ABSTRACT
BACKGROUND: Kangaroo Mother Care (KMC) is a high impact, low technology and cost-effective intervention for the care of preterm and low birth weight newborn. Cote d'Ivoire adopted the intervention and opened the first KMC unit in 2019. This study aimed to assess barriers and facilitators of KMC implementation in Cote d'Ivoire, a year after its introduction, as well as proposed solutions for improving KMC implementation in the country. METHOD: This was a qualitative study, using semi-structured interviews, carried out in September 2020 in the first KMC unit opened at the Teaching Hospital of Treichville. The study involved healthcare providers providing KMC and mothers of newborn who were receiving or received KMC at the unit. A thematic analysis was performed using both inductive and deductive (Consolidated Framework for Implementation Research-driven) approaches. NVivo 12 was used to assist with coding. RESULTS: A total of 44 semi-structured interviews were conducted, 12 with healthcare providers and 32 with mothers. The barriers identified were lack of supplies, insufficiency of human resources, lack of space for admission, lack of home visits, lack of food for mothers, lack of collaboration between health services involved in newborn care, increased workload, the beliefs of carrying the baby on the chest, father's resistance, low rate of exclusive breastfeeding, lack of community awareness. Facilitators identified were training of healthcare providers, strong leadership, the low cost of KMC, healthcare providers' perceived value of KMC, mothers-healthcare providers' relationship, mothers' adherence to KMC and the capacity of the KMC unit to network with external organizations. The proposed solutions for improving KMC implementation were volunteer staff motivation, intensifying education and counselling of mothers and families, the recruitment of a psychologist and the involvement of all stakeholders. CONCLUSION: Our study highlighted the challenges to implement KMC in Cote d'Ivoire with unique and specific barriers to implementation. We recommend to researchers and decision makers to respectively design strategies and adopt intervention that specifically address these barriers and facilitators to a better uptake of KMC. Decision makers should also take into account the proposed solutions for a better implementation and scaling up of KMC.
Subject(s)
Kangaroo-Mother Care Method , Child , Cote d'Ivoire , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , Qualitative ResearchABSTRACT
This paper examines the feasibility of the eight or more ANC contacts in Cote d'Ivoire through a qualitative study among twenty antenatal care providers through individual interviews. The eight or more ANC contacts were found useful as they will allow a better follow up of the pregnancy. Main barriers were: the lack of training on the 2016 WHO ANC model, the late initiation of ANC and the fear of increased workload. Drivers identified were: availability of supplies, adoption and dissemination of the new guidelines, assignment of antenatal care providers in underserved area, digitization of the mother and child health handbook, pregnant women and community engagement, intensification of communication for behavior change and a good relationship provider-pregnant woman-community. To ensure appropriate design and effective delivery of the eight or more ANC contacts, attention should be paid to barriers and facilitators identified.
ABSTRACT
BACKGROUND: The World Health Organization Safe Childbirth Checklist tool was specifically designed for developing countries such as sub-Saharan African countries, to ensure safety and security of the couple mother and newborn around the time of childbirth. However, the implementation of the Safe Childbirth Checklist tool requires a good knowledge of the context setting to face challenges. Our study objectives were (1) to assess the acceptability of the WHO SCC tool and (2) to identify conditions and strategies for a better introduction and use of the WHO SSC tool. METHODS: This was a pilot multi-country study conducted from January to March 2019 in Burkina Faso and Côte d'Ivoire, respectively, in the health regions of central-North and Agnéby-Tiassa-Mé. In each health region, 5 health facilities of different levels within the health system pyramid were selected through a purposive sampling. The study was conducted in 2 phases: 38 healthcare providers and 15 managers were first trained to use the Safe Childbirth Checklist tool; secondly, the trained providers were allowed to use the tool in real-life conditions for 2 weeks. Then, semi-structured interviews were conducted among healthcare providers and managers. The topics covered by the interview guides were acceptability of the tool, barriers and facilitators to its use, as well as strategies for better introduction and use within the healthcare system. Analysis was carried out using the Nvivo 12 software. RESULTS: Respondents reported an overall good acceptance of using the tool. However, they suggested minor content adaptation. The design of the tool and increased workload were the main barriers to its use. Potential facilitators to its introduction were managers' commitment, healthcare providers' motivation, and the availability of supplies. The best strategies for optimal use were its attachment to existing tool such as partograph or/and its display in the maternity ward. CONCLUSIONS: The findings showed that the implementation of the Safe Childbirth Checklist tool is acceptable in Burkina Faso and Côte d'Ivoire. These findings are important and will help to design a trial aiming at assessing the effectiveness of the tool WHO SCC tool in these two countries.
ABSTRACT
OBJECTIVE: To assess and compare the quality of intrapartum and immediate postpartum care across levels of healthcare in Burkina Faso and Côte d'Ivoire using validated process indicators. DESIGN: Health facility-based cross-sectional study with direct observation of healthcare workers' practices while caring for mother-newborn pairs during intrapartum and immediate postpartum periods. SETTING: Primary healthcare facilities and their corresponding referral hospitals in the Central-North region in Burkina Faso and the Agneby-Tiassa-Mé region in Côte d'Ivoire. PARTICIPANTS: Healthcare providers who care for mother-newborn pairs during intrapartum and immediate postpartum periods, the labouring women and their newborns after childbirth. MAIN OUTCOME MEASURES: Adherence to essential best practices (EBPs) at four pause points in each birth event and the overall quality score based on the level of adherence to the set of EBPs observed for a selected pause point. RESULTS: A total of 532 and 627 labouring women were included in Burkina Faso and Côte d'Ivoire, respectively. Overall, the compliance with EBPs was insufficient at all the four pause points, even though it varied widely from one EBP to another. The adherence was very low with respect to hand hygiene practices: the care provider wore sterile gloves for vaginal examination in only 7.96% cases (95% CI 5.66% to 11.06%) in Burkina Faso and the care provider washed hands before examination in 6.71% cases (95% CI 3.94% to 11.20%) in Côte d'Ivoire. The adherence was very high with respect to thermal management of newborns in both countries (>90%). The overall mean quality scores were consistently higher in referral hospitals in Burkina Faso at all pause points excluding immediate post partum. CONCLUSIONS: Women delivering in healthcare facilities do not always receive proven EBPs needed to prevent poor childbirth outcomes. There is a need for quality improvement interventions.
