Malawi has reduced its infant mortality by 40% in a decade, largely thanks to the Kangaroo Mother Care (KMC) method, in which a low-birth-weight baby nestles on their mother’s chest like a newborn kangaroo in a pouch. The skin-to-skin contact boosts survival and growth by providing warmth, regular breastfeeding, and resistance to infections, without the need for expensive incubators. KMC is in place at every hospital in Malawi and has expanded to over 30 countries. It has the potential to help save an additional 770,000 premature babies each year around the world.
Results & Impact
The number of babies who die before their first birthday in Malawi has fallen from 72 out of 1,000 in 2005 to 43 in 2015; a 40% decrease in ten years. An estimated 32,000 children are being saved annually in Malawi by KMC alongside other measures, though the data is not completely reliable. With universal coverage around the world, it could contribute to saving the lives of an additional 770,000 premature babies each year. Tests done on ‘kangaroo babies’ have also suggested the method can lead to higher IQs and better cognitive development.
UNICEF, Malawi Department of Health, Save the Children, Kangaroo Foundation, World Health Organisation, International Network in Kangaroo Mother Care
Immediately after birth, premature babies under a certain weight are identified, placed on their mother’s bare chest and covered in blankets. With continuous skin-to-skin contact, they quickly start regulating their own body temperature, receive regular doses of their mother’s breastmilk, and gain protection from infection from their mother’s bacteria. Unlike traditional premature care, KMC units consist of open areas where mothers sit down with their babies, and are closely examined and monitored by paediatricians, who are on hand to give the mother advice. Once they reach a base weight of 2.5kg and can breastfeed without assistance they are discharged from the hospital or health centre, which usually happens more quickly than in traditional care.
Cost & Value
In developing countries, KMC costs as little as $4.60 per child per day for operational costs like training and collecting information.
Running since 1999
The principal challenge to implementing KMC in Malawi has been the lack of a reliable data system to capture the information about babies admitted, both during care and after discharge. Meanwhile, it is difficult to ensure a high quality of care: many health facilities are less successful at identifying babies that need it, intervening early enough, and waiting until the infant has reached an optimal weight for survival before discharge.
Created in Colombia, KMC exists in over 30 countries with differing levels of coverage.
Malawi is saving an estimated 32,000 premature babies each year, largely thanks to mimicking how new-born kangaroos nestle in their mothers’ pouches.
The simple yet innovative approach, in which low-birth-weight infants nestle on their mother’s chest, significantly helped cut the country’s infant mortality rate by around 40% in a decade from 2005 to 2015; from 72 to 43 per 1,000 births.
The first ‘Kangaroo Mother Care’ (KMC) unit in Malawi was created at Zomba Central hospital in 1999, and they now exist in all hospitals in the country. KMC covers around 56% of all health facilities in the country, 296 out of 528, and the aim is to expand to full coverage.
“In many places, it is the only intervention provided, and throughout the country, you see improvements in the outcomes of these pre-term babies,” said Atnafu Getachew Asfaw, a Maternal and Newborn Health Specialist at UNICEF Malawi, which works closely with the Malawi Ministry of Health and Save the Children to implement KMC.
When a baby is born prematurely, the hospital or health centre’s KMC unit will identify low-birth-weight infants who need the extra care. The baby is then placed skin-to-skin on its mother’s chest and covered with blankets. They sit in the unit’s open area and are closely examined and monitored by trained paediatricians, who can provide advice to the mother.
This skin-to-skin connection straight after birth brings a great deal of health benefits which boost the baby’s survival chances and growth. The baby is kept warm without the need of an expensive incubator, is exposed to the mother’s bacteria which helps to ward off infections, and is regularly breastfed, which is well known to improve child growth. Importantly, KMC also helps to build a close bond between mother and baby, which is associated with several benefits including positive effects on the child’s brain development and mother’s emotional well-being.
Only when the baby has reached a base weight of 2.5kg and can breastfeed without assistance are they discharged from the hospital or health centre. Usually, this happens more quickly than if they were supported in a traditional neonatal ward.
The KMC approach first began in a Colombian neonatal unit in the late 1970s. A paediatrician was struggling with overcrowding, spiralling death rates and abandonment, and read a paper about kangaroo physiology. Its success in a number of trials led to expansion, including the creation of a Kangaroo Foundation and an International Network in Kangaroo Mother Care.
The method has now spread to over 30 countries, including high-income countries such as Australia and Spain. The problem of infant mortality is particularly pronounced in Malawi, though, because it has the highest rate of premature birth in the world. About 18% of its babies are born prematurely, compared to the average of 12% in low-income countries and 9% in high-income countries.
Where there are fewer resources for expensive neonatal wards equipped with incubators, the KMC units provide a cheap, effective alternative. The method costs barely more than $4.60 per child per day for training and other operational expenditures. In fact, the approach may even be more effective for a child’s development: studies have linked KMC to improved cognitive ability, and even a higher IQ compared to those who received traditional neonatal care.
Implementation of KMC can have its difficulties. “Primarily I would say the challenge is capturing the information; having a reliable data system that will tell you what happens to the babies that are admitted, including after discharge from the hospital,” said Asfaw.
“The second major challenge is the quality issue. You go out to the field and you’ll see that it’s not being implemented consistently to everyone who deserves it, at the same level of quality,” said Asfaw.
There are three main determinants of high-quality KMC. The first is identifying all babies that require it, because in Malawi 90% of babies are now delivered in a health facility. Secondly, the care needs to start immediately after delivery and, thirdly, only babies should only be discharged once he has the optimal chance of survival.
Balaka District Hospital is an example of highest-quality care in action, where the death rate amongst premature babies was reduced from 54% in 2012 to an average of 1% in 2016. Though there is plenty more work to be done overall, Malawi has been recognised by the World Health Organisation as a champion country in handling prematurity issues.
If Kangaroo Mother Care is implemented comprehensively around the world, it could help to avert an additional 770,000 neonatal infant deaths each year. For such a simple and cheap solution, the potential for impact is huge.
(Picture credit: Flicker/DFID)