Tigabu Eskeziya Zerihun, Woretaw Sisay Zewdu, Abel Temeche Kassaw, Samuel Agegnew Wondm, Samuel Berihun Dagnew, Getachew Yitayew Tarekegn, Tilaye Arega Moges, Fasil Bayafers Tamene, Desalegn Addis Mussie
EeKMC coverage is critically low at 4.6%, with incubator use identified as a significant barrier. Qualitative findings revealed barriers, including inadequate infrastructure, skill gaps among health care workers, cultural norms, and maternal fears. The cross-sectional design limits causal interpretation of the identified associations. Comprehensive interventions addressing health care infrastructure, provider training, family engagement, and cultural acceptance are urgently needed.
BACKGROUND: In 2020, ∼13.4 million newborns were born preterm worldwide, with 65% occurring in sub-Saharan Africa and Southern Asia. In Ethiopia, fewer than 10% of eligible newborns received Kangaroo Mother Care (KMC) in 2021, despite WHO endorsement. This study evaluated effective early KMC (EeKMC) coverage and associated factors in northwest Ethiopia.
METHODS: A facility-based cross-sectional study with a convergent parallel mixed-methods design was conducted from October 2024 to November 2025. Quantitative data were extracted from existing hospital records (secondary data) for 713 low-birth-weight neonates (<2,000 g). EeKMC was defined as ≥8 hours of skin-to-skin contact combined with exclusive breastfeeding within 24 hours of birth. Qualitative data were collected through in-depth interviews (n = 14) and observations to identify barriers and facilitators. Bivariate and multivariate logistic regression were used for quantitative analysis; thematic analysis was used for qualitative data.
RESULTS: Of the 713 newborns, only 4.6% (33/713; 95% confidence interval [CI]: 3.2-6.4%) received EeKMC, whereas 55.5% (396/713) were exclusively breastfed within 24 hours. Newborns in incubators were less likely to receive EeKMC (adjusted odds ratio = 0.07; 95% CI: 0.015-0.34). Barriers included inadequate infrastructure, skill gaps, and cultural norms, while facilitators involved quality improvement initiatives and maternal willingness.
CONCLUSION: EeKMC coverage is critically low at 4.6%, with incubator use identified as a significant barrier. Qualitative findings revealed barriers, including inadequate infrastructure, skill gaps among health care workers, cultural norms, and maternal fears. The cross-sectional design limits causal interpretation of the identified associations. Comprehensive interventions addressing health care infrastructure, provider training, family engagement, and cultural acceptance are urgently needed.