An Implementation Science Study of a Heat-Producing Wrap to Complement KMC in Rwanda

Area of Science:

• Implementation Science
• Neonatal Health
• Thermoregulation

Background:

• Neonatal hypothermia causes significant preventable newborn mortality, particularly in low-resource settings.
• Existing research on heat-producing wraps, like the Dream Warmer, is limited, especially in real-world clinical conditions.
• Kangaroo Mother Care (KMC) is vital but may be insufficient without adjuncts for maintaining infant warmth.

Purpose of the Study:

• To evaluate the safety, effectiveness, and functionality of the Dream Warmer in rural Rwandan healthcare facilities.
• To assess the impact of the Dream Warmer on clinical workflows and its integration with KMC.
• To understand healthcare provider (HCP) and parent reception of the Dream Warmer.

Main Methods:

• A prospective, interventional, mixed-methods study conducted in 6 district hospitals and 84 health centers in Rwanda.
• Intervention involved providing the Dream Warmer and thermoregulation education.
• Pre- and post-intervention data collected via medical records, audits, and surveys.

Main Results:

• The Dream Warmer demonstrated no safety concerns and was used correctly in most cases.
• Mean infant admission temperature increased from 36.41°C to 36.53°C post-intervention (p=0.002).
• 86% of infants reached a temperature ≥36.5°C; hyperthermia occurred in only 1% of cases.

Conclusions:

• The Dream Warmer is effective and functional in real-world settings, comparable to research conditions.
• Ongoing education for HCPs and parents is crucial for a continuous heat chain and preventing hypothermia.
• Family engagement in thermoregulation can support HCPs and empower parents, improving neonatal survival.