Improving Skin-to-Skin Practice for babies in Kangaroo Mother Care in Malawi through the use of a customized baby wrap: A randomized control trial

Complications of prematurity are a leading cause of newborn death in Malawi. Despite early adoption of Kangaroo mother care (KMC), coverage remains low and women have expressed challenges in using the traditional wrapper-chitenje. In 2016, a study was conducted to evaluate the acceptability and effe...

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Bibliographic Details
Published in:	PloS one Vol. 15; no. 3; p. e0229720
Main Authors:	Chavula, Kondwani, Guenther, Tanya, Valsangkar, Bina, Lwesha, Victoria, Banda, Gedesi, Bøe Wensaas, Marte, Luhanga, Richard, Chimtembo, Lydia, Kinney, Mary V, Dube, Queen
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 2020 Public Library of Science (PLoS)
Subjects:	Acceptability Babies Biology and Life Sciences Birth weight Breast feeding Breastfeeding & lactation Community involvement Complications Customization Discharge Global health Medicine and Health Sciences Mortality Mothers Multiple births Newborn babies People and Places Premature birth Randomization Skin Social Sciences Studies Malawi United States > US
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Summary:	Complications of prematurity are a leading cause of newborn death in Malawi. Despite early adoption of Kangaroo mother care (KMC), coverage remains low and women have expressed challenges in using the traditional wrapper-chitenje. In 2016, a study was conducted to evaluate the acceptability and effectiveness of a customized KMC wrap in improving adherence to KMC practices among mothers. Mother-baby dyads (301) were randomized to receive either a customized CarePlus Wrap developed by Lærdal Global Health or a traditional chitenje. Enrolled mother-baby dyads were assessed in the KMC ward at 2-3 days after of admission, and then again at 7-15 days post-discharge. Topics covered included skin-to-skin practices, breastfeeding, perceptions of the wrap, and family/community support. Chi square tests were used to assess associations between wrap type and KMC practices. The study received ethics approval. This study found that a customized KMC wrap is highly acceptable to women and improved skin-to-skin practices in facility-based KMC: 44% of mothers using a customized wrap reported 20 or more hours per day, compared to 33% of mothers using the traditional chitenje. Women using the customized wrap reported being comfortable in keeping the baby in skin-to-skin position more often than women using the chitenje (96% vs. 71%), and they were able to tie on the wrap themselves (86% vs. 10%). At the time of discharge from KMC, more women who used the customized wrap were satisfied with the wrap than those who used the traditional chitenje (94% vs. 56%). The customized wrap did not appear to impact other newborn practices, such as breastfeeding. This study provides evidence that a customized KMC wrap is highly acceptable to mothers, and it can contribute to better skin-to-skin practices. Use of a customized wrap may be one mechanism to support mothers in practicing KMC and skin-to-skin contact in addition to other interventions.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Competing Interests: The authors declare that they have no competing interests.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0229720