Breaking Barriers and Improving Newborn Survival through Kangaroo Mother Care in Benin, Sub-Saharan Africa

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Background/Purpose Kangaroo Mother Care (KMC) is cost-effective and has proven to reduce the mortality of low birth weight neonates (LBWs) in low- and middle-income countries (LMICs), but its uptake is low in Sub-Saharan Africa where neonatal mortality is high. KMC units were implemented in 4 hospitals of Benin as part of a multifaceted intervention co-funded by USAID Benin (2015-2017) to decrease neonatal mortality. Our study looks at the sustained impact of KMC units on LBWs in Benin, 2 years after the end of the implementation period, to better understand KMC barriers and built a strategy to address them. Methods Retrospective cohort study of all neonates with BW below 1750 g admitted to the two main KMC units in Benin and their respective neonatal intensive care unit (NICU) (March 1 to May 31, 2019), using data from NICU and KMC registries. Primary outcome: mortality in KMC unit versus NICU. Secondary outcomes: a) weight gain in KMC unit vs NICU, b) KMC uptake. To avoid bias from high mortality risk and physiological weight loss in the first 7 days of life (DOL), only LBWs who survived beyond DOL7 were included in mortality and weight comparisons. To better understand the barriers to KMC adherence, we reviewed the literature on KMC implementation in LMICs. Results Overall mortality was 39% (106/269) for all LBWs DOL7 cared for in KMC unit: 3.6% (2/56) compared to NICU: 35% (23/66) [Odds ratio (CI): 14.18 (3.21-130.99); p <0.001]. Over a 17-month period (January 2018 to May 2019), KMC unit mortality was similarly low: 2.4% (8/328). Neonates with BW 1250-1499 g gained a median of 11 g/kilo/day in the KMC unit, while neonates in the NICU typically lost weight. KMC uptake was low, with resistance mostly from families but also from healthcare workers (HCWs). We identified barriers to widespread practice of KMC, including lack of knowledge on KMC methods and benefits, lack of physician/nurse champions to promote KMC, and limited leadership, financial and governmental stakeholders’ involvement. Conclusion Our study confirms a sustainable impact of KMC units in reducing mortality and improving weight gain for LBW neonates in Benin, but numerous barriers prevent widespread KMC application. Future interventions to reduce neonatal mortality in LMICs should include education on KMC benefits, mobilization of HCWs to empower mothers in providing KMC, and engagement with key stakeholders to promote larger KMC implementation.

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