Initiation and immediate outcome of Kangaroo care for premature infants in Mulago hospital.
MetadataShow full item record
Title: INITIATION AND IMMEDIATE OUTCOME OF KANGAROO CARE FOR PREMATURE INFANTS IN MULAGO HOSPITAL. Introduction Prematurity remains a major cause of morbidity and mortality worldwide, accounting for 1.1 million deaths annually in developing countries. Enormous advances in the care for premature infants have been achieved especially in developed countries, but these have not significantly benefited premature infants in developing countries, where resources are limited. For this reason, an alternative method of care for premature infants called Kangaroo Care was proposed by Prof Edger Ray in 1978, and it has since become a very useful alternative of care to the standard incubator care for premature infants in developing countries. KC was introduced in SCU Mulago Hospital with lessons from elsewhere since no studies to evaluate the method had been done in Uganda, so there was a need to evaluate KC in Uganda. Objective The aim of the study was to determine factors that affect initiation of, the average duration required for premature infants to adapt to extra uterine life and start Kangaroo care and the immediate outcome of these premature infants. Study design The study was a prospective single cohort study. Study setting Special care unit of Mulago hospital Methodology The study population were premature infants with a birth weight of 1000gm to 1999gm, admitted to SCU during the study period, who ad3pted to extra uterine life and initiated KC. Study babies were closely followed up during their admission to SCU and after discharge until they attained a target weight of 2500 gm. They all received a thorough clinical assessment, resuscitation and treatment given according to guidelines in SCU. The main outcome measures were growth measured by the average weight gain per kg body weight per day, the duration of hospital stay and survival or death. Data collected was entered using EPI-INFO soft ware and analyzed using EPI-INFO and SPSS statistical packages. Data was summarized in form of means, standard deviations, percentages, probabilities, frequency tables and bar graphs. The Chi square test and logistic regression were used to test for significance of association. Results Two hundred and seventy seven LBWI were admitted to SCU during the study period, of which 162 (58.5%) LBWI were eligible for the study. The factors that significantly affected/delayed initiation of KC were very low birth weight (p value<0.001), low gestational age assessment (p value 0.002), low Apgar score (p value<0.001) and respiratory distress (p value<0.001) but at multivariate analysis only respiratory distress (p value<0.001) and low Apgar score (p value 0.001) remained independently significant. The mean time required to initiate KC was 2.88days (SD 2.72) and the mean duration of hospital stay was 4.05 days (SD 2.57). The mean growth rate was 12.3gm/kg/day (SD 2.99) and the survival rate of the 132 LBWI who completed follow up was 89.4%. Thirty LBWI (18.1%) were lost to follow up during the study. Conclusion Initiation of KC in this study was mainly affected delayed by factors related to the clinical condition of the child. All centers with the basic minimum facilities to care for preterrn babies during the stabilization phase should adopt KC to reduce on the duration of hospital stay. More studies about KC practice at community and house hold levels are recommended.