Beyond Awareness: Cultural and knowledge barriers to kangaroo mother care uptake in Lagos, Nigeria

Authors

  • Ezenwa Beatrice N Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
  • Ndukwu Lilian Department of Paediatrics, Lagos, UTH, Nigeria
  • Oyenusi Elizabeth E Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
  • Olatosi Olubukola Department of Child Dental, College of Medicine, University of Lagos, Nigeria
  • Moronkola Olaolu A Department of Paediatrics, Lagos, UTH, Nigeria
  • Fajolu Iretiola B Department of Paediatrics, College of Medicine, University of Lagos, Nigeria
  • Ojulari Opeyemi Department of Nursing Services, Lagos, UTH, Nigeria
  • Idise Anita Department of Paediatrics, Lagos, UTH, Nigeria
  • Okafor Ifeoma P Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria
  • Ezeaka Veronica C Department of Paediatrics, College of Medicine, University of Lagos, Nigeria

Keywords:

Kangaroo Mother Care; Knowle dge t ransfer; Cultural barriers; Preterm infants; Nigeria

Abstract

Background: Kangaroo Mother Care (KMC) is a World Health Organization recommended intervention proven to reduce mortality in preterm and low-birth-weight infants. Despite its efficacy, utilization remains low in many resource-limited settings. This study aimed to assess the knowledge, attitudes, and practices regarding Kangaroo Mother Care (KMC) among mothers in Lagos, Nigeria, and to identify the primary barriers to its adoption. 
Methods: This community-based, descriptive cross-sectional survey was conducted with 334 mothers of infants aged 0-12 months using a multistage sampling method. Primary outcomes included the proportion of mothers with awareness, good knowledge, positive attitudes, and practice of KMC. Barriers to KMC uptake were also assessed.
Results: Awareness of KMC was high (93.4%). However, only 35.6% possessed good knowledge, and a significant majority (82.7%) were unaware of its specific benefits. Attitudes were predominantly negative (92.2%), and practice was low (14.7%). The principal barriers identified were a cultural preference for traditional baby carrying methods (58.1%) and the perception that KMC is foreign to local culture (21.9%). Mothers expressed a preference for receiving KMC information through simple messages in their local language and direct discussions with health workers. 
Conclusions: A profound disconnect exists between high awareness and poor knowledge, attitude, and practice of KMC in this setting. The major impediments are socio-cultural, centered on a preference for traditional practices. Effective scale-up requires culturally sensitive community engagement, empowerment of healthcare workers to provide counselling, and the development of localized educational materials to bridge the knowledge-attitude-practice gap.

Author Biographies

  • Ezenwa Beatrice N, Department of Paediatrics, College of Medicine, University of Lagos, Nigeria

    Department of Paediatrics,
    College of Medicine, University of
    Lagos, Nigeria.

  • Ndukwu Lilian, Department of Paediatrics, Lagos, UTH, Nigeria

    Department of Paediatrics, Lagos
    University Teaching Hospital,
    Lagos, Nigeria

  • Oyenusi Elizabeth E, Department of Paediatrics, College of Medicine, University of Lagos, Nigeria

    Department of Paediatrics,
    College of Medicine, University of
    Lagos, Nigeria.

  • Olatosi Olubukola, Department of Child Dental, College of Medicine, University of Lagos, Nigeria

    Department of Child Dental,
    College of Medicine, University of
    Lagos, Nigeria

  • Moronkola Olaolu A, Department of Paediatrics, Lagos, UTH, Nigeria

    Department of Paediatrics, Lagos
    University Teaching Hospital,
    Lagos, Nigeria

  • Fajolu Iretiola B, Department of Paediatrics, College of Medicine, University of Lagos, Nigeria

    Department of Paediatrics,
    College of Medicine, University of
    Lagos, Nigeria.

  • Ojulari Opeyemi, Department of Nursing Services, Lagos, UTH, Nigeria

    Department of Nursing Services,
    Lagos University Teaching Hospital,
    Lagos, Nigeria.

  • Idise Anita, Department of Paediatrics, Lagos, UTH, Nigeria

    Department of Paediatrics, Lagos
    University Teaching Hospital,
    Lagos, Nigeria

  • Okafor Ifeoma P, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Nigeria

    Department of Community Health
    and Primary Care, College of
    Medicine, University of Lagos,
    Nigeria

  • Ezeaka Veronica C, Department of Paediatrics, College of Medicine, University of Lagos, Nigeria

    Department of Paediatrics,
    College of Medicine, University of
    Lagos, Nigeria.

References

1. Liang X, Lyu Y, Li J, Li Y, Chi C. Global, regional, and national burden of preterm birth, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021. e Clinical Medicine. 2024;76:102840.

2. World Health Organization. Born too soon: decade of action on preterm birth. Geneva: WHO; 2023.

3. Blencowe H, Lee AC, Cousens S, et al. Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatr Res. 2013;74 Suppl 1:17–34.

4. Ayl ward GP. Neurodevelopmental outcomes of infants born prematurely. J Dev Behav Pediatr. 2005;26(6):427–40.

5. Aarnoudse-Moens CS, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Metaanalysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics. 2009;124 (2):717–28.

6. Breeman LD, Jaekel J, Baumann N, Bartmann P, Wolke D. Attention problems in very preterm children from childhood to adulthood: the Bavarian Longitudinal Study. J Child Psychol Psychiatry. 2016;57(2):132–40.

7. Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al. Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014;384(9938):189–205.

8. Blencowe H, Cousens S, Jassir FB, Say L, Chou D, Mathers C, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2016;4(2):e98–108.

9. Sturrock S, Sadoo S, Nanyunja C, Le Doare K. Improving the treatment of neonatal sepsis in resource-limited settings: gaps and recommendations. Res Rep Trop Med. 2023;14:121–34.

10. World Health Organization. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: WHO; 2015.

11. WHO Immediate KMC Study Group. Immediate Kangaroo Mother Care and survival of infants with low birth weight. N Engl J Med. 2021;384 (21):2028–38.

12. World Health Organization. Kangaroo mother care: a practical guide. Geneva: WHO; 2003.

13. Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, et al. Kangaroo mother care and neonatal outcomes: a metaanalysis. Pediatrics. 2016;137 (1):e20152238.

14. Conde-Agudelo A, Díaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2016; (8):CD002771.

15. Vesel L, Bergh AM, Kerber KJ, Valsangkar B, Mazia G, Moxon SG, et al. Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015;15 Suppl 2:S5.

16. Fajolu IB, Satrom KM, Ezenwa BN, Kein AC, Slusher TM, Ezeaka VC. Current trends in neonatal morbidity and mortality: experiences from a tertiary center in Lagos, Nigeria. Am J Trop Med Hyg. 2022;107(3):617–23.

17. Olawuyi O, Ezenwa BN, Fajolu IB, Onwuama M, Ezeaka CV. Knowledge, attitude, and

practice of kangaroo mother care among mothers in the neonatal wards of a tertiary care center. Pan Afr Med J. 2021;38:364.

18. Federal Republic of Nigeria. Legal notice on publication of details of the breakdown of the National and State Provincial Totals of the 2006 Census. Off Gaz Nigeria. 2007;94(24):B175–98.

19. Cochran WG. Sampling techniques. 3rd ed. New York: John Wiley & Sons; 1977.

20. Dalal A, Bala DV, Chauhan S. Knowledge and attitude regarding Kangaroo Mother Care practice among health care providers in Ahmedabad District: a cross-sectional study. Int J Med Sci Public Health. 2014;3:253–6.

21. Solomons N, Rosant C. Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town. S Afr J Clin Nutr. 2012;25 (1):33–9.

22. Mathias CT, Mianda S, Ohdihambo JN, Hlongwa M, Singo-Chipofya A, Ginindza TG. Facilitating factors and barriers to kangaroo mother care utilization in low- and middle-income countries: a scoping review. Afr J Prim Health Care Fam Med. 2021;13(1):e1–e15.

23. Cai Q, Chen DQ, Wang H, Zhang Y, Yang R, Xu WL, et al. What influences the implementation of kangaroo mother care? An umbrella review. BMC Pregnancy Childbirth. 2022;22(1):851.

24. Lydon MM, Lwesha V, Likomwa D, Chimtembo L, Guenther T, Longwe M. Reenvisioning Kangaroo Mother Care implementation through a socioecological model: lessons from Malawi. Glob Health Sci Pract. 2022;10

(4):e2100727.

25. Nutbeam D, Lloyd JE. Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health. 2021;42:159–73.

26. Galmarini E, Marciano L, Schulz PJ. The effectiveness of visual-based interventions on health literacy in health care: a systematic review and meta-analysis. BMC Health Serv Res. 2024;24(1):718.

27. Chan G, Bergelson I, Smith ER, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health Policy Plan. 2017;32 (10):1466–75.

28. World Health Organization. Kangaroo mother care: implementation strategy for scaleup adaptable to different country contexts. Geneva: WHO; 2023.

29. Federal Ministry of Health. Kangaroo mother care operational guidelines. Abuja: FMOH; 2021.

Downloads

Published

2026-09-13

How to Cite

Beyond Awareness: Cultural and knowledge barriers to kangaroo mother care uptake in Lagos, Nigeria. (2026). JOURNAL OF AFRICAN NEONATOLOGY, 4(3), 133-138. https://janeonatology.org/index.php/jan/article/view/354

Similar Articles

61-70 of 82

You may also start an advanced similarity search for this article.