Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study

Authors : Prem K Mony,1 Henok Tadele,2,3 Abebe Gebremariam Gobezayehu,4 Grace J Chan,5,6 Aarti Kumar,7 Sarmila Mazumder,8 Selemawit Asfaw Beyene,9 Krishnamurthy Jayanna,10,11 Dejene Hailu Kassa,12 Hajira Amin Mohammed,4 Abiy Seifu Estifanos ,13 Pankaj Kumar,14 Arun Singh Jadaun,8 Tedros Hailu Abay,15 Maryann Washington,16 Fitsum W/Gebriel,3 Lamesgin Alamineh,17 Addisalem Fikre,18 Alok Kumar,19 Sonia Trikha,20 Fisseha Ashebir Gebregizabher,21 Arin Kar,22 Selamawit Mengesha Bilal,23 Mulusew Lijalem Belew,17 Mesfin Kote Debere ,13 Raghav Krishna,7 Suresh Kumar Dalpath,20 Samson Yohannes Amare,24 H L Mohan,22 Thomas Brune,25 Lynn M Sibley,26 Abraham Tariku,27 Arti Sahu,7 Tarun Kumar,8 Marta Yemane Hadush,15 Prabhu Deva Gowda,28 Khalid Aziz,29 Dereje Duguma,30 Pramod Kumar Singh,7 Gary L Darmstadt ,31 Ramesh Agarwal,32 Dawit Seyoum Gebremariam,15 Jose Martines,33 Anayda Portela ,33 Harsh Vardhan Jaiswal,8 Rajiv Bahl,33 Suman Rao PN,34 Birkneh Tilahun Tadesse,3 John N Cranmer,26 Damen Hailemariam,35 Vishwajeet Kumar,7 Nita Bhandari ,8 Araya Abrha Medhanyie,9,36 On behalf of KMC Scale-Up Study Group

Publication Year : 2021

Abstract :


Kangaroo Mother Care (KMC), prolonged skin-toskin care of the low birth weight baby with the mother plus exclusive breastfeeding reduces neonatal mortality. Global KMC coverage is low. This study was conducted to develop and evaluate context-adapted implementation models to achieve improved coverage.


This study used mixed-methods applying implementation science to develop an adaptable strategy to improve implementation. Formative research informed the initial model which was refined in three iterative cycles. The models included three components: (1) maximising access to KMC-implementing facilities, (2) ensuring KMC initiation and maintenance in facilities and (3) supporting continuation at home postdischarge.


3804 infants of birth weight under 2000g who survived the first 3days, were available in the study area and whose mother resided in the study area.

Main outcome measures

The primary outcomes were coverage of KMC during the 24 hours prior to discharge and at 7days postdischarge.


Key barriers and solutions were identified for scaling up KMC. The resulting implementation model achieved high population-based coverage. KMC initiation reached 68%– 86% of infants in Ethiopian sites and 87% in Indian sites. At discharge, KMC was provided to 68% of infants in Ethiopia and 55% in India. At 7days postdischarge, KMC was provided to 53%–65% of infants in all sites, except Oromia (38%) and Karnataka (36%).


This study shows how high coverage of KMC can be achieved using context-adapted models based on implementation science. They were supported by government leadership, health workers’ conviction that KMC is the standard of care, women’s and families’ acceptance of KMC, and changes in infrastructure, policy, skills and practice.