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Helping Babies Grow
CAN A
MOTHER FRIENDLY APPROACH
HELP INCREASE
THE UPTAKE AND QUALITY OF KMC ?
www.laerdalglobalhealth.com
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Every year about 15 million babies are born prematurely.1 One million of them die
An Integrated Approach
of preterm related complications while another one million die of causes where
preterm is a risk factor, and over one million of the survivors develop some degree
1
of impairment.
Kangaroo Mother Care (KMC) consists of continuous skin-to-skin
(StS) contact, providing temperature support and facilitating breastfeeding. It also
2
helps to prevent infection and enables earlier discharge.
of KMC could save 450,000 newborn lives every year.
Report titled Consensus to Kangaroo Mother Care Acceleration, published after the KMC summit
held in Istanbul, Nov 2013 summarises the barriers for KMC uptake as follows:
•KMC is incorrectly perceived as a practice for preterm in low-income countries only, as a next
best alternative to incubator care.
•Many health care providers (at all levels) do not know or do not believe in the benefits of KMC,
and lack the skills for effective implementation.
•Cultural and social norms related to mother and newborn practice make community uptake of
KMC challenging.
•Human resources for health required for KMC have been lacking, and the role of mothers and
communities has been overlooked.
•KMC has not been included in many country level government newborn agendas and policies.
Near universal coverage
3,4
KMC implementation remains extremely poor worldwide despite its introduction more than 30
years ago. An integrated approach - that involves all the stakeholders of the system may have the
most potential for an impact.
Learning from the success of Helping Babies Breathe, the integrated approach works on the same
philosophy that - ‘Training drives therapy’. Below illustration explains the integrated approach.
Health worker require to be
skilled in essential newborn
care for small babies
Training Programs
Essential Care for Every Baby
Essential Care for Small Babies
Health workers struggle to convince
and motivate mothers to adopt KMC
They also miss tools of demonstration
Education
& Skill
Health Worker
Educator
Counselling
& Support
Health System
Awareness
Mother
KMC is unknown to the community
Awareness about the therapy value
needs to be increased
Communication Media
Better design of films, posters, etc
Family
User experience can be a great barrier to effective KMC practice reducing
desirability.
Training & Motivation Tools
PreemieNatalie
MamaBreast
CarePlus
CarePlus: Helping Babies Grow
Can a KMC wrap add value to
the integrated approach?
Training Programs
New training programs - Essential Care for Every Baby and Essential Care for Small Babies
developed by the American Academy of Paediatrics according to the WHO guidelines covers
the period after birth through until discharge. Skin-to-skin care and kangaroo mother care are
important elements in the curriculum of the training programs.
Training Tools
To facilitate effective learning through simulation, Laerdal has developed the PreemieNatalie - a
preterm simulator and MamaBreast - breast feeding simulator. Both the simulators are not only
very effective for training health workers in KMC but are very useful as counselling tools for
mothers as well.
A KMC ward, Malawi
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“Can a purpose designed wrap act as a cultural
Challenges Today
ambassador or messenger to increase the adoption of KMC
by improving the experience around the therapy?”
A well designed, user focused KMC wrap may accelerate adoption by:
• Increasing Visibility
By being more visible as a stand-out product. It might raise curiosity and trigger conversations
about KMC.
• Changing Perception
Custom purpose of the wrap helps reinforce the therapy message and also raises the status
perception of KMC.
• Creates Desirability
An attractive product combined by peer use may create desirability. The improved user
experience only strengthens and sustains the practise over prolonged period.
This wrap could be one of the many accelerator ideas to drive adoption. A simple, open source
design should not only benefit from encouragement for local production but also improvisations
to match the custom requirements.
A lot of time was used in field research to understand the challenges a KMC provider, primarily
the mother in most cases faces to provide the therapy to the newborn. The field time was spent in
India, Tanzania and Malawi, understanding the perspective of health workers as well as mothers.
Even in locations with successful implementation of KMC, the quality of KMC was questionable.
There were separate challenges for continuing KMC in the facility and after discharge within the
community. The user related challenges can be briefly summarised as follows:
1. Duration of stay in KMC wards is often too short due to limited bed capacity. Mothers are often
occupying uncomfortable situations in an overcrowded KMC ward..
2. Most current solutions are home sourced like the Kanga in Africa or the Duppata in India. Both
just long pieces of cloth require an assistant to apply the solution.
3.Mothers cover themselves with lot of layers of the wrap for security which over heats the
mothers. The knot in the back is not convenient for lieing down. These layers of fabric make
frequent breastfeeding or changing for cleaning the baby a tiresome chore.
4. At home the challenges increase due to lack of beds and obligations to domestic duties.
5. Fathers are not too supportive in sharing the task of KMC.
The wrap underwent multiple iterations in its development journey and a lot of mothers and
health providers have helped to fine tune the design to its present form.
Laerdal designer working with health worker and mother to develop the KMC wrap, India
Mothers helping each other with the wraps, Malawi
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CarePlus - Helping Babies Grow
CarePlus is designed with a goal to help mothers in providing continuous and quality KMC to their
newborns. In comparison to existing solutions and methods, the users perceived CarePlus as:
• Safer
It feels more secure and keeps babies in correct posture. Mothers seemed to relax and did not
feel the need to hold the baby.
• Comfortable
Allows movement, Less fatigue for back and shoulders due to wide straps on the shoulders.
• Easy to Use
Does not need an assistant. Facilitates frequent removal for breastfeeding.
• Gender Neutral
The look was very acceptable to wear for fathers as well.
User Feedback & Implementation
CarePlus has been developed by actively engaging the end user in their surroundings. The
engagement continues in the form of studies and feedbacks for CarePlus. The final iteration has
been tested in focused group discussions in India, Nepal, Tanzania and Malawi. A select number of
mothers have also been given the wraps to try at home post discharge.
Although reasons for low uptake are complex, our studies show that a wrap has the potential to
help increase the uptake and quality of KMC. We look forward to collaborators to optimise on
the implementation models to make it available and affordable.
A mother trying CarePlus for the first time, Malawi
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Related products
Laerdal strongly believes in ‘training drives therapy’.
Our conviction is reinforced by the effectiveness
and the outcomes of training programs like Helping
Babies Breathe and Helping Mothers Survive.
Laerdal Global Health continues to direct similar
efforts to help save lives of newborns under the
Helping Babies Survive initiative. The new training
programs ‘Essential Care for Every Baby’ and ‘Essential
Care for Small Babies’ are being supported by the
development of PreemieNatalie and MamaBreast
simulators.
PreemieNatalie - Preterm Simulator
PreemieNatalie is a preterm simulator with
realistic appearance and weight. It supports
training in correct nasogastric tube placement,
proper breastfeeding attachment, and spoon,
cup and nasogastric tube feeding.
MamaBreast - Breastfeeding Simulator
MamaBreast is filled with water, and allows
realistic simulation of breast milk expression.
Use together with PreemieNatalie to practice
correct breastfeeding position, attachment and
skin-to-skin / Kangaroo Mother Care.
MamaBreast and PreemieNatalie are excellent
to use in the Essential Care for Every Baby
training, as well as other premature care,
essential newborn care and Kangaroo Mother
Care training programs.
More information on CarePlus and the new
tools to help save lives of newborns visit us on
www.laerdalglobalhealth.com
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