By Arin Kar
Prematurity and low-birth weight has been a persistent and major killer of newborns. Kangaroo Mother Care (KMC), a low-cost intervention, makes a substantial impact in halting neonatal mortality and long-term morbidity of neonates born too small (less than 2500 grams) and/or prematurely (born before 37 weeks of gestation).
Deaths due to prematurity, low birth weight increase in India
India reports the largest number of neonatal deaths (less than seven days of life), about 0.75 million per year, and causes related to preterm birth and low-birth weight (less than 2500 grams) accounts for about 35% of neonatal mortality (State of India’s Newborns). The findings from the most recent Million Death Study (an ongoing research project) shows the Neonatal Mortality Rate (NMR) is declining, but at a much slower rate than infant (less than one year) and child (12 to 59 months) causes mortality rates. Between 2000 to 2015, the NMR fell from 45 to 32.8 deaths per 1000 live births, while the child mortality declined from 41.1 to 26.8 per 1000 live births.
The study shows a decline in the NMR due to asphyxia, infections, pneuomnia, diarrhoea and measles between 2000 and 2015, but that the NMR for low birth weight or causes related to prematurity actually increased by one percent in the same period.
What is Kangaroo Mother Care and why is it so important?
Often mistaken as only skin to skin contact (SSC), Kangaroo Mother Care (KMC) comprises of both SSC (recommended more than 12 hours daily, minimum being four hours, one session being at least for an hour) and exclusive breastfeeding until the newborn reaches 40 weeks or weighs around 2500 grams. KMC is supposed to be initiated only after the newborn is declared clinically stable. Research shows KMC has numerous health benefits. KMC can prevent hypothermia, infection/sepsis, respiratory and other illnesses while also increasing the newborns weight, height, and head circumference; assists in breastfeeding and also allows for early initiation of mother-child bonding. The KMC India Network has chronicled evidence on effects of KMC from India and other countries. A recent Cochrane Review listed several randomised controlled trials which found KMC to be an effective intervention for clinically stable LBW infants, especially in resource-constrained settings. The operational guidelines on KMC published by Ministry of Health and Family Welfare, Govt. of India advised to prioritise KMC for newborns with birth weight less than 2000 gram (which are often born prematurely), considering the fact that these newborns are more vulnerable to death or morbidity.
From hospital to home: Maintaining proper KMC after discharge is ongoing challenge
So far, there is no operational evidence on what happens when initiating KMC at a facility and continuing at home after hospital discharge for newborns weighing less than about 2500 grams. In India, KMC is practiced and promoted in some medical colleges and also in some smaller community settings, but falls short when it comes to implementing KMC based on WHO-recommended guidelines, and creating linkages between health facilities and community settings.
Some of the perceived major hurdles include: A need to change health service providers’ confidence over a practice that appears non-technical, challenges with maintaining prolonged KMC at home by the mother or other family members once discharged from the facility. Consequently, the World Health Organisation (WHO) with a grant from Bill and Melinda Gates Foundation (BMGF), called for more implementation research on KMC in 2015. The implementation studies pilot scalable models for the intervention that could be context-specific, as culture norms are a primary component to KMC. An additional hurdle was the involvement of private facilities, which also attend to many newborns with low birth weight. These pilots studies are ongoing, and take place in three different districts of three different states in India: Sonepat in the state of Haryana, Rae Bareli in the state of Uttar Pradesh and Koppal, in the state of Karnataka. The projects are lead by NGOs and medical colleges and require coordination and progress updates to the respective states Health and Family Welfare departments. Project leads are also required to bring to updates on infrastructure, staff and other administrative needs, all of which are required for bringing KMC into regular practice.
I will provide updates on the implementation experience from the project in Karnataka, which is led by two organisations, St. John’s Medical College and Karnataka Health Promotion Trust. In a future post, I will provide more in-depth information about the implementation model, the process of arriving at this model, accounts from people working with this implementation strategy and on our KMC monitoring and progress.
About the Author
Mr. Arin Kar works at Karnataka Health Promotion Trust in Bangalore, India. He works in the Monitoring and Evaluation unit. Here, he spends major part of his time in projects aiming to improve quality of maternal and child health care, and also works on projects targeted for improvement of nutritional status among vulnerable population.