Community-based Kangaroo Mother Care in low-birth-weight infants: a quality improvement study in the urban slums of Kolkata, West Bengal

Abstract

Background: Kangaroo Mother Care (KMC) is recommended for low-birth-weight (LBW) infants in both facility and community, yet in India, KMC is largely confined to healthcare facilities. Evidence on the feasibility of implementing community-based KMC (c-KMC) in urban slum settings is limited. This quality improvement exploratory study explored the feasibility, safety, and adherence of implementing c-KMC in the urban slums of Kolkata, India. Methods: A preliminary qualitative assessment explored barriers to c-KMC through in-depth interviews with mothers of LBW infants (n = 3) who received facility-initiated KMC, and two focus group discussions with frontline health workers (n = 6). From September 1, 2023 to July 31, 2024, KMC was implemented on stable LBW newborns (≤2,200 g; n = 218) in community settings. Mothers received counselling, training, and KMC kits. Home visits were conducted on days 7, 14, and 28 after birth or discharge to reinforce KMC and breastfeeding. Results: Mothers had limited KMC knowledge and received minimal counselling, or follow-up post-discharge. Frontline health workers cited workload, population density, migration, and space constraints as major barriers to c-KMC. Among 218 infants enrolled, only 23.4% received facility-initiated KMC. Average KMC duration was 3.4 h/day at homes across follow-up visits. By day 28, 95% of mothers continued KMC, no KMC related adverse event was noted and 84% practiced exclusive breastfeeding. Conclusion: c-KMC implementation was feasible and safe in slum settings when supported through structured counselling, home visits, and trained workers. The findings support the operational feasibility of integrating c-KMC within existing home-based newborn care platforms.