Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage. Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge. Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area. Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge. Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%). Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice. Trial registration numbers [ISRCTN12286667][1]; CTRI/2017/07/008988; [NCT03098069][2]; [NCT03419416][3]; [NCT03506698][4]. Data are available upon reasonable request. Data are available upon reasonable request from the principal investigator of each site and/or the corresponding author. [1]: http://ISRCTN12286667 [2]: http://NCT03098069 [3]: http://NCT03419416 [4]: http://NCT03506698

中文翻译：

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在埃塞俄比亚和印度扩大袋鼠妈妈护理：一项多地点实施研究

目标 袋鼠妈妈护理 (KMC)，延长低出生体重婴儿与母亲的皮肤接触，加上纯母乳喂养，可降低新生儿死亡率。全球 KMC 覆盖率低。本研究旨在开发和评估适应环境的实施模型，以提高覆盖率。设计 本研究使用混合方法应用实施科学来制定适应性策略以改进实施。形成性研究为初始模型提供了信息，该模型在三个迭代周期中进行了改进。这些模型包括三个组成部分：(1) 最大限度地利用 KMC 实施设施，(2) 确保 KMC 在设施中启动和维护，以及 (3) 支持出院后在家中继续使用。参与者 3804 名出生体重低于 2000 克的婴儿在前 3 天存活，在研究区域有空且其母亲居住在研究区域。主要结果测量 主要结果是出院前 24 小时和出院后 7 天的 KMC 覆盖率。结果 确定了扩大 KMC 的主要障碍和解决方案。由此产生的实施模型实现了基于人口的高覆盖率。在埃塞俄比亚和印度，KMC 启动率达到了 68%–86% 和 87%。出院时，埃塞俄比亚 68% 的婴儿和印度 55% 的婴儿得到了 KMC。出院后 7 天，除奥罗米亚 (38%) 和卡纳塔克邦 (36%) 外，所有地点 53%–65% 的婴儿都获得了 KMC。结论 本研究显示了使用基于实施科学的上下文适应模型可以实现多高的 KMC 覆盖率。他们得到了政府领导的支持，卫生工作者对 KMC 是护理标准的信念、妇女和家庭对 KMC 的接受程度以及基础设施、政策、技能和实践的变化。试用注册号 [ISRCTN12286667][1]；CTRI/2017/07/008988；[NCT03098069][2]；[NCT03419416][3]；[NCT03506698][4]。可根据合理要求提供数据。数据可根据每个站点的主要研究者和/或通讯作者的合理要求提供。[1]：http://ISRCTN12286667 [2]：http://NCT03098069 [3]：http://NCT03419416 [4]：http://NCT03506698 数据可根据每个站点的主要研究者和/或通讯作者的合理要求提供。[1]：http://ISRCTN12286667 [2]：http://NCT03098069 [3]：http://NCT03419416 [4]：http://NCT03506698 数据可根据每个站点的主要研究者和/或通讯作者的合理要求提供。[1]：http://ISRCTN12286667 [2]：http://NCT03098069 [3]：http://NCT03419416 [4]：http://NCT03506698