Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1047-e1059 (doi:10.1542/peds.2007-0076)
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ARTICLE

Community-Based Kangaroo Mother Care to Prevent Neonatal and Infant Mortality: A Randomized, Controlled Cluster Trial

Nancy L. Sloan, DrPHa, Salahuddin Ahmed, MBBSb, Satindra N. Mitra, MAc, Nuzhat Choudhury, MAd, Mushtaque Chowdhury, PhDe, Ubaider Rob, PhDf and Beverly Winikoff, MD, MPHg

a Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York
b Health Systems, Johns Hopkins University, Sylhet, Bangladesh
c Mitra and Associates, Dhaka, Bangladesh
d Nutrition Department
e James P. Grant School of Public Health, Bangladesh Rural Advancement Committee, Dhaka, Bangladesh
f Programs Department, Population Council, Dhaka, Bangladesh
g Gynuity Health Projects, New York, New York

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 39888 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 ~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.

Key Words: birth weight • kangaroo care • neonatal survival

Abbreviations: LBW—low birth weight • KMC—kangaroo mother care • STS—skin-to-skin • IMR—infant mortality rate • BRAC—Bangladesh Rural Advancement Committee • CKMC—community-based kangaroo mother care • NMR—neonatal mortality rate • BINP—Bangladesh Integrated Nutrition Programme • NNP—National Nutrition Programme • GEE—generalized estimating equations • DSMB—data safety and monitoring board • CI—confidence interval • OR—odds ratio

Accepted Nov 5, 2007.