The presence of physician champions improved Kangaroo Mother Care in rural western India.
OBJECTIVE
This study determined the effect of physician champions on the two main components of Kangaroo Mother Care (KMC): skin-to-skin care and breastfeeding.


METHODS
KMC practices among a retrospective cohort of 648 infants admitted to a rural Indian neonatal intensive care unit (NICU) between January 5, 2011 and October 7, 2014 were studied. KMC champions were identified based on their performance evaluation. We examined the effect of withdrawing physician champions on overall use, time to initiation and intensity of skin-to-skin care and breastfeeding, using separate models.


RESULTS
In comparison with when KMC champions were present, their absence was associated with a 45% decrease in the odds of receiving skin-to-skin care, with a 95% confidence interval (CI) of 64% to 17%, a 38% decrease in the rate of initiation skin-to-skin care (95% CI 53-82%) and an average of 1.47 less hours of skin-to-skin care (95% CI -2.07 to -0.86). Breastfeeding practices were similar across the different champion environments.


CONCLUSIONS
Withdrawing physician champions from the NICU setting was associated with a decline in skin-to-skin care, but not breastfeeding. Training health care workers and community stakeholders to become champions could help to scale up and maintain KMC practices.
University of Massachusetts Medical School, Worcester, MA, USA.
Apurv
http://orcid.org/0000-0001-5049-3657
A
Soni
Pramukhswami Medical College, Karamsad, India.
Amee
A
Amin
Pramukhswami Medical College, Karamsad, India.
Dipen V
DV
Patel
Des Moines University, Des Moines, IA, USA.
Nisha
N
Fahey
Pramukhswami Medical College, Karamsad, India.
Nikhil
N
Shah
Pramukhswami Medical College, Karamsad, India.
Ajay G
AG
Phatak
University of Massachusetts Medical School, Worcester, MA, USA.
Jeroan
J
Allison
Pramukhswami Medical College, Karamsad, India.
Somashekhar M
http://orcid.org/0000-0003-2825-2819
SM
Nimbalkar
D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India; D007231:Infant, Newborn; D060127:Kangaroo-Mother Care Method / Q000706:statistics & numerical data*; D008297:Male; D010819:Physician's Role; D012189:Retrospective Studies
Implementation science; Kangaroo Mother Care champions; Low- and middle-income countries; Newborn care; Quality improvement