Table 4. Description of studies included in the systematic review on kangaroo mother care .
| Author, year | Country | Rural or urban | Study design | Sample size | Newborn characteristics | Kangaroo mother care components | Onset of skin-to-skin care | Provision of kangaroo mother care |
Barriers and facilitators |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hours per day | Days | Caregivers | Health-care workers | Facilities | Policies and guidelines | |||||||||
| Abul-Fadl, 201262 | Egypt | Mixed | Pop based surveillance, facility evaluation | 1052 mothers | All ages | Skin-to-skin care | N/A | N/A | N/A | Xa | X | X | –a | |
| Aliganyira, 201429 | Uganda | Mixed | Facility evaluation, focus group/interview | 11 facilities | N/A | Skin-to-skin care | N/A | N/A | N/A | – | X | X | – | |
| Alves, 200784 | Brazil | Mixed | Chart review, focus group/ interview | 33 dyads | Premature; N/A cut-off | N/A | Once eligible: N/A definition | N/A | N/A | X | – | – | – | |
| de Araújo, 201033 | Brazil | Urban | Focus group/ interview | 30 parents | Premature, ≥ 2000 g | N/A | Once eligible: N/A definition | 5–6 | N/A | X | X | X | – | |
| Arivabene, 201028 | Brazil | Urban | Focus group/ interview | 13 mothers | N/A | Skin-to-skin care | N/A | N/A | N/A | X | – | – | – | |
| Bazzano, 201251 | Ghana | Rural | Focus group/ interview | 9 mothers, 23 health-care workers | Low birthweight; N/A cut-off |
Skin-to-skin care | N/A | N/A | N/A | X | – | – | – | |
| Bergh, 201359 | Ghana | N/A | Facility evaluation | 38 facilities | N/A | Skin-to-skin care, exclusive breastfeeding, | Immediately after birth | N/A | N/A | X | X | X | X | |
| Bergh, 2003100 | South Africa | Urban | Facility evaluation | 2 facilities | N/A | N/A | N/A | N/A | N/A | – | X | X | – | |
| Bergh, 201267 | Indonesia | Urban | Facility evaluation | 10 facilities | N/A | N/A | N/A | N/A | N/A | X | – | – | – | |
| Bergh, 200899 | South Africa | Mixed | Randomized controlled trial | 36 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Bergh, 201226 | Ghana | N/A | Pop based surveillance, facility evaluation | 38 facilities | N/A | N/A | N/A | N/A | N/A | X | X | – | X | |
| Bergh, 200983 | Ghana | N/A | Facility evaluation | 4 regions (out of 10) | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Bergh, 201225 | Malawi | N/A | Facility evaluation | 14 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | X | |
| Bergh, 201255 | Mali | N/A | Facility evaluation | 7 facilities | N/A | Skin-to-skin care, exclusive breastfeeding, discharge, follow-up | N/A | N/A | N/A | X | X | X | X | |
| Bergh, 200782 | Malawi | N/A | Facility evaluation | 6 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Bergh, 201247 | Rwanda | N/A | Facility evaluation | 7 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Bergh, 201224 | Uganda | N/A | Facility evaluation | 11 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | X | |
| Bergh, 201427 | Malawi, Mali, Rwanda, and Uganda | Urban | Facility evaluation, Focus group/interview | 39 facilities | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | X | X | |
| Blencowe, 200981 | Malawi | Urban | Prospective cohort | 272 newborns | < 2000 g | N/A | Once eligible: N/A definition | N/A | N/A | X | – | X | – | |
| Blencowe, 200580 | Malawi | Urban | Facility evaluation | 1 facility | < 2000 g | Skin-to-skin care, exclusive breastfeeding, discharge, follow-up | N/A | N/A | N/A | X | – | – | – | |
| Blomqvist, 201348 | Sweden | N/A | Focus group/ interview | 76 mothers, 74 fathers | 28–33 weeks, 740–2920 g | Skin-to-skin care | N/A | N/A | N/A | X | X | X | – | |
| Blomqvist, 201139 | Sweden | Urban | Focus group/ interview | 23 dyads | All ages | Skin-to-skin care, exclusive breastfeeding | N/A | N/A | N/A | X | X | X | – | |
| Boo, 2007105 | Malaysia | Urban | Randomized controlled trial | 126 dyads | < 1501 g | Skin-to-skin care | Once eligible: N/A definition | 1 | 10 | X | X | X | – | |
| Brimdyr, 201269 | Egypt | N/A | Focus group/ interview | 40 nurses and health-care workers | N/A | Skin-to-skin care | Immediately after birth | 1 | 1 | X | X | X | – | |
| Calais, 201049 | Sweden, Norway | Urban | Focus group/ interview | 117 mothers, 107 fathers | Full term | Skin-to-skin care, discharge, follow-up | Immediately after birth | N/A | N/A | X | – | – | X | |
| Castiblanco López, 201150 | Colombia | Urban | Focus group/ interview | 8 mothers | < 36 weeks, 2320 g | N/A | N/A | N/A | N/A | X | – | X | – | |
| Charpak, 200679 | 15 developing countries | Mixed | Focus group/ interview | 17 kangaroo mother care co-ordinators, 15 facilities | N/A | Skin-to-skin care, discharge, follow-up | Immediately after birth | N/A | N/A | X | X | X | – | |
| Chia, 2006111 | Australia | Urban | Focus group/ interview | 34 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | X | – | |
| Chisenga, 201511 | Malawi | Urban | Focus group/ interview | 113 mothers | N/A | N/A | N/A | N/A | N/A | X | – | – | – | |
| Colameo, 200685 | Brazil | Mixed | Cross sectional | 28 facilities | Low birthweight; N/A cut-off | N/A | Once eligible: N/A definition | N/A | N/A | X | X | X | – | |
| Cooper, 201473 | United States of America | Mixed | Pre-post | 48 nurses and 101 parents | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | – | – | |
| Crenshaw, 201271 | United States of America | N/A | Descriptive | 261 dyads | Full term | Skin-to-skin care | ≤ 2 mins after birth | N/A | 1 | X | X | X | – | |
| Dalal, 201430 | India | Mixed | Cross sectional | 145 HCPs | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Dalbye, 201141 | Sweden, Norway | Urban | Focus group/ interview | 20 mothers | Full term | Skin-to-skin care | Immediately after birth | N/A | N/A | X | X | – | – | |
| Darmstadt, 200698 | India | Rural | Intervention | 2063 mothers | All ages | Skin-to-skin care | N/A | N/A | N/A | X | – | X | – | |
| De Vonderweid, 2003104 | Italy | Mixed | Pop based surveillance | 109 facilities | N/A | N/A | N/A | N/A | N/A | – | X | X | X | |
| Duarte, 200197 | Brazil | Urban | Focus group/ interview | 1 mother | Premature; N/A cut-off | Skin-to-skin care | N/A | N/A | 38 | X | – | X | – | |
| Eichel, 2001108 | United States of America | Urban | Facility evaluation | 1 facility | N/A | N/A | N/A | N/A | N/A | X | X | X | X | |
| Eleutério, 2008114 | Brazil | Urban | Focus group/ interview | 9 mothers | Premature; N/A cut-off | N/A | N/A | N/A | N/A | – | – | X | – | |
| Engler, 2002113 | United States of America | Mixed | Facility evaluation | 537 facilities | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Ferrarello, 201452 | United States of America | Urban | Focus group/ interview | 15 mothers, 14 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | X | – | – | X | |
| Flynn, 201066 | Ireland | Urban | Focus group/ interview | 62 health-care workers | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Freitas, 200786 | Brazil | N/A | Prospective cohort, descriptive | 22 newborns | N/A | N/A | N/A | N/A | N/A | – | – | X | – | |
| Furlan, 200387 | Brazil | Urban | Focus group/ interview | 10 parents | Premature; N/A cut-off | Skin-to-skin care | Once eligible: N/A definition | 10; mean | N/A | X | – | X | X | |
| Gontijo, 201034 | Brazil | Mixed | Facility evaluation | 293 facilities | N/A | Skin-to-skin care, exclusive breastfeeding | Once eligible: N/A definition | N/A | N/A | X | – | – | – | |
| Gontijo, 201275 | Brazil | Mixed | Focus group/ interview | 293 facilities | N/A | N/A | N/A | N/A | N/A | – | – | X | – | |
| Gonya, 201363 | United States of America | Urban | Focus group/ interview | 32 mothers | < 27 weeks | Skin-to-skin care | N/A | N/A | N/A | X | – | X | X | |
| Haxton, 201236 | United States of America | Urban | Intervention, qualitative | 30 mothers | All ages | Skin-to-skin care, exclusive breastfeeding | Within one hour after birth | 3 | 1 | X | X | X | X | |
| Heinemann, 201340 | Sweden | N/A | Focus group/ interview | 7 mothers, 6 fathers | < 27 weeks | Skin-to-skin care | N/A | N/A | N/A | X | – | X | – | |
| Hendricks-Muñoz, 201044 | United States of America | Urban | Focus group/ interview | 59 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | – | X | – | – | |
| Hendricks-Muñoz, 201365 | United States of America | Urban | Focus group/ interview | 143 mothers, 42 health-care workers | < 34 weeks | N/A | N/A | N/A | N/A | X | X | – | – | |
| Hendricks-Muñoz, 201456 | United States of America | Urban | Prospective cohort | 30 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | X | – | – | – | |
| Hennig, 200688 | Brazil | Mixed | Cross sectional | 148 doctors and nurses, 11 facilities | Low birthweight; N/A cut-off | N/A | Clinical stable | N/A | N/A | X | X | X | – | |
| Higman, 201513 | England | Urban | Focus group/ interview | 6 nurses and 51 clinicians | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Hill, 201058 | Ghana | Mixed | Focus group/ interview | 635 mothers, 14 villages | All ages | Skin-to-skin care | N/A | N/A | N/A | X | X | – | – | |
| Hunter, 201432 | Bangladesh | Rural | Focus group/ interview | 121 participants | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Ibe, 200492 | Nigeria | Urban | Crossover | 13 newborns, 11 mothers and female relatives | 1200–1999 g | Skin-to-skin care | After enrolment | 12 | N/A | X | – | – | – | |
| Johnson, 2007106 | United States of America | Peri-urban/slum | Focus group/ interview | 17 nurses | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Johnston, 201137 | Canada | N/A | Randomized controlled trial crossover | 62 newborns | 28–36 weeks | Skin-to-skin care | ≥ 15 minute before heel lance | ≤ 1 | 2 | X | – | – | – | |
| Kambarami, 200296 | Zimbabwe | Urban | Focus group/ interview | N/A mothers | Low birthweight: N/A cut-off | N/A | N/A | N/A | N/A | X | – | X | – | |
| Keshavarz, 201061 | Islamic Republic of Iran | Urban | Randomized controlled trial | 160 dyads | Full term | Skin-to-skin care | 2 hours after caesarean | 3 | N/A | X | – | – | – | |
| Kostandy, 2008112 | United States of America | N/A | Randomized controlled trial crossover | 10 newborns | 30–32 weeks | Skin-to-skin care | 30 minute before heel stick | 0.83 | 1 | – | X | – | – | |
| Kymre, 201345 | Sweden, Norway, Denmark | N/A | Focus group/ interview | 18 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | – | – | |
| Lee, 201242 | United States of America | Mixed | Focus group/ interview | 69 health-care providers, 11 facilities | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | X | – | |
| Legault, 1995120 | Canada | Urban | Randomized controlled trial, pre-post, crossover | 61 dyads | Premature: N/A cut-off 1000–1800 g | Skin-to-skin care | Once eligible: N/A definition | 0.5 | 1 | X | – | – | – | |
| Lemmen, 201364 | Sweden | N/A | Focus group/ interview | 12 families | 24–35 weeks | Skin-to-skin care | N/A | N/A | N/A | X | X | – | – | |
| Leonard, 2008102 | South Africa | Urban | Focus group/ interview | 6 parents | Premature: N/A cut-off | N/A | N/A | N/A | N/A | X | – | – | – | |
| Lincetto, 1998116 | Mozambique | Urban | Prospective cohort | 246 newborns | < 2000 g | Skin-to-skin care, exclusive breastfeeding, discharge, follow-up | Stabilized health condition, presence of a sucking reflex, thermoregulation, mother's condition enabling her to care for the low birthweight infant, cessation of the infant's need for IV therapy, oxygen, photo-therapy or feeding by NG tube | > 20 | N/A | X | X | X | – | |
| Maastrup, 201253 | Denmark | N/A | Facility evaluation | 19 facilities | N/A | Skin-to-skin care | 18 out of 19 within 24 hour postpartum for stable preterm infant | N/A | N/A | X | – | – | – | |
| Mallet, 2007107 | France | N/A | Focus group/ interview | 121 doctors and paramedical staff | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Martins, 2008115 | Brazil | Urban | Focus group/ interview | 5 mothers | N/A | N/A | N/A | N/A | N/A | X | – | – | – | |
| McMaster, 200078 | Papua New Guinea | Urban | Chart review, facility evaluation | 109 newborns | < 1500 g | Skin-to-skin care | N/A | N/A | N/A | X | – | – | – | |
| Moreira, 2009101 | Brazil | Urban | Focus group/ interview | 8 mothers | 30–32 weeks, < 2000 g | Skin-to-skin care | Once eligible: N/A definition | N/A | N/A | X | – | – | – | |
| Mörelius, 201515 | Sweden | Urban | Survey | 129 nurses | All newborns | N/A | N/A | N/A | N/A | X | X | – | – | |
| Mörelius, 201270 | Sweden | Mixed | Pop based surveillance | 520 newborns | < 27 weeks | Skin-to-skin care | N/A | N/A | N/A | – | X | – | – | |
| Nahidi, 201446 | Islamic Republic of Iran | Urban | Questionnaire | 292 midwives | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Namazzi, 201510 | Uganda | Rural | Randomized controlled trial | 20 health facilities | All newborns | Skin-to-skin care | N/A | N/A | N/A | X | X | X | – | |
| Neu, 1999117 | N/A | Urban | Focus group/ interview | 8 mothers, 1 father | Premature; N/A cut-off | Skin-to-skin care | N/A | 1 | 2 | X | X | X | – | |
| Nguah, 201123 | Ghana | Urban | Prospective cohort | 195 dyads | 1000–2000 g | Skin-to-skin care, exclusive breastfeeding, follow-up | After admission in hospital and if mother was willing | N/A | N/A | X | – | – | – | |
| Niela–Vilén, 201338 | Finland | Urban | Prospective cohort, qualitative | 170 mothers, 381 staff | All NICU newborns | N/A | Immediately after birth | N/A | N/A | X | X | – | – | |
| Nimbalkar, 201422 | India | Urban | Questionnaire | 52 paediatricians | N/A | N/A | N/A | N/A | N/A | – | X | – | – | |
| Nyqvist, 200895 | Sweden | N/A | Focus group/ interview | 13 mothers | < 32 weeks | Skin-to-skin care, discharge, follow-up | N/A | N/A | N/A | X | X | X | X | |
| Parmar, 2009109 | India | Urban | Retrospective cohort | 135 newborns | 26–37 weeks, 550–2500 g | Skin-to-skin care | N/A | N/A | N/A | X | X | X | – | |
| Pattinson, 2005110 | South Africa | Mixed | Randomized controlled trial | 34 facilities | N/A | N/A | N/A | N/A | N/A | – | – | X | – | |
| Priya, 200493 | India | N/A | Crossover | 30 dyads | Low birthweight; N/A cut-off | Skin-to-skin care | After routine care was observed and data were collected | 2 | 2 | X | – | – | – | |
| Quasem, 200377 | Bangladesh | Urban | Focus group/ interview | 35 mothers | All ages | Skin-to-skin care | N/A | N/A | N/A | X | – | X | – | |
| Ramanathan 2001103 | India | N/A | Randomized controlled trial | 28 newborns | < 1500 g | N/A | Once eligible: N/A definition | ≥ 4 | N/A | X | X | – | – | |
| Roller, 200594 | United States of America | N/A | Focus group/ interview | 10 mothers | 32–37 weeks | Skin-to-skin care | N/A | N/A | N/A | X | X | X | X | |
| Sá, 201035 | Brazil | Urban | Focus group/ interview | 10 mothers, 7 health-care providers | Premature; N/A cut-off | N/A | N/A | N/A | N/A | X | – | – | – | |
| Sacks, 201321 | Honduras | Rural | Focus group/ interview | 48–72 traditional birthing attendant (6 focus groups with 8–12 participants per group) | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Santos, 201372 | Brazil | Urban | Focus group/ interview | 12 mothers | Premature, low birthweight; N/A cut-off | Skin-to-skin care | N/A | N/A | N/A | X | – | X | – | |
| Shamba, 201420 | United Republic of Tanzania | Mixed | Focus group/ interview | 57 mothers and 14 traditional birthing attendants | N/A | N/A | N/A | N/A | N/A | X | – | – | – | |
| Silva, 201474 | Brazil | Urban | Focus group/ interview | 20 nursing technicians | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
| Silva, 201512 | Brazil | Urban | Focus group/ interview | 8 nurses | N/A | N/A | N/A | N/A | N/A | – | X | – | – | |
| Silva, 200889 | Brazil | Urban | Focus group/ interview | 5 dyads | Premature: N/A cut-off, < 1000–1550 g | Skin-to-skin care | Once eligible: N/A definition | ≤ 24 | Depended on mothers length of stay | X | – | – | – | |
| Singh, 201219 | India | Mixed | Case control | 145 662 newborns, 810 204 mothers | All ages | N/A | N/A | N/A | N/A | – | – | – | X | |
| Sinha, 201418 | India | Rural | Focus group/ interview | 320 mothers, 61 accredited social health activists, 19 home visits | N/A | Skin-to-skin care, exclusive breastfeeding | N/A | N/A | N/A | X | X | – | – | |
| Sloan, 200876 | Bangladesh | Rural | Cluster randomized controlled trial | 39 888 mothers | All ages | Skin-to-skin care | N/A | N/A | 2; data available for first 2 days of life | X | X | – | – | |
| Solomons, 201217 | South Africa | Urban | Cross sectional | 30 mothers, 15 nurses | < 2500 g | N/A | N/A | N/A | N/A | X | X | X | – | |
| Stikes, 201343 | United States of America | Urban | Focus group/ interview | 56 nurses | N/A | Skin-to-skin care | N/A | N/A | N/A | X | X | X | X | |
| Strand, 201454 | Sweden | N/A | Facility evaluation | 126 staff | N/A | N/A | N/A | N/A | N/A | X | X | X | – | |
| Tessier, 1998119 | Colombia | Urban | Randomized controlled trial | 488 newborns | < 2001 g | Skin-to-skin care, discharge, follow-up | Adapted to extra-uterine life and able to breastfeed | N/A | N/A | X | – | – | – | |
| Toma, 200390 | Brazil | Urban | Focus group/ interview | 14 mothers, 7 fathers | Premature: N/A cut-off, 1150–2300 g | N/A | Ranged from 3 to 39 days of life | N/A | N/A | X | – | – | – | |
| Toma, 200791 | Brazil | Urban | Focus group/ interview | 41 mothers | < 2000 g | N/A | Mean 18 days of life | N/A | N/A | X | – | X | – | |
| Undefined author: Save the Children, 201157 | Ethiopia, Malawi, Mali, Mozambique, Nigeria, United Republic of Tanzania, Uganda, Bolivia, Indonesia, Nepal, Viet Nam | N/A | Facility evaluation | 12 countries | N/A | N/A | N/A | N/A | N/A | X | X | X | X | |
| Vesel, 201368 | Ghana | Rural | Cluster randomized controlled trial | 98 zones | All ages | Skin-to-skin care | N/A | N/A | N/A | X | – | – | – | |
| Wahlberg, 1992118 | Sweden | Urban | Retrospective cohort | 66 dyads | Premature; N/A cut-off | Skin-to-skin care | N/A | N/A | N/A | – | X | X | – | |
| Waiswa, 201016 | Uganda | Rural | Focus group/ interview | 30 health-care workers and mothers, 16 facilities | Premature; N/A cut-off | N/A | N/A | N/A | N/A | X | X | X | – | |
| Waiswa, 20159 | Uganda | Rural | Cluster randomized controlled trial | 395 women | All newborns | Skin-to-skin care, exclusive breastfeeding | N/A | N/A | N/A | X | – | – | – | |
| Wobil, 201060 | Ghana | Urban | Facility evaluation | 2 facilities | N/A | N/A | N/A | N/A | N/A | X | – | X | – | |
| Zhang, 201431 | Singapore | Urban | Facility evaluation | 1 ICU | Less than 34 weeks; Less than 1500 g | Skin-to-skin care | Once eligible: stable preterm or low birthweight babies, excluding infants with poor respiratory status, invasive lines, or parents who are depressed, not willing to do kangaroo mother care, having infectious skin disease on chest, unfit physically, or with flu-like symptoms. | At least 1 hour several times per day | N/A | X | X | X | – | |
| Zwedberg, 201514 | Sweden | Urban | Focus group/ interview | 8 midwives | N/A | N/A | N/A | N/A | N/A | X | X | – | – | |
a ‘X means included in the study and ‘–’ means not included in the study.
ICU: intensive care unit; N/A: not available; NICU: neonatal intensive care unit.