WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

Abstract

Preterm birth complications are the largest contributor to neonatal and child mortality globally, 1 Perin J Mulick A Yeung D et al. Global, regional, and national causes of under-5 mortality in 2000–19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022; 6: 106-115 Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar and strategies to improve the care of premature or low birthweight (LBW) infants are vital. One important strategy is kangaroo mother care (KMC), which involves continuous and prolonged skin-to-skin contact (preferably for 24 h daily, with a minimum of 8 h) with support for exclusive breastfeeding or breastmilk feeding. 2 WHOWHO recommendations for care of the preterm or low birth weight infant. World Health Organization, Geneva2022https://apps.who.int/iris/bitstream/handle/10665/363697/9789240058262-eng.pdfDate accessed: May 3, 2023 Google Scholar An additional feature of facility-based KMC is timely transition to lower levels of care within the health-care facility or home with continued skin-to-skin contact and close monitoring. On May 16, 2023, WHO launched the KMC Global Position Paper 3 WHOGlobal position paper. Kangaroo mother care: a transformative innovation in health care. https://apps.who.int/iris/bitstream/handle/10665/367626/9789240072657-eng.pdfDate: May 16, 2023 Date accessed: May 16, 2023 Google Scholar and Implementation Strategy, 4 WHOKangaroo mother care: implementation strategy for scale-up adaptable to different country contexts. https://apps.who.int/iris/bitstream/handle/10665/367625/9789240071636-eng.pdfDate: May 16, 2023 Date accessed: May 16, 2023 Google Scholar prepared by the KMC Working Group convened by WHO through its Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child, and adolescent health and nutrition. This Working Group was assembled in recognition of the underuse of KMC globally, despite a strong evidence base for its effectiveness and scalability (panel), 2 WHOWHO recommendations for care of the preterm or low birth weight infant. World Health Organization, Geneva2022https://apps.who.int/iris/bitstream/handle/10665/363697/9789240058262-eng.pdfDate accessed: May 3, 2023 Google Scholar , 3 WHOGlobal position paper. Kangaroo mother care: a transformative innovation in health care. https://apps.who.int/iris/bitstream/handle/10665/367626/9789240072657-eng.pdfDate: May 16, 2023 Date accessed: May 16, 2023 Google Scholar , 4 WHOKangaroo mother care: implementation strategy for scale-up adaptable to different country contexts. https://apps.who.int/iris/bitstream/handle/10665/367625/9789240071636-eng.pdfDate: May 16, 2023 Date accessed: May 16, 2023 Google Scholar , 5 WHO KMC Scale Up Study GroupIncremental costs of scaling up kangaroo mother care: results from implementation research in Ethiopia and India. Acta Paediatr. 2022; (published online Aug 19.)https://doi.org/10.1111/apa.16490 Crossref Scopus (0) Google Scholar , 6 Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health (in press). Google Scholar , 7 Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effect of kangaroo mother care for low-birth-weight and preterm infants on maternal and paternal health: systematic review and meta-analysis. Bull World Health Org (in press). Google Scholar , 8 Al-Alaa H Al-Najjar H Fouly H Assess the effectiveness of using kangaroo mother care on reducing postpartum bleeding among laboring women: a randomized control trial. Women Health Care Issues. 2021; (published online Nov 5.)https://doi.org/10.31579/2642-9756/092 PubMed Google Scholar , 9 Tessier R Charpak N Giron M Cristo M de Calume ZF Ruiz-Peláez JG Kangaroo mother care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr. 2009; 98: 1444-1450 Crossref PubMed Scopus (50) Google Scholar , 10 Dong Q Steen M Wepa D Eden A Exploratory study of fathers providing kangaroo care in a neonatal intensive care unit. J Clin Nurs. 2022; (published online June 16.)https://doi.org/10.1111/jocn.16405 Crossref Scopus (0) Google Scholar , 11 Charpak N Tessier R Ruiz JG et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017; 139e20162063 Crossref PubMed Scopus (124) Google Scholar , 12 Charpak N Tessier R Ruiz JG et al. Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm. Acta Paediatr. 2022; 111: 1004-1014 Crossref PubMed Scopus (7) Google Scholar , 13 Hailegebriel TD Bergh AM Zaka N et al. Improving the implementation of kangaroo mother care. Bull World Health Organ. 2021; 99: 69-71 Crossref PubMed Scopus (9) Google Scholar , 14 Mony PK Tadele H Gobezayehu AG et al. Scaling up kangaroo mother care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health. 2021; 6e005905 Crossref PubMed Scopus (12) Google Scholar and the need for concerted actions to ensure universal coverage of the 2022 WHO recommendations for KMC in the care of preterm or LBW infants. 2 WHOWHO recommendations for care of the preterm or low birth weight infant. World Health Organization, Geneva2022https://apps.who.int/iris/bitstream/handle/10665/363697/9789240058262-eng.pdfDate accessed: May 3, 2023 Google Scholar , 15 Darmstadt GL Al Jaifi NH Arif S et al. New WHO recommendations for care of preterm or low birthweight infants have the potential to transform maternal and newborn health-care delivery. Lancet. 2022; 400: 1828-1831 Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar PanelBenefits, scalability, and SDG impacts of kangaroo mother careWhat are the benefits of KMC? •WHO recommendations for KMC are based on rich evidence from diverse settings on the benefits and affordability of KMC in helping preterm or LBW infants to survive and thrive. 2 WHOWHO recommendations for care of the preterm or low birth weight infant. World Health Organization, Geneva2022https://apps.who.int/iris/bitstream/handle/10665/363697/9789240058262-eng.pdfDate accessed: May 3, 2023 Google Scholar , 5 WHO KMC Scale Up Study GroupIncremental costs of scaling up kangaroo mother care: results from implementation research in Ethiopia and India. Acta Paediatr. 2022; (published online Aug 19.)https://doi.org/10.1111/apa.16490 Crossref Scopus (0) Google Scholar , 6 Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health (in press). Google Scholar •32% reduction in neonatal mortality; 25% reduction in mortality by age 6 months; 68% reduction in hypothermia by discharge or 28 days after birth; 15% reduction in severe infections or sepsis at latest follow-up; 48% increased duration of exclusive breastfeeding at discharge or 28 days after birth; and improvements in growth at latest follow-up. 6 Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health (in press). Google Scholar •Builds mothers’ confidence and comfort in caring for their infants and reduces their risk of moderate to severe depressive symptoms and postpartum haemorrhage. 7 Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effect of kangaroo mother care for low-birth-weight and preterm infants on maternal and paternal health: systematic review and meta-analysis. Bull World Health Org (in press). Google Scholar , 8 Al-Alaa H Al-Najjar H Fouly H Assess the effectiveness of using kangaroo mother care on reducing postpartum bleeding among laboring women: a randomized control trial. Women Health Care Issues. 2021; (published online Nov 5.)https://doi.org/10.31579/2642-9756/092 PubMed Google Scholar •Reduces paternal depression and spouse relationship problems, improves father–infant interactions, positively impacts family structure and the home environment in which the child is raised; as fathers and other family members provide KMC, they experience increased bonding and attachment with their infant, empathy for the newborn baby, increased confidence as caregivers, and enhanced mental health and wellbeing. 9 Tessier R Charpak N Giron M Cristo M de Calume ZF Ruiz-Peláez JG Kangaroo mother care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr. 2009; 98: 1444-1450 Crossref PubMed Scopus (50) Google Scholar , 10 Dong Q Steen M Wepa D Eden A Exploratory study of fathers providing kangaroo care in a neonatal intensive care unit. J Clin Nurs. 2022; (published online June 16.)https://doi.org/10.1111/jocn.16405 Crossref Scopus (0) Google Scholar •Intergenerational, long-lasting social and behavioural benefits for the infants, including reduced school absenteeism, hyperactivity, aggressiveness, and externalisation disorders and improved brain maturation at 20 years of age. 11 Charpak N Tessier R Ruiz JG et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017; 139e20162063 Crossref PubMed Scopus (124) Google Scholar , 12 Charpak N Tessier R Ruiz JG et al. Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm. Acta Paediatr. 2022; 111: 1004-1014 Crossref PubMed Scopus (7) Google Scholar Preterm or LBW infants who received KMC are more likely to be protective and nurturing parents and receive higher hourly wages. 11 Charpak N Tessier R Ruiz JG et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017; 139e20162063 Crossref PubMed Scopus (124) Google Scholar Is KMC scalable? •Although global coverage remains low, multiple countries have shown national or subnational implementation of KMC. 13 Hailegebriel TD Bergh AM Zaka N et al. Improving the implementation of kangaroo mother care. Bull World Health Organ. 2021; 99: 69-71 Crossref PubMed Scopus (9) Google Scholar •Increased KMC coverage can be achieved when high-intensity interventions in support of KMC are made across multiple health system building blocks, including leadership, governance, policy, and advocacy; health workforce capacity building and motivation; health financing; service delivery, including dedicated space for KMC, protocols, and job aids; supplies; and health management information systems. 14 Mony PK Tadele H Gobezayehu AG et al. Scaling up kangaroo mother care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health. 2021; 6e005905 Crossref PubMed Scopus (12) Google Scholar Which SDG will be impacted by scaling up KMC? •SDG 3.2 for ending preventive deaths of newborn babies and children younger than 5 years. •KMC empowers mothers as primary caregivers and thus is fundamental to SDG target 5.1 for ending all forms of discrimination against all women everywhere to achieve gender equality and empower all women. •KMC can contribute to SDG target 7.3 to improve global energy efficiency and ensure access to affordable, reliable, sustainable, and modern energy by catalysing the reorganisation of service delivery for maternal–infant care to be people-centred and central to primary health care rather than relying on energy-consuming technical solutions, such as incubators and radiant warmers. •KMC promotes SDG target 9.1 to develop quality, reliable, sustainable, and resilient infrastructure to support equitable economic development and human wellbeing, as infrastructure modifications to enable combined care of mother–infant dyads are likely to be more efficient, sustainable, and resilient. •Global scale-up of KMC will promote multi-stakeholder and “north–south” partnerships in support of SDG target 17.16. KMC=kangaroo mother care. LBW-low birthweight. SDGs=Sustainable Development Goals. What are the benefits of KMC? •WHO recommendations for KMC are based on rich evidence from diverse settings on the benefits and affordability of KMC in helping preterm or LBW infants to survive and thrive. 2 WHOWHO recommendations for care of the preterm or low birth weight infant. World Health Organization, Geneva2022https://apps.who.int/iris/bitstream/handle/10665/363697/9789240058262-eng.pdfDate accessed: May 3, 2023 Google Scholar , 5 WHO KMC Scale Up Study GroupIncremental costs of scaling up kangaroo mother care: results from implementation research in Ethiopia and India. Acta Paediatr. 2022; (published online Aug 19.)https://doi.org/10.1111/apa.16490 Crossref Scopus (0) Google Scholar , 6 Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health (in press). Google Scholar •32% reduction in neonatal mortality; 25% reduction in mortality by age 6 months; 68% reduction in hypothermia by discharge or 28 days after birth; 15% reduction in severe infections or sepsis at latest follow-up; 48% increased duration of exclusive breastfeeding at discharge or 28 days after birth; and improvements in growth at latest follow-up. 6 Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis. BMJ Global Health (in press). Google Scholar •Builds mothers’ confidence and comfort in caring for their infants and reduces their risk of moderate to severe depressive symptoms and postpartum haemorrhage. 7 Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effect of kangaroo mother care for low-birth-weight and preterm infants on maternal and paternal health: systematic review and meta-analysis. Bull World Health Org (in press). Google Scholar , 8 Al-Alaa H Al-Najjar H Fouly H Assess the effectiveness of using kangaroo mother care on reducing postpartum bleeding among laboring women: a randomized control trial. Women Health Care Issues. 2021; (published online Nov 5.)https://doi.org/10.31579/2642-9756/092 PubMed Google Scholar •Reduces paternal depression and spouse relationship problems, improves father–infant interactions, positively impacts family structure and the home environment in which the child is raised; as fathers and other family members provide KMC, they experience increased bonding and attachment with their infant, empathy for the newborn baby, increased confidence as caregivers, and enhanced mental health and wellbeing. 9 Tessier R Charpak N Giron M Cristo M de Calume ZF Ruiz-Peláez JG Kangaroo mother care, home environment and father involvement in the first year of life: a randomized controlled study. Acta Paediatr. 2009; 98: 1444-1450 Crossref PubMed Scopus (50) Google Scholar , 10 Dong Q Steen M Wepa D Eden A Exploratory study of fathers providing kangaroo care in a neonatal intensive care unit. J Clin Nurs. 2022; (published online June 16.)https://doi.org/10.1111/jocn.16405 Crossref Scopus (0) Google Scholar •Intergenerational, long-lasting social and behavioural benefits for the infants, including reduced school absenteeism, hyperactivity, aggressiveness, and externalisation disorders and improved brain maturation at 20 years of age. 11 Charpak N Tessier R Ruiz JG et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017; 139e20162063 Crossref PubMed Scopus (124) Google Scholar , 12 Charpak N Tessier R Ruiz JG et al. Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm. Acta Paediatr. 2022; 111: 1004-1014 Crossref PubMed Scopus (7) Google Scholar Preterm or LBW infants who received KMC are more likely to be protective and nurturing parents and receive higher hourly wages. 11 Charpak N Tessier R Ruiz JG et al. Twenty-year follow-up of kangaroo mother care versus traditional care. Pediatrics. 2017; 139e20162063 Crossref PubMed Scopus (124) Google Scholar Is KMC scalable? •Although global coverage remains low, multiple countries have shown national or subnational implementation of KMC. 13 Hailegebriel TD Bergh AM Zaka N et al. Improving the implementation of kangaroo mother care. Bull World Health Organ. 2021; 99: 69-71 Crossref PubMed Scopus (9) Google Scholar •Increased KMC coverage can be achieved when high-intensity interventions in support of KMC are made across multiple health system building blocks, including leadership, governance, policy, and advocacy; health workforce capacity building and motivation; health financing; service delivery, including dedicated space for KMC, protocols, and job aids; supplies; and health management information systems. 14 Mony PK Tadele H Gobezayehu AG et al. Scaling up kangaroo mother care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health. 2021; 6e005905 Crossref PubMed Scopus (12) Google Scholar Which SDG will be impacted by scaling up KMC? •SDG 3.2 for ending preventive deaths of newborn babies and children younger than 5 years. •KMC empowers mothers as primary caregivers and thus is fundamental to SDG target 5.1 for ending all forms of discrimination against all women everywhere to achieve gender equality and empower all women. •KMC can contribute to SDG target 7.3 to improve global energy efficiency and ensure access to affordable, reliable, sustainable, and modern energy by catalysing the reorganisation of service delivery for maternal–infant care to be people-centred and central to primary health care rather than relying on energy-consuming technical solutions, such as incubators and radiant warmers. •KMC promotes SDG target 9.1 to develop quality, reliable, sustainable, and resilient infrastructure to support equitable economic development and human wellbeing, as infrastructure modifications to enable combined care of mother–infant dyads are likely to be more efficient, sustainable, and resilient. •Global scale-up of KMC will promote multi-stakeholder and “north–south” partnerships in support of SDG target 17.16. KMC=kangaroo mother care. LBW-low birthweight. SDGs=Sustainable Development Goals.