Thesis Protocol

DR. NIKITA

Supervisor: Dr. Harish Chellani

 Title
Barriers to practice KMC at home after
discharge from the hospital:
A prospective cohort study
 Introduction

• KMC consists of prolonged skin-to-skin (STS) contact

between mother & infant, exclusive breastfeeding ,
early discharge with adequate follow-up & support, and
initiation of the practice in the facility & continuation at
home. [WHO & INAP]
• KMC is an evidence-based approach to reducing
mortality and morbidity in preterm infants
[Conde-Agudelo A, Díaz-Rossello J 2014]
 Introduction

• In spite of these benefits, mothers may face barriers to

practice, some of which may prevent them from
achieving the prolonged STS contact with their infants
(a defining feature of KMC).

• In the existing literature some of the barriers which are

listed are: Lack of privacy and family support, lack of
time, difficulty in sleeping in KMC position, low
awareness of KMC/ infant health
 Lacunae in the existing literature

• Paucity of studies: very little evidence exist to support

the continued practice of KMC at home once the
mother and baby are discharged from the hospital
 Rationale for the study
• Despite the potential benefits, there is currently
insufficient data regarding the practice of KMC in home
setting especially with regard to its feasibility and the
potential influencing factors.

• To adequately implement and effectively scale-up this

intervention, it is critical to understand the key factors
that contribute to a mother's inability to practice KMC.
 RESEARCH QUESTION

What are the barriers to practice KMC at

home after discharge from the hospital?
 Aim of the Study

• To identify the factors that the mothers of

LBW infants perceive as barriers to perform
KMC at home after discharge from hospital
and to explore the timing and reasons for
discontinuation of KMC
 Objectives

PRIMARY OBJECTIVE : To identify the barriers to practice

KMC at home after discharge from the hospital

SECONDARY OBJECTIVES :
• To estimate the proportion of mothers who continued
to practice KMC at home
• To evaluate maternal perceptions and knowledge of
KMC at the time of discharge
 Materials & Methods
• Study design: Prospective cohort study

• Study venue: Newborn unit, Department of Pediatrics,

VMMC & Safdarjung Hospital, New Delhi.

• Duration of study: 18 months

• Study population: Healthy mothers who have been

discharged with their baby weighing ≤ 2 kg at birth from
the KMC ward
 Materials & Methods
Inclusion Criteria:
1. Inborn neonates with birth weight ≤ 2 kg and
discharged from KMC ward

Exclusion Criteria:
2. Residing at a distance of more than 20 kilometres
from the hospital
 Materials & Methods
Sample size: 250
• Assuming 50% of the mothers will be continuing to
practice kangaroo mother care at home, the sample
size is calculated as 200 for an alpha error 5% and
absolute precision ±7.
N = 4 pq/d2, p=50%, d=7

• Assuming a 25% dropout or loss to follow-up rate, a

final sample size of 250 is required for the study
 Materials & Methods
Enrolment:
• All inborn babies satisfying the inclusion criteria will be
enrolled in the study at the time of discharge after
taking informed written consent from one of the parents
and demographic details will be recorded in a
predesigned performa by the study investigator.
• Mothers will be interviewed at enrolment/discharge to
ascertain their knowledge and perceptions of KMC
• As part of routine care before discharge from KMC wards,
mothers will be encouraged to continue practicing KMC
at home and bring their babies every fortnightly for
follow up care till they attain a weight of 2500 g.
 Materials & Methods
Enrolment:
• After discharge babies will be followed up in high risk clinic by study
investigator. These mothers will be administered pretested
questionnaires in the local language Hindi at 30 days (± 5 days)
after discharge by the study investigator.
• A telephonic call will be made for the babies not turning for 4 week
post discharge follow-up and will be called in next follow-up clinic.
• The questionnaire will be developed in English language by
reviewing different literature and will be translated in to Hindi.
• The questionnaire will be pre-tested on 5% of the sample size
before the actual data collection period to make sure clarity of the
questionnaire. Based on the result of the pre-test, some
amendments may be made accordingly.
The following details will be recorded in these babies:
• Demographic parameters: age of the baby at discharge &
follow-up, singleton/twins, gender of the baby, gestational age
at discharge, birth weight, discharge weight, present weight,
maternal age, education & occupation of the mother,
socioeconomic status of the family, religion, nuclear/joint
family, feeding practices at discharge & follow-up
• Knowledge and perception of mother regarding KMC: will be
evaluated at discharge
• KMC practices at home: whether doing KMC or not, duration of
KMC in last 24 hours, who all practice KMC
• Various factors influencing KMC at home
The responses of the mother will be categorized as “agree”,
“uncertain” and “disagree”. The mothers will also encouraged to
express other significant factors not mentioned in the
questionnaire but which influenced KMC at home.
 Statistical analysis
• Analysis will be done using statistical software packages
SPSS 22.0 version
• Data will be entered into a predesigned performa
• Final data after recording would be entered in Excel
spreadsheet
• For continuous variables, mean ± SD will be calculated
• For categorical variables, frequency tables and
percentages will be calculated
Thank you