Background Globally, complications due to preterm birth are the leading contributor to neonatal mortality, resulting in an estimated one million deaths annually. Kangaroo Mother Care (KMC) has been endorsed by the World Health Organisation as a low cost, safe, and effective intervention in reducing morbidity and mortality among preterm infants. The objective of this study was to describe the implementation of a KMC model among preterm infants and its impact on neonatal outcomes at a tertiary level hospital in Lusaka, Zambia. Methods We conducted a prospective descriptive study using data collected from the KMC room at the University Teaching Hospital between January 2016 and September 2017. Mothers and government nurses were trained in KMC. We monitored skin-to-skin and breastfeeding practices, weight at admission, discharge, and length of admission. Results We enrolled 573 neonates into the study. Thirteen extremely low weight infants admitted to the KMC room had graduated to Group A (1,000g-1,499g) at discharge, with a median weight gain of 500g. Of the 419 very low weight neonates at admission, 290 remained in Group A while 129 improved to Group B (1,500g-2,499g), with a median weight gain of 280g. Among the 89 low weight neonates, 1 regressed to Group A, 77 remained in Group B, and 11 improved to Group C (≥2,500g), individually gaining a median of 100g. Of the seven normal weight neonates, 6 remained in Group C individually gaining a median of 100g, and 1 regressed to Group B. Among all infants enrolled, two (0.35%) died in the KMC room. Conclusions Based on the RE-AIM metrics, our results show that KMC is a feasible intervention that can improve neonatal outcomes among preterm infants in Zambia. The study findings show a promising, practical approach to scaling up KMC in Zambia. Trial registration The trial is registered under ClinicalTrials.gov under the following ID number: NCT03923023.

Neonatal resuscitation has been poorly instituted in many parts of Africa and most neonatal resuscitation algorithms are adapted from environments with abundant resources. Helping Babies Breathe (HBB) is an algorithm designed for resource-limited situations and most other algorithms are designed for resource-rich countries. However, there are neonatal referral centers in resource-limited countries who may provide more advanced resuscitation. Thus, we developed a neonatal resuscitation algorithm for a resource-limited country (Zambia) which considers more advanced interventions in situations where they can be provided. The algorithm described in this paper is based on the Newborn Life Support algorithm from the UK as well as the HBB algorithm and accounts for all situations in a resource-limited country. Most importantly, it focuses on non-invasive ventilation but includes advice on more advanced resuscitation including intravenous access, fluid management, chest compressions and adrenaline for resuscitation. Although intubation skills are included in neonatal training workshops, it is not the main focus of the algorithm as respiratory support equipment is scarce or lacking in most health facilities in Zambia. A home-grown neonatal resuscitation algorithm for a resource-limited country such as Zambia is likely to bridge the gap between limited situations requiring only bag and mask ventilation and better equipped institutions where more advanced resuscitation is possible. This algorithm will be rolled out in all training institutions and delivery facilities across Zambia over the next months.