Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial

Mazumder, Sarmila; Taneja, Sunita; Dube, Brinda; Bhatia, Kiran; Ghosh, Runa; Shekhar, Medha; Sinha, Bireshwar; Bahl, Rajiv; Martines, José; Bhan, Maharaj Kishan; Sommerfelt, Halvor; Bhandari, Nita

doi:10.1016/s0140-6736(19)32223-8

Cited by 75 publications

(124 citation statements)

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“…It is desirable that all LBW infants have access to a medical examination at birth and to a KMC program, with a high risk follow up to allow early and opportune intervention when any deviation is detected [21]. In settings where home-based deliveries are still occurring or access to a health facility is limited, community initiated KMC could improve survival.…”

Section: Discussionmentioning

confidence: 99%

“…Even for settings with high rates of institutional birth, KMC initiation at health facilities may not happen and even if it does, it is possible that hospital to community continuum of care is not strengthened. In such situations, based on unpublished findings from the primary trial [21], community KMC programs could be cost effective if the health workers are trained in KMC and could promote it during their routine home follow up visits. In a recently published randomized controlled trial by our organization, we documented that community initiated KMC (ciKMC) substantially improved survival in the neonatal period and in the first 6 months of life in LBW infants a Others: Christian/Sikh/Jain/Parsi/Zoroastrian/Buddhist/neo Buddhist; b General-group that do not qualify for any of the positive discrimination schemes by Government of India (GOI), OBC-term used by the Government of India to classify castes which are socially and educationally disadvantaged, SC/ST-official designations given to groups of historically disadvantaged indigenous people in India; No statistically significant differences in the baseline characteristics between intervention and control group [21].…”

Section: Discussionmentioning

confidence: 99%

“…This was an individually randomized unmasked controlled trial (RCT) conducted between July 2015 to November 2016. The first 552 infants enrolled in the primary trial [21] were included for evaluation of child developmental outcomes. This cohort of LBW infants was a very selected cohort consisting majorly of stable late preterm or term small for gestational age infants without any problems at birth.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…A study in Bangladesh, designed to test the mortality impact of ciKMC, was not conclusive, but provided useful insights into the barriers of implementing KMC within the community [20]. Recently, a large communitybased randomized controlled trial in North India showed a substantial improvement in neonatal survival and infant survival up to 6 months age in stable LBW infants, majorly late preterm or term small for gestational age infants, without any problems at birth and weighing 1500-2250 g at birth, as an effect of ciKMC [21]. However, the effects of ciKMC on neurodevelopment outcomes in LBW infants are still unclear.…”

Section: Introductionmentioning

confidence: 99%

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Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

et al. 2020

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Background: In a randomized controlled trial (RCT) with 8402 stable low birthweight (LBW) infants, majority being late preterm or term small for gestational age, community-initiated KMC (ciKMC) showed a significant improvement in survival. However, the effect of ciKMC on neurodevelopment is unclear. This is important to elucidate as children born with low birth weight are at high risk of neurodevelopmental deficits. In the first 552 stable LBW infants enrolled in the above trial, we evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy. Method: This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500-2250 g at birth. The intervention comprised of promotion of skin-to-skin contact and exclusive breastfeeding by trained intervention delivery team through home visits. The intervention group mother-infant-dyads were supported to practice ciKMC till day 28 after birth or until the baby wriggled-out. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers. Cognitive, language, motor and socio-emotional outcomes were assessed at infant-ages 6-and 12-months using Bayley Scale of Infant Development (BSID-III). Other outcomes measured were infant temperament, maternal depression, maternal sense of competence, mother-infant bonding and home-environment. We performed post-hoc equivalence testing using two one-sided tests of equivalence (TOST) to provide evidence that ciKMC does not do harm in terms of neurodevelopment. Results: In the intervention arm, the median (IQR) time to initiate ciKMC was 48 (48 to 72) hours after birth. The mean (SD) duration of skin-to-skin-contact was 27.9 (3.9) days with a mean (SD) of 8.7 (3.5) hours per day. We did not find significant effect of ciKMC on any of the child developmental outcomes during infancy. The TOST analysis demonstrated that composite scores for cognitive, language and motor domains at 12 months among the study arms were statistically equivalent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Design and Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

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“…There are fewer data on community‐based kangaroo care. A randomised controlled study in India enrolled 8402 babies weighing 1500–2250 g who were at home within 72 h of birth to intervention (skin‐to‐skin contact and exclusive breastfeeding) or control groups . Most births (81.4%) occurred in a health facility.…”

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confidence: 99%

Kangaroo care saves lives of low birthweight babies in India

2020

J Paediatrics Child Health

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Effect of Community-Initiated Kangaroo Mother Care on Postpartum Depressive Symptoms and Stress Among Mothers of Low-Birth-Weight Infants

et al. 2021

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IMPORTANCE Approximately 1 in 5 women in low-and middle-income countries experience postpartum depression, and the risk is higher among mothers of low-birth-weight (LBW) infants.Kangaroo mother care (KMC) is effective in improving survival among LBW infants, but the benefits of KMC for mothers are not well described. OBJECTIVETo estimate the effects of community-initiated KMC (ciKMC) on maternal risk of moderate-to-severe postpartum depressive symptoms and on salivary cortisol concentration, a biomarker of stress. DESIGN, SETTING, AND PARTICIPANTS This was an unmasked, parallel-group, individually randomized clinical trial. Participants included 1950 mothers of stable LBW infants (weighing 1500-2250 g) in rural and semiurban low-income populations in North India enrolled between April 2017 and March 2018. Data analysis was performed from January to July 2020. INTERVENTIONS Eligible participants were randomly assigned to the intervention or control group by block randomization. The mothers in the intervention group were supported to practice ciKMC until 28 days after birth or until the infant wriggled out of the KMC position (ie, was no longer staying in the KMC position). The intervention included promotion and support of skin-to-skin contact and exclusive breastfeeding through home visits. MAIN OUTCOMES AND MEASURESPostpartum depressive symptoms at the end of the neonatal period were measured using the Patient Health Questionnaire-9, with a score of 10 or higher used to identify moderate-to-severe depressive symptoms. Salivary cortisol concentration was measured in a subsample of 550 mothers before and after breastfeeding on day 28 after birth. RESULTSOf the 1950 participants (mean [SD] age, 23 [3.5] years), outcome assessment was completed for 974 of 1047 participants (93%) in the intervention group and 852 of 903 participants (94%) in the control group. Sixty-four percent of participants (1175 of 1826 participants) belonged to the lowest 3 wealth quintiles. The proportion of mothers with moderate-to-severe postpartum depressive symptoms was 10.8% (95% CI, 8.9%-12.9%; 105 of 974 mothers) in the intervention group vs 13.6% (95% CI, 11.4%-16.1%; 116 of 852 mothers) in the control group. The adjusted relative risk of moderate-to-severe maternal postpartum depressive symptoms was 0.75 (95% CI, 0.59-0.96), or an efficacy of 25%. There was no difference in day-28 salivary cortisol concentration between the ciKMC and control group mothers before or after breastfeeding. The analysis estimated that supporting 36 mothers to perform KMC at home would prevent 1 mother from experiencing moderate-to-severe postpartum depressive symptoms. (continued) Key Points Question Does the practice of community-initiated kangaroo mother care (ciKMC), an intervention encompassing skin-to-skin-contact and exclusive breastfeeding, during the neonatal period reduce the risk of moderate-to-severe postpartum depressive symptoms among mothers of low-birth-weight (LBW) infants? Findings In a randomized clinical trial that included 1950 mothers ...

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Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial

Cited by 75 publications

References 10 publications

Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial

Kangaroo care saves lives of low birthweight babies in India

Effect of Community-Initiated Kangaroo Mother Care on Postpartum Depressive Symptoms and Stress Among Mothers of Low-Birth-Weight Infants

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