# Enhancing the Survival of Low Birth Weight Infants in Low Resource Settings using an Implementation Science Approach

> **NIH NIH R21** · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · 2024 · $222,499

## Abstract

PROJECT SUMMARY
Globally, about 20 million infants are born with low birthweight (LBW), and these infants face a myriad of health
challenges, including difficulties in regulating body temperature, poor nutritional outcomes, increased
vulnerability to infections, and delayed development, placing emotional and financial burdens on families.
Kangaroo Care (KC), consisting of continuous skin-to-skin contact, exclusive breastfeeding, and early discharge,
is an evidence-based intervention recommended for LBW newborns to improve their survival and healthy
development, especially in low-resource settings where the risks of prematurity, neonatal hypothermia, and
neonatal mortality are disproportionately high. Despite the effectiveness of KC, widespread scale-up has been
slow due to barriers to implementation and adoption. Existing efforts have primarily focused on health systems
and policy changes, neglecting the need to support mothers and families to continue practicing KC at home.
Several sociocultural and economic factors, including lack of essential warmth-related items, cultural norms,
stigma, and limited social support, hinder the KC continuation at home. To address these challenges, we have
developed an intervention grounded in the Information, Motivation, and Behavior (IMB) model. The intervention
offers emotional, informational, and motivational peer support to mothers of LBW infants and a kit containing
low-cost, locally sourced neonatal care items to facilitate skin-to-skin contact and breastfeeding. Guided by the
Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption,
Implementation, and Maintenance (RE-AIM) framework, we will conduct a type II hybrid effectiveness-
implementation study. First, we test the effectiveness of our intervention using an individual randomized
controlled trial, enrolling 328 mother-infant dyads eligible for KC from two tertiary hospitals in Ghana (Aim 1). We
hypothesize that mothers receiving the intervention will be more likely to continue KC at home 7 days after
discharge compared to those in the control group receiving the standard of care. Our primary effectiveness
outcome is any duration of skin-to-skin contact and exclusive breastfeeding at 7 days post-discharge. Second,
we will explore the implementation process including associated barriers and facilitators to implementation, using
mixed methods (Aim 2). In-depth interviews will be conducted with participants, peer supporters and healthcare
workers. Thematic analysis of the interviews will be guided by the CFIR framework and combine both inductive
and deductive approaches. Findings from this research will inform the development of effective models for KC
implementation and scale-up.

## Key facts

- **NIH application ID:** 10951866
- **Project number:** 1R21HD116063-01
- **Recipient organization:** UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
- **Principal Investigator:** Mufaro Kanyangarara
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $222,499
- **Award type:** 1
- **Project period:** 2024-08-13 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10951866

## Citation

> US National Institutes of Health, RePORTER application 10951866, Enhancing the Survival of Low Birth Weight Infants in Low Resource Settings using an Implementation Science Approach (1R21HD116063-01). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10951866. Licensed CC0.

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