SEARCHCOHORTpediatrics, obstetrics and gynecology

cohort·pediatrics, obstetrics and gynecology, public health, clinical trial, observational study·PMC10120231

The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison

BMC Pediatrics · 7 authors, 4 centres

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TL;DR

This pilot study used a prospective cohort comparison design in a Malawi Kangaroo Mother Care unit, where random assignment was not feasible due to the open-room setting.

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This pilot study used a prospective cohort comparison design in a Malawi Kangaroo Mother Care unit, where random assignment was not feasible due to the open-room setting. Mother-preterm infant dyads received either the H-HOPE behavioral intervention (teaching mothers to interact with their infants) plus KMC or KMC only. Responsivity was measured using the Dyadic Mutuality Code (DMC) during a video-recorded play session at 6-weeks corrected age. The final sample included 60 dyads in the H-HOPE+KMC group and 59 in the KMC-only group. After controlling for maternal and infant characteristics, the H-HOPE+KMC dyads were significantly more likely (AOR=11.51) to have higher responsivity. Vaginal delivery was the only other significant predictor. Limitations include the non-randomized design, a 65% follow-up rate, and potential inaccuracies in gestational age estimation. The study suggests H-HOPE is feasible in Malawi and may enhance the benefits of KMC alone.

STUDY TYPE

cohort

SPECIALTY

pediatrics

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AI pipeline

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ORIGINAL PAPER

PMC10120231

The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison

BMC Pediatrics

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ABSTRACT

Abstract Background Early behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care. Method This pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC). Results The final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96). Conclusion This study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide. Keywords: Mother-infant responsivity, Preterm birth, Kangaroo Mother Care (KMC), Early behavioral intervention, H-HOPE, Malawi

CITATION EXPORT

Esnath M Kapito, Ellen M Chirwa, Elizabeth Chodzaza et al.. The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison. BMC Pediatrics. (2023). https://doi.org/10.1186/s12887-023-04015-z

AUTHORS

7 · 4 CENTRES

Esnath M Kapito, Ellen M Chirwa, Elizabeth Chodzaza, Kathleen F Norr, Crystal Patil, Alfred O Maluwa, Rosemary White-Traut

1School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi
2Children’s Hospital of Wisconsin, Children’s Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin 53226 USA
3College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL 60612 USA
4Malawi University of Science and Technology, P. O Box 5196, Limbe, Malawi