The promise of kangaroo mother care
At birth, a baby kangaroo climbs into its mother's pouch, latches onto a nipple, and stays put until it is more fully developed. Now imagine if you could do something similar for a human baby who is born prematurely. That's the concept behind a low-tech intervention known as kangaroo mother care.
"Kangaroo mother care involves skin-to-skin care with the mother or with another family member: The father, grandmother, aunts and uncles, and brothers and sisters have all done it," says Doug McMillan, a member of the Rotary Club of Calgary, Alberta, and a neonatologist experienced in global child health. Mothers get support to breastfeed exclusively, and if someone else is helping with the kangaroo care, the baby is fed stored breastmilk.
The method was developed more than four decades ago in Colombia, when physician researchers Edgar Rey Sanabria and Héctor Martínez-Gómez were looking for a way to keep babies warm and with their mothers because their hospital didn't have incubators for low birthweight newborns. The death rate for low birthweight infants at their hospital was 70 percent at the time.
Since then, multiple studies have shown kangaroo mother care saves newborn lives: It maintains better temperature, improves nutrition and growth, decreases infection, and enhances the bonding between the mother and the baby, explains McMillan, a member of The Rotary Foundation Cadre of Technical Advisers. It has benefits for mothers too, reducing postpartum depression and enhancing their perceived ability to care for their newborns.
But while child mortality has otherwise declined dramatically, 1.6 million premature or low birthweight babies die every year in their first month, according to the Bill & Melinda Gates Foundation. More than 75 percent of deaths of premature babies are preventable using current knowledge and basic clinical care.
In Uganda, the neonatal mortality rate is about 19 per 1,000 live births. In recent years at Mbarara Regional Referral Hospital, southwest of the capital of Kampala, about 200 babies admitted to the neonatal unit died each year. About 70 percent were preterm. The two major causes of death were hypothermia, as infants born early are often too small to keep themselves warm, and infections — two conditions complicated by malnutrition.
That's where Rotarians stepped in. The Rotary clubs of Mbarara, Uganda, and Calgary at Stampede Park, Alberta, applied for a Rotary Foundation global grant to upgrade the kangaroo care program at the hospital.
Through the project, which began in late 2020, more than 40 nurses, midwives, pediatricians, and other doctors have been trained in kangaroo care. The project has also supported the development of a curriculum for health care workers to use to teach mothers how to do kangaroo care. The curriculum has been translated into the local language and printed, and mothers are now able to train other mothers on the method.
By the numbers
Babies who die each year in their first month due to premature birth or low birthweight
Share of deaths from prematurity that are preventable
Estimate for the lives that could be saved each year by immediate kangaroo mother care
Women tailors made 500 kangaroo mother care wraps as part of the project, generating income in the area. The wraps are easier to use and better accepted than the kangas, or pieces of cloth, mothers may have used earlier to carry around their babies, says McMillan, who has been volunteering in Mbarara for over 20 years. Meanwhile, Rotarians were able to secure meals for mothers who needed food, which has improved breastfeeding and reduced the rate of women leaving hospital care early.
In addition, the grant helped fund improvements in the newborn unit. Before the grant, in January 2020, the unit had just one thermometer and lacked other equipment. At least two babies would share a cot, often with a torn mattress, increasing the risk of spreading infections. The newborn unit now has the equipment to treat sick babies, more bed space, and chairs to sit on, explains Sheila Abaasa, past president of the Rotary Club of Mbarara.
Rotary members in Brazil, in partnership with members in India, are also supporting the practice through a global grant. Their grant targeted a hospital along the southern border with Paraguay and Argentina, a densely populated area with a high poverty rate. The Hospital Ministro Costa Cavalcanti is noted for its care for children, says Alexandre Kraemer of the Rotary Club of Foz do Iguaçú-Grande Lago. The hospital serves high-risk pregnant women in the city and the region, as well as Brazilians who live in neighboring countries, mainly in Paraguay. It also handles obstetric emergencies.
The grant helped purchase equipment including slings and armchairs made especially for breastfeeding. The slings are made with special fabric designed to help "the mother to welcome the baby in her lap as kangaroos do, to convey the mother's heartbeat to the baby, their body heat and affection, which helps to bring mother and child closer together," Kraemer says. "This helps to prevent mental health issues like postpartum depression. Naturally, the length of hospital stay and maternal and child mortality decreases."
The positive outcomes were numerous, Kraemer says, but most of all, "the environment became more welcoming, removing much of the typical coldness of hospitals and maternity wards. This is part of the humanization of care that we so desire."
The methods of kangaroo mother care may be evolving as well. A 2021 study in The New England Journal of Medicine suggests that starting the practice as soon as preterm or low birthweight babies are born can save up to 150,000 more lives each year. Currently, the World Health Organization recommends starting the care after the baby is stabilized in an incubator or warmer. This can take on average three to seven days.
"Keeping the mother and baby together right from birth with zero separation will revolutionize the way neonatal intensive care is practiced for babies born early or small," Rajiv Bahl, head of the WHO newborn health unit and the study's coordinator, said in an announcement about the results. "When started at the soonest possible time, kangaroo mother care can save more lives, improve health outcomes for babies and ensures the constant presence of the mother with her sick baby."
The study results point to a need for dedicated mother-newborn intensive care units, which have been established in some countries so that mothers can provide continuous kangaroo care. Mothers receive post-birth care without being separated from their babies. If a mother has complications, a surrogate continues the kangaroo care while the mother recovers.
In Uganda, the kangaroo mother care project has shown promising results at Mbarara Hospital. Abaasa says the equipment supplied under the project has been used to treat more than 4,000 newborns in the last two years. The most common conditions treated have been prematurity, birth asphyxia, and neonatal sepsis.
Overall, the inpatient neonatal mortality rate has dropped from 15 percent to 7.5 percent over the two years, and the survival of babies receiving kangaroo mother care is about 96.5 percent.
Meanwhile, McMillan says that he and others are looking for partnerships with Rotary clubs to provide kangaroo care wraps and instruction in Ukraine amid the war with Russia. "While kangaroo mother care may assist small babies throughout the world, the need in Ukraine is increased as many hospitals have been bombed and others have power shortages."
This story originally appeared in the June 2023 issue of Rotary magazine.