5450A6

[5450A.6] Community-Based Kangaroo Mother Care To Prevent Neonatal Mortality

Nancy L. Sloan, Salahuddin Ahmed, Nuzhat Chowdhury, Satindra Mitra, Mushtaque Chowdhury, Ubaider Rob. Epidemiology, Columbia University, MSPH, New York, NY; Mitra and Associates, Dhaka, Bangladesh; Bangladesh Rural Advancement Committee, Dhaka, Bangladesh; Country Office, Population Council, Dhaka, Bangladesh.

BACKGROUND:
Kangaroo Mother Care (KMC), a hospital-based method whereby stabilized neonates maintain continuous skin-to-skin contact (STS) with their mothers breasts, significantly reduces the incidence of life-threatening morbidity. We adapted KMC for immediate postnatal community-based application (CKMC) in settings where home deliveries, low birthweight and neonatal mortality (NMR) are common and where neonatal intensive care is unavailable.

OBJECTIVE:
We posited CKMC would decrease NMR by improving thermal regulation and breastfeeding. We have completed 11 months of a 15-month cluster randomized controlled trial of 4,000 neonates in 42 unions in rural Bangladesh to determine whether CKMC saves newborns lives.

DESIGN/METHODS:
Sample unions were randomly allocated 1:1 to the intervention or control group. One village was randomly selected from each union. Existing community nutrition promoters and teachers from intervention villages received six days of CKMC intensive training and then taught CKMC to women and their families as part of their routine community-based duties.
A household surveillance system has prospectively identified 4,202 pregnancies (99.9% consented and were enrolled), of whom 2,703 have delivered thus far. Information on subject characteristics was obtained by interview at enrollment, and reported morbidity, breastfeeding, STS contact, anthropometric measurements, and NMR was collected one month after birth. Bivariate comparisons and adjusted Cox proportional hazards were analyzed.

RESULTS:
Preliminary results indicate significantly more women in the intervention than the control group provide STS care (72% vs. 0.4%, p .001), initiate breastfeeding 2.7 hours sooner (p.001), delay immersing their babies in water to bathe (at 4.8 vs. 1.8 days of age, p.001), and a tendency of lower NMR (n.s.). Final results will be reported.

CONCLUSIONS: CKMC provided to neonates born at home without access to neonatal intensive care shows promise to improve neonatal care practices and thus newborn survival. As the first trial of CKMC, this study will need to be replicated to confirm its results before CKMC can be recommended as a public health strategy to reduce NMR.

E-PAS2006:59:5450A.6

Tuesday, May 2, 2006 11:30 AM

Platform Session: Neonatal Infectious Diseases in Developing Countries (10:15 AM - 12:15 PM)

Course Number: 5450A