TY - JOUR T1 - Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2021-005905 VL - 6 IS - 9 SP - e005905 AU - Prem K Mony AU - Henok Tadele AU - Abebe Gebremariam Gobezayehu AU - Grace J Chan AU - Aarti Kumar AU - Sarmila Mazumder AU - Selemawit Asfaw Beyene AU - Krishnamurthy Jayanna AU - Dejene Hailu Kassa AU - Hajira Amin Mohammed AU - Abiy Seifu Estifanos AU - Pankaj Kumar AU - Arun Singh Jadaun AU - Tedros Hailu Abay AU - Maryann Washington AU - Fitsum W/Gebriel AU - Lamesgin Alamineh AU - Addisalem Fikre AU - Alok Kumar AU - Sonia Trikha AU - Fisseha Ashebir Gebregizabher AU - Arin Kar AU - Selamawit Mengesha Bilal AU - Mulusew Lijalem Belew AU - Mesfin Kote Debere AU - Raghav Krishna AU - Suresh Kumar Dalpath AU - Samson Yohannes Amare AU - H L Mohan AU - Thomas Brune AU - Lynn M Sibley AU - Abraham Tariku AU - Arti Sahu AU - Tarun Kumar AU - Marta Yemane Hadush AU - Prabhu Deva Gowda AU - Khalid Aziz AU - Dereje Duguma AU - Pramod Kumar Singh AU - Gary L Darmstadt AU - Ramesh Agarwal AU - Dawit Seyoum Gebremariam AU - Jose Martines AU - Anayda Portela AU - Harsh Vardhan Jaiswal AU - Rajiv Bahl AU - Suman Rao PN AU - Birkneh Tilahun Tadesse AU - John N Cranmer AU - Damen Hailemariam AU - Vishwajeet Kumar AU - Nita Bhandari AU - Araya Abrha Medhanyie A2 - , Y1 - 2021/09/01 UR - http://gh.bmj.com/content/6/9/e005905.abstract N2 - Objectives Kangaroo Mother Care (KMC), prolonged skin-to-skin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.Design This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.Participants 3804 infants of birth weight under 2000 g who survived the first 3 days, were available in the study area and whose mother resided in the study area.Main outcome measures The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7 days postdischarge.Results Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%–86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7 days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).Conclusions This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.Trial registration numbers ISRCTN12286667; CTRI/2017/07/008988; NCT03098069; NCT03419416; NCT03506698.Data are available upon reasonable request. Data are available upon reasonable request from the principal investigator of each site and/or the corresponding author. ER -