P3.H157: Perceived barriers and facilitators of practicing kangaroo mother care: a qualitative study of mothers of premature infants admitted to NICU in Addis Ababa, Ethiopia

Background: Kangaroo Mother Care (KMC) is a vital method for improving the health outcomes of preterm and low birth weight (LBW) infants, particularly in resource-poor countries. However, barriers exist that hinder mothers from effectively practicing KMC. To better understand the factors influencing KMC care for preterm and LBW infants, we sought to characterize mothers’ perceptions of the barriers and facilitators in a tertiary care center in Ethiopia.

Methods: A semi-structured interview guide with probes to achieve the study objectives reviews was developed based on a literature review. The semi-structured in-depth interview questionnaires were prepared in English and then translated into Amharic for the interview. Questions focused on mothers’ experiences, challenges, and facilitators of practicing KMC. Interviews were conducted with a purposive sample of mothers who had participated in KMC care within the past 2 years, recruited from the Saint Paul's Hospital Millennium Medical College (SPHMMC) KMC unit and the High-Risk infant follow-up clinic. Interviews were transcribed and translated into English. Three coders independently performed thematic analysis, meeting regularly to resolve discrepancies and revise the codebook. Thematic saturation was reached after 20 interviews.

Results: Demographics of interviewed mothers are in Table 1; participants were from diverse educational, occupational, and religious backgrounds. Three major themes emerged. In the first theme, “perceived benefits of KMC care,” many mothers highlighted the advantages of KMC care for infants and themselves. Illustrative quotes reported in Table 2A. In the second theme, “physical and environmental factors impacting KMC care” (subthemes: identified barriers, consequences of barriers), mothers reported how the physical demands of KMC and the resource limitations hindered their ability to provide this care. Some mothers reflected that these factors contributed to care that was potentially unsafe, such as pressuring discharge before infants are ready. Illustrative quotes reported in Table 2B. In the third theme, “Hope Impacting KMC Care” (subthemes: factors threatening mothers’ hope, consequences of hopelessness, factors supporting mothers’ hope), mothers described how lack of awareness/support from their partners, families, or communities undermined hope. This not only impacted mothers' mental and emotional state; in some cases, it led to mothers leaving against medical advice, which could have potentially deleterious consequences on their infant's outcome. Illustrative quotes reported in Table 2C

Conclusion: Though mothers are encouraged by the benefits of KMC care, they face multifaceted barriers. These range from individual challenges to systemic issues within the healthcare setting and community, and may impact survival outcomes for these infants. Addressing these barriers through policy changes, enhanced community awareness, improved hospital resources, and targeted support for mothers and families is essential to promote effective KMC implementation and improve the health outcomes of preterm and LBW infants. Further research is needed to develop scalable solutions and interventions that address these complex barriers comprehensively.