Operational research and evaluation of the implementation and scale-up of kangaroo mother care and other maternal and newborn health interventions at different health-system levels
Kangaroo mother care (KMC) is a high-impact, cost-effective and life-saving intervention in the care of preterm and low birthweight newborns. These babies need special care to keep warm and to feed. Instead of being kept in an incubator or placed under a radiant warmer, stable babies are placed skin-to-skin on the mother’s or other caregiver’s chest in an upright position and tied securely. Babies who are too immature to breastfeed and have difficulty in coordinating the suck-swallow-and-breathe movement receive expressed breastmilk through a gastric tube or with a cup. The mother is intimately involved with her baby and she becomes the primary caregiver with the support of the nursing, medical and allied health care staff. She learns the skill of taking care of her small baby and she is able to go home safely. Small newborns continue to receive KMC at home. They are still very vulnerable and should be followed up regularly by an experienced multidisciplinary team.
The KMC implementation research programme started in 1999 with the implementation of KMC at Kalafong Provincial Tertiary Hospital in Gauteng Province. At that time, the method was relatively unknown globally and in South Africa. There was nothing available to assist clinicians and managers on how to implement this new intervention and for which services they should plan. In the first few years, a number of outreach strategies were developed and tested with the aid of a multimedia package that included a workbook, a poster and a wrap for tying the baby. The evidence that emerged included a stages-of-change model and a tool to assess progress with KMC implementation based on this model. Members of the Centre are involved in the training of healthcare providers and the scale-up and assessment of KMC practice and services. Many African countries have benefited from these activities, including Botswana, Chad, Comoros, Côte d’Ivoire, Eswatini, Ethiopia, Ghana, Kenya, Liberia, Mali, Malawi, Niger, Nigeria, Rwanda, Somalia, Sudan, Tanzania, The Gambia, Togo, Uganda, and Zimbabwe. Other countries that received training include Bangladesh, Belize, Egypt, Indonesia, Germany, Iran, Iraq, Jordan, Lebanon, Saudi Arabia, Syria and the United Arab Emirates.
The stages-of-change model is transferable to other interventions and has been used in the scale-up of the Essential Steps in the Management of Obstetric Emergencies (ESMOE), for understanding and assessing the implementation of maternal and perinatal death audit systems, and for implementing PMTCT and HIV-prevention programmes.
Investigators
- Anne- Marie Bergh, Researcher
- Elise Van Rooyen, Researcher/Collaborator
Sponsors
- Government departments
- South African Medical Research Council
Materials to support kangaroo mother care implementation
Technical reports
Publications
- Bergh A-M, Van Rooyen E, Kritzinger A, Skhosana MR, Tshukudu M, Feucht U. (2025). The challenging road to sustainable kangaroo mother care practice and service: reflections from a South African health district. BMC Health Services Research 25:425. https://doi.org/10.1186/s12913-025-12581-4
- Kritzinger A, Van Rooyen E, Bergh A-M. (2024). A swallowing and breastfeeding intervention programme for small and sick neonates embedded in kangaroo mother care. South African Journal of Communication Disorders 71(1):a1055.
https://doi.org/10.4102/sajcd.v71i1.1055 and https://sajcd.org.za/index.php/sajcd/article/view/1055/2278 - Udani RH, Rao S, Bergh A-M. Kangaroo mother care in India: down the memory lane. Journal of Neonatology. 2024;38(2):319-324. https://doi.org/10.1177/09732179241237885
- Muhumuza S, Nsabagasani X, Muhangi CN, Latigi G, Pirio P, Msukwa C, Mwanyumba F, Gohar F, Hailegebriel TD, Asfaw AG, Bergh A-M. Perspectives of stakeholders regarding the value of maternal and newborn health interventions and practices supported by UNICEF and other partners in the West Nile region of Uganda: a qualitative study. BMC Health Services Research. 2023;23(1):473. https://doi.org/10.1186/s12913-023-09480-x
- Mohammadi M, Bergh A-M, Jahdi NS, Valizadeh L, Hosseini M, Hakimi S. Launching continuous kangaroo mother care through participatory action research in Iran. BMC Health Services Research. 2023;23(1):436. https://doi.org/10.1186/s12913-023-09372-0
- Gooding C, Lavin Y, van Rooyen E, Bergh A-M, Preen DB. Evaluating maternal discharge readiness in kangaroo mother care. Indian Pediatrics 2021;58(10):932-935. https://www.indianpediatrics.net/oct2021/932.pdf
- Mohammadi M, Bergh, A-M, Heidarzadeh M, Hosseini MB, Sattarzadeh N, Valizadeh L, Sarvaran B, Hakimi S. Implementation and effectiveness of continuous kangaroo mother care: a participatory action research protocol. International Breastfeeding Journal. 2021;16:24. https://doi.org/10.1186/s13006-021-00367-3
- Bergh A-M. Effective health promotion and health education (chapter). In V Flenady (ed), Elements of professional care and support before, during and after pregnancy. In The Continuous Textbook of Women’s Medicine – Obstetrics Module, Volume 3; 2021. https://www.glowm.com/article/heading/vol-3--elements-of-professional-care-and-support-before-during-and-after-pregnancy--effective-health-promotion-and-health-education/id/414253#.YDJmcmhLjIU
- Hailegebriel TD, Bergh AM, Zaka N, Roh JM, Gohar F, Rizwan S, Asfaw AG, Heidarzadeh M, Zeck W. Improving the implementation of kangaroo mother care. Bulletin of the World Health Organization. 2021; 99(1):69-71. http://dx.doi.org/10.2471/BLT.20.252361
- Charpak N, Angel MI, Banker D, Bergh AM, María Bertolotto A, De Leon‐Mendoza S, Godoy N, Lincetto O, Lozano JM, Ludington‐Hoe S, Mazia G. Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale. Acta Paediatrica. 2020; 109(11):2278-86. https://doi.org/10.1111/apa.15214
- Mhango P, Chipeta E, Muula AS, Robb-McCord J, White P, Litch JA, Kamanga I, Freeman R, Bergh A-M. Implementing the Family-Led Care model for preterm and low birth weight newborns in Malawi: experience of health care workers. African Journal of Primary Health Care & Family Medicine. 2020;12(1):a2266. https://phcfm.org/index.php/phcfm/article/view/2266/4138
- Cattaneo A, Amani A, Charpak N, De Leon-Mendoza S, Moxon S, Nimbalkar S, Tamburlini G, Villegas J, Bergh A-M. Report on an international workshop on kangaroo mother care: lessons learned and a vision for the future. BMC Pregnancy and Childbirth. 2018; 18(1):170. https://doi.org/10.1186/s12884-018-1819-9
- Bergh A-M, de Graft-Johnson J, Khadka N, Om’Iniabohs A, Udani R, Pratomo H, de Leon-Mendoza S. The three waves in implementation of facility-based kangaroo mother care: a multi-country case study from Asia. International Health and Human Rights. 2016;16:4. https://doi.org/10.1186/s12914-016-0080-4
- Feucht U, van Rooyen E, Skhosana R, Bergh A-M. Taking kangaroo mother care forward in South Africa: What is the role of district clinical specialist teams? South African Medical Journal. 2016;106(1): 49-51. http://www.samj.org.za/index.php/samj/article/download/10149/7080
- Vesel L, Bergh A-M, Kerber K, Valsangkar B, Mazia G, Moxon S, Blencowe H, Darmstadt D, de Graft Johnson J, Dickson K, Ritter von Xylander S, Lawn JE. (2015). Kangaroo mother care: Multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy and Childbirth. 2015;15(Suppl 2):S5. https://doi.org/10.1186/1471-2393-15-S2-S5
- Bergh A-M, Kerber K, Abwao S, De-Graft Johnson J, Aliganyira P, Davy K, Gamache N, Kante M, Ligowe R, Luhanga L, Mukarugwiro B, Ngabo F, Rawlins B, Sayinzoga F, Sengendo NH, Sylla M, Taylor R, Van Rooyen E, Zoungrana J. Implementing facility-based kangaroo mother care: lessons from a multi-country evaluation in Africa. BMC Health Services Research. 2014;14:293. https://doi.org/10.1186/1472-6963-14-293
- Aliganyira P, Kerber K, Davy K, Gamache N, Sengendo NH, Bergh A-M. Helping small babies survive: an evaluation of facility-based Kangaroo Mother Care implementation progress in Uganda. Pan African Medical Journal. 2014;19:37. http://www.panafrican-med-journal.com/content/article/19/37/pdf/37.pdf
- Kritzinger A, van Rooyen E. The effect of formal, neonatal communication-intervention training on mothers in kangaroo care. African Journal of Primary Health Care & Family Medicine. 2014;6(1):E1-9. https://phcfm.org/index.php/phcfm/article/view/675/975
- Bergh A-M, Manu R, Davy K, Van Rooyen E, Quansah Asare G, Awoonor‑Williams JK, Dedzo M, Twumasi A, Nang‑Beifubah A. Progress with the implementation of kangaroo mother care in four regions in Ghana. Ghana Medical Journal. 2013;47(2): 57-63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743115/pdf/GMJ4702-0057.pdf
- Bergh A-M, Manu R, Davy K, Van Rooyen E, Quansah Asare G, Awoonor Williams JK, Dedzo M, Twumasi A, Nang-beifubah A. Translating research findings into practice – the implementation of kangaroo mother care in Ghana. Implementation Science. 2012;7:75. https://doi.org/10.1186/1748-5908-7-75
- Bergh A-M, Charpak N, Enzeonodo A, Udani R, Van Rooyen E for the KMC Education and Training Working Group. Education and training in the implementation of kangaroo mother care. South African Journal of Child Health. 2012;6(2): 38-45. http://www.sajch.org.za/index.php/SAJCH/article/view/417/296
- Bergh A-M, Rogers-Bloch, Pratomo H, Uhudiyah U, Poernomo Sigit Sidi I, Rustina Y, Suradi R, Gipson R, for the participating hospitals and Perinasia. Progress in the implementation of kangaroo mother care in ten hospitals in Indonesia. Journal of Tropical Pediatrics. 2012;58(5): 402-405. https://doi.org/10.1093/tropej/fmr114
- Pratomo H, Uhudiyah U, Poernomo Sigit Sidi I, Rustina Y, Suradi R, Bergh A-M, Rogers-Bloch Q, Gipson R. Supporting factors and barriers in implementing kangaroo mother care in Indonesia. Paediatrica Indonesiana. 2012;52(1): 43-50. https://pdfs.semanticscholar.org/a736/8ca2992fdaf8dd1fba71e7723aee69405d84.pdf
- Davy K, Bergh A-M, Van Rooyen E. The neonatal nurse’s role in kangaroo mother care. Professional Nursing Today. 2011;15(3):32-37. https://www.researchgate.net/publication/277172051_The_neonatal_nurse's_role_in_kangaroo_mother_care
- Bergh A-M, Van Rooyen E, Pattinson RC. On-site’ versus ‘off-site’ facilitation: a randomised trial of outreach strategies for scaling up kangaroo mother care. Human Resources for Health. 2008;13. https://human-resources-health.biomedcentral.com/articles/10.1186/1478-4491-6-13
- Pattinson RC, Bergh A-M, Malan AF, Prinsloo R. Does kangaroo mother care save lives? Journal of Tropical Pediatrics. 2006;52(6):438-441. https://doi.org/10.1093/tropej/fml032
- Bergh A-M, Arsalo, I, Malan AF, Patrick M, Pattinson RC, Phillips N. Measuring implementation progress in kangaroo mother care. Acta Paediatrica. 2005;94(8):1102-1108. https://doi.org/10.1111/j.1651-2227.2005.tb02052.x
- Pattinson RC, Arsalo I, Bergh A-M, Malan AF, Patrick M, Phillips N. Implementation of kangaroo mother care: A randomised trial of two outreach strategies. Acta Paediatrica. 2005;94(7):924-927. https://doi.org/10.1111/j.1651-2227.2005.tb02012.x
- Bergh A-M, Pattinson RC. The development of a conceptual tool for the implementation of kangaroo mother care. Acta Paediatrica. 2003;92(6): 709-714. https://pubmed.ncbi.nlm.nih.gov/12856983/