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

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

doi:10.1186/s12887-023-04015-z

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

BMC Pediatr. 2023 Apr 21;23(1):187. doi: 10.1186/s12887-023-04015-z.

Authors

Esnath M Kapito¹, Ellen M Chirwa², Elizabeth Chodzaza², Kathleen F Norr^{3

4}, Crystal Patil⁴, Alfred O Maluwa⁵, Rosemary White-Traut^{3

4}

Affiliations

¹ School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi. kapito2017esnath@kcn.unima.mw.
² School of Maternal, Neonatal and Reproductive Health Studies, Kamuzu University of Health Sciences, Private Bag 360, Blantyre, Malawi.
³ Children's Hospital of Wisconsin, Children's Research Institute, 9000 Winsconsin Avenue, Milwaukee, Winsconsin, 53226, USA.
⁴ College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (M/C 806), Chicago, IL, 60612, USA.
⁵ Malawi University of Science and Technology, P. O Box 5196, Limbe, Malawi.

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: Early behavioral intervention; H-HOPE; Kangaroo Mother Care (KMC); Malawi; Mother-infant responsivity; Preterm birth.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Female
Humans
Infant, Newborn
Infant, Premature
Kangaroo-Mother Care Method*
Malawi
Mothers*
Pregnancy
Prospective Studies