a comparative study to assess the effect of kangaroo
TRANSCRIPT
i
A Comparative Study to Assess the Effect of Kangaroo Mother Care versus
Routine Care for Low Birth Weight (1500 G – 2500 G)
Neonates and Perception of Mothers Regarding
Kangaroo Mother Care in General
Hospital, Jayanagar, Bangalore
By
ALPHONSA MATHEW (SR. ALPHONSA)
Dissertation Submitted to the
Rajiv Gandhi University of Health Science, Karnataka, Bangalore
In partial fulfillment
of the requirements for the degree of
Master of Science in Nursing
In
Obstetrics and Gynaecology Nursing
Under the Guidance of
Mrs. Sangeetha
Department of Obstetrics and Gynaecology
Sarvodaya College of Nursing
Vijayanagar, Bangalore – 560 040
May 2005
ii
©Rajiv Gandhi University of Health Sciences, Karnataka
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled “A Comparative Study to
assess the effect of Kangaroo Mother Care versus Routine Care for low birth weight
(1500 g – 2500 g) Neonates and perception of mothers regarding Kangaroo Mother
Care in General Hospital, Jayanagar, Bangalore” is a bonafide and genuine research
work carried by me under the guidance of Mrs. Sangeetha, Asst. Professor,
Department of Obstetrics and Gynecology, Sarvodaya College of Nursing.
Date : Signature of the Candidate
Place : Bangalore - 40. Sr. Alphonsa Mathew
iii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “A Comparative Study to assess
the effect of Kangaroo Mother Care versus Routine Care for low birth weight (1500
g – 2500 g) Neonates and perception of mothers regarding Kangaroo Mother Care
in General Hospital, Jayanagar, Bangalore” is a bonafide research work done by Sr.
Alphonsa Mathew in partial fulfillment of the requirement for the degree of Master of
Science in Nursing.
Date :
Place :
Signature of the Guide Mrs. Sangeetha Asst. Professor Department of Obstetrics and Gynecology, Sarvodaya College of Nursing
iv
ENDORSEMENT BY THE HOD, PRINCIPAL / HEAD OF THE INSTITUTION
This is to certify that the dissertation entitled “A Comparative Study to assess
the effect of Kangaroo Mother Care versus Routine Care for low birth weight
(1500g – 2500g) Neonates and perception of mothers regarding Kangaroo Mother
Care in General Hospital, Jayanagar, Bangalore” is a bonafide research work done by
Sr. Alphonsa Mathew, under the guidance of Mrs. Sangeetha, Asst. Professor,
Department of Obstetrics and Gynecology, Sarvodaya College of Nursing.
Seal & Signature of the HOD
Mrs. Sangeetha M.Sc. (N) Date :
Place :
Seal & Signature of the Principal
Prof. G.R. Chanmalkar M.Sc. (N) Date :
Place :
v
COPY RIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka
shall have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.
Date : Signature of the Candidate
Place : Bangalore - 40. Sr. Alphonsa Mathew
© Rajiv Gandhi University of Health Sciences, Karnataka
ACKNOWLEDGEMENT
I raise my Heart in gratitude to GOD ALMIGHTY
Who has been my shephered and guiding force behind all
my efforts. His Omni presence has been my anchor
through the hard times.
I wish to express my sincere appreciation and deep
sense of gratitude to all those who helped me in
accomplishing this task successfully
I owe a great deep sense of gratitude to Rev.
Mother Lucius Elipulicattu, SABS Provincial
superior, provincial team members, sisters of
Deva Matha Hospital, Koothattukulam and all
the SABS sisters for their love, concern and
encouragement.
My heart felt thanks to Mrs. Sangeetha
M.Sc(N) OBG.My teacher and my guide who deserves the
respect in great extent for her untiring guidance and
words of encouragement, throughout this study.
I am deeply grateful to Mr. V. Narayanaswamy
Chairman, Sarvodaya Institutions for his encouragement
support and his deep inspiration to conduct this P.G.
programme in his esteemed institution.
I express my gratitude Prof. G.R. Chamnalkar
Principal, Sarvodaya College of Nursing for enduring
interest and support rendered during the entire study.
My heart felt thanks to Mrs. Chitra M.Sc (N)
prof and Research guide in Nursing for her constructive
criticism and keep interest in completing this study.
My sincere thanks to Prof. Victorial
Selvaraj M.Sc(N) Co-ordinator and all the other
faculty members of Master of sciences in
Nursing Programme in Sarvodaya College of nursing
for their Suitable, suggestions, genuine interest and
timely encouragement which contributed towards
completion of the study.
I am immensely thankful to my beloved parents,
brothers and sisters for their support and prayers.
My special thanks and appreciation to
All the neonates and their mothers,
All the nurses and doctors in postnatal ward
Jayanagar General Hospital
All the medical and Nursing experts for
validating the content of the tool.
Rev. Fr. Zaccharias for kannada translation
Prof P.G. Sebastion for editing the script
Mr. Martin, for Hindi translation.
Mrs. B.S. Srinivasan, Bio-Statistician,
Shalini Graphics for Computer assistance
All My Friends and classmates who trod along
with me throughout this study.
Date :
Place : Bangalore – 40 Sr. Alphonsa Mathew
LIST OF ABBREVIATIONS USED
1) ANOVA - Analysis of Variance
2) CPAP - Continuous positive airway pressure.
3) DBM - Direct Breast Milk.
4) EBM - Expressed Breast Milk.
5) KMC - Kangaroo Mother Care
6) LBW - Low Birth Weight
7) NNF - National Neonatal Forum.
8) NICU - Neonatal Intensive Care Unit.
9) O2 - Oxygen Saturation
10) RC - Routine Care
11) RCT - Randomized Controlled Trials
12) SGA - Short for Gestational Age.
13) Vs - Versus.
14) WHO - World Health Organization
ABSTRACT
Background & Objectives
A comparative study to assess the effectiveness of intermittent kangaroo Mother
care Versus Routine care for stable low birth weight neonates and perception of mothers
regarding kangaroo Mother care in general hospital Jayanagar Bangalore was under taken
by Sr. Alphonsa Mathew in partial fulfillment of the requirement for the Degree of
Masters science in Nursing, under the Rajiv Gandhi University of Health sciences,
Karnataka, Bangalore.
The objectives of the study were:
1 To identify and compare the physiological parameters of neonates during
KMC and RC.
2 To assess the behavioural state of neonates during kangaroo Mother care
Versus Routine care.
3 To determine Mothers preception about KMC
4 To prepare a pamphlet for KMC intervention.
Methods
The research design adopted for the study was quasi experimental research design
with same sample serving as their own control group; purposive sampling technique was
used to select 60 mothers with their LBW neonates.
In view of nature of the problem an observational checklist was prepared to assess
the effect of physiological and behavioural parameters of LBW neonates during KMC
and routine care. The physiological parameters were observed four times per session.
Just before inciation of KMC (RC-I) and 15 minute after iniciating KMC (KMC-I) just
before discontinuing (KMC-I) and half an hour after discontinuing KMC(RC-II)
Behavioural state of the neonates also assessed at the same time, using modified
Brazelton Behavioral Assessment scale.
A questionnaire containing 20 items were formulated and used to interview the
mothers regarding their perception about KMC using a five point likert scale.
Results and Interpretation
The data was collected and analyzed using both descriptive and inferential
statistics. The finding reveals that:
• No significant changes were seen in physiological parameters (Temperature,
Heart Rate and Respiration) during KMC and Routine care.
• All the neonates were found to have improved behavioural state during KMC than
routine care. The mean crying state was found to be less during KMC (8%) than
during Routine care, (11.6%). ANOVA was computed to find the differences in
behavoioural state of neonates during Kangaroo Mother Care and Routine care
which was found highly significant. (F=25.86 at 5% level)
• Perception of mothers regarding KMC was found to be positive. No mother
expressed any negative attitude about KMC.
Conclusion
KMC is found to be feasible and cost effective. For a developing country like
India where there are only limited resources and inappropriate distribution of health
services the Intervention like KMC can help in reducing the mortality and morbidity of
Low Birth Weight babies.
Keywords
Kangaroo Mother Care; Routine Care; LBW neonates; Physiological Parameters
TABLE OF CONTENTS
Sl.No.
Contents
Page No.
1
Introduction
1-11
2
Objectives
12
3
Review of Literature
13-34
4
Methodology
35-46
5
Results
47-69
6
Discussion
70-75
7
Conclusion
76-79
8
Summary
80-81
9
Bibliography
82-87
10
Annexure
88-103
LIST OF TABLES
SL. NO.
CONTENT
PAGE NO.
1
The effect of KMC on Breast Feeding
21
2
Constraints in Implementing KMC
31-34
3
Blue print of the Questionnaire
43
4
Flow Chart depicting Assessment of physiological parameters.
44
5
Frequency and Percentage Distribution of Neonates According to their Sex, Gestational week and mode of delivery
48
6
Distribution of Age and Birth weight of Neonates according to frequency, Percentage, mean and standard Deviation.
49
7
Duration of KMC per session and total number of minutes KMC per day.
51
8
Distribution of mean score temperature of neonates During each sessions at specified intervals.
52
9
Comparison of neonates temperature During KMC and Routine Care by using t-test.
54
10
Mean Heart Rate at specified intervals for neonates.
55
11
Comparison of neonates Heart Rate During KMC and RC by using t-test.
57
12
Mean Respiratory Rate of Neonates at specified intervals.
58
13
Comparison of Respiratory Rate of LBW neonates During KMC and RC using t-test.
60
14
Comparison of Behavioural state of LBW neonates During KMC and RC using ANOVA test.
62
15
Frequency and Percentage distribution of mothers According to Gravida, parity and age.
62
16
Frequency and percentage distribution of mothers According to their Family Income.
64
17
Perception of mothers Regarding KMC in terms of Range, Frequency, percentage, Mean and standard deviation.
65
18
Perception of mothers regarding effect of KMC on neonates.
66
19
Perception of mothers regarding requirements to implement KMC.
68
LIST OF FIGURES
SL. NO
CONTENT
PAGE NO.
1
Conceptual Frame work Based on General System Theory
12
2
Schematic Representation of Research design.
37
3 Percentage Distribution of mothers According to type of feeding at initiation of KMC.
50
4 Distribution of mean Temperature of neonates during KMC and RC.
53
5 Distribution of mean Heart Rate of neonates during KMC and RC.
56
6 Distribution of mean Respiratory Rate of neonates during KMC and RC.
59
7 Distribution of Behavioural state of neonates during KMC and RC.
61
8 Frequency and percentage distribution of mother’s educational status.
63
9 Frequency and percentage distribution of mothers according to family Income.
64
10 Frequency and percentage distribution of mothers according to range of score.
65
11 Distribution of mothers according to perception regarding benefits of KMC for the mother.
67
12 Distribution of mothers according to whether they will continue KMC at home.
69
13 Distribution of mothers according to whether they will encourage others to implement KMC
69
Look! Who’s The apple of every eye And shines brighter than the Stars in the sky! Look who’s Having lots of fun and Getting hugs and kisses In many, many tones! It’s a cute lil’ honey bun, The tiny little baby
tion
Introduc
13
1. Introduction
Children are the wealth of the Nation, take care of them,
if you wish to have a strong India, ever ready to meet various challenges.
( Nehru)
Yes, child health is the foundation of the family and wealth of the Nation.
New born is the VIP of the home, who all family members give him or her warm
welcome. If the child is born with any health problem the whole family becomes
upset.
Among the major child health challenges facing the world at the turn of the
new millennium is the problem of exorbitantly high neonatal mortality. The global
burden of newborn deaths is estimated to be a staggering five million per annum.
Only two percentage (0.1 million) of these death occur in the developed countries, the
rest 98 percentage (4.9 million) take place in the developed countries. The highest
neonatal mortality rates are seen in countries of South Asia resulting in almost 2.0
million new born deaths in the region each year, with India contributing 60 percent
(1.2 million) of it. Countries of the Sub-Saharan Africa experience another million
newborn deaths annually.
WHO estimates that globally about 25 million low birth weight babies are
born each years consisting of 17% of all live births. Approximately 16 to 18 percent
neonates born in the developing world are of LBW having a weight of less than 2500
g. The highest low birth weight rates are found in South Asia, where one out of three
infants is with LBW. In developing countries two thirds of LBW infants are due to
intrauterine growth retardation, while only one third are pre-term2.
24
The basic needs of low birth weight infants include love, touch, warmth,
safety and security. These needs of these high risk group infants must be met when
they are admitted in neonatal care unit. Nurses working in neonatal unit play a vital
role in providing an individualized comprehensive care for high risk low birth weight
babies based on their needs3.
The past few years have shown changes in neonatal care that has been
influenced by rapid advances in technology and treatment along with the
advancement of knowledge. One such change is the implementation of Kangaroo
Mother Care. This is an alternative approach that was developed in view to the lack of
adequate incubator for low birth weight babies and is proposed as an appropriate
technology for the care of low birth weight babies in developing countries. Kangaroo
mother care gives the alienated mother to her rightful place in the management of her
neonate or infant and has been found to re-establish human milk as the nutrition of
choice3.
Kangaroo Mother Care adapted from Kangaroos involves placing the new
born infant in close skin – to – skin contact with the mother. It is an effective method
to meet the baby’s needs for warmth following birth and in the immediate postnatal
period4.
NEED FOR THE STUDY:
Life with all its vagaries is never a catwalk to any one. This is proved by many
adventurous journeys one has to undertake during the course of life. The authenticity
35
of Lan Donald’s Statement is “off all the journeys we ever make the most dangerous
one is the very first one we undertake”. The well being of neonate at the start of life
will have lasting effect on children.
The reasons for high neonatal mortality in developing countries are not far to
seek. Illiteracy, low income levels and socio-cultural constraints create ground for the
poor health and neglect of pregnant women. They suffer from deficiencies of micro
and macro nutrients, encounter a host of infections, undergo stress of excessive work
and are exposed to toxic substances. These factors predispose them to adverse
pregnancy outcomes such as foetal loss and low birth weight1.
The developed nations have attained excellent neonatal health through access
to institution based technology intense care. The challenge before the international
community is to package the well-established scientific principles of new born care
into affordable stratergies for the 127 million neonates born annually in the resource
poor nations of the world. It is time for a Global Mission to bring down neonatal
mortality by one third in five years and two thirds by the year 20101.
The KMC intervention was developed in Colombia in the tale 1983 by
neonatologists Dr. Hector and Edges. Since the pre-term infants and low birth weight
babies in Meterno Infantile Hospital Bagota were dying from infection caused by
cross contamination due to shared incubator care and equipment, the mothers of LBW
babies were advised to hold the baby in skin-to-skin contact until the babies were
stable enough to be discharged from hospital. After the introduction of Kangaroo
46
mother care, the mortality rate of LBW babies decreased from 70 percentage to 10
percentage in Materno Infantile Hospital Bagota5.
Kangaroo Mother Care is becoming very popular through out the world. In
developing countries where less health facilities and resources are available, KMC has
become an alternative way of caring for LBW babies due to lack of incubators. In
most of the developed countries KMC is widely practiced in NICU. KMC offers an
easy and practical replacement for incubator. In KMC position the newborn exhibit
specific non-stress behavior patterns such as “crawling” towards the nipple and self-
attachment. The physical closeness that occurs due to KMC has the potential to help
parents to grow in their attachment and move through their grief following the birth of
a sick or preterm baby.
Kangaroo mother care has been studied in many countries. The studies
supported that it has a major positive impact on babies and their parents. Anderson,
did a study on the effect of KMC. The findings includes parents expressed an
increased sense of meaning, mastery and self-enhancement with their premature
infants. After participating in KMC, parents felt excitement and happiness; were no
longer afraid of their infants small size and fragility, and demonstrated a range of
behaviors, such as looking at, taking to and touching their infants. It was also found to
improve lactation, as well as increase confidence of mothers in their abilities to know
and monitor their babies.
A similar positive effect documented through research of the impact of KMC
on neonate includes decreased variation in heart rate, improved oxygenation,
57
reduction in apneic and bradycardiac episodes, improved lung mechanics, decreased
energy expenditure, decreased arousal and increased quiet sleep. The vertical
positioning with KMC may also provide vestibules stimulation, relieve horizontal
pressure on the head and body and reduce cranial flattening. (Gale and Vanden Berg
1998) The close contact between infant and parent provides a source of contingent
stimulation and exposure to the sensory environment (i.e. tactile, smell) of the breast7.
In India, this concept has been gaining popularity and also recommended by
the National Neonatal Forum (NNF). The NNF conducted a workshop in Kochi,
Kerala on Kangaroo mother care in December 2002. Nursing staff from various
institutions of the country were trained on how to promote this concept in NICU.
Neonatolgy Unit Civil Hopsital, Ahmedabad has been the pioneer in KMC from
India. The result from their study has shown a significantly better weight gain without
any associated increase in mortality and morbidity including sepsis and hypothermia.
This method was found to be culturally acceptable by the mothers and the health
personnel in the unit. In India, other centers have conducted feasibility studies and
have introduced KMC in their units like All India Institute of Medical Sciences, New
Delhi, seth GS Medical College Mumbai and CMC Velloor4.
In Karnataka only St. John’s Medical College Hospital, Bangalore introduced
this concept 5 years back in NICU. In Government Hospitals, with luck of incubators
and other facilities most of the LBW babies are shifted to referral Hospitals. In
present setting most of the mothers from low socioeconomic status are unable to
afford high quality care for their neonate in specialist hospital. So the researcher felt
the need for conducting a study on KMC intervention in postnatal Ward.
STATEMENT OF THE PROBLEM
A comparative study to assess the effect of Kangaroo mother care versus
Routine care for low birth weight (1500 g – 2500 g) Neonates and perception of
mothers regarding Kangaroo Mother Care in General Hospital, Jayanagar, Bangalore.
OBJECTIVES OF THE STUDY
1) To identify and compare the changes in specific physiological parameters of
neonates while receiving Kangaroo Mother Care and during routine care.
2) To identify and compare the changes in behaviour of neonates while receiving
Kangaroo Mother Care and during routine care.
3) To determine the mother’s perception regarding Kangaroo Mother Care.
4) To prepare a pamphlet for Kangaroo Mother Care Intervention
OPERATIONAL DEFINITION
1) Kangaroo Mother Care:
It is referred to when the neonate is held in upright position, with direct skin-
to-skin contact on the chest of the mother.
2) Mother:
It is referred to a woman in the postnatal period whose neonate is admitted in
the postnatal ward.
3) Neonate:
It is defined as a baby aged between 0 – 28 days admitted in obstetric ward
whose birth weight is between 1500 g – 2500 g.
4) Effect:
It means possible change of physiological parameters of the low birth weight
neonate during KMC as compared to neonate nursed in routine care.
5) Routine Care:
It means when some neonate nursed with mother as ordinary means.
6) Physiological Parameters:
It means temperature, pulse and respiration of the neonate was measured at
regular set intervals, i.e. just before KMC, 15 mts after initiating KMC, just
before discontinuing KMC, and half an hour after KMC.
7) Perceptions:
It means how acceptable KMC for mothers as described by their responses to
validated five point likert scale questionnaires.
HYPOTHESIS:
There is no significant difference in physiological parameters during KMC and
routine care.
ASSUMPTIONS
1) Mother gains confidence to care for their LBW baby when allowed to be in close
contact with their baby.
2) KMC Satisfies all five senses of the baby, i.e. feels warmth of the mother, listens
to mother’s voice and heart rate, sucks on breast, has eye to eye contact with
mother, and smells mothers odor.
3) An environment that is conductive, would facilitate KMC; some of the factors
presumed to be conductive are support from the health personnel, privacy for the
neonate – mother dyad.
INCLUSION CRITERIA
1) Mothers available at the time of data collection.
2) Mothers with the low birth weight neonate. (1500 g – 2500 g).
3) Mothers who are willing to participate.
EXCLUSION CRITERIA
1) Mothers who are not available during the study.
2) Mothers whose babies birth weight more than 2500 g.
DELIMITATIONS
The study findings could be generalized only to the Jayanagar General
Hospital Setting, Bangalore, as it was not possible to take neonate mother dyads from
other setting due to logistic constraints.
PROJECTED OUTCOME
This study would help to initiate Kangaroo Mother Care intervention in NICU
and Obstetric ward in General Hospital Jayanagar, Bangalore. KMC would facilitate
the provision of optimal and quality care for the neonate. The effect of Kangaroo
mother care would be understood further and that might prompt its utilization in low
birth weight babies in other settings in Bangalore.
CONCEPTUAL FRAME WORK
Conceptual frame work is interrelated concepts on abstractions that are
assembled together in some rational scheme by virtue of their relevance to a common
scheme. It is a device that helps to stimulate research on the extension of knowledge
by providing both direction and impetus. The present study was aimed at determining
the effect of KMC Versus. Routine Care for LBW babies and perception of mothers
regarding KMC.
The conceptual frame work for this study was derived from Ludwing Van
Bertalnffy (1968) as cited by Christensen J. Paula and Kenney W.Janet (1995) the
General system theory. This theory consists of a set of interacting components that co-
ordinate mutually. The systems are composed of both structural and functional
components. Structural components referred to the process of continuous change in
the system as matter, energy and information were exchanged with the environment.
The general system theory is described in this chapter under three phases,
which include input, process and output. The system approach permitted the
investigator to focus on aspects of Kangaroo Mother Care.
INPUT:
Input is any form of energy information, material, human that enters into the
system through its boundaries. In this study the input referred to mothers and neonates
who fulfilled inclusion criteria in order to be selected in this study. The input
specifically referred to provision of kangaroo mother care and routine care for stable
low birth weight neonates.
PROCESS:
Process denotes the different operational procedures in the over all programme
implementation. The interventions that have been taken place are observation of
physiological and behavioural parameters of neonates during KMC and routine care
and also assessed the perception of mothers regarding KMC.
OUTPUT:
Output after processing the input the system returns output to the environment
in an altered state, affecting the environment. It would show that exposure to KMC
may provides better physiological parameters and more effective behavioural state
compaired to being treated routinely.
Routine care
• Kept well wrapped in low cradle
• Change in Physiological state • Temperature • Heart rate • Respiratory rate
• Change in behavioural state • Deep quiet sleep
state • Active sleep state • Drowsy state • Quiet alert state • Active alert state • Crying state
Physiological state • Altered thermoregulation • Episodes of bradycardia or
tachycardia • Increased respiratory rate
Behavioural state
• Decreased sleep state • Increased Crying • Poor progression to sleep
from other states
R C
Physiological state • Effective thermo regulation • Regular heart rate and no
episodes of bradycardia or tachycardia
• Normal respiratory rate • Adequate oxygen saturation • No apneic spells
Behavioural state • Increased sleep state • Decreased crying • Good progression to sleep
from other behavioural states
KMCLow Birth
Weight
Kangaroo mother care • In skin to
skin contact with mother
OUTPUT THROUGHPUT INPUT
Fig1: CONCEPTUAL FRAMEWORK (Adopted from General System Theory 1968)
1
1. Introduction
Children are the wealth of the Nation, take care of them,
if you wish to have a strong India, ever ready to meet various challenges.
( Nehru)
Yes, child health is the foundation of the family and wealth of the Nation.
New born is the VIP of the home. All family members give him or her warm
welcome. If the child is born with any health problem the whole family becomes
upset.
Among the major child health challenges facing the world at the turn of the
new millennium is the problem of exorbitantly high neonatal mortality. The global
burden of newborn deaths is estimated to be a staggering five million per annum.
Only two percentage (0.1 million) of these death occur in the developed countries, the
rest 98 percentage (4.9 million) take place in the developed countries. The highest
neonatal mortality rates are seen in countries of South Asia resulting in almost 2.0
million new born deaths in the region each year, with India contributing 60 percent
(1.2 million) of it. Countries of the Sub-Saharan Africa experience another million
newborn deaths annually.
WHO estimates that globally about 25 million low birth weight babies are
born each years consisting of 17% of all live births. Approximately 16 to 18 percent
neonates born in the developing world are of LBW having a weight of less than 2500
g. The highest low birth weight rates are found in South Asia, where one out of three
infants is with LBW. In developing countries two thirds of LBW infants are due to
intrauterine growth retardation, while only one third is pre-term2.
2
The basic needs of low birth weight infants include love, touch, warmth,
safety and security. These needs of these high risk group infants must be met when
they are admitted in neonatal care unit. Nurses working in neonatal unit play a vital
role in providing an individualized comprehensive care for high risk low birth weight
babies based on their needs3.
The past few years have shown changes in neonatal care that has been
influenced by rapid advances in technology and treatment along with the
advancement of knowledge. One such change is the implementation of Kangaroo
Mother Care. This is an alternative approach that was developed in view to the lack of
adequate incubator for low birth weight babies and is proposed as an appropriate
technology for the care of low birth weight babies in developing countries. Kangaroo
mother care gives the alienated mother to her rightful place in the management of her
neonate or infant and has been found to re-establish human milk as the nutrition of
choice3.
Kangaroo Mother Care adapted from Kangaroos involves placing the new
born infant in close skin – to – skin contact with the mother. It is an effective method
to meet the baby’s needs for warmth following birth and in the immediate postnatal
period4.
NEED FOR THE STUDY:
Life with all its vagaries is never a catwalk to any one. This is proved by many
adventurous journeys one has to undertake during the course of life. The authenticity
3
of Lan Donald’s Statement is “off all the journeys we ever make the most dangerous
one is the very first one we undertake”. The well being of neonate at the start of life
will have lasting effect on children.
The reasons for high neonatal mortality in developing countries are not far to
seek. Illiteracy, low income levels and socio-cultural constraints create ground for the
poor health and neglect of pregnant women. They suffer from deficiencies of micro
and macro nutrients, encounter a host of infections, undergo stress of excessive work
and are exposed to toxic substances. These factors predispose them to adverse
pregnancy outcomes such as foetal loss and low birth weight1.
The developed nations have attained excellent neonatal health through access
to institution based technology intense care. The challenge before the international
community is to package the well-established scientific principles of new born care
into affordable stratergies for the 127 million neonates born annually in the resource
poor nations of the world. It is time for a Global Mission to bring down neonatal
mortality by one third in five years and two thirds by the year 20101.
The KMC intervention was developed in Colombia in the tale 1983 by
neonatologists Dr. Hector and Edges. Since the pre-term infants and low birth weight
babies in Meterno Infantile Hospital Bagota were dying from infection caused by
cross contamination due to shared incubator care and equipment, the mothers of LBW
babies were advised to hold the baby in skin-to-skin contact until the babies were
stable enough to be discharged from hospital. After the introduction of Kangaroo
4
mother care, the mortality rate of LBW babies decreased from 70 percentage to 10
percentage in Materno Infantile Hospital Bagota5.
Kangaroo Mother Care is becoming very popular through out the world. In
developing countries where less health facilities and resources are available, KMC has
become an alternative way of caring for LBW babies due to lack of incubators. In
most of the developed countries KMC is widely practiced in NICU. KMC offers an
easy and practical replacement for incubator. In KMC position the newborn exhibit
specific non-stress behavior patterns such as “crawling” towards the nipple and self-
attachment. The physical closeness that occurs due to KMC has the potential to help
parents to grow in their attachment and move through their grief following the birth of
a sick or preterm baby.
Kangaroo mother care has been studied in many countries. The studies
supported that it has a major positive impact on babies and their parents. Anderson,
did a study on the effect of KMC. The findings includes parents expressed an
increased sense of meaning, mastery and self-enhancement with their premature
infants. After participating in KMC, parents felt excitement and happiness; were no
longer afraid of their infants small size and fragility, and demonstrated a range of
behaviors, such as looking at, taking to and touching their infants. It was also found to
improve lactation, as well as increase confidence of mothers in their abilities to know
and monitor their babies.
A similar positive effect documented through research of the impact of KMC
on neonate includes decreased variation in heart rate, improved oxygenation,
5
reduction in apneic and bradycardiac episodes, improved lung mechanics, decreased
energy expenditure, decreased arousal and increased quiet sleep. The vertical
positioning with KMC may also provide vestibules stimulation, relieve horizontal
pressure on the head and body and reduce cranial flattening. (Gale and Vanden Berg
1998) The close contact between infant and parent provides a source of contingent
stimulation and exposure to the sensory environment (i.e. tactile, smell) of the breast7.
In India, this concept has been gaining popularity and also recommended by
the National Neonatal Forum (NNF). The NNF conducted a workshop in Kochi,
Kerala on Kangaroo mother care in December 2002. Nursing staff from various
institutions of the country were trained on how to promote this concept in NICU.
Neonatolgy Unit Civil Hopsital, Ahmedabad has been the pioneer in KMC from
India. The result from their study has shown a significantly better weight gain without
any associated increase in mortality and morbidity including sepsis and hypothermia.
This method was found to be culturally acceptable by the mothers and the health
personnel in the unit. In India, other centers have conducted feasibility studies and
have introduced KMC in their units like All India Institute of Medical Sciences, New
Delhi, seth GS Medical College Mumbai and CMC Velloor4.
In Karnataka only St. John’s Medical College Hospital, Bangalore introduced
this concept 5 years back in NICU. In Government Hospitals, with luck of incubators
and other facilities most of the LBW babies are shifted to referral Hospitals. In
present setting most of the mothers from low socioeconomic status are unable to
afford high quality care for their neonate in specialist hospital. So the researcher felt
the need for conducting a study on KMC intervention in postnatal Ward.
6
STATEMENT OF THE PROBLEM
A comparative study to assess the effect of Kangaroo mother care versus
Routine care for low birth weight (1500 g – 2500 g) Neonates and perception of
mothers regarding Kangaroo Mother Care in General Hospital, Jayanagar, Bangalore.
OBJECTIVES OF THE STUDY
1) To identify and compare the changes in specific physiological parameters of
neonates while receiving Kangaroo Mother Care and during routine care.
2) To identify and compare the changes in behaviour of neonates while receiving
Kangaroo Mother Care and during routine care.
3) To determine the mother’s perception regarding Kangaroo Mother Care.
4) To prepare a pamphlet for Kangaroo Mother Care Intervention
OPERATIONAL DEFINITION
1) Kangaroo Mother Care:
It is referred to when the neonate is held in upright position, with direct skin-
to-skin contact on the chest of the mother.
2) Mother:
It is referred to a woman in the postnatal period whose neonate is admitted in
the postnatal ward.
7
3) Neonate:
It is defined as a baby aged between 0 – 28 days admitted in obstetric ward
whose birth weight is between 1500 g – 2500 g.
4) Effect:
It means possible change of physiological parameters of the low birth weight
neonate during KMC as compared to neonate nursed in routine care.
5) Routine Care:
It means when some neonate nursed with mother as ordinary means.
6) Physiological Parameters:
It means temperature, pulse and respiration of the neonate was measured at
regular set intervals, i.e. just before KMC, 15 mts after initiating KMC, just
before discontinuing KMC, and half an hour after KMC.
7) Perceptions:
It means how acceptable KMC for mothers as described by their responses to
validated five point likert scale questionnaires.
HYPOTHESIS:
There is no significant difference in physiological parameters during KMC and
routine care.
8
ASSUMPTIONS
1) Mother gains confidence to care for their LBW baby when allowed to be in close
contact with their baby.
2) KMC Satisfies all five senses of the baby, i.e. feels warmth of the mother, listens
to mother’s voice and heart rate, sucks on breast, has eye to eye contact with
mother, and smells mothers odor.
3) An environment that is conductive would facilitate KMC; some of the factors
presumed to be conductive are support from the health personnel, privacy for the
neonate – mother dyad.
INCLUSION CRITERIA
1) Mothers available at the time of data collection.
2) Mothers with the low birth weight neonate. (1500 g – 2500 g).
3) Mothers who are willing to participate.
EXCLUSION CRITERIA
1) Mothers who are not available during the study.
2) Mothers whose babies’ birth weight more than 2500 g.
DELIMITATIONS
The study findings could be generalized only to the Jayanagar General
Hospital Setting, Bangalore, as it was not possible to take neonate mother dyads from
other setting due to logistic constraints.
9
PROJECTED OUTCOME
This study would help to initiate Kangaroo Mother Care intervention in NICU
and Obstetric ward in General Hospital Jayanagar, Bangalore. KMC would facilitate
the provision of optimal and quality care for the neonate. The effect of Kangaroo
mother care would be understood further and that might prompt its utilization in low
birth weight babies in other settings in Bangalore.
CONCEPTUAL FRAME WORK
Conceptual frame work is interrelated concepts on abstractions that are
assembled together in some rational scheme by virtue of their relevance to a common
scheme. It is a device that helps to stimulate research on the extension of knowledge
by providing both direction and impetus. The present study was aimed at determining
the effect of KMC Versus. Routine Care for LBW babies and perception of mothers
regarding KMC.
The conceptual frame work for this study was derived from Ludwing Van
Bertalnffy (1968) as cited by Christensen J. Paula and Kenney W.Janet (1995) the
General system theory. This theory consists of a set of interacting components that co-
ordinate mutually. The systems are composed of both structural and functional
components. Structural components referred to the process of continuous change in
the system as matter, energy and information were exchanged with the environment.
10
The general system theory is described in this chapter under three phases,
which include input, process and output. The system approach permitted the
investigator to focus on aspects of Kangaroo Mother Care.
INPUT:
Input is any form of energy information, material, human that enters into the
system through its boundaries. In this study the input referred to mothers and neonates
who fulfilled inclusion criteria in order to be selected in this study. The input
specifically referred to provision of kangaroo mother care and routine care for stable
low birth weight neonates.
PROCESS:
Process denotes the different operational procedures in the over all programme
implementation. The interventions that have been taken place are observation of
physiological and behavioural parameters of neonates during KMC and routine care
and also assessed the perception of mothers regarding KMC.
OUTPUT:
Output after processing the input the system returns output to the environment
in an altered state, affecting the environment. It would show that exposure to KMC
may provides better physiological parameters and more effective behavioural state
compaired to being treated routinely.
11
Routine care
• Kept well wrapped in low cradle
• Change in Physiological state • Temperature • Heart rate • Respiratory rate
• Change in behavioural state • Deep quiet sleep
state • Active sleep state • Drowsy state • Quiet alert state • Active alert state • Crying state
Physiological state • Altered thermoregulation • Episodes of bradycardia or
tachycardia • Increased respiratory rate
Behavioural state
• Decreased sleep state • Increased Crying • Poor progression to sleep
from other states
R C
Physiological state • Effective thermo regulation • Regular heart rate and no
episodes of bradycardia or tachycardia
• Normal respiratory rate • Adequate oxygen saturation • No apneic spells
Behavioural state • Increased sleep state • Decreased crying • Good progression to sleep
from other behavioural states
KMCLow
Birth Weight babies
Kangaroo mother care • In skin to
skin contact with mother
OUTPUT THROUGHPUT INPUT
Fig1: CONCEPTUAL FRAMEWORK (Adopted from General System Theory 1968)
12
2. OBJECTIVES
STATEMENT OF THE PROBLEM
A comparative study to assess the effect of Kangaroo mother care versus
Routine care for low birth weight (1500 g – 2500 g) Neonates and perception of
mothers regarding Kangaroo Mother Care in General Hospital, Jayanagar,
Bangalore.
OBJECTIVES OF THE STUDY
1) To identify and compare the changes in specific physiological parameters of
neonates while receiving Kangaroo Mother Care and during routine care.
2) To identify and compare the changes in behavioural state of neonates while
receiving Kangaroo Mother Care and during routine care.
3) To determine the mother’s perception regarding Kangaroo Mother Care.
4) To Prepare a pamphlet for Kangaroo Mother Care Intervention
13
3. REVIEW OF THE LITERATURE
The review of related literature is a valuable guide to define the problem,
recognizing its significance, suggesting data gathering devices, appropriate study design
and sources of data.
Abdullah and Levine state that the review of literature provides a basis for future
investigations, justifies the need for replication, throws light on the feasibility of the
study, indicate constraints of data collection and helps to relate the findings of one study
to another.
The review of literature is organized under the following headings.
• Meaning of kangaroo mother care
• Historical background (origin)
• Indian experience with KMC
• Need for KMC
• Benefits of KMC
• Method of kangaroo mother care.
• Constrains
14
Meaning of Kangaroo Mother Care:
The term Kangaroo was derived from practices that are similar to marsupial care,
in which the infant Kangaroo, always born pre maturely, is guided in to the maternal
pouch where he is kept warm, contained and close to the breast for unlimited feeding
opportunities until maturation. The LBW baby remains beneath the mother’s clothing for
varying periods of time that suit the mother.
Kangaroo Mother Care (KMC) adapted from Kangaroos, involves placing the
new born infant in close skin-to-skin contact with the mother. It is an effective way to
meet the baby’s need for warmth following birth and in the immediate postnatal period.
Its key features are
• Early, continuous , prolonged skin-to-skin contact between the mother and baby
• Exclusive breast feeding
• Early initiation in the hospital and continued at home.
• Early discharge form the hospital
• Adequate support and regular follow up for practicing mother-baby dyad.
Origin of Kangaroo Mother care:
Kangaroo mother care was originated in Bogota, Columbia in 1983 by
neonatologists Dr. Edges Rey and Dr. Hector Martinez, since the pre-term infants and
LBW babies in Materno Infantile Hospital, Bagota were dying from infection caused by
15
cross contaminations due to shared incubator care and equipment the mothers of LBW
babies were advised to hold the baby in skin-to-skin contact until the babies were stable
enough to be discharged. After the introduction of KMC the mortality rate of LBW
babies decreased from 70% to 10% in Materno Infantile Hospital, Bagoto.
The first International workshop on Kangaroo care in Trieste, Italy in 1996
Kangaroo Mother care has been advocated and it is in practice in the neonatal Intensive
care unit environment in Africa, Europe, South America and the United states10 . This
was started out of necessity in a developing country, which is similar in its demographic
profile to that of India in order to promote positive neonatal health under adverse
conditions1.
Indian experience with KMC:
India is in its infancy in relation to the practice of Kangaroo Mother care. Very
few Neonatal Intensive care units, primarily teaching institutions, have implemented this
technique.
A Study on KMC was Conducted in Neonatology Unit, Civil Hospital, Ahmedabad. This
unit has been the pioneer in KMC from India. Result from their study has shown a
significantly better weight gain without any associated increase in mortality and
morbidity including sepsis and hypothermia. This method was found to be culturally
acceptable by the mothers and the health personnel in the unit11.
16
A randomized controlled trial on KMC was conducted in All India Institute of
medical sciences, New Delhi. Result from the study has shown Bella weight gain and
early discharge in the group of neonates receiving KMC. Breast-feeding rate was
significantly high (86% Vs 43%) in the group receiving KMC compared to routine care.
The procedure was found culturally and technically acceptable to mothers and the health
personnel in the unit8.
Seth GS Medical College and KEM Hospital, Mumbai Unit have evaluated the
efficiency of KMC in the alleviation of pain secondary to heel lancing. Result from their
study shows that KMC is an effective means of decreasing pain. Their unit has also
fabricated a KMC bag using local clothing to facilitate round the clock KMC practice12.
Others, CMC Vellor and St. John’s National Academy of Health Science,
Bangalore have been practicing KMC in their units since 5 years. Recently, faculty from
five regional institutions has received training in KMC at Bagota in Colombia.
NEED FOR KMC:
Kangaroo mother care is advocated worldwide. The need for introducing KMC
includes:
• Facilities for the care of LBW babies are sometimes unavailable or scarce.
• Traditional care of neonates includes neutral thermal environment, controlled
feeding and monitoring for common conditions such as apnea, hypoglycemia, etc.
could prove to be costly beyond the resources of the common man9.
17
• Management of such neonates can expose them to several risks such as
nosocomial infections9.
• Traditional care of neonates result in delay in the beginning of a healthy
relationship between the mother and the baby and their integration within the
family9, 13.
• Baby nursed in incubator an additional barrier could be developed between
parent-neonate dyad and this could have long-term psychological consequences13.
• KMC could reduce the need for expensive and sophisticated equipment13
• Its simplicity could be applied anywhere including peripheral health centers and
home environment.
• KMC does not require additional staff compared to incubator care4.
BENEFITS OF KANGAROO MOTHER CARE
KMC has been shown to have benefits both for the baby and mother. This section
reviews the benefits with regard to the following outcome mortality and morbidity, breast
feeding and growth, thermal protection and metabolism and other effects.
Mortality and Morbidity
Four published randomized controlled trials (RCT) comparing KMC with
conventional care were conducted in low-income countries. 24-26 The results showed no
difference in survival between the two groups. Almost all deaths in the three studies
occurred before eligibility, i.e. before LBW infants were stabilized and enrolled for
research. Infants weighting less than 2000g were enrolled after an average period of 3-14
18
days on conventional care, in urban third level hospitals. The KMC infants stayed in
hospital until they fulfilled the usual criteria for discharge, as the control infants did, in
two of the studies, 24,26 while in the third study they were discharged earlier and subjected
to a strict ambulatory follow-up.25 The follow-up periods lasted one, 26 six24 and twelve
months,25 respectively.
The RCT carried out in Ecuador by Sloan and collaborators showed a lower rate
of severe illness among KMC infants (5%) than in the control group (18%).24 The
sample size required for that study was 350 subjects per group for a total of 700 infants,
but only 603 babies were recruited. Recruitment, in fact, was interrupted when the
difference in the rate of severe illness became apparent. The other controlled studies
conducted in low-income countries revealed no significant difference in severe
morbidity, but found fewer hospital infections and readmissions in the KMC group.
Kambarami and collaborators from Zimbabwe also reported reduced hospital infections.27
High-income countries report no difference in morbidity. However, it is notable that no
additional risk of infection seems to be associated with skin-to skin contact.24-27
Observational studies showed that KMC could help reduce mortality and
morbidity in preterm/LBW/ infants. Rey and Martinez, 9 in their early account, reported
an increase in hospital survival from 30% to 70% in infants between 1000g and 1500g.
However, the interpretation of their results is difficult because numerators, denominators
and follow-up in the KMC group were different from those in the historical control
group.28 Bergman and Jurisoo, in another study with an historical control group
conducted in a remote mission hospital without incubator care in Zimbabwe, 14 reported
19
an increase in hospital survival from 10% to 50% in infants weighing less than 1500g,
and from 70% to 90% in those weighing between 1500 to 1999g. Similar results are
reported from a secondary hospital in nearby Mozambique.15 The difference in survival,
however, may be due to some uncontrolled variables. The studies in Zimbabwe and
Mozambique, conducted in hospitals with very limited resources, applied KMC very
early on, well before LBW and preterm infants were stabilized. In the early study by Rey
and Martinez, KMC was applied later, after stabilization. In both cases the skin-to-skin
contact was maintained virtually 24 hours a day.
Charpak and collaborators, in a two-cohort study carried out in Bogota,
Colombia,29 found a crude death rate higher in the KMC group (relative risk = 1.9; 95%
CI: 0,6 to 5.8), but their results reverted in favour of KMC (relative risk = 0.5, 95% CI:
02 to 1.2) after adjustment for birth weight and gestational age. The differences,
however, were not statistically significant. The two cohorts recruited in two third-level
hospitals, showed many social and economic differences. KMC was also applied after
stabilization and 24 hours a day. In a controlled but not randomized trial carried out in a
tertiary-care hospital in Zimbabwe, there was a slight difference in survival in favour of
the KMC infants, but this might have been due to differences in feeding.27
As for morbidity, while there is no strong evidence of a beneficial effect of KMC,
there is no evidence of it being harmful. In addition to the little evidence already
published,14,15 some preliminary results on a small number of newborn infants with mild
respiratory distress seem to confirm that very early skin-to-skin contact might have a
beneficial effect.30 a work of warning about discharge: KMC infants discharged during
the cold season may be more susceptible to severe illness, especially lower respiratory
20
tract infections, than those discharged during the warm season.31 A closer follow-up is
needed in such cases.
Breast feeding: Many studies conducted to assess the effect of KMC on breastfeeding
the results of all these studies are summarized in Table 1
Table 1. The effect of KMC on breastfeeding
Study Author Year Ref. Outcome KMC Control
RCT Charpak et al. 1994 29 Partial or exclusive breastfeeding at: 1 month 93% 78% 6 months 70% 37%
1 year 41% 23%
RC
Charpak et al. 1997 25 Partial or exclusive breastfeeding at
3 months
82% 75%
RCT Cattaneo et al. 1998 26 Exclusive breastfeeding at discharge 88% 70%
Schmidt et al. 1986 32 Daily volume 640ml 400ml Daily feeds 12 9 Whitelaw et al. 1988 33 Breastfeeding at 6 weeks 55% 28% Wahlberg et al. 1992 34 Breastfeeding at discharge 77% 42% Syfrettetal. 1993 35 Daily feeds (34 weeks of gestational
)
12 12
Blaymore-Bier 1996 36 Breastfeeding at: discharge 90% 61%
et al. 1 month 50% 11%
Hurst et al. 1997 37 Daily volume at 4 weeks 647ml 530ml
Exclusive breastfeeding at discharge 37% 6%
21
Two randomized controlled trials and a cohort study carried out in low-income
countries looked at the effect of KMC on breastfeeding. All three studies found that the
method increased the prevalence and duration of breastfeeding.25,26,29 Six other studies
conducted in high-income countries, where skin-to-skin contact was applied late and only
for a limited amount of time per day, also showed a beneficial effect on
breastfeeding.32-37
It appears that KMC and skin-to-skin contact are beneficial for breastfeeding in
settings where it is less commonly used for preterm/LBW infants, especially if these are
cared for in incubators and the prevailing feeding method is the bottle. Other studies
have shown a positive effect of skin-to-skin contact on breast feeding. It could therefore
be expected that the earlier KMC is begun and the earlier skin-to-skin contact is initiated,
the greater the effect on breastfeeding will be.
Growth
The two-cohort study conducted in Colombia29 revealed slower weight gain in
KMC infants when compared with the control group, but the two cohorts also showed
many social and economic differences. In the subsequent RCT25 no difference in growth
was observed at one year of age. In another RCT,26 KMC infants showed a slightly
larger daily weight gain while they were cared for in hospital, but the overall period of
study their growth did not differ from that of the control group. Similar results in terms of
daily weight gain were observed in Zimbabwe.27
22
Thermal control and metabolism
Studies carried out in low-income countries26 show that prolonged skin-to-skin
contact between the mother and her preterm/LBW infant, as in KMC, provides effective
thermal control and may be associated with a reduced risk of hypothermia. Fathers too
can effectively conserve heat in newborn infants38 despite and initial report of worse
performance of males in thermal control.39
Heart and respiratory rates, respiration, oxygenation, oxygen consumption, blood
glucose, sleep patterns and behaviour observed in preterm/LBW infants held skin-to-skin
tend to be similar to or better than those observed in infants separated from their
mothers.40-42 Contact between mother and child has other effects also. For instance,
salivary cortisol, an indicator of possible stress, appears to be lower in newborn infants
held skin-to-skin.43 This observation is consistent with the reporting of significantly more
crying in full-term healthy infants 90 minutes after birth44,45 and in LBW and preterm
infants at 6 months33 of age when they are separated from their mothers.
Others
Mothers report being significantly less stressed during kangaroo care than when
the baby is receiving conventional care. This shows that mothers prefer skin-to- skin
contact to conventional care26 and report and an increased confidence, self-esteem, and
feeling of fulfillment, also in high-income countries. They describe a sense of
empowerment, confidence and a feeling that they can do something positive for their
23
preterm infants in different settings and cultures.46-49 Fathers too said that they felt
relaxed, comfortable and contented while providing kangaroo care.
KMC is acceptable to health-care staff, and the presence of mothers in the ward
does not seem to be a problem. Most health workers consider KMC beneficial. They
may think that conventional incubator care allows better monitoring of sick LBW and
preterm infants, but they recognize that it increases the risk of hospital infections and it
separates infants from their mothers. Health workers would prefer KMC for their own
preterm/LBW infant.26
Lower capital investment and recurrent costs is yet another advantage of KMC
and could bring about some savings to hospitals and health care systems in low-income
countries. Savings may result from reduced spending on fuel, electricity, maintenance
and repair of equipment26 as well as possible reduction in staffing costs, since mothers
provide the greater proportion of care. Compared with conventional incubator care,
Ecuador26 has reported lower costs per infant, in part associated with a reduced rate of
readmission to hospital. This may partly be due to a shorter length of hospital stay in
KMC infants, reported from both low25-27 and high-income countries.33,35,46 Capital and
recurrent savings may be more substantial in tertiary than in first-referral and small
facilities in low-income countries.
METHOD OF KMC:
This section has been reproduced from the recommendations that were given by
the 36 participants from Africa, Asia, Europe, and South America who attended the first
24
International work shop on KMC in 1996 at Trieste. They said that KMC could be
implemented in three different settings. These settings include:
1. First and second maternity settings with very limited resources:
These include rural hospitals or health centers in low-income countries without
equipment and supplies for the care of LBW infants, without postgraduate doctors or with
no doctors at all and most often staffed only by a small number of skilled nurses or
midwives. Many of the States in India fall under this category based on these criteria. In
such a setting, newborn infants are usually kept with their mothers and are discharged
early. Exclusive breast-feeding is the rule.
Neonates are categorized based on birth weights (1800 grams and more; between
1200 – 1799 grams; and less than 1200 grams). Should a scale be unavailable, birth
weight must be estimated by the use of surrogates such as chest circumference or just
grouped based on appearance as large, small, and very small. The rationale for this
categorization is because the problems, type of care, and the role as well as possible
benefits of KMC differ considerable in these groups.
Recommendations:
i. Large LBW infants or birth weight 1800 – 2499 grams
In these babies most of the prematurity related problems such as respiratory
distress syndrome is uncommon but most deaths do occur due to asphyxia,
infections, associated with hypothermia and hypoglycemia. KMC is
25
recommended as soon as possible since it would promote bonding, facilitate in
breast-feeding as well as in thermal control, thereby reduce the likelihood of
increased morbidity and thus consequent mortality. It is one of the best means of
transport (within facilities, between facilities and between home and the setting)
when needed. It could also result in considerable savings and more efficient use of
staff time, for regular assessment of the baby and support of the mothers.
Additionally it would provide the much-wanted human element to care.
ii. Small LBW infants or birth weight 1200 – 1799 grams
In this group the prematurity related problems may be higher and depend on the
existing premature – SGA ratio. The potential of KMC mortality and morbidity is
likely to be optimal in LBW infants of gestational age 32 weeks or more. Regular
assessments of these infants are a must in terms of how they breathe, feed and
maintain their temperature. When infants are observed to do well, KMC could be
implemented just like for larger babies. It would be preferable to have these
babies transferred to a higher level of care, but if referral is impossible due to
reasons ranging from cost to distance to parental rejection, these babies could be
cared with KMC in the same setting, with additional support for feeding or
breathing as and when needed.
26
iii. Very small LBW infants or birth weight below 1199 grams.
These babies have very high morbidity and mortality rates primarily due to
prematurity related problems. It is preferable to have these babies transferred to
either the second or third level hospital for specialized care; and if possible
referral should be made even before the birth of the baby. If this is impossible
then the baby would have to be looked after in the first level setting with no
guarantee for their survival. KMC has not been documented to have any
additional benefits and is thus recommended only once the baby has reached the
stage of the previous two categories.
2. Second and Third Level maternity units in settings with limited resources:
This group would include most district and provincial hospitals in several
countries, but only a small number of urban tertiary care hospitals in developing countries
as well as in low income countries, the number of deliveries in such settings would range
between a few hundreds to several thousands a year. A common feature is the availability
of skilled personnel (specialist nurses and midwives, pediatricians, obstetricians, or at last
very experienced physicians); and of basic equipment and supplies for the care of LBW
babies (incubators, radiant warmers, oxygen therapy, drugs, CPAP, and sometimes
ventilators). Despite this care may often be sub-optimal (poor hygiene, more than one
baby in an incubator, inadequate thermal control, insufficient clinical observations and
follow-up) due to poor maintenance, equipment, poor infrastructure, as well as lack of
27
availability and commitment of health personnel. Most of these settings are overcrowded
as a result. Newborns have limited contact with their mothers and hence exclusive breast-
feeding is insufficiently promoted; formula feeding with a bottle, palada or gastric tube is
the usual pattern of feeding.
Recommendations:
In these settings, despite the availability of some human resources and material
resources, neonatal mortality may be relatively high even in relatively mature newborn
infants. This is due to overcrowding, inadequate thermal control, hospital infections,
breakdown or improper use of equipment, insufficient surveillance and follow-up. KMC
has been documented to have several benefits for both babies as well the mother in such
settings. Hence the extent to which KMC is applicable would vary with birth weight and
gestational age, but in these settings it would be indicated for all pre-term and LBW
newborns, from about 32 week’s gestation onwards. Those less than 32 weeks could be
provided KMC if they are physiologically stable. These criteria for stabilization should
be defined in any given setting and would depend on the skills and the competence of
staff as well as the availability of equipment. The criteria for eligibility to KMC are
recommended to be broad. All LBW newborns could be place on Kangaroo Position
provided they are free from severe disease or malformation, are able to breath
autonomously, and the mother or relative is available (alive, not severely ill, in the
hospital, willing to collaborate, supported by the family).
28
3. Second and third level maternity and neonatal care units in settings with ample
resources and infant mortality rates below 15 per thousand.
These are settings with adequate human, material and financial resources for
highly sophisticated neonatal care, and may or may not be found in developing countries
like ours but are a common feature in developed countries. Consequently mortality rates
of LBW neonates are minimal but care usually lacks the human touch simply due to the
high tech environment in which the neonate is nursed. Hence again most of these
neonates may experience separation form their mothers for prolonged periods, formula
feeding or even parental nutrition and a difficult shift to breast feeding.
Recommendations:
These settings have also been documented to show increasing benefits both for
the mother and the baby. In these settings KMC could be started for any LBW neonate of
any post conceptual age from 28 weeks onward, of any gestational age, of any weight (as
low as 600 grams), including sick newborns, as tolerated by the mother-neonate dyad, by
the family and by the health care system. KMC should be offered to all mothers of LBW
newborns and is particularly beneficial for adolescent mothers and for those with social
risk factors. KMC could be applied through out phases of hospitalization, during the
stabilization period, that might be shortened, during the transition period, while the
newborn is growing, and just before discharge. KMC should last as much as possible
during the day and as long as possible; when skin-to skin contact cannot be continuous, it
29
should be as frequent as possible, provided each contact lasts more than 60 minutes to
avoid excessive manipulation.
Contraindications for KMC include instability of vital functions (in this case
KMC can be progressively started until the vital functions stabilize), extremely LBW
newborns (KMC can be started after the first week of life), and critical phase of an acute
illness or acute exacerbation of underlying illness (in this case specific treatment should
get priority over KMC). Other possible contraindications include necrotizing
enterocolitis, therapy with vasopressors, the weaning phase after intensive care, and
newborn infants who do not tolerate being removed in and out of KMC.
Eligibility Criteria for babies for KMC
• Weight more than 1800 gm or gestation more than 34 weeks: KMC can be started
soon after birth if baby is stable.
• Weight less than 1200 – 1799 gm or gestation 30 – 34 weeks: KMC can be started
soon after a week even in ventilated babies provided physiological parameters are not
deteriorating further.
• Weight less than 1200 gm or gestation less than 30 weeks: Once physiological
status has been stabilized. The physiological stability of neonate is defined as one
who is not tachycardia, maintains mean arterial blood pressure with minimal
fluctuations, who is not acidotic and whose pulse oxymetry is stable.
30
Eligibility criteria for mothers :
She should be
• Willing
• Available full time
• In good health
• Able to stay in the hospital
• Able to have a supportive family
Discharge:
LBW babies can be discharged from the hospital when the following criteria are
met:
The baby is able to suck well on the breast
The baby is able to swallow adequately
The baby is thriving and is gaining weight (at least recovered its birth
weight)
Its temperature is stable in kangaroo position
The mother is able to care for the baby at home
The mother is able to come for follow-up. If she cannot ensure this then the
discharge weight should be 1500 grams or more Mothers must be taught to use an
elevated sleeping position when the baby is in kangaroo position. It is essential
that follow-up is hospital-based. These should be availability of the best pediatric
care in the hospital until the post conceptual age of 40 weeks. Later the baby can
31
join the normal follow-up program for high-risk babies. A support structure in the
community made up of experienced nurses as well as mothers with previous
KMC experience would be an asset for the KMC program stated by any hospital.
Constraints
KMC has been included in national guidelines for the care of LBW and
preterm infants, and successfully implemented in many countries. Experience shows
that the main problems, obstacles and constraints fall under four categories: policy,
implementation, communication and feeding. Some possible solutions are suggested
in Table 2:
Table 2: Implementing KMC
Problems, obstacles and constraints Possible solutions Policy
• Lack of plans, policies, guidelines,
protocols, manuals
• Lack of institutional, academic and
professional support
• Lack of adequate training and
continuous education
• Risk of an isolated and vertical
programme
• Poor access to evidence, literature
• Development of plans, policies,
guidelines, protocols, manuals
• Establishing links with ministries,
medical schools, agencies and
organizations; advocacy work
• Establishing basic, post-graduate
and in-service courses
• Integration with existing
programmes
32
and documentation
• Legal problems (e.g. KMC not
included in the interventions
financed by the health care system)
• Creation of local and regional
libraries; links with main
documentation centers
• Proposing changes to existing laws,
rules and regulations; involving
mothers and families
Implementation
• Resistance of managers,
administrators and health workers
• Poor facilities, equipment, supplies,
organization, lack of time
• Cultural problems: misguided
beliefs, attitudes, practices
• Apparent initial increase of
workload
• Redistribution of tasks,
multidisciplinary approach
• Resistance of mothers and families
• Lack of monitoring and evaluation
• Adequate information on
effectiveness, safely, feasibility and
cost
• Improving structure and
organization, procurement of basic
equipment, ensuring supplies
• Appropriate training and
information strategies, community
participation
• Introducing changes step-by-step
• Writing new job descriptions,
encouraging team work and
frequent joint review of problems
• Hospital and community support
groups
• Gathering, analyzing and discussing
33
standard data
Communication
• Mothers and families unaware of
KMC
• Poor communication and support in
hospital and during follow-up
• Inadequate community and family
support
• Hostility of politicians and other
health professionals
• Adequate information in the
antenatal period and at the referral
facility
• Improving communication and
support skills of health workers
• Community meetings, mass media,
hot lines
• Articles, newsletters, interest
groups, testimonies
Feeding
• Low rate of exclusive breastfeeding
after long separation of infants from
mothers
• Difficult growth monitoring, lack of
adequate standards
• Inadequate growth despite good
implementation of breastfeeding
guidelines
• Reducing separation as much as
possible; implementation of feeding
guidelines
• Accurate scales, appropriate growth
charts, clear instructions
• Good skills for assessing
breastfeeding and alternative
feeding methods
34
• High prevalence of HIV- positive
mothers
• Voluntary counseling and testing of
parents; infant feeding counseling,
appropriate replacement feeding for
preterm infants; safe alternatives to
breast milk; pasteurizers
From the review of literature, the various benefits KMC have as well as the
method of implementing the KMC program in a setting could be understood. Many of the
elements included in the implementation of KMC were considered in the design of the
present study. The review also helped the investigator to get an overall frame work of the
methods to be followed, and the analyses to be used for interpreting the data collected in
the present study.
35
4. METHODOLOGY
Research methodology is the systematic way to carry out an academic study and
research in a flawless manner. According to Dempsey (1996) research methodology
defines the way in which pertinent information is to be gathered in order to answer the
question of research analyze the facts and problems. The methodology enables the
researcher to project a blue print of the details, data, approach, analysis and findings of
research undertaken.
This chapter includes the description of research approach, research design,
variable, setting, population, sample and sample size, sampling technique, sampling
criteria, development of tool, description of the tool, pilot study, data collection
procedure, plan of data analysis and ethical considerations.
This study was done to assess the effect of Kangaroo Mother Care verses Routine
Care for low birth weight neonates and perception of mothers regarding Kangaroo
Mother Care in General Hospital, Jayanagar, Bangalore.
RESEARCH APPROACH:
The selection of research approach is a basic procedure for conducting research
study. The research approach tells the researcher as to what data to collect and how to
analyze them. It suggests possible conclusion to be drawn from the data.
36
In view of the nature of the problem selected for the study and objective to
be accomplished experimental research approach was considered as an appropriate
research approach for the present study.
RESEARCH DESIGN:
A researcher's overall plan for obtaining answers to the research questions as
for testing the research hypothesis is referred to as research design. In the research
process, the research design can be considered as the back bone of the study.
The over all purpose of developing research design is two fold, one being to
help in the solution of research problem and the other to control variance. The research
design adopted for the study was quasi-experimental research design with the same sample
serving as their own control group.
37
Target population Postnatal Mothers with
LBW Neonates
Accessible population
Postnatal Mothers with LBW Neonates in
General Hospital Jayanagar, Bangalore
Sampling Technique Purposive Sampling
Figure 2: Schematic representation of research design
Assessing the Physiological and
Behavioural state of Neonates during RC
versus KMC
Assessing the perception of mothers Regarding Kangaroo
Mother care
60 LBW neonates and
Their Mothers
Data Analysis Descriptive and
Inferential statistics
Findings
Reporting
38
VARIABLES
Variables are characteristics that can have more than one value. The variables
in the present study, include,
1) Independent Variable: Kangaroo Care and Routine Care.
2) Dependent Variable: Physiological Parameters of low birth weight
neonates.
SETTING:
The word setting points out to the place where the study was conducted.
The study was conducted in postnatal ward, General Hospital, Jayanagar,
Bangalore. The hospital is 500 bedded with multispeciality such as Surgery, Medicine
Ortho, Gastroenterology, Psychiatry, Pediatric, Obstetric and Gynecology. Maternity unit
comprises one Antenatal ward, two labour rooms, two postnatal wards and one special
baby care unit.
Maternity unit equipped with 120 beds. Average 160 - 200 deliveries are
conducted per month. 50-60% of the neonates are LBW (1.5 kg - 2.5 kg).Very low
birth weight neonates are shifted to referral hospital. Postnatal ward consisting of two
units with 100 in patient capacity. The mothers with normal delivery are discharged
after '3' or '4' days of delivery. The general hospital, Jayanagar was selected for
the study because of the availability of the subject and feasibility of conducting the
study. Review shows that all the studies so for conducted are in well-equipped hospitals,
yet arguably the most significant impact of KMC will be felt in setting with limited
resources. There is an urgent need for research in these setting. In the meantime it seems
39
that where poor conventional care is available, KMC offers a safe substitute, with little
risk of raised morbidity or mortality.
POPULATION:
The term population referred as the aggregate of all the objects, subjects or
members that confirm to a set of specifications. Population may be of two types target
population and accessible population. The purpose of defining population for a research
projects arises from the requirement specific to the group to which the result of the study
can be applied.
The target population for present study is postnatal mothers with LBW
babies and the accessible population is the postnatal mothers with LBW babies
admitted in General Hospital, Jayanagar, Bangalore.
SAMPLE AND SAMPLING TECHNIQUE:-
The sample is a portion of the population that has been selected to represent
the population of interest. Sample selected for present study was 60 postnatal mothers
with their LBW babies.
In the study sampling technique used is purposive sampling provided they
fulfilled the inclusion criteria for the study.
SAMPLING CRITERIA:
The following inclusion and exclusion criteria were used in selecting the
samples.
40
Inclusion Criteria:-
1) Selection of neonates for the study was based on:
• Physiologically stable.
• Birth weight ranging between 1500 g - 2500 g.
2) Selection of the mother
• Available at the time of data collection.
• Willing to participate
• Able to follow instructions
Exclusion Criteria:
1) Neonates:
• Lethal health problems (physiologically not stable)
• Not recommended KMC by treating physician.
2) Mothers:
• Not available at the time of data collection
• With serious health problems.
Development of the tool:
Data collection tool is an instrument that measures the variables of interest of the
study accurately, precisely and sensitively.
The tool was developed based on review of literature, opinion from experts, and
internet. Resources were reviewed extensively by the researcher to collect information,
for developing the tool. A blue print of the tool was prepared by the investigator.
41
Description of Tools:
Based on objectives of the study following sections of the tool were developed
Section I: - Baseline Performa of the Neonate and mother. (Annexure E)
• Bio-data of the Neonate: - Age, Birth weight, gestational week, date
of admission.
• Details about KMC : date of initiation, weight at initiation, number
of sections per day, duration ;
• Method of feeding
• Problems during KMC
• Details about mother: Gravida, parity, age, income, education,
occupation.
Section II: - Observation of physiological parameters (ANNEXURE-H)
1) Axiliary Temperature: It was checked with thermometer.
2) Heart Rate: Counted using Stethoscope.
3) Respiratory Rate: It was counted by Observation of chest movement
for one full minute.
These parameters were checked before initiation of KMC, after 15 of
initiation of KMC, Just before discontinuation of KMC and half an hour after
discontinuation of KMC.
Section III Behavioral state (ANNEXURE-I)
Modified Braselton Behavioral Assessment Scale (1984) was used for the assessment of
behavioral state.
42
Deep quiet sleep state (score-6), closed eyes, with no eye or body movement, little or
nor response to noise or stimuli.
Active sleep state (score-5) movement of extremities, stretching of limbs body,
changes of facial expression, eyes closed with eye movement and started with noise or
disturbance.
Drowsy state (score-4), eyes opened or closed and if eyes open, appearing glazed and
unfocussed, quiet, startle present or slow movement of extremities.
Quiet alert state (score-3), eyes opened, bright and interested in their surrounding and
the presence of minimal body movements.
Active alert state (score-2) being, fussy, restless, opened eye, movement of face, hands
and legs.
Crying state (score-1), continuous cry (lusty cry), red face and presence of movement
of hands and legs.
Section IV: - Questionnaire.
A questionnaire containing 20 items were formulated and used to interview
the mothers regarding their perception about Kangaroo Care using a five point likert
scale.
A blue print of the tool was prepared by the researcher which includes
content areas, number of questions, serial number of questions and weightage in
percentage for each content area.
43
Table 3 : Blue Print
SI No
Items
No. of Questions
Serial No. Weightage in%
1. General Information
regarding KMC
5
1 - 5
25%
2
Benefits of KMC
5
6 - 1 0
25%
3. Requirements to
implement KMC
5
11-15
25%
4. Continuation of KMC
at home.
5
16-20
25 %
Maximum Score - 100 Minimum Score - 20
TESTING OF THE INSTRUMENT:
(i) Content validity of the tool: -
Eight experts were asked to establish content validity for the instrument.
Five of these experts from Nursing field and three were medical personnel. The
instrument was sent to them for validation along with a checklist and validation
certificate. Modifications were made after receiving their suggestions and comments.
• Gestational week and income included in the baseline data.
• Modification made in problem statement.
The questionnaire for mother was translated in local languages such as Kannada,
Hindi, and Tamil and then translated back to English.
44
(ii) Reliability:
For checking the reliability of the tool test retest method was used. The co-
efficient correlation value was p=0.84(p<0.05) Heart rate was auscultated, respiratory
rate is checked by observing the chest movement one full minute. Accuracy of
measurement of respiratory rate was ascertained by doing inter rater reliability. The co-
efficient correlation values was 0.80(p<0.05. The temperature is checked using
thermometer. The investigator alone monitored all these parameters.
Method of data collection:
An official formal written permission was obtained from the Medical
Superintendent and head of the department of OBG and neonatal ward. The study was
conducted six weeks from March 1st -April 15th. The purpose of the study was
explained to them and formal consent was obtained. A pamphlet about KMC was
distributed and the procedure, preparation and timings for KMC were explained to the
mothers.
Three babies were selected per day. Observation of physiological parameters
during KMC and routine care was assessed on the same selected babies for two
consecutive days twice daily with the interval of 3 to 4 hours. Each time, routine
care observation was made first followed by KMC - I and KMC - II. After half an
hour of discontinuation routine care observation is made once again. On the third
day the mother was interviewed about her perception of KMC using five point likert
scale.
45
Table 4: Flow Chart Depicting Assessment of Physiological Parameters
Physiological
parameters
RC-I KMC -I KMC - II RC-II
Temperature
Heart Rate
Respiration
I set of reading
Just before
KMC
1 5 mts after
initiation of
KMC
Before
discontinuation
KMC
Half an hour
after
discontinuation
PILOT STUDY:
The pilot study is a preliminary research conducting to test the elements of
design before the commencement of an actual full scale project. It is designed to
acquaint the researcher with problems that can be corrected in preparation for the large
research project.
A pilot study was done on six LBW neonates from December 1st to 10th, 2004.
After pilot study following modifications in the study were made.
Inclusion criteria:
To add the minimum time of KMC to be 45 minutes.
Add mothers who are stable and able to follow instructions.
Data Collection:
The entire process of assessing the physiological parameters and
perception of the mothers where assessed without any difficulty. The co-operation from
46
the authorities was encouraging. The study was found feasible in terms of time,
money, accessibility and co-operation.
Data Analysis:
The data itself do not provide us with answers to our research questions. They
need to be processed and organized in some orderly, coherent fashion. To facilitate
analysis and correlate the facts relationships can be discerned. The data obtained
would be analyzed using both descriptive and inferential statistics.
Data were analyzed and interpreted in the light of objectives, using both
descriptive and inferential statistics. Test of significance paired ‘t’ test, ANOVA test was
used to compare the physiological and behavioral states of LBW babies during routine
care and Kangaroo Care.
Ethical Consideration:
Ethical consideration taken into account for the purpose of the study was to
assess the effectiveness of KMC versus Routine Care. Each individual client was
informed about the purpose of the study and confidentiality was promised and ensured.
Informed consent was obtained from each client. The client had freedom to leave the
study at her will without assigning any reason. Thus ethical issues were ensured in the
study.
47
5. RESULTS
Polit and Hanger State that statistical analysis is a process, which can be adapted
for rendering quantitative information in a meaningful and intelligible manner. This
chapter deals with the analysis and interpretation of the data collected to evaluate the
effectiveness of the Kangaroo care versus routine care for stable low birth weight
neonates. Analysis and interpretation of the data were done by descriptive and inferential
statistics based on the objectives of the study.
The Objectives of the study were:
1. To identify and compare the physiological states of LBW babies during routine
care and Kangaroo Mother care.
2. To determine the behavioural states of neonates.
3. To determine the mother’s perception about Kangaroo Mother Care.
4. To prepare a pamphlet on Kangaroo Mother Care.
The data collected were edited, tabulated, analyzed and the results obtained were
organized in the following sections.
SECTION I: Sample characteristics of LBW babies.
SECTIONII: Physiological state of LBW neonates.
SECTION III: Behavioural state of LBW neonates.
SECTION IV: Sample characteristics of mothers.
SECTION V: Mothers perception about KMC.
48
SECTION I: Sample characteristics of LBW babies.
This section deals with all the baseline variables of LBW neonates selected for
particular study.
Table 5: Frequency and Percentage Distribution of Neonates According To Their
Sex, Gestational Age, and Mode of Delivery.
Demographic Variables
Frequency
Percentage (%)
Sex Male
Female
30
30
50
50
Gestational Age 35-37
38-40
25
35
41.7
58.3
Mode of delivery
Normal delivery
ND with episiotomy
LSCS
12
32
16
20
53.3
26.7
Data Table 5 reveals that, sex distribution of the neonates are equal ie, 50% male
and 50% female. Gestational age was ascertained for neonate by LMP was ranged from
35-40 weeks with a mean of 37.5( +3.2) weeks. The commonest modes of delivery for
babies are Normal Vaginal 73.3% and the others (26.7%) are delivered by LSCS.
49
Table 6: Distribution of Age and Birth Weight of the LBW Neonates According To
Frequency, Percentage, Mean and Standard Deviation
Variables Frequency Percentage Mean SD
Age (in days)
0-3
4-7
8-12
49
9
2
81.7
15
3.3
2.5
2.04
Birth Weight (Grams)
1500-1700
1701-1900
1901-2100
2101-2300
2301-2500
2
11
26
16
5
3.2
18.4
43.3
26.7
8.3
2000g
250
Majority of neonates are 0-3 days of age 49(81.7%) with mean 2.5 ( + 2.04) days
and least number of babies 2(3.3%) were aged between 8-12 days. The range of neonate’s
weight at incitation of KMC was 1700-2500gram, with mean 2000gram. The comparison
of birth weight during KMC and routine care not done because the normal weight loss
expected in the first ten days of life. The least 2(3.3%) babies weighed between 1500-
1700grams.
50
DBM73%
DBM+EBM5%
EBM22%
DBM EBM DBM+EBM
Figure 3: Distribution of Neonates in Percentage According To Type of
Feeding At Iniciation of Kmc.
Figure 3: reveals that when KMC was initiated for Neonates, they were on type of
feeding namely Direct breast feeding 44 (73.3%), Expressed breast milk 13(21.7%) and
3(5%) were on direct breast milk along with extracted breast milk.
51
Table 7: Duration of KMC per Sessions and Total Number of Minutes KMC
per day.
Variables with range Frequency Percentage Mean SD
Duration of KMC per Session (minutes)
40-50
51-60
61-70
20
25
15
33.33
41.67
25
55.33
10.2
Total number minutes KMC per
day
80-90
91-100
101-110
111-120
10
15
20
15
16.67
25
33.33
25
102.2
10.2
Data in Table 7. shows that mean duration of KMC per session was 55.33 (+10.2)
minutes. Mean score of total number of minutes KMC per day was 102.2 ( + 10.2).
Section II. Physiological Parameters of LBW Neonates Observed During KMC
For clarity following codes are used in this section.
• RC-I : Reading taken just before incitation of KMC
• RC-II : Reading taken half an hour after discontinuing KMC
• KMC-I : Reading taken 15 minutes after initiating KMC
• KMC-II Reading taken just before discontinuing KMC
• Each neonate – mother dyad was observed at 4 separate
sessions.
52
Table 8: Distribution of Mean Score Temperature (Of) Of Neonates during Each
Sessions at Specified Intervals.
Sessions Variables RC-I KMC-I KMC RC-II
Range
96.2-98.6
95.6-98.8
96.6-100
96.2-99.2
Mean
97.59
97.8
98.2
97.9
1
SD
1.01
1.6
1.5
1.6
Range
95.2-99.6
95.6-99.8
96.6-100
96.4-99.4
Mean
97.76
98.02
98.4
98
2
SD
1.61
1.6
1.5
1.2
Range
96.4-98.6
96.6-98.8
96.8-100
96.4-99.4
Mean
97.7
97.9
98.8
97.9
3
SD
1.1
1.2
1.5
1.4
Range
95.4-99.6
95.6-99.8
96.8-100
96.4-99
Mean
97.85
98.01
98.59
98
4
SD
1.27
1.8
1.5
1.2
53
97.6
97.997.997.7
98.398
98.4
97.7
97
97.2
97.4
97.6
97.8
98
98.2
98.4
98.6
98.8
99
99.2
RC.I KMC-I KMC-II KMC-II
Tem
pera
ture
I-set Reading II-set Reading
Figure 4: Distribution of Mean Temperature of LBW Babies during Routine
Care and KMC.
54
Table 9: Comparison of Neonates Temperature during KMC and Routine Care
Using T-Test.
Variables
Mean
SD
Paired t- value
P Value
KMC
98.2
1.5
1.96
RC
97.9
1.3
1.5
P > 0.05
NS-Non significant
Two way ANOVA was computed to compare the temperature during KMC and
routine care. Source of variation between treatments was 1.5, source of variation between
the people were 1.2 and the interaction variation were 1.86 at 1% level of significance.
Both analyses reveal that there is no significant difference in temperature during
Kangaroo Mother Care and Routine care. Though there is increase in temperature during
KMC than Routine care it is statistically not significant.
55
Table 10: Mean Heart Rate (Beats/Minute) At Specified Intervals for
Neonates
Sessions
Variables
RC-I
KMC-I
KMC
RC-II
Range
120-156
120-154
120-158
120-154
Mean
135
138
138
135
1
SD
20.4
19.1
19.5
19.5
Range
122-156
120-156
120-156
122-152
Mean
135
138.5
138
135
2
SD
19.1
19.5
19
19.5
Range
120-158
120-156
120-154
120-156
Mean
134.5
136
136
135
3
SD
17.9
19.1
19
19
Range
120-156
120-158
120-156
120-154
Mean
134.5
136
136
135
4
SD
19.1
19
19.5
19
56
138
135135
138
135136136
134.5
130
132
134
136
138
140
142
RC-I KMC-I KMC-II RC-II
Hea
rt R
ate
Bea
ts/m
ts
I-set Reading II-set Reading
Fig.5 Distribution of The Heart Rate of LBW Babies during RC and KMC.
As shown in the figure 5. The LBW babies were found to have normal heart rates
during both routine care and Kangaroo care in all sessions. The heart rates were slightly
higher during Kangaroo care than routine care and but it was found to be within normal
limits.
57
Table 11: Comparison of Heart Rate of Neonates during KMC and RC Using
T-Test.
Variables
Mean
SD
Paired t- value
P Value
KMC
137
19
1.96
RC
134
19
0.86
P > 0.05
NS-Non significant
Two way ANOVA was computed to compare the Heart rate during KMC and
routine care. Source of variation between treatments was 2.14, source of variation
between the people were 0.089 and the interaction variation were 3.16 at 1% level of
significance. Both analysis reveals that there is no significant difference in Heart Rate
during Kangaroo mother care and routine care. The calculated value 0.09 is less that the
table value 1.96 at 0.05 level of significance.
58
Table 12: Respiratory Rate (Beats/Minute) At Specified Intervals for Neonates
Sessions Variables RC-I KMC-I KMC RC-II
Range
30-60
30-60
30-58
32-60
Mean
45.7
44
43.7
46
1
SD
12.4
12.9
12.9
13
Range
32-60
30-60
32-60
34-60
Mean
45.5
42
43.7
46
2
SD
11.3
12
12.9
12
Range
32-60
30-60
30-60
34-60
Mean
45.8
42.5
43.8
46
3
SD
12.9
12
12.9
12
Range
30-60
30-60
30-58
34-60
Mean
45.8
42.5
43.8
46
4
SD
12.9
12
13
12
Data of Table 12. Shows the mean values of respiratory rate of neonates obtained
at different session at the specified intervals. It can be observed that all the means are
within the normal ranges irrespective of KMC or RC.
59
45.845.8
43.643
45.6 46
43.6
42.5
40
41
42
43
44
45
46
47
RC-I KMC-I KMC-II RC-II
I-set Reading II-set Reading
Fig.6 Distribution of Mean Respiratory Rate of LBW Babies During RC And KMC.
As shown in figure 6 the low birth weight babies were found to have normal and
stable respiratory rate during routine care. In Kangaroo care, the respiratory rates were
found to be lowered after the starting of each section and were maintained within normal
limits.
60
Table 13: Comparison of Respiratory Rate of LBW Babies during KMC and RC
Using T-Test.
Variables
Mean
SD
Paired t- value
P Value
KMC
44
12.5
1.96
RC
46.5
12.5
1.56
P > 0.05
NS-Non significant
Two way ANOVA was computed to compare physiological parameters during
KMC and routine care source of variable between treatments was 3.43, source of
variation between people were 0.11 and residual error was 1.72 at 1% level of
significance.
Both analysis reveals that there is no significant difference in Respiration during
Kangaroo Mother Care and routine care though there is 3 beat /minute fall in respiratory
rate during KMC, which is statistically not significant.
Analysis given in Tables 9,11,13 the hypothesis that was made can be accepted ie.
one can conclude that there no significant difference between temperature, heart rate and
respiratory rate in neonates during KMC and RC.
61
SECTION III: Behavioural state of LBW neonate
This section deals with distribution of behavioural state of neonates which was
assessed by Modified Brazalton Assessment scale.
0
10
20
30
40
50
60
70
Percentage
1 2 3 4 5 6Behavioural State Score
6.Deep Quiet Sleep5.Active Sleep4.Drowsy State3.Quiet Alret2.Active Alret State1.Crying State
KMC RC
Figure. 7: Distribution of Behavioral State Of LBW Babies during KMC and
Routine Care.
Figure. 7 shows the computed value of behavioural state of neonates during KMC
and RC. Increased deep quiet sleep state (60%) was found during KMC. Majority of the
babies had higher mean score during KMC 21.33 (89.70%) than during routine care
12.33 (51.37%) in RC sessions most of the babies had active sleep state (29.6%) than
deep quiet state (6.3). The mean crying state was found to be less during KMC (0.8%)
than during routine care (11.6%) which is statistically significant.
62
Table 14: Comparison of Behavioural State Of LBW Neonates during KMC and
RC Using Anova Test
Degrees of freedom F-ratio Table value Level of
significance
1,58
25.86
4.00
P<0.05
S*
S* - significant
SECTION –IV Sample characteristics of Mothers.
Table 15: Frequency and Percentage Distribution of Mothers According To
Gravida, Parity and Age.
Variables Frequency Percentage%
Gravida
• 1
• 2
• 3 and above
11
34
15
18.3
56.7
25
Parity
• 1
• 2
• 3 and above
44
10
6
73.3
16.7
10
Age
• 20-25
• 26-30
• 31-35
26
29
5
43.3
48.4
8.3
63
Table 15. Reveals that out of 60 mothers most of them 34 (56.7%) comes under
the category Gravida II. The range of gravida is from 1-4. Regarding the age, majority are
aged “Between” 20-30 (91.7%) and 5 (8.3%) are 31-35yrs of Age.
31.7%
23.3%20%
13.3%17.7%
High School Primary Higher Secondary illiterate College
Figure 8: Frequency and Percentage of Mother’s Educational Status.
Figure 8. Reveals that educational statuses of the mothers are varied 31.7% had
finished their high school education, 23.3% are studied up to primary class and 13.3% are
illiterate. Association between educational status and perception about KMC is not tested
by the researcher.
64
Table 16. Frequency and Percentage Distribution of Mothers According To Their
Family Income.
Income per month Frequency Percentage.
Below 2000
2001-3000
above 3000
25
30
5
41.7
50%
8.3%
The above table and figure 9 explains that 25 (41.7%) mothers having family
income of below 2000, 30 (50%) mothers belongs to 2001-3000 only 5 (8.3%) had above
3000 family income per month.
50%
0
5
10
15
20
25
30
35
40
45
50
Perc
enta
ge
41.7%
8.3%
Below 2000 2001-3000 Above 3000
Income / month
Section – V Fig.9- Frequency and percentage distribution of mothers according to family Income.
65
This section deals with distribution of mother’s perception regarding kangaroo
mother care. It was assessed by using five point likert scale.
Table 17: Perception of Mothers Regarding KMC In Terms of Range, Frequency,
Percentage, Mean And Standard Deviation.
Range of score
Frequency
Percentage
Mean
Standard deviation
70-80
81-90
91-100
7
48
5
11.67
80.00
8.03
85.3
10.2
Table 17 and Figure 10: depicts that the over all mean perception score is 85.3%
It indicates that mothers are having good perception about kangaroo mother care.
11.69
80
8.30
10
20
30
40
50
60
70
80
Perc
enta
ge
70-80 81-90 91-100Range of Score
Fig. 10 – Frequency and percentage distribution of mothers according to range of
score.
66
According to total score obtained by each subject’s perception is categorized into
three groups below 70 satisfactory 70%-80% good perception and 90-100% very good
perception figure 15 shows 48(80%) mothers had very good perception regarding KMC
and 20% had good perception regarding Kangaroo mother care.
Table -18 Perception of Mother’s Regarding Effect of KMC On Baby
Variables
Strongly
Agree
%
Agree
%
Undecided
%
KMC Provides
warmth
43
71.67%
15
25%
2
3.33%
Baby feels
secure
35
58.33%
23
38.33%
2
3.33%
Reduces duration
of Hospital stay
34
56.66%
24
40%
2
3.33%
Increases weight
of the baby
24
40%
30
50%
6
10%
Duration of sleep
is increased
16
26.6%
44
73.33%
-
-
Table 18 data shows that 43(71.67%) strongly agreed 15(25%) are agreed KMC
provides warmth for the baby. No mother disagreed with this statement.
67
66.66
33.33
0
33.34
63.33
3.3
58.34
38.33
3.3
70
30
0
68.3
31.66
00
10
20
30
40
50
60
70
Perc
enta
ge
IncreasesConfidence
Improves Lactation Self Satisfaction Costless practice Reduces feeling ofseparation
Statement
Strongly agree Agree Undecided
Figure 11: Distribution Shows The Perception of Mothers Regarding Benefits of
KMC For The Mother.
Figure 11: shows that 40 (66.66%) strongly agreed and 20 (33.34%) agreed KMC
improved their confidence to care their LBM babies 20(33.34%) strongly agreed and 38
(63.33%) agreed KMC improve their lactation 35(58.33%) strongly agreed, 23(38.33%)
agreed that KMC improved their self satisfaction 2(3.33%) subject’s particular statement.
Above data reveals that mothers are well aware about benefits of KMC for mothers.
68
Table 19: Distribution of Mothers Perception Regarding Requirements to
Implement KMC.
Variables Strongly
Agreed % Agreed % Undecided %
Comfortable
position for baby
and mother
35
58.33%
16
26.67%
9
15%
Willingness of
mother
35
58.34%
25
41.66
0
0
Privacy
36
60%
16
26.67%
8
13.33%
Proper cloth
16
26.67%
30
50%
14
23.33
Baby must be
stable
16
26.67
40
66.66
4
6.67
Table 19 shows that 35 (58.33) subjects strongly agreed and 16 (26.67) subjects
agreed that comfortable position of the mother is important requirement for KMC. 35
(58.34) mothers strongly agreed and 25(41.66) agreed that willingness of the mother is
necessary in providing KMC.
69
63.3336.67
Strongly agreed Agreed
Figure.12: Distribution of Mothers According To Whether They Will Continue KMC At Home.
Majority of the mothers 38(63.33) agreed to 22(36.67) subjects are felt that they
will continue KMC even at home also.
A20%
SA80%
Figure 13: Distribution of Mothers According To Whether They Will
Encourage Others to Implement KMC.
Figure shows that 48(80%) mothers strongly agreed and 12(20%) mothers are
agreed to encourage others to implement KMC.
70
6. DISCUSSION
The present study was aimed to determine the effectiveness of kangaroo mother
care versus routine care for stable low birth weight neonate. The effect was assed in terms
of specific physiological parameters like Temperature Heart Rate, Respiration and
behavioural state of neonates. The study was based on general systems theory.
The study was conducted in obstetrics ward of General Hospital Jayanagar
Bangalore staff in the OB ward were not aware about this concept. So these staffs were
exposed to the concept during the period of the study.
A check list for assessment and recording of physiological and behavioural states
of LBW babies was used. The research design adopted for the study was quasi-
experimental research design with the same samples serving as their own control group.
Purposive sampling technique was used to select 60 LBW babies and their mothers.
Main findings of the study were discussed under the objectives.
Section I: - Sample characteristics of Neonates.
Among the LBW babies 30(50%) are female and 30(50%) are male. Regarding
gestational age 41.7% are preterm babies and 58.3% are term babies. Among 60
neonates, the mode of delivery 20% are normal delivery without episiotomy 53.3%
71
normal delivery with episiotomy and 26.7% had LSCS. The LBW babies involved in the
study belong to the age group of 0-12 days. And the mean age limit was 2.5+ 2. Majority
of the babies had 43.3% birth weight ranging from 1700g-2500g. The mean rate was
2000.4g+253. Out of 60 babies 73.3% had direct breast feeding and 21.7% had taken
Extracted breast milk. Only 5% are taking DBF with EBF.
Section-II: Physiological state of LBW neonates
The temperature, Heart Rate, Respiratory Rate of LBW babies were maintained
within normal ranges during Kangaroo care and routine care.
i) Axiliary Temperature:
The mean temperature of LBW babies during KMC was 98.8 oF. In routine care
LBW babies were found to maintain a constant temperature. During KMC a significant
steady rise in temperature was observed among LBW babies. None of the babies
developed hypothermia during KMC. Although changes in temperature were observed in
neonates during KMC and routine care, all temperature reading at the various intervals
were within normal ranges, this shows that KMC did not have an adverse effect on
temperature Previous studies have also similar finding3, 9, 23, 30.
ii) Heart Rate:
The mean Heart Rate of LBW babies during RC and KMC were 135 and 138
beats per minute respectively. In KMC all the babies had regular stable heart rate which
was 3 beats per minute (135) higher than RC (138) which the low birth weight babies had
72
stable heart rate during RC and KMC. This shows that KMC did not have an adverse
effect on Heart Rate, previous studies have also similar finding 3, 9, 23, 30.
iii) Respiratory Rate:
The low birth weight babies were found to have Normal and stable respiratory
rates during KMC and routine care. The mean respiratory rate of LBW babies during
Routine care (45/mt) was higher than the mean respiratory rate during RC (42/minutes) at
the starting of Kangaroo care LBW babies had sudden drop in respiratory rate in each
session and were maintained within normal limits. In KMC sessions, the babies were
found to have regular and deep respiration as they started to sleep (deep quiet sleep state)
comfortably in skin-to-skin contact with their mothers.
The above findings show that KMC does not have an adverse effect on Heart Rate,
Temperature and Respiratory rate. Based on the findings of the present study it was
possible to accept the hypothesis that there would be no difference in physiological
parameters during KMC and routine care. This reaffirms literature available on KMC
which emphasized this fact15,19,30. The present study in the kangaroo mother care was
limited to only two days yet similar findings were found with longer duration of study3, 9,
23, 30.
Section IV: Sample characteristics of mothers
The Mothers of LBW babies participated in the study belongs to the age group of
20-35. Majority of them, 56.7%, were second Gravida, 18.3% were First Gravida and
73
only 8.3% were Gravida three. Regarding type of family majority 42(70%) are from
nuclear family and 18(30%) are from joint family. Among 60 mothers only 7% had
college education 12% higher education, 19% High School education, 14% primary
education and only 8% Illiterate. Majority of the mothers 42(70%) were house wives and
18 (30%) working. Most of the mothers had Normal delivery 44 (73.3%) and 16(26.7%)
subjects had LSCS. The average family income of most of the mothers 55(91.7%) was
below Rs. 3000/-
Section III: Behavioural State.
Modified Braselton Behavioural Assessment scale was used to for the assessment
of behavioural state. Increased deep quiet sleep 60% was found in KMC where as in RC
only 6.3%. In Routine care most of the babies had active sleep state 29.6% than deep
quiet sleep. Majority of the babies had higher mean score during KMC 21.53(89.70%)
than during routine care 12.33 (51.77%) The mean crying state was found less in KMC
0.8% than during routine care 11.6%. Similar findings were found in other studies
also.3,12.
Section V: Mothers perception about KMC.
This section discussed with perception of mothers regarding kangaroo Mother
Care, which was assessed by using five point likert scales.
74
Table 17 depicts that over all mean perception score is 85.3% According to total
score obtained by each subject perception is categorized into three groups below 70
satisfactory 70%-80% good perception and 80-100 very good perception. Findings
reveals that 48(80%) mothers had very good perception, and 12(20% ) and good
perception about kangaroo mother care. No mother expressed any negative attitude about
Kangaroo Mother Care.
Table 18 shows regarding benefits of KMC to the babies 43(71.67%) strongly
agreed 15(25%) agreed KMC provides warmth for the baby. No mother disagreed with
this statement. Regarding security 35(58.33%) mothers strongly agreed and 23 (38.33%)
agreed, 34(56.66%) strongly agreed and 24(40%) agreed KMC reduce the hospital stay.
Regarding weight gain 24(40%) strongly agree and 30(50%) agreed that KMC will
improve LBW babies weight 16(26.6%) strongly agreed and 44 (73.3%) agreed that
KMC improved their babies sleep. No mother disagrees with any of these statements,
which reveals that mothers had good perception regarding benefits of KMC to their
babies.
Responses from the mothers regarding benefits of the KMC for the mothers are as
follows; 40 (66.66%) strongly agreed and 20 (33.34%) agreed KMC improved their
confidence to care their LBM babies 20(33.34%) strongly agreed and 38 (63.33%) agreed
KMC improve their lactation. 35(58.33%) strongly agreed, 23(38.33%) agreed that KMC
75
improved their self satisfaction 2(3.33%) subjects had particular statement. Above data
reveals that mothers are well aware about benefits of KMC for mothers.
If Kangaroo Mother Care has to be implemented successfully the basic
requirements have to be met. It does not require any sophisticated equipment of skills.
But if mothers are motivated appropriately and are given the right kind of support they
would be able to provide KMC and also continue to do so in the home setting. The
continuation of KMC is necessary for promotion of growth and development of the
neonates. Majority of the mothers 38(63.33) agreed, 22(36.67) subjects felt that they will
continue KMC even at home also.
From the result of the present study it could be concluded that KMC is safe, no
difficulty to implement and mothers had good perception regarding Kangaroo Mother
Care. Behavioural state of the neonates also found good during KMC than Routine care.
76
7. CONCLUSION
The vulnerable tiny low birth babies are at risk to develop much complication
right from their birth. All health care professionals are responsible for providing a
comprehensive and holistic care and to reduce the mortality and morbidity of these high-
risk group babies. Any novel intervention which proves to improve the baby’s physical
and behavioural states and their sense of security and not having any adverse effect on
their health can be safely introduced in the neonatal care units.
KMC was found to be as effective as routine care (neonates being nursed either in
an incubator, warm cradle or by the mother’s bedside) in relations to maintenance of
physiological parameters. This intervention was simple, inexpensive, and convenient. It
also was observed that it did not demand any extra skills, or equipment. Mothers
appreciated this intervention as an exchange for premature birth of a baby. Mothers had
positive perceptions regarding the benefits and use of KMC in the present setting. Yet
health personnel should guard against the possibility of problems occurring during KMC
by careful monitoring of the neonates while in kangaroo position, and reminders need to
be given to the mothers to feed the babies at regular intervals and they need to report any
thing that they are uneasy about.
IMPLICATION
The findings of the study have implications for nursing practice, education,
administration and research.
77
NURSING PRACTICE
KMC must be encouraged in all settings both maternity units as well as neonatal
units, and even more in settings where the proportion of nursing personnel to neonate is
less. When a mother provides KMC it has been shown that she becomes more skilled in
observing for changes in the baby.
NURSING EDUCATION
Nursing staff and students should receive training on KMC. This may promote
attitudinal changes, as well as inculcation of skills that are required such as teaching of
mothers on breast-feeding and how to adapt to modifications such as expressing breast
milk yet, maintaining exclusive breast-feeding.
In service training of all health professionals especially nurses on KMC (its
advantages, method of implementation, and its use), breast-feeding and thermal control
should be carried out in every hospital where LBW babies are cared for. In addition,
staff should have sufficient knowledge on newborn care and infant development as
well, should be able to know how to provide encouragement and support to mothers in
this crucial period of their lives. The information on the advantages of KMC and its use
must be given to all other health personnels in the hospital. It would be ideal if it
were taught in the undergraduate and postgraduate curricula of nursing students.
78
Nursing administration
Provisions should be made for facilities required for the successive implementation
of KMC. These include:
• Training of staff on KMC
• Forming a core team for implementation of KMC
• Scheduling KMC meetings which would be interactive sessions between
mothers and health personnel
• Having a policy for the implementation of KMC with a written protocol
• Providing infrastructure such as a separate room if need be with comfortable
chairs, toilet and bathroom facilities for mothers to practice KMC in privacy
Nursing research
The practice of KMC in hospitals, and community need more research studies
concentrating on practical problems in implementation of KMC. This study has been done
in the hospital setting. It would be worthwhile to see the impact of KMC on babies who
are born at homes and where professional help is not as easily available as in the hospital.
Limitations
• Sample being purposive was not a true representative of study
population.
• The study was confined only in General Hospital Jayanagar, Bangalore and
that limits the generalization that can be made.
• Parameters such as respiratory rate, and heart rate were assessed by direct
observation, ideally a cardio-pulmonary monitor would be more accurate.
79
• Questionnaire used to elicit the perceptions of mothers had its limitations. The
number of items were less hence, it may not be reflective of all their perceptions
regarding KMC.
Recommendations
• A similar study can be done on a home setting.
• A study on the effectiveness of Kangaroo Care on the weight gain of LBW
babies may be done.
• "Kangaroo Care" or "Skin-to-Skin Care" is an effective intervention, which can
be safely included in the management of LBW babies in N1CU and in maternity
wards. Also after discharge, at home the mothers can continue it.
• KC can be implemented as alternative methods where adequates resources like incuba-
tor are not available for the management of LBW babies and thus ensuring the
best possible care for them.
• Education and demonstration must be provided to each mother of LBW babies
and they should be encouraged to practice KMC.
• Education on Kangaroo Mother Care and its benefits should be organized for nurses,
nursing students and primary hea1th care workers.
• The fitness of LBW babies and mothers should be evaluated before starting KMC.
• Nurses must to e n c o u r a g e proper hygiene and hand w a s h i n g technique and
hygienic practices to be followed by the mothers, before starting KMC.
• This skin-to-skin care should be taught to all levels of health care workers and
should be practiced by all mothers of LBW babies. The lives of this high risk
group babies can thus be saved to a greater extend.
80
7. SUMMARY
The aim of the study was to determine the effect of KMC on specific
(temperature, heart rate, respiration) physiological and behavioural parameters of LBW
neonates in general hospital Jayanagar, Bangalore. It was also intended to assess the
perceptions of Mothers regarding KMC.
In all 60 neonates mother dyads were obtained. Each of these dyads was observed
for four separate sessions of KMC. The physiological parameters were monitored four
times for each session (Just before initiating KMC, 15 minutes after initiating KMC, just
before discontinuing KMC, and half an hour after discontinuing KMC.
Once physiological parameters and behavioural states were obtained from each
mother-neonate dyad, then the perceptions of mothers were elicited using five point
lickert scale.
Major findings in terms of objectives were:-
• All the physiological parameters namely temperature, heart rate, and respiration
rate of LBW neonates were maintained within normal ranges irrespective of
whether neonates received KMC or routine care.
• Regarding the behavioural state, “Increased Deep Quiet Sleep” state was found
during KMC”. Majority of the neonates were found to have improved behavioural
81
state during KMC than RC. The mean crying state was found to be less during
KMC (3%) then during RC.
• All the mothers had a positive attitude towards KMC. No mother expressed any
negative attitude towards KMC. About 92% mothers expressed that they wanted
to continue KMC in home.
• None of the babies presented with problems like apnea, or hypothermia during
KMC.
82
9. BIBLIOGRAPHY
1) Vinod K. Indian Council of Medical Research. Research priorities in neonatal health.
Report of an expert group meeting, New Delhi: January 2000.
2) UNICEF: The State of World’s Children Report 2000.
3) Jeba Jothi Priya. Kangaroo Care for Low Birth Weight Babies. Nursing Journal of
India, 2004, September, 95(9); 209 – 12.
4) Aggarwal Rajiv, Kangaroo Mother Care; Is it Beneficial? abstracts, WHO
Collaborating Centre for Training and Research in Newborn Care. All India Institute
of Medical sciences, New Delhi.
5) Essential Newborn care, Report of a technical working group, World Health
Organisation, 1996 (WHO/FRH/MSM/96.13).
6) Larossa M.M, Understanding preterm infant behaviour in the NICU, 2000; Oct,
Available From: http:// med.emory.edu/pediatrics/neonatology/DPC/ nicubebneu.
7) Ramanathan K, Paul UK, deorari AK, Taneja U and George G. Kangaroo Mother
Care in very low birth weight infants. Indian Journal of Pediatrics 2001 Nov; 68(11):
1019-23.
8) Chapak N. RUIZ, Pelaez JG, Charpat Y. Rey – Mortinez Kangaroo Mother Program :
an alternative way of caring for low birth weight infants ? One year mortality in a
Cohort Study. Peadiatrics. 1994, Dec : 94(6) : 804-10.
83
9) Kristen GF, Bergman NJ and Hann FM. Kangaroo Mother Care in the nursery.
Peadiatric Clinies of North America. 2001 April ; 48(2) : 443 – 52.
10) Goel A. Vani SN. Kangaroo – Mother Method for the care of low birth weight infants
– An Indian experience. Abstracts XVII Annual Convention of National Neonatology
Forum, November 6 – 8th 1998, P – 2, Pg 80.
11) Kiran Kumar B.V. Udani RH. Analgesic effect of skin – to – skin contact in
Kangaroo Position in preterm newborns. Abstracts XXII Annual Convention of
National Neonatology Forum, December 19 – 22nd , Pg 48, P 158.
12) Cattaneo A. Davanzo R, and Tamburlini G for the International Network on
Kangaroo Mother Care. Recommendations for the implementation of Kangaroo
Mother Care for low birth weight neonates Acta Pediatrics 1998; 87: 440 – 5.
13) Feldman R, Eidelman AT, Sirota L and Weller A. Comparison of Kangaroo and
Traditional care ; parenting outcomes and preterm infant development, pediatrics
2002 Jul; 110(I) : 16 – 26.
14) Cattaneo A, Davanzo R, Bergman N and Charpak N. Kangaroo Mother Care in Low
income countries. Journal of Tropical pediatrics, 1998 Oct; 44; 279 – 81.
15) Larimer K. Kangaroo Care Benefits, 1999 (Internet Source).
16) Anderson G.C. Marks EA and Wablberg V. Kangaroo care for premature infants.
AJN Jul 86: 807 – 09.
84
17) Jones J and Ellen E. Kangaroo Care. Indian Journal of Continuing Nursing education.
2002 Jan – Dec 3(2) : 10 – 13.
18) Leyault M. Goulet .C Comparison of Kangaroo Care and traditional methods of
removing preterm infants from incubators. Journal of obstetrics, Gynaecology and
Neonatal Nursing. 1995 Jul – Aug; 24 (6) 501 – 6.
19) Johnson RB, Spencer SA, Rolfe P. Malla DS, Effect of Post – delivery care on
neonatal body temperature. Acta Pediatrics 1992 Nov : 81 911) : 859 – 63.
20) Tessier R. Cristo M. Velez S, Giron M. de Calume ZF, Ruiz – Palae JG; Kangaroo
Mother Care and the bonding hypothesis. Pediatrics. 1998, Aug : 102 (2) Rg 17.
21) Chwo MJ, Anderson GC, Good M, Dowling DA, Shiau Sh, Chu DM. A randomized
controlled trial of early Kangaroo Care for preterm infants; effects on temperature,
weight, behavior and acuity. Journal of Nursing Research; 2002 Jan; 10 (2): 129 – 42.
22) Bosque, M.E, Brady, Affonso and Wablberg, physiological measure of Kangaroo
versus incubator care in tertiary level nursery. Journal of obstetrical, Gynaecology
and Neonatal Nursing 24 (8) Pg 216 – 19.
23) Sloan NL, et al. Kangaroo mother method : randomized controlled trial of an
alternative method of care for stabilized low – birth weight infants. The Lancet, 1994,
344:782-785.
24) Charpak N, et al. Kangaroo mother versus traditional care for newborn infants ≤ 2000
grams: a randomized controlled trial. Pediatrics, 1997, 100:682-688.
85
25) Cattaneo A, et al. Kangaroo mother care for low birth weight infants : a randomized
controlled trial in different settings. Acta Paediatrica, 1998, 87 : 976 – 985.
26) Kambarami RA, Chidede O, Kowo DT. Kangaroo Care versus Incubator Care in the
management of well preterm infants : a pilot study. Annals of Tropical Pediatrics,
1998, 18:81-86.
27) Whitelaw A, Sleath K. Myth of marsupial mother : home care of very low birth
weight infants in Bogota, Colombia. The Lancet, 1985, 1:1206-1208.
28) Charpak N, et al. Kangaroo – mother programme : an alternative way of caring for
low birth weight infants ? One year mortality in a two – cohort study. Pediatrics,
1994, 84:804-810.
29) Anderson GC, et al. birth – associated fatigue in 34 – 36 week premature Infant: rapid
recovery with very early skin-to-skin (Kangaroo) care. Journal of Obstetric,
Gynecologic, and Neonatal Nursing, 1999, 28:94-103.
30) Lincetto O, et al. Impact of season and discharge weight on complications and growth
of Kangaroo mother care treated low birth weight infants in Mozambique. Acta
Paediatrica, 1998, 87 : 433 – 439.
31) Schmidt E, Wittreich G. Care of the abnormal new born : a random controlled trial
study of the “Kangaroo Method” of care of low birth weigh newborns. In : Consensus
Conference on Appropriate Technology Following Birth, Trieste, 7 – 11 October
1986. WHO Regional officer for Europe.
86
32) Whitelaw A, et al. Skin – to – skin contact for very low birth weight infants and their
mothers. Archives of Disease in Childhood, 1988, 63:1377-1381.
33) Wahlberg V, Affonso D, Persson B. A retrospective, comparative study using the
kangaroo method as a complement to the standard incubator care. European Journal
of Public Health, 1992, 2:34-37.
34) Syfrett EB, et al. Early and virtually continuous Kangaroo Care for lower – risk
preterm infants : effect on temperature, breast – feeding, supplementation and weight.
IN : Proceedings of the Biennial Conference of the Council of Nurse Researchers.
Washington, DC, American Nurses Association, 1993.
35) Blaymore – Bier JA, et al. Comparison of skin-to-skin contact with standard contact
in low birth weight infants who are breastfed. Archives of Pediatrics & Adolescent
Medicine, 1996, 150 : 1265 – 1269.
36) Hurst NM, et al. Skin – to – skin holding in the neonatal intensive care unit influences
maternal milk volume. Journal of Perinatology, 1997, 17 : 212 – 217.
37) Christensson K. Fathers can effectively achieve heat conservation in healthy newborn
infants. Acta Paediatrica, 1996, 85 : 1354 – 1360.
38) Ludington – Hoe SM, et al. selected physiologic measures and behavior during
paternal skin contact with Colombian preterm infants. Journal of Developmental
Physiology, 1992. 18: 223 – 232.
87
39) Acolet D, Sleath K, Whitelaw A. Oxygenation, heart rate and temperature in very low
birth weight infants during skin – to – skin contact with their mothers. Acta
Paediatrica Scandinavia, 1989, 78 : 180 – 193.
40) de Leeuw R, et al. Physiologic effects of Kangaroo Care in very small preterm
infants. Biology of the Neonate, 1991, 59:149 – 153.
41) Fischer C, et al. Cardiorespiratory stability of premature boys and girls during
Kangaroo Care. Early Human Development, 1998, 52: 145-153.
42) Anderson GC, Wood CE, Chang HP. Self – regulatory mothering vs. nursery routine
care postbirth : effect on salivary cortisol and interactions with gender, feeding, and
smoking. Infant Behavior and development, 1998, 21: 264.
43) Christensson K, et al. Temperature, metabolic adaptation and crying in healthy full –
term newborn cared for skin-to-skin or in a cot. Acta Paediatrica, 1992, 81: 488– 193.
44) Christensson K, et al. Separation distress call in the human infant in the absence of
maternal body contact. Acta Paediatrica, 1995, 84:468 –473.
45) Affonso D, Wahlberg V, Persson B. Exploration of mother’s reactions to the
Kangaroo method of pre-maturity care. Neonatal Network, 1989, 7: 43 –51.
46) www.kmc.india.co.org.
47) http://www.kangaroomothercare.com
88
ANNEXURE - A
Letter Seeking permission for conducting Research. From, Sr. Alphonsa IInd Year M.Sc Nursing Sarvodaya College of Nursing, Bangalore. To, The Medical Superintendent, Jayanagar General Hospital Bangalore. Through, The Principal Sarvodaya College of Nursing Bangalore. Sub: Seeking permission for conducting research study. Respected Sir, I am a student of M.Sc Nursing in Sarvodaya College of Nursing affiliated to
Rajiv Gandhi University of Health Science, Bangalore with a specialization in OBG
Nursing.
I have to conduct a research study for the purpose of partial fulfillment of my
course. “A comparative study to assess the effect of Kangaroo mother care versus
Routine care for low birth weight (1500 g – 2500 g) Neonates and perception of
mothers regarding Kangaroo Mother Care in General Hospital, Jayanagar,
Bangalore”. I request you to kindly give permission for conducting study in your
institute.
Thanking You,
Yours Faithfully SR. ALPHONSA Place: Date:
89
ANNEXURE. B
LETTER SEEKING PERMISSION FOR VALIDATION OF A TOOL
From : Sr. Alphonsa Mathew Second Year M.Sc. Nursing Student Sarvodaya College of Nursing Bangalore – 560 040. To : Forwarded Through : The Principal Sarvodaya College of Nursing Bangalore – 560 040.
Sub : Request to validate the research tool Respected Sir / Madam,
I, Sr. Alphonsa Mathew am a second year M.Sc. Nursing Student (OBG
Nursing) student at Sarvodaya College of Nursing, Bangalore. I would be obliged, if
you could kindly accept to validate my research tool on the topic.
TITLE OF THE TOPIC :
Study on Kangaroo Mother Care in General Hospital, Jayanagar Bangalore. If you would kindly agree to peruse my research tool by endorsing your valuable suggestions on this topic, I would be obliged if you could kindly affirm your acceptance by December 15,2004. I will send you the details of the study with the tool prepared on hearing from you. Kindly fill up acceptance form.
Thanking you in anticipation Yours faithfully,
(SR. ALPHONSA MATHEW) Encl :
• Reply Letter. • Envelop
90
ANNEXURE. C LETTER FOR CONTENT VALIDITY OF THE TOOL
From : Sr. Alphonsa Mathew Second Year M.Sc. Nursing Student Sarvodaya College of Nursing Bangalore – 560 040. To :
SUB : EXPERT OPINION ON CONTENT VALIDITY OF TOOL. Respected Sir / Madam, I am a student of Masters of Science at Sarvodaya College of Nursing Bangalore. working on dissertation, “A study on Kangaroo mother care in general hospital Jayanagar with the view to develop a guidelines for its practice” as a partial fulfillment of Masters of Science in Nursing Degree of Rajiv Gandhi University of Health Sciences, Bangalore.
OBJECTIVES OF THE STUDY :
1) To determine changes in specific Physiological and Behavioural parameters of neonates while receiving intermittent Kangaroo mother care and during routine care.
2) To assess the perceptions of mothers regarding Kangaroo mother care. 3) To prepare a protocol for Kangaroo Care Intervention.
In this connection, I have prepared the research tool for assessing the
perception of mother regarding Kangaroo mother care and observational tool for comparing the physiological parameters in neonates. I would be obliged you would give me your valuable suggestions would regarding the items and please sign in the certificate of validation tool. I would appreciate your reply by December 15, 2004.
Thanking you in anticipation
Yours faithfully,
(SR. ALPHONSA MATHEW) Encl :
• Tools on assessment of perception and observation. • Certificate of validation. • Evaluation criteria list.
91
ANNEXURE. D
EVALUATION CRITERIA CHECK LIST
Kindly go through the evaluation criteria checklist for a validation of the tool.
There are two columns given for your responses and a columns for remarks, kindly
place a check ( ) in the appropriate column and give your remarks in the remark
column whenever appropriate.
I request you to kindly give me your valuable suggestion to the content of the
tool. Please give your expert comments on the items you think should be modified or
deleted in respective tool.
Sl
No.
Criteria
YES NO
Remarks
1.
1.1
1.2
1.3
Baseline Proforma All the items necessary for the study are present
Items are in measurable terms
Any other suggestions
____________________________________________
____________________________________________
2.
2.1
2.2
2.3
2.4
2.5
2.6
Interview schedule Relevant to the objectives of the study
Flow of thought about concept present
Language is clear to understand
Content is
- Appropriate
- Organised well
Items would permit responses, which would be in
measurable terms
Any other suggestions.
92
3.
3.1
3.2
3.3
3.4
Observation tool to assess the physiological parameters Relevant
Appropriate
It would help meet the objective
Any other suggestions.
____________________________________________
____________________________________________
Any other suggestion(s) about the tool in general
________________________________________________
________________________________________________
Thanking you in anticipation Yours sincerely,
(SR. ALPHONSA MATHEW)
93
ANNEXURE. E
SECTION – A
Base Line Information
a. neonate
1. Serial No. ________________
2. Sex ________________
3. Age of Baby ________________
4. Birth weight (kg) ________________
5. Type of Delivery ________________
6. Date of Admission ________________
7. Date of Discharge ________________
8. Date of Initiation of KMC ________________
9. Weight at initiation of KMC ________________
10. Weight at discharge ________________
11. No. of Sessions per day________________
12. Total duration of KMC (minutes) day________________
13. Duration of KMC in minutes at each setting ________________
14. Feeding
a. Type: DBF/EBM(Mother) EBM (other mother) EBM and clear fluids,
clear fluids cows milk.
b. Method : DBM / Palada / gavage
15. Any episodes of infections / sepsis / UTI / pneumonia / meningitis /
conjunctivitis / nil / others.
94
16. Problems during KMC : Tachypnoea / Apnoea / Cardiorespiratory arrest /
vomiting / any other / nil.
17. Out come – Discharge / Died / Transferred / Referred.
B. MOTHER :
1. Gravida _____________________________
2. Para _____________________________
3. Age (Years) _____________________________
4. Education _____________________________
5. Working Yes / No. _____________________________
6. Occupation _____________________________
7. Type of Family : Joint / Nuclear / Extended : ____________________
95
ANNEXURE. F
Certificate of Validation
To certify that the instruments :
1. Baseline Performa
2. Checklist Format
3. Observation tool.
Constructed by Sr. Alphonsa Mathew, II Year Master of Science in Nursing
SCON, Bangalore to be used in her study titled “Study on Kangaroo mother care in
General Hospital, Jayanagar, Bangalore with the view to develop guidelines for its
practice” has been found to be valid by me.
She has lots / none / few / some / of modifications required to be made in her
tools.
Signature :
Designation :
Date :
Place :
96
ANNEXURE. G
Section - D Five Point likert scale for assessing the perception of mothers regarding KMC.
SL
NO. Content SA
A
UND
DA
SDA
I. Perception of Mothers Regarding effect of
KMC.
1. KMC Provides warmth for baby.
2. During KMC Baby Feels Secure.
3. KMC Reduces duration of hospital stay.
4. KMC is an important method to improve
weight of low birth weight babies.
5. Duration of sleep is improved during KMC.
II. Perception of mothers regarding benefits of
KMC for mothers.
1. KMC increase the confidence of the mother to
take care of their baby.
2. KMC improves lactation
3. KMC gives more self satisfaction.
4. KMC is a costless practice.
5. Feeling of separation and inadequacy is
reduced during KMC.
III. Perception of mothers regarding
requirements to implement KMC.
1. Baby should be in comfortable position while
receiving KMC.
2. Without mothers willingness we can’t provide
KMC.
3. Privacy play an important role in providing
KMC.
97
4. Mother should be in comfortable position
while giving KMC.
5. Baby must be stable before initiation of KMC.
IV Perception of mother’s regarding
continuation of KMC at home.
1. You will continue KMC at Home.
2. I will encourage others to implement KMC.
3. I am happy to implement KMC.
4. KMC is a safe and easy method to take care of
baby.
5. KMC is time consuming.
98
s̈ÁUÀ – r LzÀÄ CA±ÀUÀ¼ÀÄ °PÀgïÖ ¸ÉÌïï PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ PÀÄjvÀAvÉ vÁ¬ÄAiÀÄ «ÃPÀëuÉAiÀÄ£ÀÄß ¤±ÀѬĸÀ®Ä EgÀĪÀAvÀºÀ ¤±ÀѬĸÀ®Ä EgÀĪÀAvÀºÀÄzÀÄ
PÀæ.¸ÀA ¥Àj«r SA A U DA SDI PÁAUÀgÀÄ vÁ¬ÄAiÀÄ À̧AgÀPÀëuÉAiÀÄ bÀ®UÀ¼À PÀÄjvÀAvÉ vÁ¬ÄAiÀÄ «ÃPÀëuÉ.
1 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAAiÀÄÄ ªÀÄUÀĪÀ£ÀÄß ¨ÉZÀÑVqÀÄvÀÛzÉ
2 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ°è ªÀÄUÀÄ ¨sÀzÀævÉAiÀÄ£ÀÄß C£ÀĨsÀ«¸ÀÄvÀÛzÉ.
3 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ D¸ÀàvÉæAiÀÄ°è G½AiÀÄĪÀÅzÀgÀ CªÀ¢üAiÀÄ£ÀÄß PÀrªÉÄ ªÀiÁrvÀÛzÉ
4 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ PÀrªÉÄ vÀÆPÀ«gÀĪÀ ªÀÄUÀÄ«£À vÀÆPÀªÀÅ ºÉZÁÑUÀ®Ä vÀÄA¨Á C£ÀÄPÀÆ®PÀgÀ «zsÁ£ÀªÁVzÉ
5 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ ¤zÉæAiÀÄ C¨sÁªÀªÀ£ÀÄß GvÀÛªÀÄUÉÆý¸ÀÄvÀÛzÉ.
II PÁAUÀgÀÄ vÁ¬ÄAiÀÄ À̧AgÀPÀëuɬÄAzÀ zÉÆgÉPÀªÀ ¥ÀæAiÉÆÃd£ÀUÀ¼À PÀÄjvÀAvÉ CªÀjVgÀĪÀ «ÃPÀëuÉ.
1 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÀªÀÄä ªÀÄUÀÄ«£À ¸ÀAgÀPÀëuÉUÉ CUÀvÀåªÁzÀ DvÀä «±Áé¸ÀªÀ£ÀÄß ªÀÈ¢ÞUÉÆý¸ÀÄvÀÛzÉ.
2 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÁ¬ÄAiÀÄ JzÉ ºÁ°£À GvÁàzÀ£ÉUÉ ºÉZÀÄÑ ¥ÀæAiÉÆÃd£ÀPÁjAiÀiÁVzÉ.
3 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÁ¬ÄUÉ ºÉZÀÄÑ DvÀä ¸ÀAvÀȦÛAiÀÄ£ÀÄß ¤ÃqÀÄvÀÛzÉ.
4 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÀÄA¨Á PÀrªÉÄ ªÉZÀÑzÀ «zsÁ£ÀªÁVzÉ.
5 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄAiÀÄ°è MAn vÀ£ÀzÀ ºÁUÀÆ vÁ¬ÄAiÀÄ CUÀ®Ä«PɬÄAzÁUÀ§ºÀÄzÁzÀ ¨sÁªÀ£ÉAiÀÄ£ÀÄß PÀrªÉÄ UÉÆý¸ÀÄvÀÛzÉ.
III PÁAUÀgÀÄ vÁ¬ÄAiÀÄ À̧AgÀPÀëuÉAiÀÄÄ eÁjUÉ vÀgÀĪÀÅzÀgÀ CªÀ±ÀåPÀvÉAiÀÄ PÀÄjvÀAvÀºÀ vÁAiÀÄA¢gÀ w¼ÀÄ«PÉ
1 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ£ÀÄß ¹éÃPÀj¸ÀĪÁUÀ ªÀÄUÀĪÀÅ ¨sÀzÀæªÁVgÀ¨ÉÃPÀÄ
2 vÁ¬ÄAiÀÄ M¦àUɬĮèzÉ PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ ¸ÁzÀåªÉà E®è.
3 JPÁAvÀ ¸ÀܼÀ PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ°è ¥ÀæªÀÄÄRªÁVgÀ¨ÉÃPÀÄ
4 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ°è vÁ¬ÄAiÀÄÄ ¨sÀzÀæªÁzÀ ¹ÜwAiÀÄ°ègÀ¨ÉÃPÀÄ
5 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ°è vÉUÉzÀÄPÉƼÀîªÀ ªÀÄÄAZÉ ªÀÄUÀÄ«£À ¹Üw GvÀÛªÀĪÁVgÀ¨ÉÃPÀÄ.
IV PÁAUÀgÀÄ vÁ¬ÄAiÀÄ À̧AgÀPÀëuÉAiÀÄ£ÀÄß PÀÄlÄA§UÀ¼À°è ªÀÄÄAzÀĪÀj À̧ĪÀÅzÀgÀ PÀÄjvÀAvÉ vÁAiÀÄA¢gÀ «ÃPÀëuÉ
1 ¤ÃªÀÅ PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ£ÀÄß ªÀÄ£ÉAiÀįÉèà ªÀÄÄAzÀĪÀj¸ÀÄ«gÁ?
2 ¤ÃªÀÅ PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ£ÀÄß C¼ÀªÀr¸À®Ä EvÀgÀjUÉ GvÉÛÃd£À ¤ÃqÀÄvÀÛªÉ
3 ¤ªÀÄUÉ PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄ£ÀÄß C¼ÀªÀr¸À®Ä ¸ÀAvÉÆμÀ«zÉAiÉÄ?
4 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÀÄA¨Á gÀPÀëuÉ ºÁUÀÆ ¸ÀÄ®¨sÀªÁzÀ «zsÁ£ÀªÁVzÉ.
5 PÁAUÀgÀÄ vÁ¬ÄAiÀÄ ¸ÀAgÀPÀëuÉAiÀÄÄ vÀÄA¨Á ¸ÀªÀÄAiÀĪÀ£ÀÄß ªÀå¬Ä¸ÀÄvÀÛzÉ.
99
ANNEXURE. H
Observation tool for assessing kangaroo mother care Just Before initiation
of KMC 15 (MTS) after
initiation of KMC Before Discontinuation
of KMC After Half an Hour of
KMC Sl No.
T HR RR T HR RR T HR RR T HR RR
T : Temperature (Axilla), HR : Heart Rate, RR : Respiratory rate.
100
ANNEXURE- I
Behaviour Assessment scale.
Deep Quiet Sleep State
6
Active Sleep
State 5
Drowsy State
4
Quiet Alert
State 3
Active Alert
State 2
Crying State
1
Sl
NO.
RC KMC RC KMC RC KMC RC KMC RC KMC RC KMC
1
2
3
4
Total No.
%
101
ANNEXYRE-J
LIST OF EXPERTS 1) DR. Sheela V. Mane, 9) MR. B.S. Srinivasan Professor Professor of Biostatistics Department of Obstetrics and Gynecology J.S.S Medical College DR. Ambedkar Medical College Mysore-570015 Bangalore 2) DR.Vasudevarao 10) Prof. P.G. Sebastian Pediatric Department Dept. of English. General Hospital Jayanagar Surana College, Bangalore. 16, South End Road, Jayanagar, 3) DR.Puppu Vithalachar Bangalore-560004. Pediatric Department General Hospital Jayanagar Bangalore. 4) K. Thamarai Selvi Asst. Professor. OBG Sarvodaya College of Nsg Bangalore. 5) Mrs. Sangeetha Asst. Professor. OBG Sarvodaya College of Nsg Bangalore. 6) SR. Suma .K Asso: Professor and HOD OBG St. John’s National Academy of Health Sciences Bangalore. 7) SR. Borgia Professor and H.O.D O.B.G.Department Nirmala College of Nsg. Calicut 8) Mrs. Chitra Professor and H.O.D Department of Research Methodology Sarvodaya College of Nsg. Bangalore.
102
ANNEXURE - K
LETTER SEEKING CONSENT OF THE SUBJECTS FOR
PARTICIPATION IN RESEARCH STUDY.
Dear Participant,
I am a Post Graduate Nursing Student at the Sarvodaya College of Nursing,
Bangalore, Conducting a study to “A comparative study to assess the effect of Kangaroo
mother care versus Routine care for low birth weight (1500 g – 2500 g) Neonates and
perception of mothers regarding Kangaroo Mother Care in General Hospital,
Jayanagar, Bangalore”. as a partial fulfillment of Master of Science in Nursing Degree
of Rajiv Gandhi University of Health Sciences, Bangalore.
The information given by you will be kept confidential and used only for the
study purpose. Kindly sign the consent form given below.
Thanking you,
Yours faithfully,
(Sr.Alphonsa)
CONSENT FORM
I ….......................................... herewith consent for the above said study knowing that all
the information provided by me will be treated with utmost confidentiality by the
investigator.
Date :
Place : Signature of the Participant
Name :
103
¸ÀA±ÉÆÃzsÀ£ÉAiÀÄ°è ¨sÁUÀªÀ» À̧®Ä C£ÀĪÀÄw ¥ÀvÀæ
ªÀiÁ£ÀågÉ,
gÁfêï UÁA¢ü DgÉÆÃUÀå «±Àé«zÁå®AiÀÄ¢AzÀ ªÀiÁ£ÀåvÉUÉƼÀ¥ÀlÖ ¸ÀªÉÇðÃzÀAiÀÄ ±ÀıÀÆæμÁ ªÀĺÁ
«zÁå®AiÀÄzÀ°è £Á£ÀÄ JgÀqÀ£Éà ªÀμÀðzÀ JA.J¹ì (£À¹ðAUï) ±ÀıÀÆæμÁ «zÉåAiÀÄ£ÀÄß ªÀiÁqÀÄwÛzÉÝãÉ. CzÀgÀ
MAzÀÄ CAUÀªÁV ¸ÀA±ÉÆÃzsÀ£ÉAiÀÄ£ÀÄß PÉÊUÉÆArzÉÝãÉ. £À£Àß «μÀAiÀÄ : “dAiÀÄ£ÀUÀgÀ ¸ÁªÀðd¤PÀ D¸ÀàvÉæAiÀÄ°è
zÁRˉÁzÀ PÀrªÉÄ vÀÆPÀ«gÀĪÀ ªÀÄUÀÄ«£À°è PÁAUÀgÀÄ vÁ¬ÄAiÀÄ DgÉÊPÉAiÀÄ ¥ÀjuÁªÀÄzÀ §UÉÎ MAzÀÄ CzsÀåAiÀÄ£À”
£Á£ÀÄ PÉýzÀ ¥Àæ±ÉßUÀ½UÉ ¸ÀjAiÀiÁV GvÀÛj¹ JAzÀÄ vÀªÀÄä°è «£ÀAw¸ÀÄvÉÛãÉ. ¤ÃªÀÅ PÉÆlÖAvÀºÀ
«μÀAiÀÄUÀ¼À£ÀÄß UË¥ÀåªÁVlÄÖPÉƼÀî¯ÁUÀÄvÀÛzÉ ªÀÄvÀÄÛ ¸ÀA±ÉÆÃzsÀ£ÉUÉ ªÀiÁvÀæ §¼À¸À¯ÁUÀÄvÀÛzÉ. PɼÀUÉ PÉÆlÖ
C£ÀĪÀÄw ¥ÀvÀæzÀ°è ¤ªÀÄä ¸À»AiÀÄ£ÀÄß ªÀiÁrj.
zsÀ£ÀåªÁzÀUÀ¼ÀÄ,
¤ªÀÄä DwäÃAiÀÄ
(¹¸ÀÖgï D É̄ÆáãÁì)
C£ÀĪÀÄw ¥ÀvÀæ
£Á£ÀÄ …………………………………………………………………………………………………ªÉÄÃ¯É ºÉýzÀ «μÀAiÀÄUÀ¼À£ÀÄß ¸ÀA±ÉÆÃzÀPÀgÀÄ
UË¥ÀåªÁVqÀÄvÁÛgÉ JAzÀÄ F ªÀÄÆ®PÀ w½zÀÄ F C£ÀĪÀÄw ¥ÀvÀæPÉÌ ¸À» ªÀiÁqÀÄwÛzÉÝãÉ.
¢£ÁAPÀ :
¸ÀܼÀ : ¸À» :
