Community-based kangaroo mother care to prevent neonatal and infant mortality: A randomized, controlled cluster trial
Sloan,Nancy L.; Ahmed,Salahuddin; Mitra,Satindra N.; Choudhury,Nuzhat; Chowdhury,Mushtaque; Rob,Ubaidur; Winikoff,Beverly
Pediatrics 121(5): 1047-1059
Publication date: 2008
We adapted kangaroo mother care for immediate postnatalcommunity-based application in rural Bangladesh, where the incidenceof home delivery, low birth weight, and neonatal and infantmortality is high and neonatal intensive care is unavailable.This trial tested whether community-based kangaroo mother carereduces the overall neonatal mortality rate by 27.5%, infantmortality rate by 25%, and low birth weight neonatal mortalityrate by 30%.
Half of 42 unions in 2 Bangladesh divisions with thehighest infant mortality rates were randomly assigned to community-basedkangaroo mother care, and half were not. One village per unionwas randomly selected proportionate to union population size.A baseline survey of 39888 eligible consenting women collectedsociodemographic information. Community-based workers were taughtto teach community-based kangaroo mother care to all expectantand postpartum women in the intervention villages. A total of4165 live births were identified and enrolled. Newborns werefollowed for 30 to 45 days and infants were followed quarterlythrough their first birthday to record infant care, feeding,growth, health, and vital status.
Forty percent overall and ~65% of newborns who diedwere not weighed at birth, and missing birth weight was differentialby study group. There was no difference in overall neonatalmortality rate or infant mortality rate. Except for care seeking,community-based kangaroo mother care behaviors were more commonin the intervention than control group, but implementation wasweak compared with the pilot study.
The extensive missing birth weight and its potentialbias render the evidence insufficient to justify implementingcommunity-based kangaroo mother care. Additional experimentalresearch ensuring baseline comparability of mortality, adequatekangaroo mother care implementation, and birth weight assessmentis necessary to clarify the effect of community-based kangaroomother care on survival.