Kangaroo Mother Care: A Lifeline for Premature Babies In Ghana

Kangaroo mother care method of caring for preterm babies is a simple but proven method that saves preterm babies and helps with their proper development by reducing complications such as hypothermia (low body temperature).

Preterm babies are highly susceptible to difficulty in breathing infections which are significant threats to their lives. Every year, more than 20 million infants are born weighing less than 2.5kg, over 96% of them in developing countries.

These low – birth – weight (LBW) infants are at increased risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood. Conventional neonatal care of LBW infants is expensive and needs both highly skilled personnel and permanent logistic support.

Evidence suggests that kangaroo mother care is a safe and effective alternative to conventional neonatal care, especially in under-resourced settings and may reduce morbidity and mortality in LBW infants as well as increase breastfeeding.

Kangaroo mother care involves: early, continuous and prolonged skin-to-skin contact between a mother and her newborn, frequent and exclusive breastfeeding, early discharge from hospital.

Image of Kangaroo Mother Care (KMC)

This is simply and basically the skin-to-skin contact the mother has with the child the child to simulate warmth and foster the WHO recommendations. Kangaroo mother care is a method of care of preterm infants.

This guide is intended for health professionals responsible for the care of low-birth-weight and preterm infants. Designed to be adapted to local conditions, it provides guidance on how to organise services at the referral level and on what is needed to provide effective kangaroo mother care.

The guide includes practical advice on when and how the kangaroo mother care method can best be applied.

Its key features are:

1. Early, continuous and prolonged skin-to-skin contact between the mother and the baby;

2. Exclusive breastfeeding (ideally)

3. It is initiated in hospital and can be continued at home;

4. Small babies can be discharged early;

5. Mothers at home require adequate support and follow-up;

6. It is a gentle, effective method that avoids the agitation routinely experienced in a busy ward with preterm

Where KMC can be practiced effectively

a. Maternity homes

b. Referral Hospitals

Owusu Nyarko et al views on the benefits of Kangaroo Mother care

– Kangaroo mother care stimulates proper breathing in the baby and also helps the mother to produce adequate breast milk which contains the right amount of nutrients the preterm or low birth weight baby needs for proper development.

– KMC is at least equivalent to conventional care (incubators), in terms of safety and thermal protection, if measured by mortality.

– KMC, by facilitating breastfeeding, offers noticeable advantages in cases of severe morbidity.

– KMC contributes to the humanisation of neonatal care and to better bonding between mother and baby in both low and high-income countries.

– KMC is, in this respect, a modern method of care in any setting, even where expensive technology and adequate care are available.

Kangaroo Mother Care and How Ghana Has Embraced It

The four components of kangaroo mother care are all essential for ensuring the best care options, especially for low birth weight babies. They include skin – to – skin positioning of a baby on the mother’s chest; adequate nutrition through breastfeeding; ambulatory care as a result of earlier discharge from hospital; and support for the mother and her family in caring for the baby.

The most important method of spreading kangaroo mother care has been by means of training programmes.

Often, the training remains confined to hospital settings. A new approach was adopted in Ghana under a kangaroo mother care (KMC Ghana) project undertaken in four regions, with the support of UNICEF and the South African Medical Research Council’s Unit for Maternal and Infant Health Care Strategies.

Instead of merely providing training, a longitudinal, open door approach based on continuous support from health-care facilities was adopted. Under the programme, kangaroo mother care was singled out for special attention for two to three years.

A study by A-M Bergh, R Manu et al on Kangaroo Mother Care (KMC)

A study conducted in Ghana and published in the Ghana medical journal and titled: Progress with the Implementation of Kangaroo Mother Care in Four Regions in Ghana. It gave a detailed stage with variations on KMC as a method and how Ghana was embracing it. Their aim was to measure progress with the implementation of kangaroo mother care (KMC) for low birth-weight (LBW) infants at a health systems level.

Views from a study by Owusu Nyarko et al on caring for babies in kangaroo position

Babies can receive most of the necessary care, including feeding, while in kangaroo position.

They need to be moved away from skin-to-skin contact only for:

a. Changing diapers, hygiene and cord care; and

b. Clinical assessment should be according to hospital schedules or when needed.

c. Daily bathing is not needed and is not recommended. If local customs require a daily bath and it cannot be avoided, it should be short and warm (about 37°C).

d. The baby should be thoroughly dried immediately afterwards, wrapped in warm clothes and put back into the KMC position as soon as possible.

Addressing KMC and the way forward

Implementation of KMC and its protocol will need to be facilitated by supportive health authorities at all levels. These include the various ministries of health through the government, non – governmental organisations, hospital directors and the people in charge of the health care system at district, provincial and regional levels.

A national policy may ensure a coherent and effective integration of the practice within pre-existing structures of the health system and education and training.

Preterm and low birth weight babies are best born in institutions that can provide the special medical care required for managing their frequent complications.

Thus, when a premature baby is expected, the mother should be transferred to such an institution before birth. If this is not possible, very small babies or small babies with problems should be transferred there as soon as possible.

The referral system should be organized in such a way as to guarantee the safety of mothers and their babies. National standards and protocols need to be developed for the care of small babies, including those mentioned above, once they have overcome the initial problems.

Standards must include clear criteria for monitoring and evaluation. These can best be developed by the appropriate professional groups with the participation of parents.

Furthermore, local protocols will be easier to implement if national policies and guidelines are clearly set out. Continuous monitoring and regular evaluation according to established criteria will help improve practice and design, and carry out research that may help refine the method.

Conclusion

On balance the evidence shows that although KMC does not necessarily improve survival, it does not reduce it. After stabilization, there is no difference in survival between KMC and good conventional care. The hypothesis that KMC might improve survival when applied before stabilization needs to be further explored with well-designed studies.

If such an effect on survival exists, it will be more evident and easier to demonstrate in the poorest settings, where mortality is very high. As for morbidity, while there is no strong evidence of a beneficial effect of KMC, there is no evidence of it being harmful.

In addition to the little evidence already published, some preliminary results on a small number of newborn infants with mild respiratory distress seem to confirm that very early skin-to-skin contact might have a beneficial effect.

A word of warning about discharge: KMC infants discharged during the cold season may be more susceptible to severe illness, especially lower respiratory tract infections, than those discharged during the warm season.

A closer follow-up is needed in such cases. It should be noted that all the studies so far have taken place in well-equipped hospitals, yet arguably the most significant impact of KMC will be felt in settings with limited resources. There is an urgent need for further research in these settings.

Recommendations

Every health facility that offers maternal services in sub-Saharan Africa should have a KMC unit especially in Ghana where incubators are scarce in about 90% of health facilities.

Nurses, midwives, nursing and midwives assistants, community health workers and even registered traditional birth attendants should be given special training on kangaroo mother care in order to let them spread these practical skills and powerful life – saving technique to expectant mothers in the various communities and health facilities.