Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi

Area of Science:

• Neonatal care
• Public health
• Sociology

Background:

• Kangaroo Mother Care (KMC) is vital for preterm and low birth weight infants, especially in resource-limited settings.
• Low KMC coverage is often attributed to sociocultural barriers, despite its proven effectiveness and low cost.
• Understanding community perceptions is crucial for effective KMC implementation.

Purpose of the Study:

• To explore social norms and community perceptions of preterm infants and KMC in Malawi.
• To inform a pilot social and behavior change program aimed at increasing KMC uptake.
• To identify barriers and facilitators to KMC engagement within the Malawian context.

Main Methods:

• Qualitative study utilizing 11 focus group discussions and 20 in-depth interviews.
• Purposive and snowball sampling included diverse stakeholders: pregnant women, KMC parents, health workers, community members, and religious leaders.
• Inductive thematic analysis of transcribed and translated audio recordings.

Main Results:

• Three key injunctive norms influence KMC: preterm infants require care, men provide while women nurture, and community support is essential.
• Norms operate across community, family, household, and individual levels, with community and family support playing crucial roles.
• KMC engagement is influenced by social norms, economic status, family obligations, and maternal health.

Conclusions:

• Strengthening KMC requires context-specific interventions that reinforce supportive social norms and address discouraging ones.
• Interventions must focus on community and family levels to drive meaningful household-level change.
• Tailoring KMC programs to local sociocultural contexts is essential for improved coverage and infant outcomes.