Effect of training on implementation of kangaroo mother care among healthcare workers in Muranga county hospital, Kenya.

Abstract

Background: Care for preterm and low birth weight infants poses a great challenge to the health care providers and their care takers. In order to reach their target weight, low-birth-weight infants are often admitted for a long time increasing the incidence of hospital acquired infections. Additionally, in order to get the required warmth and special care they often share incubators with other sick infants further decreasing their chances of survival due to cross infection. Kangaroo mother care (KMC) is a low cost but effective method which has been shown to significantly reduce morbidity and mortality. The main barrier to KMC is lack of healthcare workers’ skills and awareness as evidenced from several previous studies conducted, thus it is important to evaluate simple, practical and scalable approaches to training to improve knowledge and practice. Primary objective: To assess the impact of a 1- day didactic and competency based KMC training on healthcare workers’ knowledge in Murang’a County Referral Hospital. Secondary objectives: To assess the impact of 1-day didactic and competency based KMC training on practice and to assess barriers and facilitators to KMC implementation. Study method: Study design: Quasi-experimental (before and after) study with a qualitative arm. Study site and subjects and tools: Healthcare workers in Murang’a County Referral Hospital. Baseline knowledge and practice on KMC of healthcare workers was assessed 2 weeks before training. Thereafter, a one day didactic training was conducted and a repeat assessment of their knowledge and practice was analyzed after 2 weeks of training. Focused group discussions with health care workers were used to determine barriers and facilitators to KMC implementation. Data was collected using pre and post training questionnaires, observers’ checklist and from focused group discussions. Qualitative data was manually transcribed and translated. Thematic content analysis was analyzed for recurring themes. Results: Fifty seven (57) participants were recruited in the study out of which 45(79.0%) of the participants were female. Majority of the participants were nurses 37(64.9%) and 56(98.4%) of the health care workers had not undergone training. Fourteen (24.6%) of the participants were working in the NBU department. Forty seven (82.5%) of the HCWs correctly defined what KMC was before training and 98.2% after training (p value=0.012). Twenty nine (54.7%) HCWs were able to correctly point out criteria for starting KMC before training and 44(81.5%) after training About two thirds of the participants 35(61.4%) and 39(68.4%) of the HCWs had the correct knowledge on discharge criteria of baby and mother on KMC before training respectively and 57(100%) and 56(98.3%) after training. Approximately half of the HCWs 29 (52.7%) had correct knowledge on readmission criteria for babies on KMC before training and 57(100%) after training. There was no change in KMC practice as observed on mother infant dyads on KMC before and after training. Majority of the participants pointed out that lack of infrastructure 25(43.9%) and training 19(33.3%) were barriers to KMC implementation in the facility, whereas LBW infants 17(30.4%) and availability of resources 14(24.5%) were facilitators to KMC success. Conclusion: There was significant change in knowledge noted after training on feeding options for the LBW and preterm infants, admission, readmission, discharge criteria and follow up of babies on KMC. There was however no change noted on KMC practice after training. Recommendation: Continuous medical education and sensitization on KMC should be done to the healthcare workers and priority offered to those working in maternity and newborn departments.