(a defining feature of KMC). For example, a survey of 46 mothers of preterm infants who were trained on KMC in a facility in Andhra Pradesh, India found that only 6.5 of mothers felt that providing KMC for 12 hours / day or greater was feasible, whereas 52 of mothers felt that only 1 hour / day was order PP58 practical[8]. Similarly, in a trial of community-initiated KMC with 1,565 mother-infant pairs, only 23.8 practiced STS for more than 7 hours / day in the s11606-015-3271-0 first 48 hours of life, and the average number of hours of STS during days 3? of life was 2.7 ?3.4 hours [11]. Barriers to the other components of KMC, including breastfeeding [12,13], and adequate follow-up after discharge [14,15], have also been noted. KMC has emerged as a key intervention package for a number of newborn health initiatives, and this is epitomized by the Every Newborn Action Plan (ENAP) [16]. Additionally a recent convening of ideas from 600 key programmers, policymakers, researchers and stakeholders in newborn health, using the Child Health and Nutrition Research Initiative [CHNRI] method, highlighted KMC as a top preterm intervention agenda [17]. Many agencies, such as Save the Children’s Saving Newborn Lives III (SNL), USAID, WHO and the Bill Melinda Gates Foundation, and some countries, such as Malawi and South Africa, have also made KMC a priority [18?2]. Therefore, to adequately implement and effectively scale-up this intervention, it is critical to understand the key factors that contribute to a mother’s (in)ability to practice KMC. However,PLOS ONE | DOI:10.1371/journal.pone.0125643 May 20,2 /Barriers and Enablers of KMCthere is a dearth of synthesized information on all of the sociocultural, resourcing, and experiential factors that influence a mother’s practice of KMC. Accordingly, this review sets out to synthesize existing JWH-133 supplier literature on the factors which influence a mother’s ability to practice KMC by answering two questions. First, what are the most frequently cited barriers that could prevent a mother from successfully practicing KMC? These barriers can exist at multiple levels, including barriers to implementation of a KMC program, deficiencies in the program itself, or specific challenges associated with the practice of KMC which the mother has to perform. Second, are there any key positive factors, cited in the relevant literature, that can enable a mother to practice KMC? We believe that it is of utmost importance to consider these different types of barriers together (along with key enablers to practice), even though the solutions for solving each barrier might be different. Even though the specific barriers most relevant for mothers may vary based on context, a comprehensive list of this type jir.2014.0026 will give program implementers, policymakers, and researchers a synthesized set of factors to consider as they attempt to implement new or improve existing KMC programs.Methodology Search strategy and selection criteriaWe undertook a systematic review according to PRISMA 2009 guidelines to answer these two questions [23]. (See S1 Appendix for complete PRISMA checklist). We developed a review protocol with methods and eligibility criteria that were specified in advance. We included any publication in our study that met the following criteria: 1) the aim of the study was to document experiences implementing KMC, STS, or other interventions related to Reproductive, Maternal, Newborn, Child Health and Nutrition (RMNCH N) that may have included KMC / STS, or the.(a defining feature of KMC). For example, a survey of 46 mothers of preterm infants who were trained on KMC in a facility in Andhra Pradesh, India found that only 6.5 of mothers felt that providing KMC for 12 hours / day or greater was feasible, whereas 52 of mothers felt that only 1 hour / day was practical[8]. Similarly, in a trial of community-initiated KMC with 1,565 mother-infant pairs, only 23.8 practiced STS for more than 7 hours / day in the s11606-015-3271-0 first 48 hours of life, and the average number of hours of STS during days 3? of life was 2.7 ?3.4 hours [11]. Barriers to the other components of KMC, including breastfeeding [12,13], and adequate follow-up after discharge [14,15], have also been noted. KMC has emerged as a key intervention package for a number of newborn health initiatives, and this is epitomized by the Every Newborn Action Plan (ENAP) [16]. Additionally a recent convening of ideas from 600 key programmers, policymakers, researchers and stakeholders in newborn health, using the Child Health and Nutrition Research Initiative [CHNRI] method, highlighted KMC as a top preterm intervention agenda [17]. Many agencies, such as Save the Children’s Saving Newborn Lives III (SNL), USAID, WHO and the Bill Melinda Gates Foundation, and some countries, such as Malawi and South Africa, have also made KMC a priority [18?2]. Therefore, to adequately implement and effectively scale-up this intervention, it is critical to understand the key factors that contribute to a mother’s (in)ability to practice KMC. However,PLOS ONE | DOI:10.1371/journal.pone.0125643 May 20,2 /Barriers and Enablers of KMCthere is a dearth of synthesized information on all of the sociocultural, resourcing, and experiential factors that influence a mother’s practice of KMC. Accordingly, this review sets out to synthesize existing literature on the factors which influence a mother’s ability to practice KMC by answering two questions. First, what are the most frequently cited barriers that could prevent a mother from successfully practicing KMC? These barriers can exist at multiple levels, including barriers to implementation of a KMC program, deficiencies in the program itself, or specific challenges associated with the practice of KMC which the mother has to perform. Second, are there any key positive factors, cited in the relevant literature, that can enable a mother to practice KMC? We believe that it is of utmost importance to consider these different types of barriers together (along with key enablers to practice), even though the solutions for solving each barrier might be different. Even though the specific barriers most relevant for mothers may vary based on context, a comprehensive list of this type jir.2014.0026 will give program implementers, policymakers, and researchers a synthesized set of factors to consider as they attempt to implement new or improve existing KMC programs.Methodology Search strategy and selection criteriaWe undertook a systematic review according to PRISMA 2009 guidelines to answer these two questions [23]. (See S1 Appendix for complete PRISMA checklist). We developed a review protocol with methods and eligibility criteria that were specified in advance. We included any publication in our study that met the following criteria: 1) the aim of the study was to document experiences implementing KMC, STS, or other interventions related to Reproductive, Maternal, Newborn, Child Health and Nutrition (RMNCH N) that may have included KMC / STS, or the.
