Facility readiness and stakeholders’ perceptions on preterm and low birth weight care, including immediate Kangaroo Mother Care (iKMC) in Rajshahi District, Bangladesh: A mixed-methods formative research

Background: Preterm and low birth weight (LBW) infants remain major contributors to neonatal mortality in Bangladesh. Following the WHO’s recommendation on immediate Kangaroo Mother Care (iKMC), national efforts are underway to introduce and scale up this intervention. This formative study assessed facility readiness and stakeholder perceptions of preterm/LBW care, including iKMC, to inform future implementation strategies. Methods: A mixed-methods study was conducted in hospitals within the Rajshahi District catchment area, Bangladesh. Quantitative data included a one-year review of delivery records (September 2023–March 2024) and a comprehensive readiness assessment of Rajshahi Medical College Hospital (RMCH), the planned iKMC implementation facility (iKMCIF). Qualitative data were collected through in-depth interviews and focus group discussions with mothers and families of preterm/LBW infants, healthcare providers, and key stakeholders. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic analysis. Results: Among the 58 birthing facilities assessed, six were public, 49 private, and three operated by non-governmental organizations (NGOs). Over a one-year period, a total of 39,568 births occurred across the study facilities, of which 38,749 were live births. Nearly half of all births (47%) took place at the designated iKMCIF. More than half of the facilities (53%) determined gestational age using ultrasonography and last menstrual period and measured birth weight with digital scales (70%). The iKMCIF faced notable shortages of obstetricians and neonatologists, along with limited training among nurses in KMC and resuscitation. Qualitative findings revealed limited community awareness of preterm and LBW care and several barriers to iKMC adoption, including inadequate space, privacy, and trained staff. Conclusions: Strengthening facility readiness, workforce capacity, and community awareness is essential to improve preterm and LBW care. These findings provide evidence to guide the design and development of a context-specific model for effective iKMC implementation in Bangladesh.