Improving the Duration and Rate of Home-Based Kangaroo Mother Care: A Before-and-After Intervention Study

Abstract

IntroductionKangaroo mother care (KMC) is an evidence-based, simple, time-tested, low-cost, and high-impact intervention for neonatal survival in hospitals and the community, particularly in resource-constrained areas. This has many beneficial effects on sick and stable low-birth-weight babies, lactating mothers, families, society, and the government. However, despite the World Health Organization (WHO) and United Nations International Children's Emergency Fund (UNICEF) recommendations for KMC, there is no satisfactory implementation of it in the community as well as in facilities. This study aimed to improve the duration of home-based kangaroo mother care (HBKMC). Material and methodsWe conducted a before-and-after intervention hospital-based, single-center study in a level III neonatal intensive care unit (NICU) to improve the duration of HBKMC. The KMC duration was classified into four categories: short, extended, long, and continuous where KMC was provided for 4 hours/day, 5-8 hours/day, 9-12 hours/day, and more than 12 hours/day, respectively. All neonates with birth weight < 2.0 kg and their mothers/alternate KMC providers at a tertiary care hospital in India in the time period of five months from April 2021 to July 2021 were considered eligible for the study. We tested three sets of interventions by using the plan-do-study-act cycle (PDSA cycle). The first set of interventions was the sensitization of parents and healthcare workers regarding the benefits of KMC by comprehensive counseling to mothers and other family members using educational lectures, videos, charts, and posters. The second set of interventions was to reduce maternal anxiety/stress while maintaining maternal privacy by providing more female staff and teaching proper gown-wearing techniques. The third set of interventions was to solve lactation and environment temperature issues by providing antenatal and postnatal lactation counseling and warming of the nursery. The paired T-test and one-way analysis of variance (ANOVA) were used for statistical analysis, and p<0.05 was taken as significant. ResultsOne hundred and eighty neonates were enrolled along with their mothers/alternate KMC providers in four phases, and three PDSA cycles were implemented. Out of 180 LBW infants, 21 (11.67%) infants received KMC < 4 hours/day. According to the KMC classification, 31% have continuous KMC in the institution, followed by 24% long KMC, 26% extended KMC, and 18% short KMC. After three PDSA cycles, HBKMC was 38.88% continuous KMC, followed by 24.22% long KMC, 20.55% extended KMC, and 16.11% short KMC. Continuous KMC was improved from 21% to 46% at the institute and 16% to 50% at home from phase 1 to phase 4 of the study after the implementation of three sets of interventions in three PDSA cycles. The phase-by-phase KMC rate and duration were improved after the application of the PDSA cycles, and this was maintained in HBKMC as well, but it was statistically not significant. ConclusionSets of intervention packages based on needs analysis using the PDSA cyc...