Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit.

BACKGROUND: Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. This study sought to understand barriers and facilitators to provision of KMC in the NICU. METHODS: We conducted semi-structured in-depth interviews with mothers of preterm infants (N = 20) at a large academic medical center in Massachusetts. A series of open-ended interview questions were designed to elicit all aspects of mothers' experiences and to understand how these experiences influence provision of KMC. All interviews were recorded and transcribed verbatim. We conducted an inductive thematic analysis to identify themes in the data with a focus on the barriers and facilitators of KMC provision in the NICU. RESULTS: Findings show that engaging in KMC is heavily influenced by the mental, emotional, and physical effects of preterm birth on the birth mother, such as stress around preterm birth and difficulty recovering from birth. These challenges are compounded by structural barriers such as costly accommodations, unreliable transportation, lack of child care, and inadequate maternity leave policies that limit the frequency and duration of KMC and parental ability to provide care. CONCLUSIONS: A complex array of mental, emotional, physical, and structural factors determine a mother's ability to visit the NICU and provide kangaroo mother care. Providing social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation services, may address the structural barriers that inhibit KMC, reduce burdensome costs, and improve the health of mothers and their preterm infants.

Study comparing "Kangaroo Ward Care" with "Intermediate Intensive Care" for improving the growth outcome and cost effectiveness: randomized control trial.

AIMS: The aim of this study was to compare growth outcome and cost effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable infants with birth weight 1000 g to <1100 g. MATERIAL AND METHODS: In this secondary analysis, we included 79 infants, with birth weight 1000 g to <1100 g. Thirty-eight were randomized to KWC and 41 to IIC group once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attained a weight of 1250 g before shifting to Kangaroo Ward. After shifting to Kangaroo ward, infants in the IIC group received equivalent care to KWC group infants. RESULTS: There was significant better weight gain post-randomization during hospital stay and better length gain till 40 weeks of gestational age in intervention arm. There was reduction of post-randomization hospital stay by 2 d in the KWC group. The infants in the KWC group were shifted 6 d earlier to Kangaroo ward from IIC when compared with the IIC group. The cost-effective analysis that used "top-down" and "bottom-up" accounting method showed significant reduction of hospital and parents expenditure in the KWC group (p < .001) with saving of 570 USD per patient in the KWC group. CONCLUSION: Early shifting of infants to Kangaroo ward with birth weight 1000 g to <1100 g leads to better growth and is cost effective (CTRI/2014/05/004625). CLINICAL TRIAL REGISTRATION: Clinical trial registry of India CTRI/2014/05/004625.

Latin American Clinical Epidemiology Network Series - Paper 4: Economic evaluation of Kangaroo Mother Care: cost utility analysis of results from a randomized controlled trial conducted in Bogotá.

BACKGROUND AND OBJECTIVE: Although kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention. METHODS: A cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost-utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed. RESULTS: ICUR at 1 year of corrected age was $ -1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ -7,963 to $ 4,910). CONCLUSION: In Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings.

To compare growth outcomes and cost-effectiveness of "Kangaroo ward care" with "intermediate intensive care" in stable extremely low birth weight infants: randomized control trial.

AIMS: To compare growth outcome and cost-effectiveness of "Kangaroo ward care" (KWC) with "Intermediate intensive care" (IIC) in stable extremely low birth weight (ELBW) infants. MATERIALS AND METHODS: This is secondary analysis of the study and we analyzed 62 ELBW infants, 33 were randomized to KWC and 29 to IIC once the infant reached a weight of 1150 g. Infants in the KWC group were shifted to the Kangaroo ward immediately after randomization and in the IIC group received IIC care till they attain a weight of 1250 g before shifting to Kangaroo ward. RESULTS: The gain in weight (g/day), length (cm/week), and head circumference (cm/week) were comparable between the two groups. The mean weight, length, and head circumference were comparable at term gestational age. The infants in KWC group were shifted five days earlier to Kangaroo ward when compared to IIC group. The cost-effective analysis using "top-down" and "bottom-up" accounting method showed that there was significant reduction of hospital and parents expenditure in KWC group (p < 0.001) with approximate saving of 452 USD for each patient in the KWC group. CONCLUSION: Early shifting of ELBW infants for KWC is very efficacious and cost-effective intervention when compared to IIC. (CTRI/2014/05/004625).

The cost-savings of implementing kangaroo mother care in Nicaragua.

OBJECTIVE: To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. METHODS: After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010 The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. RESULTS: A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (P = 0.017) and 71% were exclusively breastfed (P < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1 - 2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). CONCLUSIONS: Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.

Impacto orcamentario da utilizacao do Metodo Canguru no cuidado neonatal / Impacto presupuestario de la utilizacion del metodo Canguro en el cuidado neonatal / Budget impact of using the Kangaroo Method in neonatal care

OBJETIVO Estimar o impacto orçamentário da utilização do Método Canguru na rede municipal de saúde. MÉTODOS Um modelo de decisão analítico foi desenvolvido para simular os custos do Método Canguru e Unidade Intermediária Neonatal no Rio de Janeiro, RJ, em 2011. A população de referência foi constituída pelos recém-nascidos estáveis clinicamente, que podem receber assistência nas duas modalidades de cuidado. O impacto orçamentário foi estimado para uma coorte hipotética de 1.000 recém-nascidos elegíveis em um ano. A proporção de recém-nascidos elegíveis que recebem assistência nas duas modalidades foi obtida por coleta de dados nas maternidades incluídas no estudo. As probabilidades dos eventos e o consumo de recursos de saúde, no período da assistência, foram incorporados ao modelo. Cenários foram desenvolvidos para refletir a adoção do método Canguru em maior ou menor escala. RESULTADOS A utilização do Método Canguru significou redução de gastos equivalente a 16% em um ano, se todos os recém-nascidos elegíveis fossem assistidos por esse método. CONCLUSÕES A opção Método Canguru é de menor custo comparado com a da Unidade Intermediária Neonatal. A análise de impacto orçamentário da utilização desse método no Sistema Único de Saúde indicou economia importante para o período de um ano. .

OBJETIVO Estimar el impacto presupuestario de la utilización del método canguro en la red municipal de salud. MÉTODOS Un modelo de decisión analítico fue desarrollado para simular los costos del método Canguro y Unidad Intermediaria Neonatal en Rio de Janeiro, RJ, en 2011. La población de referencia estuvo constituida por los recién nacidos estables clínicamente, que pueden recibir asistencia en las dos modalidades de cuidado. El impacto presupuestario fue estimado para una cohorte hipotética de 1.000 recién nacidos elegibles en un año. La proporción de recién nacidos elegibles que reciben asistencia en las dos modalidades fue obtenida por colecta de datos en las maternidades incluidas en el estudio. Las probabilidades de los eventos y el consumo de recursos de salud, en el período de asistencia, fueron incorporados al modelo. Escenarios fueron desarrollados para reflejar la adopción del método Canguro en mayor o menor escala. RESULTADOS La utilización del método Canguro significó reducción de gastos equivalente a un 16% en un año, si todos los recién nacidos elegibles fueran asistidos por ese método. CONCLUSIONES La opción método Canguro es de menor costo en comparación con el de la Unidad Intermediaria Neonatal. El análisis de impacto presupuestario de la utilización de ese método en el Sistema Único de Salud indicó economía importante para el período de un año. .

OBJECTIVE To estimate the budget impact of using the Kangaroo Method in a municipal health care network. METHODS An analytical decision model was developed to simulate the costs of the Kangaroo Method and Neonatal Intermediate Care Unit in Rio de Janeiro, RJ, in 2011. The reference population was clinically stable newborns, who may receive either of the two types of care. The budget impact for a hypothetical cohort of 1,000 eligible newborns was estimated for one year. The proportion of eligible infants receiving the two type of care was obtained through data collection in hospitals included in the study. The probabilities of events and resource consumption of health care in the period were incorporated into the model. A scenario analysis was developed to reflect the adoption of the Kangaroo Method on a greater or smaller scale. RESULTS The use of the second and third stage of Kangaroo Method means a cost reduction of R$ 1,085,379.64 (16.0%) in a year if all eligible infants were assisted in Kangaroo Method. CONCLUSIONS The Kangaroo Method options costs less than the Neonatal Intermediate Care Unit. The analysis of the budget impact of this method on the public health care system showed significant savings in the year long period analyzed. .

The cost-savings of implementing kangaroo mother care in Nicaragua / Reducción de costos mediante la implantación del método madre canguro en Nicaragua

OBJECTIVE: To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. METHODS: After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010 The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. RESULTS: A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (P = 0.017) and 71% were exclusively breastfed (P < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1 - 2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). CONCLUSIONS: Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.

OBJETIVO: Analizar los costos de la implantación del método madre canguro en un hospital de referencia de Nicaragua, incluidos los costos de capacitación, implantación y funcionamiento, y calcular la repercusión económica en el sistema de salud nicaragüense si se aplicara el método en otras maternidades del país. MÉTODOS: Tras recibir capacitación clínica en el método, los miembros del equipo encargado de su implantación capacitaron a sus colegas, elaboraron directrices para los médicos y material educativo para los padres, y garantizaron la adhesión a las nuevas directrices. La intervención empezó en septiembre del 2010. El estudio comparó los siguientes datos: peso de los lactantes, empleo de medicamentos, consumo de leches maternizadas, uso de incubadoras, y hospitalizaciones durante los seis meses previos y posteriores a la implantación. Los datos relativos a los costos se recopilaron a partir de los registros contables de los ejecutores y los formularios del Ministerio de Salud. RESULTADOS: Los datos de 46 lactantes seleccionados aleatoriamente antes de la implantación se compararon con los de 52 lactantes del período posterior a la intervención. Mediante el control de los factores de confusión, después de la intervención, el tiempo medio de hospitalización de los recién nacidos fue inferior en 4,64 días (P = 0,017), y el 71% (P < 0,001) de los lactantes recibieron lactancia materna exclusiva. La intervención tuvo un costo de US$ 23 113 pero el dinero ahorrado gracias a la menor duración de las hospitalizaciones, la eliminación del uso de incubadoras, y la reducción de los costos en antibióticos y leches maternizadas compensó estos gastos en uno a dos meses. Se proyecta extender el método a otros 12 establecimientos sanitarios de Nicaragua para ahorrar aproximadamente US$ 233 000 (con base en el cálculo del uso de incubadoras en el hospital de referencia) o US$ 166 000 (con base en un cálculo más conservador del uso de incubadoras) al cabo de un año. CONCLUSIONES: El tratamiento de los neonatos prematuros y con bajo peso al nacer mediante el método madre canguro, implantado como un programa de mejora de la calidad en Nicaragua, ahorra dinero en un período corto, incluso sin tener en cuenta los efectos beneficiosos del método sobre la salud. Se recomienda su implantación en otros establecimientos sanitarios.

[Cost analysis of hospital care for newborns at risk: comparison of an Intermediate Neonatal Care Unit and a Kangaroo Unit]. / Análise de custos da atenção hospitalar a recém-nascidos de risco: uma comparação entre Unidade Intermediária Convencional e Unidade Canguru.

The aim of this study was to compare the direct costs of implementation of the Kangaroo Method and an Intermediate Neonatal Care Unit, from the perspective of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. Newborns were eligible for inclusion if they were clinically stable and were able to receive care in those two modalities. A decision tree model was developed that incorporated baseline variables and costs into a hypothetical cohort of 1,000 newborns, according to the literature and expert opinions. Daily cost was BR$343.53 for the second stage of the Kangaroo Unit and BR$394.22 for the Intermediate Neonatal Care Unit. The total cost for the hypothetical cohort was BR$5,710,281.66 for the second and third stages of the Kangaroo Unit and R$7,119,865.61 for the Intermediate Neonatal Care Unit. The Intermediate Neonatal Care Unit cost 25% more than the Kangaroo Unit. The study can contribute to decision-making in health, in addition to providing support for studies related to economic evaluation in neonatal health.

Análise de custos da atenção hospitalar a recém-nascidos de risco: uma comparação entre Unidade Intermediária Convencional e Unidade Canguru / Cost analysis of hospital care for newborns at risk: comparison of an Intermediate Neonatal Care Unit and a Kangaroo Unit / Análisis de los costes de la atención hospitalaria para los recién nacidos en riesgo: una comparación entre la Unidad Intermedia Neonatal y la Unidad Canguro

O objetivo deste estudo foi realizar uma análise comparativa entre o custo da Unidade Canguru e da Unidade Intermediária Convencional sob a perspectiva do SUS, no Município do Rio de Janeiro, Brasil. A população de referência é de recém-nascidos estáveis clinicamente, que podem receber assistência nas duas modalidades de cuidado. Um modelo de análise de decisão para uma coorte hipotética de mil recém-nascidos elegíveis foi elaborado para comparar os custos em cada estratégia avaliada. As probabilidades dos eventos e o consumo de recursos de saúde foram incorporados ao modelo com base na literatura e consulta a especialistas. O custo da diária foi de R$343,53 para a 2ª etapa da Unidade Canguru e de R$394,22 para a Unidade Intermediária Convencional. O custo para a coorte hipotética foi de R$5.710.281,66 para a assistência na 2ª e 3ª etapa da Unidade Canguru e de R$7.119.865,61 para a Unidade Intermediária Convencional. A Unidade Intermediária Convencional apresentou custos 25% superiores aos da Unidade Canguru. O estudo pode contribuir para a tomada de decisão na área da saúde, além de fornecer subsídios para pesquisas relacionadas à avaliação econômica na área neonatal.

The aim of this study was to compare the direct costs of implementation of the Kangaroo Method and an Intermediate Neonatal Care Unit, from the perspective of the Brazilian Unified National Health System (SUS) in Rio de Janeiro, Brazil. Newborns were eligible for inclusion if they were clinically stable and were able to receive care in those two modalities. A decision tree model was developed that incorporated baseline variables and costs into a hypothetical cohort of 1,000 newborns, according to the literature and expert opinions. Daily cost was BR$343.53 for the second stage of the Kangaroo Unit and BR$394.22 for the Intermediate Neonatal Care Unit. The total cost for the hypothetical cohort was BR$5,710,281.66 for the second and third stages of the Kangaroo Unit and R$7,119,865.61 for the Intermediate Neonatal Care Unit. The Intermediate Neonatal Care Unit cost 25% more than the Kangaroo Unit. The study can contribute to decision-making in health, in addition to providing support for studies related to economic evaluation in neonatal health.

El objetivo de este estudio fue realizar un análisis comparativo entre el coste de la Unidad Canguro y la Unidad Intermedia Convencional, dentro de la perspectiva del Sistema Único de Salud (SUS) en el municipio de Río de Janeiro, Brasil. La población de referencia son los recién nacidos clínicamente estables, que pueden recibir asistencia en ambas modalidades de atención. Se diseñó un modelo de análisis de decisión para una cohorte hipotética de 1.000 bebés elegibles, con el fin de comparar los costes de cada estrategia evaluada. Las probabilidades de ocurrencias y consumo de recursos sanitarios se incorporaron al modelo de la literatura y la consulta con expertos. El coste diario fue de R$343,53 en la 2ª etapa de la Unidad Canguro y R$394,22 en la Unidad Intermedia Convencional. El coste de la cohorte hipotética fue R$5,710,281.66 para la asistencia en la segunda y tercera etapa de la Unidad Canguro y R$7,119,865.61 para la Unidad Intermedia Convencional. La Unidad Intermedia Convencional tiene costes un 25% más altos que la Unidad Canguro. El presente estudio puede contribuir a la toma de decisiones en el cuidado de la salud.

[Budget impact of using the Kangaroo Method in neonatal care]. / Impacto orçamentário da utilização do Método Canguru no cuidado neonatal.

OBJECTIVE: To estimate the budget impact of using the Kangaroo Method in a municipal health care network. METHODS: An analytical decision model was developed to simulate the costs of the Kangaroo Method and Neonatal Intermediate Care Unit in Rio de Janeiro, RJ, in 2011. The reference population was clinically stable newborns, who may receive either of the two types of care. The budget impact for a hypothetical cohort of 1,000 eligible newborns was estimated for one year. The proportion of eligible infants receiving the two type of care was obtained through data collection in hospitals included in the study. The probabilities of events and resource consumption of health care in the period were incorporated into the model. A scenario analysis was developed to reflect the adoption of the Kangaroo Method on a greater or smaller scale. RESULTS: The use of the second and third stage of Kangaroo Method means a cost reduction of R$ 1,085,379.64 (16.0%) in a year if all eligible infants were assisted in Kangaroo Method. CONCLUSIONS: The Kangaroo Method options costs less than the Neonatal Intermediate Care Unit. The analysis of the budget impact of this method on the public health care system showed significant savings in the year long period analyzed.

[The kangaroo mothers' programme: a simple and cost-effective alternative for protecting the premature newborn or low-birth-weight babies]. / Programa madre canguro: una alternativa sencilla y costo eficaz para la protección de los recién nacidos prematuros o con bajo peso al nacer.

OBJECTIVE: Describing the efficacy and achievements of the kangaroo mothers' programme (KMP) regarding preterm or low-birth-weight babies' health and development in Hospital San Rafael in Tunja from November 2007 to December 2009. METHODS: This was a retrospective observational cohort study; 374 infants born prematurely or having low-birth-weight were included to assess household socio-demographic factors, maternal and obstetric history, delivery characteristics and complications and follow-up until 40 weeks post-conception age. RESULTS: There was a high prevalence of teenage pregnancy (17.5 %) and in women older than 35 years (12.6 %), unwanted pregnancy (40.6 %), low quality and poor availability of food in families, complications such as preeclampsia, infection and premature rupture of membranes, 1,969 grams average birth weight, 2,742.9 grams average weight on discharge and 22 grams average weight gain per day. CONCLUSIONS: It was found that KMP methodology substantially improved the mothers' psychological aspects and health status and the newborns' prognosis and led to stabilising body temperature and weight gain rate while decreasing risks of complications and nosocomial infection. It also lowered health care costs and shortened hospital stay.

Programa madre canguro: una alternativa sencilla y costo eficaz para la protección de los recién nacidos prematuros o con bajo peso al nacer / The kangaroo mothers' programme: a simple and cost-effective alternative for protecting the premature newborn or low-birth-weight babies

Objetivo Describir la eficacia y logros del PMC sobre la salud y el desarrollo de los recién nacidos prematuros o con bajo peso al nacer en el Hospital San Rafael de Tunja durante el periodo comprendido entre Noviembre de 2007 y Octubre 31 de 2009 en sus diferentes componentes. Métodos Estudio observacional descriptivo de una cohorte. Se incluyeron 374 recién nacidos prematuros o con bajo peso al nacer, para evaluar factores sociodemográficos del hogar, antecedentes maternos y obstétricos, características y complicaciones del parto y seguimiento hasta las 40 semanas de edad postconcepcional. Resultados Altas prevalencias de embarazo adolescente (17,5 %) y en mayores de 35 años (12,6 %); embarazo no deseado (40,6 %); baja calidad y disponibilidad de alimentos en la familia; complicaciones como toxemia gravídica, infecciones y ruptura prematura de membranas; peso promedio al nacer de 1 969 gramos; peso promedio al egreso 2 742,9 gramos; ganancia promedio de peso por día de 22 gramos. Conclusiones Se encuentra que la metodología del programa Madre Canguro mejora sustancialmente los aspectos psicológicos de la madre y el pronóstico de salud de los recién nacidos y permite la estabilización de la temperatura corporal, del ritmo de ganancia de peso, a la vez que disminuye los riesgos de complicaciones y de infección nosocomial. También disminuye los costos de atención y estancia hospitalaria.

Objective Describing the efficacy and achievements of the kangaroo mothers' programme (KMP) regarding preterm or low-birth-weight babies' health and development in Hospital San Rafael in Tunja from November 2007 to December 2009. Methods This was a retrospective observational cohort study; 374 infants born prematurely or having low-birth-weight were included to assess household socio-demographic factors, maternal and obstetric history, delivery characteristics and complications and follow-up until 40 weeks post-conception age. Results There was a high prevalence of teenage pregnancy (17.5 %) and in women older than 35 years (12.6 %), unwanted pregnancy (40.6 %), low quality and poor availability of food in families, complications such as preeclampsia, infection and premature rupture of membranes, 1,969 grams average birth weight, 2,742.9 grams average weight on discharge and 22 grams average weight gain per day. Conclusions It was found that KMP methodology substantially improved the mothers' psychological aspects and health status and the newborns' prognosis and led to stabilising body temperature and weight gain rate while decreasing risks of complications and nosocomial infection. It also lowered health care costs and shortened hospital stay.