Table 2 KMC training needs for different levels of care
Level | Description | KMC training focus | Indicators for effective KMC training |
|---|---|---|---|
1 | Primary health care in the community • Births occur at community health centres or at home with the assistance of traditional birth attendants or community workers • All LBW and premature infants must be referred to a higher level of care for evaluation by a doctor or paediatrician | Use this opportunity to integrate essential newborn care and basic concepts of resuscitation into one package. • Transportation: - Identification of pregnant women at risk of premature delivery and in utero transfer before infant is born - Infants not referred before birth: how to avoid hypothermia with the kangaroo position during the transfer of the infant • Initiating kangaroo nutrition as soon as possible (breastmilk or water with sugar if mother is not available) to avoid hypoglycaemia • Sensitisation of the community regarding KMC • Teaching mothers and families how to practise KMC and detect danger signs • Familiarity with the most common problems and risk factors for all small and premature babies once discharged, and awareness of the need to ensure both medical follow-up and support to the family in a higher level of care or in a KMC program​me | • Mortality • Number of infants referred in kangaroo position • Number of LBW and premature infants who received breastfeeding within the first hour after birth |
2 | Corresponds to district, provincial or regional hospitals with or without neonatal units and with health staff varying accordingly | All healthcare workers: • Use of simple tools such as the Ballard test for assessment of gestational age Hospital setting without a neonatal unit: • Providing the initial management of immediate complications before referring the infant in the KMC position to a facility with a neonatal unit Hospital setting with a neonatal unit and ability to manage complications of prematurity (e.g. jaundice, sepsis, respiratory distress): • Full KMC training: - See also level 3 - Set-up and running of a KMC unit/ward - Conducting KMC follow-up clinics, with neurological assessment (could be high-risk follow-up, depending on availability of trained staff and the number of infants attended in the institution) | • Mortality (including cause of death) • Length of hospital stay • Breastfeeding rates • Number of days the infants received KMC • Infection rates during admission • Number of LBW and premature infants who arrive from level 1 with hypothermia or hypoglycaemia |
3 | Corresponds to teaching and university hospitals with neonatal intensive care (such as advanced ventilation and nutritional support) | Full KMC training • KMC components: - kangaroo position - kangaroo nutrition - early discharge with strict follow-up in the KMC ambulatory programme • Establishment and running of a KMC ward • KMC data collection and analysis • Initiation of KMC: should start as soon as possible, ideally in the delivery room or neonatal intensive care unit (NICU) • Transfer to level 2: once infants have been treated for complications they can be transferred back (‘stepped down’) to level 2 after completing 40 weeks of gestational age (presumed term) • High-risk follow-up to at least one year of corrected age: - monitoring of somatic growth and neurosensory and neuro-psychomotor development - with timely intervention by physical, audiometric or optometric therapists when needed • Specific developmental problems and needs of premature babies, including psychosocial support to parents (verbal and written information for and counselling of parents to improve their ability to cope with the new situation at home). | • Same as level 2 • Nutrition at discharge, 3, 6, 9 and 12 months corrected age • Neuro-psychomotor and sensory development • Number of infants readmitted to the NICU or KMC ward |