Journal club

Article reviewed
Barriers and enablers of health system
adoption of kangaroo mother care: a
systematic review of caregiver perspectives.
Emily R. Smith, Ilana Bergelson et al.
BMC Pediatrics, 2017.
 Objectives
Explain overview of the study.

To describe study method.

Explain the results of systematic review.

To critique this systematic review.

 Overview of the study
6.3 million children less than 5 years age die each
year.
40% of these deaths occur in the neonatal period.
Leading cause of death: complications related to
preterm birth.
Kangaroo mother care (KMC) is life-saving
intervention.
KMC is associated with 36% reduced risk of neonatal
mortality.
 KMC has never been fully integrated into health
systems around the world.
A previous systematic review identified barriers to
health system adoption of KMC and noted that
families play an important role in KMC adoption.
Further, the review noted that family interactions
with the health system were critical to KMC
adoption.
 Framework :
(1) Definition of the problem;
(2) Definition and attributes
(3) The adoption
(4) Health system characteristics; and
(5) The broad context including demographic,
economic, and cultural factors.
 Research methodology
Searched
Pubmed,
Embase,
Web of Science,
Scopus,
 Search terms included:
kangaroo mother care, or
kangaroo care, or
skin to skin care.

Studies between January 1, 1960 and August

19, 2015 were included.
 Inclusion criteria
published work had to include information about
barriers to or enablers of successful
implementation of KMC from the family
perspective based on the experience of caregivers
and health providers who had implemented KMC.
 Exclusion criteria:
Studies with non human subjects
Studies with no primary data
 Two independent reviewers used a
standardized data abstraction form to assess
eligibility and abstract data from each article.
Two researchers coded themes, perspectives
and experiences using NVivo software.
 2875

Findings
1515

1360

716

644

546

98
 Critique
The researcher identified a gap, there was no
systematic review in the past regarding KMC
and caregivers perspective.
Searched more no. of databases.
Identified different themes / frameworks and
collected data accordingly.
Could list out barriers and enablers clearly.
Majority of the studies were of past 5 years.
 The review included majority of American
studies. (1/3rd )
Most of the studies had sample size of 50 or
less.
Majority of the studies included the areas with
NMR of <15 deaths per 1000 live births.
Africa and south east Asia where KMC is very
important, there were very less studies.
 Conclusion
KMC is very important intervention to prevent
complications related to pre term birth.
By knowing care givers perspectives enablers
should be promoted and barriers should be
reduced.
KMC team should insure that the experience
should be positive and valuable from
caregivers side.
 What is the level of evidence for this
study?
Evidence
Level 5 1 Systematic review & meta-analysis of randomized controlled
trials; clinical guidelines based on systematic reviews or meta-
analyses
2 One or more randomized controlled trials
Controlled trial (no randomization); quasi-experimental
4 Case-control or cohort study
5 Systematic review of descriptive studies; systematic review of
qualitative studies (metasynthesis)
6 Single descriptive or qualitative study

7 Program evaluation, research utilization, quality improvement

projects; case reports (JC sentinel event); benchmarking studies
(NDNQI data, UHC reports); or research-based clinical practice
guidelines
8 Expert opinion (authorities and/or reports of expert committees)
textbooks, clinical product guidelines; non-research based
clinical practice guidelines