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REPRODUCTIVE HEALTH Kangaroo Mother Care Low birth weight (LBW) is a major contributor to infant mortality. In some countries 15–20 percent of LBW babies die in their first year of life. Past efforts to reduce neonatal and infant mortality have focused on preventing LBW, but these efforts have had limited success. Low birth weight and premature (less than 37 weeks gestation) babies born in hospitals are usually kept in incubators. These babies are especially prone to heat loss and particularly vulnerable to life-threatening respiratory and gastrointestinal diseases. Hospital neonatal intensive care is costly, and, in developing countries, resources for neonatal care are scarce, so nurseries are overcrowded and staffing is insufficient. The risk of infection in such circumstances is high because it is often necessary for infants to share an incubator. In 1979, Drs. Martinez and Rey of the Maternal Child Institute in Bogotá, Colombia developed a simple method to care for LBW infants called "The Kangaroo Mother Care Method" (KMC) to overcome the inadequacies of neonatal care in developing countries. KMC is used in hospitals, when the stabilized LBW infant is placed without clothes, except for diapers, a cap, and booties, upright between the mother's breasts held inside the pouch or mothers' blouse, to maximize skin-to-skin contact. The KMC method was developed as a curative method to reduce infant morbidity and mortality by promoting breastfeeding on demand, thermal maintenance, and maternal-infant bonding. The method has been demonstrated to reduce severe illness in infants. But Kangaroo Mother Care has never been proven to reduce neonatal or infant mortality, because most of this mortality occurs in the early neonatal period, before infants are considered stabilized and thereby eligible for KMC. Nor have there been attempts to adapt and evaluate community-based kangaroo care. The Population Council forged a new frontier for kangaroo care by formally adapting the method for community-based application, and is testing its impact where it is likely to reduce infant mortality, in areas where the incidence of LBW is highest, and where most births occur at home without medical or trained assistance or institutional support, including technology such as incubators to stabilize infants. The study will be the first to measure the potential effect of kangaroo care on neonatal and infant mortality. Together with the Bangladesh Rural Advancement Committee (BRAC), the largest NGO in the world, and Mitra and Associates, a renowned research organization, the study is being conducted in rural Bangladesh where 95 percent of births occur at home and 35 percent are estimated to be LBW. The study will enroll 4,000 women expected to deliver within an 18-month period. Information regarding mortality, reported morbidity, nutritional status, breastfeeding, skin-to-skin and sleeping contact will be collected at three month intervals until the infants' first birthdays. A government community-based health and nutrition programs is provided to women and children in the study area. In addition, half of the women in the study sample will be enrolled in the kangaroo intervention and half will not to determine the effects of community-based kangaroo care on neonatal and infant mortality. BRAC will train government community-based nutrition workers to teach the Kangaroo Mother Care method to village women. In a hospital setting nurses and other professionals can determine who is most eligible for KMC and frequently instruct mothers in Kangaroo Mother Care. But in the community, there may be challenges with community workers giving the appropriate messages to mothers and with the mothers willingness to conduct KMC. The study will be able to demonstrate whether community-based kangaroo care reduces the reported incidence of diarrhea and respiratory diseases and neonatal and infant mortality by 27.5 percent and 25 percent, respectively. |
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