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Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial.
Pediatrics. 2008 May; 121(5):e1047-59.Ped

Abstract

OBJECTIVE

We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%.

METHODS

Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39,888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status.

RESULTS

Forty percent overall and approximately 65% of newborns who died were not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study.

CONCLUSIONS

The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival.

Authors+Show Affiliations

Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th St, New York, NY 10032, USA. nlsloan@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18450847

Citation

Sloan, Nancy L., et al. "Community-based Kangaroo Mother Care to Prevent Neonatal and Infant Mortality: a Randomized, Controlled Cluster Trial." Pediatrics, vol. 121, no. 5, 2008, pp. e1047-59.
Sloan NL, Ahmed S, Mitra SN, et al. Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics. 2008;121(5):e1047-59.
Sloan, N. L., Ahmed, S., Mitra, S. N., Choudhury, N., Chowdhury, M., Rob, U., & Winikoff, B. (2008). Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. Pediatrics, 121(5), e1047-59. https://doi.org/10.1542/peds.2007-0076
Sloan NL, et al. Community-based Kangaroo Mother Care to Prevent Neonatal and Infant Mortality: a Randomized, Controlled Cluster Trial. Pediatrics. 2008;121(5):e1047-59. PubMed PMID: 18450847.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Community-based kangaroo mother care to prevent neonatal and infant mortality: a randomized, controlled cluster trial. AU - Sloan,Nancy L, AU - Ahmed,Salahuddin, AU - Mitra,Satindra N, AU - Choudhury,Nuzhat, AU - Chowdhury,Mushtaque, AU - Rob,Ubaider, AU - Winikoff,Beverly, PY - 2008/5/3/pubmed PY - 2008/6/5/medline PY - 2008/5/3/entrez SP - e1047 EP - 59 JF - Pediatrics JO - Pediatrics VL - 121 IS - 5 N2 - OBJECTIVE: We adapted kangaroo mother care for immediate postnatal community-based application in rural Bangladesh, where the incidence of home delivery, low birth weight, and neonatal and infant mortality is high and neonatal intensive care is unavailable. This trial tested whether community-based kangaroo mother care reduces the overall neonatal mortality rate by 27.5%, infant mortality rate by 25%, and low birth weight neonatal mortality rate by 30%. METHODS: Half of 42 unions in 2 Bangladesh divisions with the highest infant mortality rates were randomly assigned to community-based kangaroo mother care, and half were not. One village per union was randomly selected proportionate to union population size. A baseline survey of 39,888 eligible consenting women collected sociodemographic information. Community-based workers were taught to teach community-based kangaroo mother care to all expectant and postpartum women in the intervention villages. A total of 4165 live births were identified and enrolled. Newborns were followed for 30 to 45 days and infants were followed quarterly through their first birthday to record infant care, feeding, growth, health, and vital status. RESULTS: Forty percent overall and approximately 65% of newborns who died were not weighed at birth, and missing birth weight was differential by study group. There was no difference in overall neonatal mortality rate or infant mortality rate. Except for care seeking, community-based kangaroo mother care behaviors were more common in the intervention than control group, but implementation was weak compared with the pilot study. CONCLUSIONS: The extensive missing birth weight and its potential bias render the evidence insufficient to justify implementing community-based kangaroo mother care. Additional experimental research ensuring baseline comparability of mortality, adequate kangaroo mother care implementation, and birth weight assessment is necessary to clarify the effect of community-based kangaroo mother care on survival. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18450847/Community_based_kangaroo_mother_care_to_prevent_neonatal_and_infant_mortality:_a_randomized_controlled_cluster_trial_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=18450847 DB - PRIME DP - Unbound Medicine ER -