INTRODUCTION:

Worldwide 25 million low birth weight infants are born each year, the great majority and 96% of them in developing countries (WHO 1998). About 2/3 of all infant deaths in developed countries occur in this group of infants (Guyer 1998).

In developing countries, financial and human resources for neonatal care are limited and hospital wards for low weight infants are often overcrowded.

Kangaroo Mother Care is a natural way of caring of newborns especially premature and low birth Weight baby. It is proved that the newborn thrives best in its original “right place” on its be. Kangaroo Mother Care is humanization of high technology and is an alternative for minimum neonatal care unit. In communities where majority of deliveries are at home and very limited resources for neonatal care are available, Kangaroo Mother Care is an alternative for all low birth weight and sick newborn babies.

Under the National Rural Health Mission [NRHM] program, the government of India is committed to improve the newborn care and bring down the neonatal and infant mortality to meet the millennium development Goals. It is, therefore, important to operationalise primary health for round the clock deliveries and upgrade the health facilities at the district hospitals and referral centers. It is also important to build up public private partnership at each level of healthcare.

BACKGROUND OF THE STUDY:

Low birth weight defined as weight at birth of less than 2500gm irrespective of gestational age, has an advanced effect on child survival and development and may even be an important risk factor for adult disease (Barker 1995).

Worldwide 25 million low birth weight infants are born each year, the great majority, and 96% of them in developing countries (WHO 1998). About 2/3 of all infant deaths in developed countries occur in this group of infants (Guyer 1998). In developing countries, financial and human resources for neonatal care are limited and hospital wards for low weight infants are often overcrowded. Hamelin and Ramachandran (1993) submitted their report of their experience with KC in NICU stable infants 800 -1500 g of body weight have contact with parents as much as 3 hours/day as tolerated. They stated this encourages mothers to continue expressing milk promotes early breast feeding and enhances breast feeding success.⁵

InstitutoMaternoInfantil in Bogota, Colombia (E. Rey, H. Martinez, L. Navarrete) in 1978 The original components of the intervention (prolonged skin-to-skin contact –kangaroo position-, breast milk based nutrition and early discharge in kangaroo position) have been scientifically tested in observational and experimental studies and have been shown to be an effective and safe alternative to caring for LBWI in minimal care units after stabilization of infants conditions. It offers additional advantages, regarding mother’s empowerment and family bonding to the LBWI. Modifications of the technique have beenemployed and tested under different circumstances.

NEED FOR THE STUDY:

Four million newborns die each year, 99% in developing countries. Twenty-eightpercent of newborn deaths are attributed to low birth weight (LBW) and prematurity and 26% to severe infections including pneumonia. Kangaroo mother care (KMC) is a method wherebythe hospital-born stabilized LBW newborn is placed in skin-to-skin (STS) contact on the mother’s breast to promotethermal regulation, breastfeeding, and maternal–infant bonding. Traditional KMC reduces the incidence of morbiditybut not mortality in LBW infants; because it is generally applied to clinically stabilized newborns and mostneonatal mortality occurs in the first 2 days of life before stabilization.⁶

LBW and preterm birth are thus associated with high neonatal and infant morbidity. This represents more than a fifth. In India, 32.8% of newborn babies are LBW .Larger numbers of deliveries are done by unattended experts especially in rural areas and urban slums. Therefore, the care of such infants becomes a burden for health and social systems everywhere.

Studies related to Low Birth Weight and Kangaroo Mother Care:

Suman RP, Udani R, Nanavathi R. (2008) conducted a randomized controlled trial to compare the effect of Kangaroo Mother Care (KMC) and Conventional Methods of Care (CMC) on Growth in Low Birth Weight babies (>2000g) on 206 neonates with weight <2000g. The subjects were randomized into two groups; the intervention group (KMC-103) received Kangaroo Mother Care. The control group (CMC-103) received conventional care. Study finding revealed that KMC group babies had better average weight gain/day (KMC: 23.99g v/s CMC: 15.58g, p<0.0001). The weekly increments in head circumferences (KMC: 0.75 cm v/s CMC: 0.49cm, p<0.02). A significantly higher number of babies in the CMC group suffered from hypothermia, hypoglycemia and sepsis. By this study we can conclude that Kangaroo Mother Care improves growth and reduces morbidities in low birth weight infants. And also it is simple, acceptable to mothers and can be practiced in home.¹¹

Ndiaye O, Diout A, Diousf S, Diouff NN, CisseBathily A, Cisse CT, et al (2006) conducted a retrospective study to evaluate the efficiency of Kangaroo Mother Care on thermoregulation and weight gain of a cohort of preterm. Based on the files of preterm baby weighing below 2000grams included after discharge to neonatal unit of Aristide Le Dantec Maternity for Kangaroo Mother Care. Efficiency was appreciated on thermic curve evolution and daily weight gain. Findings of the study revealed that mean temperature was satisfying during follow-up and was stable around 37+/- 7.6°C at discharge of program with mean daily weight gain of 33 +/- 7.6 g with one case of death. The results of this study point out efficacy of Kangaroo method on thermoregulation, weight gain and survival of preterm babies. So it can be promoted in developing countries as it is low cost and more effective. ¹²

Mbazor OJ, Umeora Ou. (2007) conducted a study to determine the incidence of and risk factors associated with delivery of low birth weight singletons at term at Benin City. A review of retrospective data extracted from the case records of all booked parturient who had low birth weight singletons at term at the Teaching Hospital over a four-year period. The term low birth weight singletons constituted 3.4% of the 4735 term deliveries at the Benin City. They discussed that Low birth weight in term infants is a major determinant of neonatal and infant morbidity and mortality.¹³

Celeste Johnson. et al, conducted study on preterm neonates (n=16) between 28/7 and 316/7 weeks gestational age in three level NICU’s in Canada skin to skin contact, or kangaroo (KMC) has been efficacious in diminishing pain response comprised sample a single blind randomized crossover design was employed in the experimental condition pain response to heal once in full term and moderate preterm neonates. The purpose of study was to determine if KMC would also be efficacious in very preterm neonates the infant was in prone position swaddled in a blanket in the incubator. The primary outcome was the premature infant pain profile (PIPP) which is comprised of three facial actions. Maximum heat rate minimum 0₂ salvation levels form baseline 30 seconds blocks from heel lance. PIPP scores at 90 seconds post lance were significantly lower in KMC condition (8871 (95% CI 7.852 – 9.889) verses 10.677 (95% CI 9.563 – 11.792) P < .001 and non significantly mean difference ranging from 1.2 to 1.8 favoring, KMC condition at 30,60,120 seconds. Time to recovery was significantly shorter by a minute (123 seconds (95% CI 103 – 142) verses 193 seconds (95% CI 158 – 227) facial actions were highly significantly lower across all point in time reacting a two-fold difference by 120 seconds post-lance and heart - was significantly lower across the first 90 seconds in the KMC condition. ¹⁴

OBJECTIVES OF THE STUDY:

1. To assess the existing knowledge of postnatal mothers regarding Kangaroo Mother Care.

2. To assess the efficacy of planned teaching on knowledge of kangaroo Mother Care among postnatal mothers.

3. To correlate knowledge of postnatal mothers with selected demographic variables such as education and occupation.

MATERIALS AND METHODS:

An evaluative research approach was adopted for this study. Pre-experimental one group pretest and posttest design was used. 50 postnatal mothers who fulfilled inclusion criteria were recruited for the study by convenient sampling techniquefrom maternal ward of a tertiary rural hospital i.e. Kasturba Hospital Sevagram (MGIMS, Sevagram). The Questionnaire was validated by 6 experts for appropriateness, organization of content, adequacy, relevance and comprehensiveness.

The questionnaire consists of two parts:

Section A consists of demographic variables of the Postnatal Mothers to be participated in the study e.g. Age, education, occupation, number of deliveries etc.

Section B consists of 30 questions on knowledge regarding Kangaroo Mother Care.

SCORING:

· Score 1 was given for correct answer

· Score 0 was given for wrong answer

· The 30 items there is 30 maximum obtainable scores

· Knowledge was graded from poor knowledge to excellent knowledge based on scores.

Reliability of the tool was assessed by using split half method of Karl Pearson Correlation. The tool was found to be reliable (r=0.86) for the main study.

METHOD OF DATA COLLECTION:

The data gathering process began from 15 June to 22 July 2013. The investigator visited the selected Hospital Maharashtra. in advance and obtained the necessary permission from the concerned authorities. The investigator introduced himself and informed them about the nature of the study so as to ensure better cooperation during the data collection.

The investigator personally approached each subject and explained the purposes of the study and explained how it will be beneficial for them.

He confirmed their willingness to participate in the study. The investigator collected a group of subjects, made them comfortable and oriented them to the study and administered questionnaire to them, instructed them not to interact with each other and their doubts were clarified. Once the questionnaire was completed, investigator collected them back. The subjects required mean time of 30 min. to complete the structured questionnaire. After the pretest planned teaching was given by the investigator. They were informed to take retest after 7 days.

Post test was administered with the same questionnaire on the 7^th day. The collection of data was performed within the stipulated time. After the data gathering process the investigator thanked all the study samples as well as the authorities for their cooperation.

RESULTS:

• Assessing the existing knowledge of the postnatal mothers by pre- test. It shows the postnatal mothers had deficient knowledge in all the sections. The planned teaching was implemented.

The data was analyzed on the basis of Objectives of the study using descriptive and inferential statistics.

The effectiveness of planned teaching was done by the post test and the analysis shows that the existing knowledge was increased by to 8 point this shows that the planned teaching was effective in all the areas of knowledge. post –test score (mean pre- test score - and mean post- test score - 19.54).

• The pre- and post test knowledge scores were compared with the selected demographic variables such as education and occupation of postnatal mothers. In these demographic variables there were no significant correlation was found. Thus the null hypothesis was accepted.

DISCUSSION:

Ndiaye O, Diout A, Diousf S, Diouff NN, CisseBathily A, Cisse CT, et al (2006) conducted a retrospective study to evaluate the efficiency of Kangaroo Mother Care on thermoregulation and weight gain of a cohort of preterm. Based on the files of preterm baby weighing below 2000grams included after discharge to neonatal unit of Aristide Le Dantec Maternity for Kangaroo Mother Care. Efficiency was appreciated on thermic curve evolution and daily weight gain. Findings of the study revealed that mean temperature was satisfying during follow-up and was stable around 37+/- 7.6° C at discharge of program with mean daily weight gain of 33 +/- 7.6 g with one case of death. The results of this study point out efficacy of Kangaroo method on thermoregulation, weight gain and survival of preterm babies.

So it can be promoted in developing countries as it is low cost and more effective.

Gathwala, Singh, Balhara conducted a study based on the theory that kangaroo care facilitates parent baby attachment in low birth weight infants, a randomized controlled trial done. The Neonates were randomized into a kangaroo care group and a control group in multiple trials. The kangaroo care group was subjected to this care at least 6 hours per day and received care after shifting out from the NICU and into the home setting, while the control group received the standard incubator care until discharge.

At a 3 months follow-up appointment, an interview was conducted to assess attachment between parents and their babies.

With these researchers concluded, their attachment rate was significantly higher than that obtained in the control group.²⁵

Kadam S, Binay S, Kanbur W, Mondkar JA, Fernandez A. (2005) conducted randomized controlled trial to determine the feasibility and acceptability of Kangaroo Care in a tertiary care hospital in India. Over one year period in which 89 neonates were randomized into two groups Kangaroo Mother Care (KMC) and Conventional Method of Care (CMC) group. 45 babies were randomized into KMC group and 45 to CMC group. Findings of study revealed that 70% of mothers felt comfortable during the Kangaroo Mother Care. 73% felt they would able to give Kangaroo Mother Care. Kangaroo Mother Care is a easy and powerful way to improve the attachment between Mother and her low birth weight baby. It also plays a very important role in reducing the incidences of hypothermia in low birth weight babies.

From the above studies it will concluded that the Kangaroo Mother Care is effective to the newborn baby as well as low birth weight baby. It shows that it will reduce the morbidity and mortality rate among newborn.

Analysis and Interpretation of Data:

Analysis and interpretation is based on the objectives of the study.

A structured questionnaire to collect knowledge was used for data collection. The analysis was done with the help of inferential and descriptive statistics.

Table No.1 Distribution of postnatal mothers according to their Demographic Variables n=50

Demographic Variables	Frequency	Percentage(%)
Age(yrs) of mother
18-21 yrs	12	24.0
22-25 yrs	20	40.0
26-29 yrs	15	30.0
30-33 yrs	3	6.0
34-37 yrs	0	0.00
38-41 yrs	0	0.00
Type of family
Joint	22	44.0
Nuclear	26	52.0
Extended	2	4.0
Educational Status
Primary	3	6.0
Secondary	36	72.0
Higher Secondary	9	18.0
Graduation	2	4.0
Occupation
Housewife	43	86.0
Daily Wages	6	12.0
Govt. Servant	1	2.0
Others	0	0.00
No of deliveries
One	28	56.0
Two	22	44.0

Table No. 2. Significance of difference between knowledge score in pre and post test of postnatal mothers in relation to Knowledge regarding Kangaroo Mother Care n=50

Knowledge regarding Kangaroo Mother Care	Comparison of Knowledge	Mean knowledge score	SD	Mean percentage	t value	p-value
Overall	Pre Test	11.46	2.61	38.20	16.87	0.000 S,p<0.05
Overall	Post Test	19.54	2.73	65.13	16.87	0.000 S,p<0.05
Normal Physiology	Pre Test	1.38	0.63	69.00	2.60	0.012 S,p<0.05
Normal Physiology	Post Test	1.70	0.46	85.00	2.60	0.012 S,p<0.05
Kangaroo Mother Care	Pre Test	2.24	1.25	32.00	12.77	0.000 S,p<0.05
Kangaroo Mother Care	Post Test	4.80	0.98	68.57	12.77	0.000 S,p<0.05
Components	Pre Test	2.92	1.20	36.50	5.50	0.000 S,p<0.05
Components	Post Test	4.26	1.30	53.25	5.50	0.000 S,p<0.05
Advantages	Pre Test	1.16	0.73	38.66	4.47	0.000 S,p<0.05
Advantages	Post Test	1.94	1.03	64.66	4.47	0.000 S,p<0.05
Kangaroo Mother Care procedure	Pre Test	3.76	1.40	37.60	10.38	0.000 S,p<0.05
Kangaroo Mother Care procedure	Post Test	6.84	1.63	68.40	10.38	0.000 S,p<0.05

Fig.No. 1. Significance of difference between knowledge score in pre and post test of postnatal mothers in relation to knowledge regarding Kangaroo Mother Care .

IMPLICATIONS TO NURSING:

The findings of the study have definite implications in nursing practice, nursing education, nursing administration and nursing research.

Nursing service:

Nurses should enhance their professional knowledge. The finding of the study can be used to bring about awareness among the postnatal mother’s knowledge regarding kangaroo mother care which will help in the improvement in the reproductive health. Nurses can also plan teaching in clinical as well as in the Community.

Nursing education:

The result of the study can be used by nursing teacher as an informative illustration for nursing student. The finding can be utilized to prepare a planned teaching and health education material to educate the nursing students. Nurse educator should educate the peripheral level health workers and also the community by motivating them to create awareness regarding kangaroo mother care.

Nursing Research:

The finding of the study can be utilized for conducting research on the knowledge regarding kangaroo mother care among postnatal mothers. Future investigators can use the finding and the methodology as reference material. It highlights the area, which requires future exploration.

The suggestion and the recommendation can be utilized by other researchers for conducting further studies in the same field.

Nursing Administration:

The finding of the study reveals the need to conduct an ongoing in-service education program for the nurses who are working in the clinical settings as well as in the community. The in-service education program should include both theoretical and practical input. This can also bring awareness among nurse administrators of the need to provide training to new staff nurses regarding kangaroo mother care. Nurse administrators can prepare a new protocol about the teaching.

RECOMMENDATIONS:

On the basis of the findings, it is recommended that

• A similar study may be conducted with a control group on a larger Sample.

•A similar study can be conducted to evaluate the effectiveness of self Instructional module (SIM) of postnatal mothers.

•A similar study can be done in the form of a comparative study between urban and rural area.

LIMITATIONS:

• This study is limited to those postnatal mothers only who are readily available in postnatal ward.

• Non probability convenient sampling was done which restrict the generalization of the study.

CONCLUSION:

Periodic skilled based teaching program is necessary to educate the postnatal mothers in maternal area viz. kangaroo mother care to reduce mortality and morbidity rate in newborns.

TAKE HOME MESSAGE:

Mother is the best caretaker for a child.

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Received on 11.09.2015 Modified on 28.09.2015

Asian J. Nur. Edu. and Research. 2016; 6(3): 331-336

DOI: 10.5958/2349-2996.2016.00062.8