Research Article

First Experience of Implementation of Kangaroo Mother Care in Punjab- Pakistan to Reduce Morbidity and Mortality in Preterm Infants

Noreen Rasul1*, Madeeha Rashid2, Aqeela Abbas1 and Rubina Sohail3

1Senior Registrar of Obstetrics and Gynaecology, Services Hospital, Lahore; 2Assistant Professor of Obstetrics and Gynaecology, SIMS/ Services Hospital, Lahore; 3Professor of Obstetrics and Gynaecology, SIMS/ Services Hospital, Lahore.

Received | July 13, 2017; Accepted | December 05, 2017; Published | December 24, 2017

*Correspondence | Noreen Rasul, Senior Registrar of Obstetrics and Gynaecology, Services Hospital, Lahore; Email:[email protected]

Citation | Rasul, N., M. Rashid, A. Abbas and R. Sohail. 2017. First experience of implementation of Kangaroo Mother Care in Punjab- Pakistan to reduce morbidity and mortality in preterm infant. Annals of King Edward Medical University, 23(4): 496-502.

DOI | http://dx.doi.org/10.21649/journal.akemu/2017/23.4.496.502

Keywords | Kangaroo mother care, Neonatal mortality, Low birth weight, Skin to skin contact

Introduction

Each year approximately twenty million low birth weight babies are born globally (1). Prematurity is one of the most common causes of low birth weight. Low birth weight results in 60% to 80% of neonatal deaths. About 27% of 4 million neonatal deaths every year are due to prematurity (2).Neonatal mortality contributes to two - third of all deaths under the age of five years. Pakistan has NMR of 55/1000 live births(3). Low birth weight infants are not only associated with neonatal mortality but also infant mortality(2). Such infants become a challenge and burden on health and social system. Pakistan is amongst the top three countries with the highest neonatal mortality and has to reduce NNM for a sustainable developmental goal by 2030 to 12 per 1,000 live births. Pictures below gives a glimpse of KMC.

Care of low birth weight babies (less than 2500 gm) is expensive and requires specialist care. Effective interventions and modern technology is limited in developing countries. There is shortage of skilled staff and incubators. Maintenance of equipment is also very expensive. Incubator care costs about Rs 5000 per day that is 50 dollars per day and total cost of hospital is about three thousand dollars at private setup. Kangaroo Mother Care is an effective and safe substitute of incubators for preterm infants. Breast-feeding success rate is only 20% while in KMC babies it is exclusive breast feeding (3).

Kangaroo Mother Care was first proposed by Rey and Mortinez in 1978 in Bogota, Colombia. It was alternative to incubator, where care of preterm infants was not satisfactory(4). In North America, Gene Granston Anderson and Susan Ludington introduced Kangaroo Mother Care for the first time(5). Kangaroo Mother Care is now recognized by global experts as an integral part of new born care for premature and low birth babies(6).

Kangaroo Mother Care promotes maternal bonding, confidence and increases milk production resulting in successful breast feeding.(7) If mother is unable to carry baby due to section or any other medical problem, father or other family members can also give Kangaroo Care.(8) Kangaroo Mother Care prevents hypothermia and, normalizes heart rate and respiratory rate resulting in decreased nosocomial and respiratory tract infections. (9)Weight gain is more in KMC babies with improvement in sleep pattern and relief for colic. (10), (11)

With the support of UNICEF Kangaroo Mother Care project was started to improve neonatal care. KMC kit is shown in Figure 1. Master trainers were trained in Vietnam in June 2016 and started the project at Service Hospital Lahore and further trained other doctors and nurses from and other districts of Punjab and Sindh by multiple workshops.

We conducted this study to determine the effects of early skin-to-skin contact and kangaroo mother care (KMC) on the growth, development and survival of preterm and low birth weight infants. Results of our study will help us to determine whether execution of KMC is a cost-effective approach in preventing neonatal mortality on wider scale.

Material and Method

The study was carried out in the department of Obstetrics and Gynaecology department Services Hospital Lahore in Gynae unit 2 and 3.The study started from 1 August 2016 till 31 January 2017 for six-month duration. Figure 2 shows mortality in preterm babies in this period. It is a case series study. In this study, all the stable pre-term babies with weight between 1.5 to 2.5 kg were included. The babies that required immediate admission in neonatal unit due to any reason after birth were not included in the study. Initially for three month our criteria was 2-2.5kg weight but now we extended to 1.5 to 2.5 kg as the results obtained from KMC were satisfactory. All the babies received early essential newborn care (EENC) (Figure 3).

Criteria for discharge is weight gain of 15 to 20 gram daily for three consecutive days and breast feeding established for 20 to 30 minutes. After discharge Baby is called for examination and routine follow up weekly till 40 weeks of gestation, then after one month, then after three months and finally after six months. Data is summerized in Table 1.

Table 1: KMC data.

Table 2: General characteristics of KMC Mother (121).

In this study the neonates were followed for a period of three months atleast. General characteristics of KMC mother and neonates are given in Table 2 and Table 3, respectively.

Results and Discussion

Pakistan, with 748,100 preterm births annually has the fourth highest number after India (1). In low revenue countries such as Pakistan the burden on health systems produced by care of preterm infants is well recognized. Indeed it is estimated that the cost of care for a single preterm birth is Rs.5000 per day in incubator. The resources available are fewer, characterized by understaffed hospitals with ill equipped or non-existent neonatal care units which ultimately result in higher neonatal mortality rates.(12)

Table 3: General characteristics of KMC Neonate (121).

Table 4a: Follow-up of KMC Babies. Data of Follow Up From August to January.

In our study no mortality in KMC babies noted. Table 4 (a and b) shows schedule of follow up of KMC babies. Joy E Lawn in 2010 assessed overall health benefits of preterm babies from KMC. Benefits lie in weight gain, breastfeeding, psycho- social outcome like bonding and especially satisfaction of mothers. The meta- analysis of observational study showed marked reduction of neonatal mortality. In the control group the babies were kept in incubator. Most of the neonatal mortalities were due to infections. Then KMC was started in stable preterm babies which show significant reduction in mortality (14).

KMC was first established by Dr. Jose Fabella in 1999 in Manila. Due to good results, within two years seven more hospitals were opened in same city. The workshops were conducted for training of medical staff for KMC babies. In 2008 Bless Tetada KMC foundation was made for monitoring the working ofall KMC centers. (15) According to Fabella, neonatal mortality in preterm was reduced by 15%. The percentage of sepsis was reduced from 34% to 24%. There was increase in breast feeding of babies for first six months. The duration of stay in hospital was reduced to 50% and estimated savings of cost was 75%.

In our study initially KMC center opened in Services Hospital Lahore. Workshops were conducted first for medical staff of same hospital, then to other hospitals of same city. Few members of other hospitals arealso trained. Gradually KMC centers will be increased.

No neonatal death was found in KMC babies in last six months data (Table 5). In 3 babies infection was recorded during stay in hospital but they recovered and were discharged back to KMC room. All the babies were breast fed. The stay in hospital for maximum babies is about a week.

Table 5: Comparison of mortality of preterm in KMC and neonatal unit. (121).