Process and costs for readiness to safely implement immediate kangaroo mother care: a mixed methods evaluation from the OMWaNA trial at five hospitals in Uganda.
Implementation
Intervention costs
Kangaroo mother care
Low birthweight
Newborn care
Preterm
Service readiness
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
10 Jun 2023
10 Jun 2023
Historique:
received:
22
01
2023
accepted:
30
05
2023
medline:
12
6
2023
pubmed:
11
6
2023
entrez:
10
6
2023
Statut:
epublish
Résumé
Preterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000-1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings. We describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children's Fund. Following the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m These five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable. ClinicalTrials.gov, NCT02811432 . Registered: 23 June 2016.
Sections du résumé
BACKGROUND
BACKGROUND
Preterm birth complications result in > 1 million child deaths annually, mostly in low- and middle-income countries. A World Health Organisation (WHO)-led trial in hospitals with intensive care reported reduced mortality within 28 days among newborns weighing 1000-1799 g who received immediate kangaroo mother care (iKMC) compared to those who received standard care. Evidence is needed regarding the process and costs of implementing iKMC, particularly in non-intensive care settings.
METHODS
METHODS
We describe actions undertaken to implement iKMC, estimate financial and economic costs of essential resources and infrastructure improvements, and assess readiness for newborn care after these improvements at five Ugandan hospitals participating in the OMWaNA trial. We estimated costs from a health service provider perspective and explored cost drivers and cost variation across hospitals. We assessed readiness to deliver small and sick newborn care (WHO level-2) using a tool developed by Newborn Essential Solutions and Technologies and the United Nations Children's Fund.
RESULTS
RESULTS
Following the addition of space to accommodate beds for iKMC, floor space in the neonatal units ranged from 58 m
CONCLUSIONS
CONCLUSIONS
These five Ugandan hospitals required substantial resource inputs to allow safe implementation of iKMC. Before widespread scale-up of iKMC, the affordability and efficiency of this investment must be assessed, considering variation in costs across hospitals and levels of care. These findings should help inform planning and budgeting as well as decisions about if, where, and how to implement iKMC, particularly in settings where space, devices, and specialised staff for newborn care are unavailable.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov, NCT02811432 . Registered: 23 June 2016.
Identifiants
pubmed: 37301974
doi: 10.1186/s12913-023-09624-z
pii: 10.1186/s12913-023-09624-z
pmc: PMC10257176
doi:
Banques de données
ClinicalTrials.gov
['NCT02811432']
Types de publication
Clinical Trial
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
613Subventions
Organisme : Medical Research Council
ID : MR/S004971/1
Pays : United Kingdom
Informations de copyright
© 2023. The Author(s).
Références
Trials. 2020 Jan 31;21(1):126
pubmed: 32005286
Pediatr Res. 2017 Aug;82(2):194-200
pubmed: 28419084
Implement Sci Commun. 2021 Oct 9;2(1):115
pubmed: 34625121
Pediatrics. 2016 Jan;137(1):
pubmed: 26702029
Lancet. 2012 Jun 9;379(9832):2162-72
pubmed: 22682464
Semin Fetal Neonatal Med. 2013 Dec;18(6):373-8
pubmed: 23896083
Int Breastfeed J. 2015 Mar 20;10:11
pubmed: 26000029
Cochrane Database Syst Rev. 2016 Aug 23;(8):CD002771
pubmed: 27552521
BMJ Glob Health. 2020 Oct;5(10):
pubmed: 33055093
BMJ. 2017 Mar 6;356:i6795
pubmed: 28264797
Lancet Glob Health. 2014 Nov;2(11):e635-44
pubmed: 25442688
BMC Pregnancy Childbirth. 2015;15 Suppl 2:S5
pubmed: 26391115
Lancet. 2018 Nov 10;392(10159):1859-1922
pubmed: 30415748
J Clin Epidemiol. 2017 Jun;86:91-100
pubmed: 27989952
Lancet. 2020 Oct 17;396(10258):1204-1222
pubmed: 33069326
Health Policy Plan. 2002 Mar;17(1):112-8
pubmed: 11861593
BMC Med. 2016 Jan 18;14:5
pubmed: 26782822
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
J Glob Health. 2016 Jun;6(1):010701
pubmed: 27231546
BMC Pregnancy Childbirth. 2015;15 Suppl 2:S7
pubmed: 26391335
Rev Panam Salud Publica. 2013 Sep;34(3):176-82
pubmed: 24233110
Lancet Glob Health. 2019 Jan;7(1):e37-e46
pubmed: 30389451
EClinicalMedicine. 2021 Aug 06;39:101050
pubmed: 34401686
Ann Trop Paediatr. 2000 Mar;20(1):22-6
pubmed: 10824209
J Glob Health. 2018 Jun;8(1):010702
pubmed: 30023050
BMJ Open Qual. 2022 May;11(Suppl 1):
pubmed: 35545274
Acta Paediatr. 1998 Sep;87(9):976-85
pubmed: 9764894
Value Health. 2016 Dec;19(8):921-928
pubmed: 27987641
BMJ Glob Health. 2021 Sep;6(9):
pubmed: 34518203
Lancet. 2017 Dec 17;388(10063):3027-3035
pubmed: 27839855
Pediatrics. 2017 Jan;139(1):
pubmed: 27965377
N Engl J Med. 2021 May 27;384(21):2028-2038
pubmed: 34038632
Health Policy Plan. 2019 May 1;34(4):289-297
pubmed: 31106346