KANGAROO MOTHER CARE

By

Charles Mhango

Student MSc.RH, BSc.NM

Outline

• Introduction

• Background

• Statistics

• Current practice

• Challenges

• Evidence based/best practices

• Recommendations

• Conclusion

• Reference

Introduction

• Kangaroo Mother Care is early, prolonged

continuous skin-to-skin contact between a mother

(or her surrogate) and her low birth weight (LBW)

infant (Ministry of Health, 2009)

• An effective way to meet LBW babies’ needs

• Warmth, breastfeeding, protection from infection,

stimulation, safety, love

• Can be continuous or intermittent

Introduction

• Applied only after stabilisation of the infant

• Results in early hospital discharge of LBW infants

• Considered equivalent to conventional neonatal

care for stable preterm infants

• Its elements are position, feeding and support

Introduction

• It is one of the interventions taken by government

that has helped Malawi to remain on track in

achieving MDG 4 (Zimba et al., 2012)

Background

• 1978: KMC first suggested by Dr Edgar Rey in

Bogotá, Colombia, in response to shortage of

incubators and severe hospital infections (Thukral,

Chawla, Agarwal, Deorari, & Paul, 2008)

• 1979: Together with Hector Martinez, they used the

idea in Bogotá, Colombia (“History of KMC,” 2014)

• 1984: First reported by UNICEF

Background

• 1985: Visits from USA, UK and Scandinavia to

Bogotá, Colombia

• 1st English report published in The Lancet by

Whitelaw and Sleath

• 1986: Early implementation in some African

countries

• Continued KMC research-found many benefits

(“History of KMC,” 2014)

Background

• 1998: First International Conference on KMC,

Baltimore, Maryland, USA (“History of KMC,” 2014)

• Supported by WHO and many organizations as a

life saving method of care

• WHO published guidelines (last updated 2003)

• 2011: May 15th - International KMC awareness day

Background – KMC in Malawi

• Early 1990s: KMC started at Bwaila Hospital

• Stopped after two deaths - associated with mortality

• 1999: KMC unit at Zomba Central Hospital

established

• EU funded renovation of nursery to include a KMC

unit

(Save the Children, 2007)

Background – KMC in Malawi

• 2000-2005: Introduction of KMC in 6 hospitals

• KMC introduced in Essential Newborn Care (ENC)

• Partnership to widen KMC services

• MOH/RHU, DHOs, Save the Children, KCN, CHAM

(Save the Children, 2007)

• 2005: KMC national guidelines (Revised 2009)

• ENC incorporated in RNM curriculum

Background – KMC in Malawi

• 2007: Retrospective KMC evaluation

• 5 hospitals doing well, 2 doing poorly (Bergh et al., 2007)

• 2009: KMC integrated in IMNC and CBMNC

training manuals

• By 2011, at least 121 health care facilities provided

some form of KMC services (Bergh et al., 2012)

Statistics - Global

• 7.6 million under five deaths

• 3 million neonatal deaths (40%)

• Preterm birth – leading cause (1.078 million; 14%)

• second from pneumonia in all under five deaths

(Liu et al., 2012)

Statistics - Global

• >75% of deaths of preterm births can be prevented

without intensive care i.e. KMC and infection control

(March of Dimes, PMNCH, Save the Children, &

WHO, 2012)

• If started in the first week KMC is associated with a

51% reduction in neonatal mortality for stable

babies weighing <2000g compared to incubator

care (Lawn et al., 2010)

Statistics - Global

• KMC can save up to 450 000 lives a year (March of

Dimes et al., 2012)

Statistics - Africa

• 3.552 million under five deaths

• 30% - neonatal deaths

• Preterm birth contributes 10%

(Liu et al., 2012)

Statistics - Malawi

• 18.1% preterm births – highest in the world (March

of Dimes et al., 2012)

• NMR: 31/1000 live births (NSO & IFC Macro, 2011)

• 37% due to preterm complications (Zimba et al.,

2012)

• ˃700 service providers, ˃15 tutors trained in KMC

and ˃1000 HSA sensitized to their role in supporting

KMC intervention (Zimba et al., 2012)

Current practice: The case of ZCH

Stabilisation of baby

Education + Demonstration

(mother + guardians)

Return demonstration

(mother + guardians)

Current practice: The case of ZCH

Current practice: The case of ZCH

Current practice: The case

of ZCH

Feeding

• Amount calculated per body weight

• Steadily increased by 5ml per day

• Amount increased if no weight gain, no abdominal distension nor vomiting

• <1500g fed 2 hourly

• >1500g fed 3 hourly

• Encouraged to breastfeed

Current practice: The case of ZCH

Daily monitoring

• Weighing using

electronic scale

• Vital signs

• Monitoring feeds

• Danger signs

• Clinical review

Support

• Emotional

• Health education +

Encouragement

• Physical

• Involvement of family

members

Current practice: The case of ZCH

• Mother competent with

KMC

• Mother able to feed

baby correctly

• Weight gain at least

15g/kg/day for 3

consecutive days after

regaining birth weight

• Baby weighing at least

1500g or more

• No any other major

illness

Discharge criteria

Current practice: The case of ZCH

• Given review date• Weekly

• Fortnight

• Community follow-up

rarely done• Use of HSAs

At discharge• Mother and guardians

advised to continue

KMC at home

Challenges

• Poor monitoring in the hospital

• Lack of resources

• Lack of infrastructure

• Frequent staff rotations (Bergh et al., 2012)

Challenges

• Poor data collection and utilization

• At facility level - poor documentation (Bergh et al., 2012)

• At policy level- unclear if data used to improve quality

(Bergh et al., 2014)

• Lack of prior knowledge about KMC

• 84% of mothers on KMC at Bwaila and ZCH were not

aware of the service prior to their hospitalisation

(Chisenga, Chalanda, & Ngwale, 2014)

Challenges

• Early discontinuation after discharge from hospital

• Lack of support

Although mothers and their attendants were informed

that family members can also practice KMC, no family

members did so at home (Parikh, Banker, Shah, & Bala,

2013)

At Bwaila and ZCH lack of support and multiple roles of

the mother affected compliance and continuation of KMC

after discharge (Chisenga, Chalanda, & Ngwale, 2014)

Challenges

• Lack of follow up after discharge

• Bergh et al. (2014) found that weak follow-up

arrangements such as lack of home visits and KMC

services close to the communities were a major

barrier to the successful implementation of KMC in

Malawi, Mali, Rwanda and Uganda

• Many mothers do not return for review because of the

difficulty they experienced in returning to the hospital

(Bergh et al., 2013)

Challenges

• Lack of supervision

• Donor project dependent

• Lack of transport

• Internal conflict between different health structures or

authorities

(Bergh et al., 2014)

Challenges

• KMC service data not part of existing national

information systems and nationally agreed

indicators (Zimba et al., 2012)

Evidence based / best practices

• Integration of KMC in national health guidelines

• Stabilisation of babies before initiating KMC

• Initiation of KMC as early as possible

• Mothers should be willing to participate in KMC

Evidence based / best practices

• Only remove baby in KMC position during cup

feeding, when changing nappies, visiting toilet, and

bathing

• Promoting KMC during antenatal care

• Prepares mothers in case of preterm birth

• Counselling of mothers on KMC should not only be

limited to mothers who have given birth to low birth

weight babies

Evidence based / best practices

• Use of trained support staff

• Patient attendants play an active role in KMC

implementation (Blencowe & Molyneux, 2005)

Evidence based / best practices

• KMC reduces pain in preterm neonates during

painful procedures

• In a randomised crossover trial, Johnston et al.

(2008) found that very preterm neonates appear to

have endogenous mechanisms elicited through skin-

to-skin maternal contact that decrease pain response,

though not as powerfully as in older preterm

neonates

Evidence based / best practices

• KMC reduces risk of infection

• A review of literature from randomised trials found

that KMC was associated with a reduced risk of

nosocomial infection at 41 weeks corrected

gestational age, severe illness and lower respiratory

tract disease at 6 months follow-up (Conde-Agudelo,

Diaz-Rossello, & Belizan, 2003)

Evidence based / best practices

• Prolonged KMC promote physical growth and motor

and mental development

• Findings by Bera et al. (2014) from a controlled

clinical trial on effect of KMC on growth and

development of low birth weight babies up to 12

months of age

Recommendations

• Improve follow-up system

• Empower health centres

• Promote use of community health team e.g. HSAs

• Use of village health committee

• Community awareness

• Prioritise KMC as a basic neonatal health service in

health centres

Recommendations

• Train support staff e.g. Patient attendants

• Introduce KMC in existing national information

systems e.g. HMIS

• Set up national indicators on KMC and include them

in MDHS

Recommendations

• There is need to balance the demands placed on

HSAs

• Integrate CBMNC package into the basic HSA (pre-

service) training

Conclusion

• KMC is a cost effective intervention that helps save

lives of LBW newborns

• It should be made available at all levels of care

• Engagement of communities is important for the

successful implantation of KMC

Reference

Bera, A., Ghosh, J., Singh, A. K., Hazra, A., Mukherjee, S., & Mukherjee, R.

(2014). Effect of kangaroo mother care on growth and development of

low birthweight babies up to 12 months of age: a controlled clinical trial.

Acta Paediatrica (Oslo, Norway: 1992), 103(6), 643–650.

doi:10.1111/apa.12618

Bergh, A.-M., Banda, L., Lipato, T., Ngwira, G., Luhanga, R., & Ligowe, R.

(2012). Evaluation of Kangaroo Mother Care services in Malawi. Save

the Children. Retrieved from

http://www.mchip.net/sites/default/file/Malawi%20KMC%20Report.PDF

Bergh, A.-M., Kerber, K., Abwao, S., Johnson, J. de-G., Aliganyira, P.,

Davy, K., … Zoungrana, J. (2014). Implementing facility-based

kangaroo mother care services: lessons from a multi-country study in

Africa. BMC Health Services Research, 14(1), 293. doi:10.1186/1472-

6963-14-293

Reference

Bergh, A.-M., Manu, R., Davy, K., Van Rooyen, E., Quansah Asare, G.,

Awoonor-williams, J., … Nang-Beifubah, A. (2013). Progress with the

Implementation of Kangaroo Mother Care in Four Regions in Ghana.

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Bergh, A.-M., Van Rooyen, E., Lawn, J., Zimba, E., Ligowe, R., & Ciundu,

G. (2007). Retrospective evaluation of Kangaroo Mother Care

practices in Malawian hospitals. Ministry of Health. Retrieved from

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Reference

• Chisenga, J. Z., Chalanda, M., & Ngwale, M. (2014). Kangaroo Mother

Care: A review of mothers experiences at Bwaila׳ hospital and Zomba

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Reference

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