Operational research on the uptake of kangaroo mother care for small babies along the health facility-community continuum in a selected sub-district of northern Karnataka, India

Abstract

Introduction: Kangaroo Mother Care (KMC) scale-up is a proposed game changer for accelerating reduction in neonatal mortality rate. This operational research study aimed to identify determinants of KMC practice for small babies with birth weight less than 2000 gms (<2000 gms) irrespective of gestational age along the health facility-community continuum in Gangawati Sub-district and was nested within the district-wide WHO implementation research study. The latter aimed to identify a model for KMC scale-up in Koppal district of Northern Karnataka, India.

Methods: Following ethical and administrative approvals data on health facility preparedness, competence (knowledge, attitude, and skills) of health care workers (HCWs) from eight purposively selected health facilities in Gangawati were assessed at two time-points. Knowledge, attitude, and support mothers (n=209) received for KMC practice were assessed between 4-8 weeks of the small baby’s life. Determinants of KMC practice (initiation day and duration) were analysed using multivariate log-binomial analysis.

Results: 227 (55.6%) from 408 small babies born between Dec 2017-Sept 2018, with a mean unadjusted age of 35.6 (+7.5) days; and 1693.9 (+263.1) gms birth weight were recruited to this study. KMC was initiated for 216/227 (95.2%) babies at the health facility, at ≤3days of life for 173/226 (59.6%) and was continued >4weeks at home [30.2 (±8.4) days]. Early KMC initiation (≤3days of life), effective KMC (≥8hours skin-to-skin contact and exclusive breastfeeding) 24hours before discharge and ≥8hours KMC a week after discharge were observed for those hospitalised in public health facilities. Knowledge, attitude, and skills of HCWs were found to be key determinants of KMC practice. Support for KMC at the health facility was associated with early KMC initiation and ≥8 hours KMC before discharge.

Conclusion: Findings from this study concluded that the support mothers received from HCWs who were competent are key determinants for KMC practice along the health facility-community continuum. Context specific implications for policy, practice, education, and further research have been identified as appropriate.