Abstract

Background: Kangaroo mother care (KMC) is an effective low-cost technique that reduces neonatal morbidity and mortality. It entails the collective effort of the health care team, mother, and careers of the neonate. The knowledge, attitude, and practice of KMC are of utmost importance in developing countries such as Cameroon.

Objectives: This paper sought to assess the knowledge, attitude, and practice (KAP) of mothers with LBW and preterm babies on KMC and to identify the challenges faced in practicing KMC.

Materials and methods: A descriptive cross-sectional design was adopted for this study on a sample of 75 conveniently selected mothers whose LBW or preterm babies were admitted at the neonatology or who came for KMC rendezvous/ IWC at the Buea and Limbe Regional Hospitals and the Baptist Hospital Mutengene. Data collected with questionnaires were entered in an excel spreadsheet and analysis was done using IBM SPSS version 25 for windows.

Results: Among the 75 recruited participants, 49.3% were aged 21-30 years. The majority (60%) of the mothers had heard about KMC and the majority (54.7%) had good knowledge of KMC as they could explain what KMC entailed. Most (58.7%) of the mothers had a positive attitude towards KMC and only 48.0% practiced KMC with 56.0% with correct practice of KMC. All (100%) of the mothers faced some challenges during KMC practice. There was an association of gestational age at birth and low birth weight at birth with knowledge, attitude, and practice with p<0.05.

Conclusion: This study reveals good knowledge, attitude, and practices on KMC, limited practice, and many challenges faced during KMC practice. Thus, KMC should be implemented as a routine care method, KMC education should be given during ANC, with adequate support during practice.

CHAPTER ONE

INTRODUCTION

 1.1 Background Of The Study

Although important progress has been made towards Millennium Development Goal 4 to reduce mortality rates of children below 5 years, less improvement has been achieved in the neonatal period [1]; and neonatal morbidity still accounts for approximately 47% of deaths globally [2].

According to the World Health Organization (WHO), premature birth defined as birth before 37 completed weeks of pregnancy, and low birth weight (LBW) as birth weight less than 2.5 kg, are also important indirect causes of neonatal deaths [3].

Furthermore, WHO posits that globally, 15 million babies are born prematurely each year while 1.1 million die due to complications associated with preterm births [4]; with approximately 60% of these preterm births concentrated in Africa and South Asia.

Preterm births have been reported to have a significant influence on neonatal morbidity, including gastrointestinal, respiratory, nervous, and immunological complications, and mortality rates [5, 6]. Healthcare technological advancements such as incubators have improved outcomes in high-risk infants; however, the advanced technologies essentially involve increased capital and such equipment are not widely available in low- and middle-income countries where about 99% of these neonatal deaths occur [7].

Therefore, it is necessary to implement effective and low-cost methods of neonatal care, particularly in low- and middle-income countries, as most of these preterm-related complications are inherently preventable. In particular, the application of kangaroo mother care (KMC) seems to provide promising outcomes to reduce the mortality of LBW and premature infants [8].

Kangaroo mother care is an evidence-based, life-saving intervention that is aimed at reducing the risk(s) of neonatal mortality among low birth weight and premature babies [9]. KMC was an innovative method developed to provide thermal care for low birth weight and premature newborns and also to serve as a replacement for incubators [10].

The term was coined owing to the similarities to marsupial caregiving, in which mothers are considered as “natural incubators” to preserve infants’ body temperature as well as other vital signs through continuous skin-to-skin contact (SSC).

The impact of KMC on neonatal outcomes is apparent in literature and randomized clinical trials have shown that KMC significantly reduces the risk of mortality in infants born preterm or weighing less than 2.5 kg. Kangaroo mother care also reduces the risk of hypothermia, severe illness, nosocomial infections, the length of stay in the hospital, and improves growth, breastfeeding, and maternal-infant attachment [11].

According to WHO, there has been evidence on improvements in the health outcomes of LBW and preterm infants who received kangaroo mother care therefore, the practice of KMC should be routine care for preterm and babies weighing less than 2.5 kg [12].

However, despite showing evidence for mortality and morbidity reduction in low birth weight and premature infants in both low- and middle-income settings, and endorsement from the WHO; adoption and implementation have been limited, the cause of which is mostly lack of awareness and implementation by health care providers [13].

Several reasons have been given for the resistance to KMC implementation in developing countries. The implementation of KMC also focuses on the decision-making process, which depends not only on the mother’s desire and willingness but also on the support provided by the family network and empathetic health care teams [14].

Mothers are the main caregiver to newborns hence the care is habitually dependent on their level of knowledge, attitude, and practice (KAP) about newborn care. Apart from the fact that this innovative strategy (KMC) is being implemented in very few hospitals in Cameroon, there is also little or no data regarding the knowledge, attitude, and practice of KMC among mothers.

Hence, this study intended to investigate the knowledge, attitude, and practice of mothers about kangaroo mother care and to identify the various challenges experienced by mothers during the practice of KMC in the three selected hospitals.

 1.2 Problem Statement

Despite advances in health care, neonatal morbidity and mortality continue to be a problem in developing countries and still account for (1.16 million) neonatal deaths in Sub-Saharan Africa [15]; there is no doubt that technological advancement has improved neonatal outcomes especially for low birth weight and premature babies; however these health care technologies are unavailable in some health care facilities and even when available, they usually involve increased capital which sometimes becomes a financial burden to some families with financial constraints.

Even though the use of the kangaroo method has been approved as an alternative for incubators so as to improve outcomes for LBW and preterm babies and also reduce the financial burden on families on the use of high technologies; adoption and implementation have been limited across different health facilities in Cameroon.

Further, given that in the course of the researcher’s nursing training, it was observed through the mothers are shown how to do KMC, they do not practice it regularly. Moreover, there is little or no study carried out on mothers’ knowledge, attitude, and practice on KMC in Cameroon.

Hence it is against this background that this study sought to assess the knowledge, attitude, and practice of KMC among mothers and also to identify their challenges face in practicing KMC in the Buea Regional Hospital (BRH), Limbe Regional Hospital (LRH), and the Baptist Hospital Mutengene (BHM).

1.3 Rationale

Neonatal morbidity and mortality is still a problem in developing countries, especially in Sub-Saharan Africa. Advance technologies used to improve outcomes in high-risk infants involve increased capital as well as unavailability in some health facilities, especially in low-income countries.

This study sought to assess knowledge, attitude, and practice as well as to create awareness and improve knowledge on the use of kangaroo mother care as a care method for LBW and preterm babies which is essential to help improve neonatal outcomes and also reduce the financial burden on families with financial constraints on the use of incubators.

 1.4 Research Objectives

1.4.1 General objective

This study aimed to assess the knowledge, attitude, and practice of kangaroo mother care among mothers in the Buea Regional Hospital, Limbe Regional Hospital, and Baptist Hospital Mutengene and to identify the challenges mothers face in practicing kangaroo mother care.

1.4.2 Specific objectives

1. To assess the knowledge of mothers in the Buea Regional Hospital, Limbe Regional Hospital, and Baptist Hospital Mutengene on kangaroo mother care.
2. To determine the attitude of mothers in the Buea Regional Hospital, Limbe Regional Hospital, and Baptist Hospital Mutengene towards kangaroo mother care.
3. To assess the practices of mothers in the Buea Regional Hospital, Limbe Regional Hospital, and Baptist Hospital Mutengene on kangaroo mother care.
4. To identify the challenges mothers in the Buea Regional Hospital, Limbe Regional Hospital and Baptist Hospital Mutengene face in practicing kangaroo mother care.