Kangaroo Mother Care for Low-Birth-Weight Babies in Low and Middle-Income Countries: A Narrative Review

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TL;DR

Kangaroo Mother Care (KMC) is a low-cost, skin-to-skin intervention that significantly reduces mortality and morbidity in low-birth-weight (LBW) infants in low and middle-income countries (LMICs). This narrative review of 42 articles finds that KMC improves thermoregulation, breastfeeding, mother-infant bonding, and reduces hospital stay length, while also benefiting maternal mental health. Despite proven efficacy, KMC adoption remains limited in LMICs due to inadequate infrastructure, lack of training, and cultural barriers, highlighting the need for broader policy implementation.

Full summary

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**Background:** Low-birth-weight (LBW) infants, comprising roughly 15% of newborns, account for 70% of all neonatal mortality. The Sustainable Development Goals aim to reduce newborn mortality to less than 12/1000 live births by 2030, which depends heavily on reducing deaths in LBW infants, particularly in LMICs of Sub-Saharan Africa and Asia. Kangaroo Mother Care (KMC) is a neonatal procedure involving skin-to-skin contact between a mother's bare chest and a stable infant, first introduced in 1979 by Dr. Hector Martinez and Dr. Edgar Rey in Bogota, Colombia, and launched by UNICEF in other nations including LMICs in 1983. KMC emerged as a tactical solution to compensate for the lack of facilities for treating LBW babies, requiring no special equipment.

**Methods:** This narrative review conducted a comprehensive literature search using PubMed/MEDLINE, Google Scholar, and WHO Data Collections in November 2022. Medical subject headings (MeSH) terms included 'Kangaroo Mother Care' and 'Low Birth Weights,' with additional key references searched from relevant studies. The review included English-language studies published from 2000 to 2022. Additional filters such as free full text and full text were applied. Keywords used included 'Preterm births,' 'Infant mortality,' 'Child Health,' 'National Health Programs for Infants,' 'Low-Income Countries,' and 'Middle-Income Countries.' Out of 1,168 articles initially identified, 42 articles were selected for review after screening and elimination of duplicates.

**Key Results:** The review found that over 20 million LBW births occur annually worldwide, with 18 million of those in LMICs. More than 50% of LBW infants born in LMICs do not survive each year compared to counterparts in high-income countries. Evidence suggests KMC lowers mortality by promoting better thermoregulation, enabling earlier breastfeeding, reducing the risk of nosocomial infection, lowering the risk of obstructive sleep apnea, and enhancing mother-infant bonding. KMC also reduces the length of hospital stay. For mothers, KMC has a favorable effect on maternal mental health, reducing postpartum depression, anxiety, sleeping disorders, and fatigue. However, major obstacles to performing KMC include pain/weariness, positioning difficulties, temperature discomfort, and maternal health problems such as postpartum depression, episiotomy repair pain, and cesarean section recovery. Postpartum depression affects roughly one in five women in LMICs, with higher risk for mothers of LBW infants. An Indian training program found that 88% of mothers could comprehend KMC after just one training session. Fathers who administered KMC reported greater eagerness to participate in baby care, increasing bonding and attachment. KMC was established in India in 1994 and became a nationwide guideline in 2014 as part of the Newborn Action Plan. The Indian government promotes KMC through programs such as Navjaat Shishu Suraksha Karyakram (NSSK) and Facility-Based Integrated Management of Newborn and Childhood Illnesses (F-IMNCI).

**Clinical Implications:** KMC is a cost-effective, equipment-free intervention that can be implemented even in resource-limited settings. The WHO recommends KMC should be provided to infants weighing 2,500g or less, including those needing medical care such as IV fluids, medications, or oxygen. Successful implementation requires hospital-wide staff buy-in, training of healthcare providers including nurses, Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs), and traditional birth attendants. Media promotion, school education, and governmental policy formulation are essential for broader adoption. The Government of India has allocated funds for adaptation of KMC spaces within Special Newborn Care Units (SNCUs), and the IXth International KMC Conference was held in Ahmedabad in 2012. National policies, as per the WHO publication 'Kangaroo Mother Care: A Practical Guide,' should include clear monitoring and evaluation criteria developed with assistance from parents and relevant professional groups.