Davanzo R, et al. Towards universal kangaroo mother
care: recommendations and report from the first European
conference and seventh international workshop on kangaroo
mother care. Acta Paediatr. 2010;99:820-6.
2. Conde-Agudelo A, Beliz:in JM, Diaz-Rosse llo J. Kangaroo
mother care to reduce morbidity and mortality in low
birthweight infants. Cochrane Database Syst Rev [Internet].
2011 [cited 2011]. Avalaible from: http://onlinelibrary.wiley.
com/doi/10.1002!14651858.CD002771.pub2/abstract
3. Ludington-Hoe SM, Morgan K, Abouelfettoh A. A
clinical guideline for implementation of kangaroo care with
premature infants of 30 or more weeks' postmenstrual age.
Adv Neonatal Care. 2008;8:3-23.
4. Ruiz JG, Charpak N. Evidence-based clinical guidelines
for an optimal use of the kangaroo moth er method in
preterm and/or low birthweight infants at birth. Bogota,
Colombia: Fundaci6n Canguro and Department of Clinical
Epidemiology and Biostatistics, Sch ool of Medicine,
Pontificia Universidad J averiana; 2007.
5. Lawn J, Mwan sa-Kambafwile J, Barros FC, Cousens S.
'Kangaroo mother care' to prevent neonatal deaths due
to preterm birth complications. Int J Epidemiol. 2010;39:
144-54.
6. Badan Pusat Statistik (Central Bureau of Statistics),
Badan Koordinasi Keluarga Berencana Pusat (National
Coordinating Board of Family Planning, Departemen
Kesehatan (Ministry of Health), & Macro International.
Survei Demografi clan Kesehatan Indonesia 2007 (Indonesia
Demographic and Health Survey 2007), Jakarta, BPS,
BKKBN Depkes; USAID, Dec. 2008. p. 119.
7. World Health Organization. Neonatal and Perinatal
Mortality: Country, Regional and Global Estimates. Geneva:
WHO; 2006. p. 31.
8. Kusharisupeni DS. Gizi maternal, langkah awal dalam meniti
daur kehidupan [Maternal nutrition: early step in passing the
life cycle]. Professional inauguration lecture in Public Health
Nutrition, Faculty of Public Health, University of Indonesia,
Depok, 12 November 2008.
9. DepKes RI [Ministry of Health]. Laporan Hasil Riser
Kesehatan Dasar RISKESDAS, Indonesia - Tahun 2007
[Report on Basic Health Research, Indonesia, 2007]. Jakarta:
Departemen Kesehatan RI, BPPK; 2008. p. 279.
10. DepKes RI [Ministry ofHealth]. Laporan Data Rumah Sakit
(Report of Hospital Data) . Jakarta: Departemen Kesehatan
RI, Dirjen Yanmedik (Director General Medical Services);
2004. p. 3.
11. Suradi R, Chair I, Thaha RM. Acceptance of the kangaroo
care method by mothers in rural areas. Paediatr lndonesiana.
1998;38:215 -23 .
12. Pratomo H. Pandangan clan kebiasaan perawatan bayi barn
lahir pada wanita di gugus pulau seram barat, Kabupaten
Maluku Tengah, Propinsi Maluku [Opinions and habits
of caring for low birth weight infants in Central Maluku
district, Maluku Province] . Jurnal Epidemiologi Indonesia
[Indonesian } Epidemiol] . 1998;2:1-12.
13. Haksari EI, Surjono A, Setyowireni D. Kangaroo-mother
care in low birthweight infants: a randomized controlled
trial. Paediatr Indonesiana. 2002;42:56-61.
14. Suradi R, Yanuarso PB, Sastroasmoro S, Dharmasetiawani
N. Early kangaroo mother care vs. conventional method in
stabilizing low birth weight infant: physiology parameters
(preliminary report). Paediatr Indones. 2002:42:273-9.
15. Endyarni B, Roeslani RD, Rohsiswatmo R, Soedjatmiko.
Mothers' response to kangaroo mother care intervention for
preterm infants. Paediatr Indonesiana. 2009;49:224-8.
16. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero
L, et al. Changing provider behavior: an overview of systematic
reviews of interventions. Med Care. 2001;39Suppl 2:II2-45.
17. Gruen RL, Weeramanthri TS, Knight SSE, Bailie RS.
Specialist outreach clinics in primary care and rural hospital
settings. Cochrane Database Syst Rev [Internet]. 2003
[cited 2003]. Available from: http: //onlinelibrary.wiley.com/
doi /10.1002!1 4651858.CD003 798.pub2 /abstract
18. O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, OdgaardJ
ensen J, Kristoffersen DT, et al. Educational outreach
visits: effects on professional practice and health care
outcomes. Cochrane Database Syst Rev [Internet]. 2007
[cited 2007]. Available from: http: //onlinelibrary.wiley.com/
doi/10.1002 /1 4651858.CD000409.pub2 /abstract
19. Pattinson RC, Arsalo I, Bergh A-M, Malan AF, Patrick M,
Phillips N. Implementation of kangaroo mother care: a
randomised trial of two outreach strategies. Acta Paediatr.
2005;94:924-7.
20. Bergh A-M, Van Rooyen E, Pattinson RC. 'On-site' versus
'off-site' facilitation: a randomised trial of outreach strategies
for scaling up kangaroo mother care. Hum Resour Health.
2008;6:13.
21. Bergh A-M, Pattinson RC. Development of a conceptual
tool for the implementation of kangaroo mother care. Acta
Paediatr. 2003;92:709-14.
22. Charpak N, Ruiz JG. Resistance to implementing kangaroo
mother care in developing countries, and proposed solutions.
Acta Paediatr. 2006;95:529-34.
23. Bergh A-M, Van Rooyen E, Lawn J, Zimba E, Ligowe R,
Chiundu G. Retrospective evaluation of kangaroo mother
care practices in Malawian hospitals, July-August 2007
(report). Lilongwe: Malawi Ministry of Health; 2007. p. 7,
9, 13, 24.
24. Bergh A-M, Davy K, Van Rooyen E, Manu R, Greenfield
J, Ghana Health Service. Scaling up kangaroo mother
care in Ghana. Proceedings of the 28th Conference on
Priorities in Perinatal Care in South Africa, 10-13 March
2009; Champagne Sports Castle, KwaZulu-Natal, 2009.
p. 88-90.
25. Bergh A-M, Arsalo I, Malan AF, Patrick M, Pattinson RC,
Phillips N. Measuring implementation progress in kangaroo
mother care. Acta Paediatr. 2005;94:1102-8.
Published
2012-03-30
How to Cite
1.
Pratomo H, Uhudiyah U, Sidi I, Rustina Y, Suradi R, Bergh A-M, Rogers-Bloch Q, Gipson R. Supporting factors and barriers in implementing kangaroo mother care in Indonesia. PI [Internet]. 30Mar.2012 [cited 25Apr.2024];52(1):43-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/298
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Received 2016-08-21
Accepted 2016-08-21
Published 2012-03-30
Accepted 2016-08-21
Published 2012-03-30
