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Scaling Up Kangaroo Mother Care in Ethiopia and India: A Multi-Site Implementation Research Study

2020; RELX Group (Netherlands); Linguagem: Inglês

10.2139/ssrn.3686832

1556-5068

Prem Mony, Henok Tadele, Abebe Gebremariam Gobezayehu, Grace J. Chan, Aarti Kumar, Sarmila Mazumder, Selemawit Asfaw Beyene, Krishnamurthy Jayanna, Dejene Hailu Kassa, Hajira Amin Mohammed, Abiy Seifu Estifanos, Pankaj Kumar, Arun Singh Jadaun, Tedros Hailu Abay, Maryann Washington, Fitsum W Gebriel, Lamesgin Alamineh, Addisalem Fikre, Alok Kumar, Sonia Trikha, Fisseha Ashebir, Arin Kar, Selamawit Mengesha Bilal, Mulusew Lijalem Belew, Mesfin Kote, Raghav Krishna, Suresh Dalpath, Samson Yohannes Amare, H L Mohan, Thomas Brune, Lynn Sibley, Abraham Tariku, Arti Sahu, Tarun Kumar, Marta Yemane Hadush, Prabhu Deva Gowda, Khalid Aziz, Dereje Duguma, Pramod K. Singh, Gary Lee Darmstadt, Ramesh Agarwal, Dawit Seyoum Gebremariam, Anayda Portela, Harsh Vardhan Jaiswal, José Carlos Martines, Rajiv Bahl, Suman Rao, Birkneh Tilahun Tadesse, John N. Cranmer, Damen Haile Mariam, Vishwajeet Kumar, Nita Bhandari, Araya Abrha Medhanyie, KMC Scale-Up Study Group,

Innovative Approaches in Technology and Social Development

Background: Kangaroo Mother Care (KMC), defined as prolonged skin-to-skin contact of the low birth weight baby with the mother and exclusive breastfeeding, is highly effective in reducing neonatal mortality. Yet the coverage of KMC globally is 8 hours of skin to skin contact per day and exclusive breastfeeding) before discharge, and 7 days after discharge, among infants with birth weight <2000g born in study districts.Findings: At baseline, KMC coverage was virtually zero in all sites. The study produced an implementation model which was implemented in the entire study population. With the final model implemented, KMC was initiated for 68-86% of eligible infants in Ethiopian sites and 87-88% in Indian sites. KMC was initiated at a mean age of 1·2-9·7 days. Effective KMC was provided to 68% infants in Ethiopia and 55% in India at discharge. At a home visit 7 days after discharge, effective KMC was provided to 53%-66% of infants in all sites, except Karnataka (36%) and Oromia (17%). Interpretation: Our study is the first to show that KMC implementation to achieve high coverage is possible at scale in LMICs. Success factors include strong government leadership, health workers’ conviction of the importance of KMC, and changes in infrastructure, policy and practice to achieve zero separation between mothers and newborns.Funding Statement: The study was funded by the Bill and Melinda Gates FoundationDeclaration of Interests: All authors declare no competing interests.Ethics Approval Statement: Individuals were not asked for consent to receive the intervention as it was the government’s standard of care. Individual written informed consent was requested from mothers, caregivers, and health workers for the collection of study data. For those unable to read, the information was read by a team member in the presence of a witness who subsequently signed the consent form based on mother’s decision. Ethics approvals were received from the ethics committees of the World Health Organization and the participating research institutions.