evaluation of kangaroo mother care in malawi n.
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Evaluation of Kangaroo Mother Care in Malawi. Reuben Ligowe, 1 Anne-Marie Bergh, 2 Elise van Rooyen, 2 Joy Lawn, 3 Evelyn Zimba, 1 George Chiundu 1.

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evaluation of kangaroo mother care in malawi

Evaluation of Kangaroo Mother Care in Malawi

Reuben Ligowe,1 Anne-Marie Bergh,2

Elise van Rooyen,2 Joy Lawn,3

Evelyn Zimba,1 George Chiundu1

1 Save the Children Malawi Country Office; 2 MRC Unit for Maternal and Infant Health Care Strategies and University of Pretoria; 3 Save the Children/Saving Newborn Lives

background newborn deaths
Background - Newborn deaths
  • 1.2 million newborn deaths in Sub-Saharan Africa per year
    • 60-90% in low birth weight infants
    • 27% of deaths are directly due to preterm birth complications
  • Malawi (2006):
    • Under five mortality has been reduced by 30% in 5 years, but neonatal is not reducing so fast
    • 14,900 newborns die every year (NMR 31/1000 live births)
    • Newborn LBW rate of 20%
    • Preterm births are the leading cause of newborn deaths
    • 57% of births are in facilities

Source: Opportunities for Africa’s Newborns. Eds Lawn and Kerber. 2007

background kangaroo mother care
Background – Kangaroo Mother Care

Benefits of Kangaroo Mother Care are well known:

  • To the mother
  • To the baby
  • To the hospital and the health system
background kmc in malawi
Background – KMC in Malawi
  • 1999:Establishment of KMC unit in Zomba Central Hospital (ZCH) with European Union funding
  • 2000-2005: Introduction of KMC in 6 more hospitals with the support of Save the Children, and KMC was introduced as part of Essential Newborn Care (ENC) in Malawi
      • 3 central hospitals (tertiary, public)
      • 4 secondary (1 public, 3 mission)
      • Training: Zomba as training centre – 5-10 days’ training
  • 2005: National guidelines for KMC
  • 2007:Evaluation of the state of KMC implementation – purpose:
    • What had worked and what not?
    • Scaling-up to all district hospitals? Community links?
    • How to deal with lack of human resources and long off site training time?
methods for the evaluation
Methods for the evaluation
  • Use of South African standardised progress-monitoring tool to get a sense of the nature of quality of KMC practice
  • Qualitative data collected through discussions with key informants
  • Visit to 6 hospitals supported by Save the Children for KMC
  • Telephone conference with 7th supported hospital
  • Visit to 3 other health care facilities for comparison
  • Successful & sustainable KMC implementation:
    • 5 of 7 supported hospitals
    • 3 central hospitals & 2 mission hospitals
    • Other 2 supported hospitals have KMC wards, but problems sustaining services (partly human resource challenges)
  • 3 of supported hospitals have trained providers from other sites
  • High awareness of KMC outside study hospitals
  • Not all health workers have sufficient information and confidence to start KMC in other facilities
achievements and strengths
Achievements and strengths


  • National KMC policy - 2004
  • KMC included in pre-service training for nurses
  • High degree of awareness of KMC


  • Dedication of staff despite hardships
  • Good use of visual material (posters and cards)
  • Availability of KMC register

Human resources – management and perceptions:

  • Health workers not perceiving newborn care as a priority in health system
  • Insufficient nursing and clinical supervision in some units
  • Staff shortages
  • Staff rotations – staff with skills in KMC are lost
  • Long off-site training, and limited on-site follow-up, especially if started in “project mode”
  • Resistance to on site training by other trained staff – perceived loss of remuneration during off-site training
  • Limited orientation of new health care staff in KMC

Implementation and follow-up:

  • Perception that KMC can not be implemented without a special unit, special beds and heaters
  • Improvement in quality of records, especially on feeding
  • Simple feeding job aids needed to calculate and record volumes for expressed breast milk
  • Variation in discharge criteriabetween hospitals
  • Lack of appropriate follow-up systems, and major challenges in follow up and access
missed opportunities
Missed opportunities

Recommendations for immediate attention:

  • Introduce intermittent KMC for stable infants in neonatal unit
    • Do not wait for establishment of a KMC unit
    • Do not wait until the criteria is met for continuous KMC

(2) Strengthening current feeding practices for all babies in KMC:

    • Misunderstanding of “feeding on demand”—>
    • Scheduled feeding times needed for LBW infants
    • Supervision, using patient attendants to support mothers

(3) Use of KMC (skin-to-skin position) to transport babies between home and facilities or between facilities

potential for scaling up kmc
Potential for scaling up KMC


  • Shorter, integrated off-site training & on-site facilitation/ support
  • 1-day workshops for district officials
  • 2-day workshops for key implementers in district hospitals

Factors crucial for sustainability:

  • Active support of management at all levels
  • Experienced person needed to drive the process
  • Good communication and consultative participation
  • Sending the right people for training – ongoing support essential
  • Sensitisation of community health structures and local leaders
  • Integration of KMC into current services –not project mentality
  • Establishment of a community follow-up system essential
  • There are awareness of the benefits of KMC in Malawi, even in hospitals and health centres not practising KMC
  • Strong support from Ministry of Health, good partnerships
  • Possible to design and implement a scale-up programme for Malawi to involve all district hospitals
  • Tracking of practices and quality advisable
  • Leadership and enough personnel are crucial
final conclusion
Final Conclusion
  • Extreme lack of medical staff in Malawi - Only 3 national paediatricians in the country
  • Novel approaches are therefore required - e.g. use of patient attendants

Thank you