1.1 Magnitude of the problem/ Background
Tanzania is among those countries that have had success in reducing child mortality, 24% reduction in under fives and 31% reduction in infant mortality. The reduction in infant mortality was mostly post neonatal and there has been no significant progress in reducing neonatal deaths. The neonatal mortality rate was 40.4 per 1,000 live births in 1999 and 32 per 1,000 live births in 2004/05(TDHS). Up to 50% of neonatal deaths occur in the first 24 hours of life, with over 75% of them arising in the first week of life. Newborn mortality is a sensitive indicator of the quality of care provided during the antenatal period, delivery and immediate postnatal period.
Low birth weight (LBW) has detrimental effects on the survival, growth and development of newborns and carries an increased risk of neonatal mortality. It is estimated that around 16% of babies are born with low birth weight in Tanzania most of whom are born prematurely. An estimated 27% of newborns deaths are directly due to complications of preterm birth (TDHS 2004/5).
In less developed countries including Tanzania, high rates of LBW are due to preterm birth and impaired intrauterine growth, and their prevalence is decreasing slowly. Since causes and determinants remain largely unknown, effective preventive interventions are limited. Moreover, modern technology is either not available or cannot be used properly, often due to the shortage of skilled staff. Incubators, for instance, where available, are often insufficient to meet local needs or are not adequately cleaned. Purchase of the equipment and spare parts, maintenance and repairs are difficult and costly; the power supply is intermittent, so the equipment does
not work properly. Under such circumstances good care of preterm and LBW babies is difficult: hypothermia and nosocomial infections are frequent, aggravating the poor outcomes due to prematurity. Frequently and often unnecessarily, incubators separate babies from their mothers, depriving them of the necessary contact. However, Kangaroo Mother Care (KMC) is an effective way to meet baby’s needs for warmth, breast feeding, and protection from infection, stimulation, safety and love.
Additionally, KMC for preterm and low birth weight babies is one of the evidence-based and cost-effective child health interventions that contribute to reduction in neonatal morbidity and mortality when implemented at high coverage. It is less labour intensive and requires few/limited resources than conventional care, hence financially and economically feasible.
1.2 The purpose of the guideline
This guideline describes the KMC method for care of stable preterm/LBW infants (i.e. those who can breathe air and have no major health problems) who need thermal protection, adequate feeding, frequent observation, and protection from infection.
It provides guidance on how to organize services at the health facilities and on what is needed to introduce and carry out KMC, focusing on settings where resources are limited.
This guideline is meant for policy makers, planners, health care providers, trainers and health training institutions at all levels. Each health facility should have and use the KMC guidelines.