Evaluation of Facility Based Kangaroo Mother Care Practices at Bungoma County Referral Hospital, Kenya

Abstract

Background: Kangaroo Mother Care (KMC) is a low-cost, easy to adopt intervention recommended by World Health Organization to improve health outcomes and survival rates of pre-term and low birthweight infants. In Kenya, even though the implementation guidelines are available and facility based KMC has been practised for over ten years, the extent to which the implementation process conforms to the required standards and the proportion of eligible infants accessing this service has not been widely evaluated. The aim of this study was to evaluate implementation of KMC practices at a level 4 facility in Kenya. Methodology A cross-sectional study design was used to evaluate KMC practices at Bungoma County referral hospital newborn unit. Health care worker and mother were involved in the survey to assess aspects of KMC including availability of policy documents, infrastructure, human resource, the actual skin-to-skin practice, nutrition, documentation and reporting, strengths and challenges. Available three years data was analyzed to assess the utilization of KMC. Results The implementation of KMC began in October 2014. The facility had a newborn unit with a room designated for KMC with 9 heath care workers who supported mothers to practise continuous KMC. All the 10 KMC beds were occupied during the survey. Mothers had good knowledge on benefits of KMC and they reported having been taught during the admission in NBU. The facility had 3 incubators and only two of them were functional, five phototherapy machines and two continuous positive airway pressure machines. The strong stakeholder involvement at the inception of KMC, presence of nurse champions and availability of a KMC room with beds were their strengths whereas staff shortage, lack of comprehensive KMC training and poor resource allocation were the main challenges to the implementation of KMC. A review of three years data revealed that a total of 3738 infants were admitted to the new born unit out of whom 1572 (42%) had low birth weight. A total of 1094 (29.3%) babies had birth xii weight less than 2000g, of whom 1083 (99%) were reported to have been managed with KMC. Among infants born weighing less than 2000g 551 (44%) had a length of stay more than 21 days, 330 (28%) stayed between 7-21 days and 356 (28%) stayed less 7 days. The crude mortality rate for infants with birth weight less than 2000g admitted to the newborn unit over the last three years was 36% (n=454) whereas the mortality for infants with birth weight more than 2000g was 16% (n=384). Conclusion There was a ninety nine percent utilization of facility based Kangaroo mother care at Bungoma county hospital. However, staff shortage and lack of health care worker training are the main barriers to the implementation of facility based KMC.