Safety, effectiveness and barriers to follow-up using an 'early discharge' Kangaroo Care policy in a resource poor
Hannah Blencowe1, Marko Kerac, Elizabeth Molyneux
1College of Medicine of Malawi, Paediatric Department, P/Bag 360, Blantyre, Malawi. hblencowe@gmail.com
Insights
Early discharge for low-birth-weight infants using Kangaroo care is safe. However, higher outpatient mortality in infants under 1500g highlights the need to address healthcare access barriers.
Area of Science:
- Neonatal care
- Public health
- Pediatrics
Background:
- Low-birth-weight (LBW) infants require specialized care.
- Kangaroo care (KC) is a proven method for improving LBW infant outcomes.
- Early discharge policies aim to optimize resource utilization and family bonding.
Purpose of the Study:
- To evaluate the outcomes of LBW infants managed under an early discharge Kangaroo care policy.
- To identify barriers to post-discharge follow-up care for these infants.
Main Methods:
- Prospective descriptive study conducted in Malawi from November 2003 to May 2004.
- Included 272 infants admitted to a Kangaroo Care Ward.
- Infants discharged when weighing over 1300g and gaining weight, with follow-up until 2500g.
Main Results:
- 73.9% of infants reached the target weight of 2500g.
- Overall mortality was 16.9%, with higher outpatient mortality for infants discharged under 1500g (RR = 2.41).
- Identified barriers included transportation issues and delayed illness recognition.
Conclusions:
- Early discharge using Kangaroo care is feasible and safe for LBW infants.
- Healthcare access barriers significantly impact post-discharge outcomes, particularly for vulnerable subgroups (<1500g).
- Further research is needed to reduce mortality in specific high-risk infant populations.
Aim:
To describe the outcomes of low-birth-weight babies using an 'early discharge' Kangaroo care policy and to identify barriers to their follow-up.
Methods:
Prospective descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004. Infants were discharged to outpatient care once weighing over 1300 g and gaining weight. Follow-up was carried out until 2500 g.
Results:
Infants [201 of 272 (73.9%)] reached a weight >2500 g; 46 out of 272 (16.9%) died; outcome was unknown in 25 of 272 (9.2%). Outpatient mortality was higher amongst discharges weighing under 1500 g [RR = 2.41(1.25-4.63) P = 0.01]. Discharge below birth weight did not affect mortality [RR = 0.77(0.40-1.46) P = 0.42]. Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness.
Conclusions:
Early discharge is safe and feasible, but issues regarding access to healthcare need to be addressed. Future research is needed to determine how best high mortality can be reduced in specific subgroups: notably infants <1500 g.
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