KANGAROO MOTHER CARE FOR LOW-BIRTH-WEIGHT INFANTS - A RANDOMIZED CONTROLLED TRIAL IN DIFFERENT SETTINGS

A randomized controlled trial was carried out for 1 y in three tertiar y and teaching hospitals, in Addis Ababa (Ethiopia), Yogyakarta (Indon esia) and Merida (Mexico), to study the effectiveness, feasibility, ac ceptability and cost of kangaroo mother care (KMC) when compared to co nventional methods of care (CMC). About 29% of 649 low birthweight inf ants (LBWI; 1000-1999 g) died before eligibility. Of the survivors, 38 % were excluded for various reasons, 139 were randomly assigned to KMC (almost exclusive skin-to-skin care after stabilization), and 136 to CMC (warm room or incubator carl). There were three deaths in each gro up and no difference in the incidence of severe disease. Hypothermia w as significantly less common in KMC infants in Merida (13.5 vs 31.5 ep isodes/100 infants/d) and overall (10.8 vs 14.6). Exclusive breastfeed ing at discharge was more common in KMC infants in Merida. (80% vs 16% ) and overall (88% vs 70%). KMC infants had a higher mean daily weight gain (21.3 g vs 17.7 g) and were discharged earlier (13.4 vs 16.3 d a fter enrolment). KMC was considered feasible and presented advantages over CMC in terms of maintenance of equipment. Mothers expressed a cle ar preference for CMC and health workers found it safe and convenient. KMC was cheaper than CMC in terms of salaries (US$ 11 788 vs US$ 29 8 88) and other running costs (US$ 7501 vs US$ 9876). This study confirm s that hospital KMC for stabilized LBWI 1000-1999 g is at least as eff ective and safe as CMC, and shows that it is feasible in different set tings, acceptable to mothers of different cultures, and less expensive . Where exclusive breastfeeding is uncommon among LBWI, KMC may bring about an increase in its prevalence and duration, with consequent bene fits for health and growth. For hospitals in low-income countries KMC may represent an appropriate use of scarce resources.