766 - Kangaroo Mother Care Training in Kenyan Facilities during Mobile WACh NEO Study was Associated with Increased Skin to Skin Care at Home

Publication Number: 766.5647

Anna B. Hedstrom, University of Washington School of Medicine, Seattle, WA, United States; Erica Wetzler, University of Washington, Seattle, WA, United States; Peninah N. Kithao, University of Washington School of Medicine, Kisumu, Nyanza, Kenya; June Pheline. Moraa, University of Washington School of Medicine, Nairobi, Nairobi Area, Kenya; Brenda wandika, University of Washington, SEATTLE, WA, United States; Jenna Udren, University of Washington, Seattle, WA, United States; Millicent Masinde, Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya; Maneesh Batra, University of Washington School of Medicine, Seattle, WA, United States; Keshet Ronen, University of Washington, Seattle, WA, United States; John Kinuthia, Kenyatta National Hospital, Nairobi, Nairobi Area, Kenya; Jennifer Unger, The Warren Alpert Medical School of Brown University, Duxbury, MA, United States; Dalton Wamalwa, University of Nairobi, Nairobi, Nairobi Area, Kenya

Background: Preterm birth is the leading cause of under five mortality, with the highest burden in low resource areas. Kangaroo mother care (KMC) allows a parent to provide warmth and frequent breastfeeding opportunities for their low birthweight (LBW) baby and reduces mortality by up to 40%. Kenya released KMC implementation guidelines in 2023 with a particular emphasis on training parents of at-risk infants in the facility before discharge.

Objective: We aim to describe the receipt of facility based training and practice of KMC among mothers of low birthweight infants in Kenyan facilities and factors associated with increased home KMC.

Design/Methods: This is a secondary analysis from the Mobile WACh NEO randomized controlled trial which took place in Western Kenya from 2020 to 2022. Pregnant women were enrolled and followed until 18 weeks postpartum with data collected via structured questionnaire at enrollment, two weeks postpartum and 16 weeks postpartum. We analyzed data of LBW infants who were at home for at least 14 days post-discharge and therefore eligible for home KMC. We reported demographic and clinical data from maternal report, and performed multivariate analysis of factors associated with home KMC.

Results: Neonates eligible for home KMC (n= 131) had a median weight of 2.3kg [IQR 2.1, 2.4]. Training for KMC in the delivery facility occurred for 19% of participants and more frequently among multigravid mothers (p < 0.001) and for babies below 2kg (p < 0.001). Twenty percent of participants reported ever holding their baby “skin to skin” after coming home. KMC training while in the facility was the only independently predictive factor for performance of home KMC in adjusted analysis [RR 2.1 (CI 1.7, 2.5), p< 0.001]. Among the 26 participants who reported holding their baby skin to skin at home, it was most commonly practiced “once or twice”, for a few hours per day and stopped by two weeks of age.

Conclusion(s): We report low levels of KMC training among LBW neonates as well as low rates of home KMC in the time period before KMC implementation guidelines were in place. The fidelity of practice was inadequate to be significantly protective for the infant. Training while in the birth facility was the only factor associated with increased provision of KMC at home and should be the focus for Kenyan scale-up of this life-saving intervention.

Table 1. Factors associated with KMC initiation at home among eligible LBW neonates
Table 1.pdf(n=26 out of 131 did home KMC )

Table 1. Factors associated with KMC initiation at home among eligible LBW neonates
Table 1.pdf(n=26 out of 131 did home KMC )