To Assess the Effectiveness of a Structured Teaching Program on Knowledge Regarding Kangaroo Mother Care Among Postnatal Mothers in District Hospital Kishtwar

Introduction

Kangaroo Mother Care (KMC) is a proven, cost-effective intervention recommended by the World Health Organization (WHO), which involves prolonged skin-to-skin contact between mother and newborn, exclusive breastfeeding, early discharge, and close postnatal follow-up. Numerous studies have highlighted its significant benefits, including improved thermoregulation, accelerated weight gain, enhanced maternal-infant bonding, and a reduction in neonatal morbidity and mortality [1]. Despite its effectiveness, the adoption of KMC remains limited, particularly in rural and resource-limited settings such as Kishtwar, due to persistent knowledge gaps, cultural barriers, and misconceptions [2].

Globally, approximately 30 million infants are born each year under high-risk conditions, including preterm births, low birth weight, and being small for gestational age (SGA), all of which are associated with increased risk of illness, disability, and mortality [3]. Preterm birth complications continue to be a leading cause of neonatal death. KMC has emerged as a crucial strategy to improve the survival and health outcomes of these vulnerable infants [4].

The neonatal period remains the most critical phase for child survival, with a significant proportion of under-five mortality occurring within the first 28 days of life. In 2017 alone, an estimated 2.5 million neonatal deaths were recorded worldwide—approximately 80% of which involved low birth weight infants, and nearly two-thirds were born preterm [5]. In this context, the wider implementation of Kangaroo Mother Care represents a vital opportunity to address preventable neonatal deaths and promote equity in neonatal healthcare.

The term “Kangaroo Mother Care” was coined because of its resemblance to how kangaroos carry their young in a pouch. This innovative approach was initially developed in the 1970s by Colombian paediatricians Edgar Rey and HéctorMartínez.‘Skin-to-Skin Contact, where in KMC, the infant is placed skin-to-skin on the mother’s chest, typically beneath her clothing, promoting direct physical contact [6]. This skintoskin contacts helpand to regulate the baby’s body temperature, heart rate, and breathing. KMC encourages exclusive breastfeeding, providing essential nutrients and promoting bonding between the mother and infant. Supportive Environment, KMC emphasizes a nurturing environment where mothers are educated on infant care and are encouraged to stay close to their babies throughout the day and night.  KMC is particularly beneficial for premature infants and has been associated with several advantages [7]. Thermal Regulation, Skin-to-skin contact helps maintain the infant’s body temperature, reducing the risk of hypothermia. Respiratory Stability, where KMC has been shown to improve respiratory rates and oxygen saturation in preterm infants. ‘Weight Gain Infants practicing KMC often experience improved weight gain, which is crucial for their development. Kangaroo care supports early initiation and successful breastfeeding, providing essential nutrients and antibodies. KMC promotes maternal-infant bonding, reducing stress for both mother and baby [8]. Reduction in Hospitalization, where in some cases, KMC has led to shorter hospital stays for premature infants. Kangaroo Mother Care has gained recognition and is recommended by organizations such as the World Health Organization (WHO) as a cost-effective and safe method for improving the health and well-being of premature infants, especially in low-resource healthcare settings. It is an approach that empowers mothers to actively participate in the care of their infants, enhancing the chances of survival and healthy development for these vulnerable new-borns'[9-13].

Postnatal mothers, also referred to as postpartum mothers, are women who have recently given birth and are in the period following childbirth. The postnatal period, often called the postpartum period, typically extends from the hours immediately after birth to about six weeks after delivery [14-15]. This is a critical phase during which both the mother and her new-born require special care and attention. The concepts associated with postnatal mothers, postnatal mothers undergo physical changes and recovery after childbirth. This period involves healing from any surgical procedures (e.g., caesarean section) and physical adjustments as the body returns to its pre-pregnancy state. The postnatal period can be emotionally challenging for mothers due to hormonal fluctuations and the adjustment to a new role. Emotional support and mental health during this time are essential. Postnatal mothers are responsible for the care of their new-born infants. This includes feeding, changing diapers, soothing, and ensuring the infant’s overall well-being[16-18].

This study aims to assess the impact of a structured teaching program on KMC knowledge among postnatal mothers in District Hospital Kishtwar. By evaluating pre-intervention and post-intervention knowledge levels, this research provides insight into the effectiveness of educational programs in promoting evidence-based neonatal care practice.

Objectives

1. To assess pre-intervention knowledge levels of postnatal mothers regarding KMC.
2. To implement a structured teaching program on KMC.
3. To evaluate the effectiveness of the teaching program through post-intervention assessment.
4. To identify factors influencing KMC knowledge retention and adoption.

Literature Review

A study was conducted in 2014 regarding Kangaroo mother care (KMC) is a nonconventional low‐cost method of new-born care. The aim was to assess the effect of sustained KMC on the growth and development of low birth weight Indian babies up to the age of 12 months. As enrolled 500 mother and baby pairs, in groups of five, in a parallel group controlled clinical trial. The three infants with the lowest birth weight in each group received KMC, while the other two received conventional care. All babies were exclusively breastfed for 6 months. Babies in the intervention group were provided KMC until the infant was 40 weeks of corrected gestation or weighed 2500 g. Weight, length and head, chest and arm circumferences were evaluated at birth and at the corrected ages of 0, 3, 6, 9 and 12 months. Development was assessed using the Developmental Assessment Scales for Indian Infants (DASII) at 12 months [6].

A descriptive study was conducted (in 2022) to assess the knowledge regarding kangaroo mother care among postnatal mothers. Data was collected regarding knowledge of kangaroo mother care by structured knowledge questionnaire. The study was conducted at selected hospitals of Gulbarga, a total of 60 post natal mothers who were selected by using non probability convenience sampling technique. The study results revealed that 53% of post natal mothers had poor knowledge regarding kangaroo mother care followed by 45% had average knowledge and least i.e. 1% had good knowledge regarding kangaroo mother care. The knowledge scores ranged from 01-23. Mean knowledge score was 9.18 with a standard deviation of ±4.45 [7].

A studywas conducted in 2021 which is a hospital-based descriptive cross-sectional survey of sixty mothers selected from the Neonatal ward of the Lagos University Teaching Hospital (LUTH), Idi-Araba using convenient sampling technique. Data was collected with the use of a questionnaire and analysed using descriptive statistics. Frequency and percentages were presented in tables and chi-square was used to test associations between categorical variables; p-value <0.05 was considered significant. The findings revealed that 80% of respondents had heard of kangaroo mother care with 66.6% having good knowledge. Two-thirds (65%) of the respondents had a good attitude towards the use of KMC with 71.7% feeling happy when their baby is in kangaroo position. The knowledge of mothers significantly influenced their attitude and practice of KMC, p <0.05[8].

A study was conducted in Azamgarh, Uttar Pradesh, in 2021 to evaluate the effectiveness of a Structured Teaching Programme (STP) on enhancing knowledge regarding Kangaroo Mother Care (KMC) among postnatal mothers. The study involved 30 postnatal mothers whose infants were admitted to the Neonatal Intensive Care Unit (NICU). Initially, a pre-test was administered using a structured knowledge questionnaire to assess baseline knowledge about KMC. Following this, the Structured Teaching Programme was implemented, and a post-test was conducted to evaluate knowledge gains.The pre-test results indicated that 50% (15 mothers) had an average level of knowledge, 16.66% demonstrated good knowledge, while 33.33% (10 mothers) had poor knowledge regarding KMC. However, after the implementation of the structured teaching module, a significant improvement was observed: 53.3% of the mothers attained a good level of knowledge, 46.6% showed average knowledge, and none remained in the poor knowledge category.The study concluded that the Structured Teaching Programme was effective in significantly improving the knowledge of postnatal mothers regarding Kangaroo Mother Care, emphasizing its potential as a practical educational tool in neonatal care settings [9].

A study conducted in 2016 aimed to assess the knowledge of Kangaroo Mother Care (KMC) among postnatal mothers at JSS Hospital, Mysuru. The study included 60 postnatal mothers who were selected using a non-probability convenience sampling technique. Data were collected through a structured knowledge questionnaire designed to evaluate understanding of KMC practices. The findings revealed that 53% of the participants had poor knowledge, 45% demonstrated average knowledge, and only 1% exhibited good knowledge of KMC. The knowledge scores among the mothers ranged from 1 to 23, with a mean score of 9.18 ± 4.45, highlighting a general lack of awareness and the need for effective educational interventions [10].A study conducted in 2016 addressed the concern that low birth weight accounts for 30% of live births, posing a significant risk for neonatal mortality. Given that adherence to Kangaroo Mother Care (KMC) is critical for reducing neonatal deaths, the aim of the study was to enhance maternal knowledge regarding KMC.

The findings revealed that during the pre-test, 15 mothers (50%) had inadequate knowledge, 14 (46%) had moderate knowledge, and only 1 (3%) demonstrated adequate knowledge. In contrast, the post-test showed that only 2 mothers (6%) had moderate knowledge, while 28 (94%) achieved adequate knowledge. The overall mean score improved significantly from 8.86 (SD = 9.4) in the pre-test to 20 (SD = 12) in the post-test, with a t-value of 3.04, which is significant at the 0.005 level.Thus, the Structured Teaching Programme was effective in improving maternal knowledge of Kangaroo Mother Care, and the study concluded that the intervention was successful [11].

Methodology

A quasi-experimental pre-test and post-test research design was adopted to assess the effectiveness of the structured teaching program on KMC knowledge among postnatal mothers.

Results The study results indicate a significant improvement in postnatal mothers’ knowledge following the structured teaching program.

Findings

1. The structured teaching program significantly improved maternal knowledge about KMC, as evidenced by the increase in mean knowledge scores from 9.5/20 to 17/20.
2. The proportion of mothers with inadequate knowledge reduced from 65% to 20%, while those with good knowledge increased from 10% to 30%.
3. The results were statistically significant (p-value < 0.05), confirming that the intervention had a meaningful impact on knowledge improvement.
4. Factors contributing to improved knowledge retention included visual aids, interactive demonstrations, and printed informational materials provided during the sessions.
5. Barriers to knowledge retention and adoption of KMC practices included pre-existing cultural beliefs, limited literacy levels, and lack of prior exposure to KMC-related information.

Discussion

The study findings highlight the effectiveness of structured educational programs in increasing awareness and adoption of KMC among postnatal mothers. Mothers exposed to the intervention exhibited greater knowledge retention and willingness to practice KMC. However, barriers such as low literacy levels, cultural beliefs, and limited hospital resources must be addressed for long-term sustainability. Integrating KMC education into routine maternal health services and ensuring continuous reinforcement can help improve neonatal care outcomes.The structured teaching program significantly enhanced knowledge regarding KMC among postnatal mothers in District Hospital Kishtwar. To ensure sustained practice and positive neonatal outcomes, the following recommendations are proposed:

1. Integration into Maternal Health Programs: Routine KMC education should be included in antenatal and postnatal care services.
2. Training of Healthcare Providers: Nurses and midwives should receive specialized training on KMC education.
3. Community Awareness Campaigns: Outreach programs should target rural populations to address cultural barriers.
4. Further Research: Longitudinal studies should assess long-term behavioural changes and neonatal health outcomes post-intervention.
5. Policy Implementation: Government and healthcare authorities should mandate KMC education in all maternity hospitals to ensure standardized knowledge dissemination.

References

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