247 - Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: a Cluster-Randomized Controlled Trial

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 247
Publication Number: 247.127

SHABINA ARIFF, AKU, karachi, Sindh, Pakistan; Saleema Khowaja, Aga khan University, KARACHI, Sindh, Pakistan; Muhammad Atif Habib, Aga Khan University, Karachi, Sindh, Pakistan; Zahid Ali Memon, Aga Khan University, Karachi, Sindh, Pakistan; Ikramullah Maznani, The Aga Khan University Pakistan, Dadu, Sindh, Pakistan; Muhammad Jawwad, Aga Khan University Hospital, Karachi, Sindh, Pakistan; Arjumand Rizvi, Aga Khan University, Karachi, Sindh, Pakistan; Sajid B. Soofi, Aga Khan University, Karachi, Sindh, Pakistan; Zulfiqar A. Bhutta, The Aga Khan University, Karachi, Sindh, Pakistan

Presenting Author(s)

SHABINA ARIFF, MD, FCPS (she/her/hers)

Associate Professor
AKU
karachi, Sindh, Pakistan

Background: Kangaroo mother care (KMC) is a low-cost intervention that can reduce neonatal mortality. However, its effectiveness in community settings in Pakistan is still unknown.

Objective:

To assess the effect of community KMC (cKMC) on neonatal mortality, exclusive breastfeeding, weight gain and incidence of possible serious bacterial infection (PSBI).

Design/Methods:

A cluster-randomized control trial was conducted in rural Pakistan. 24 clusters were randomized to intervention and control arms. A pregnancy surveillance system instituted in study areas identified pregnant women. Stable neonates weighing ≥1200 to < 2500g were recruited within 72 hours of birth. Neonates in intervention clusters received cKMC while those in control received essential newborn care. The intervention package comprised KMC calendar in local language and KMC kit with diapers, caps, socks, towels, soap, and sanitary pads. Community mobilization included one-to-one and group sessions and peer to peer learning through KMC champions. An independent team collected data on vital status and outcomes.

Results: Between April 2019 and October 2021, 4977 neonates were enrolled, 2468 from intervention and 2510 from control clusters. 99.8% parents in intervention clusters performed KMC for 26.9±3.8 days with a mean duration of 7.8±3.7 hours/day. Risk of neonatal mortality was lower in intervention clusters (HR:0.66, 95% CI:0.44-0.99, p=0.045). Proportion of exclusive breastfeeding at 6 months was 36.5% in intervention and 6.8% in control clusters, p< 0.001. From enrolment to 59 days, 15.1% and 39.9% infants in the intervention and control arm, respectively had symptoms of PSBI, p=0.002. Risk of stunting at 6 months (RR:0.76, 95% CI:0.62-0.93 p=0.007) was lower among infants in the intervention arm. However, risk of wasting was similar in both groups (RR:0.73, 95% CI:0.51-1.06 p=0.095)

Conclusion(s):

Our findings suggest that KMC is feasible in community context and can reduce neonatal mortality, increase exclusive breastfeeding rates, and decrease risk of PSBI and stunting. We recommend that cKMC be scaled-up to improve neonatal outcomes in Pakistan and other developing countries.