Tinku Thomas, Arin Kar, Suman P N Rao, Swaroop Narayana, Maryann Washington, Shashidhar Rao, K. Jayanna, Prabhu Deva Gowda, M. Lakkappa, P. Mony
{"title":"扩大袋鼠妈妈护理对印度南部一个地区出生体重小于 2000 克的新生儿死亡率的影响：前瞻性队列分析","authors":"Tinku Thomas, Arin Kar, Suman P N Rao, Swaroop Narayana, Maryann Washington, Shashidhar Rao, K. Jayanna, Prabhu Deva Gowda, M. Lakkappa, P. Mony","doi":"10.1136/bmjph-2023-000349","DOIUrl":null,"url":null,"abstract":"To assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Within an implementation research setting, analysis of a prospective birth cohort of babies with birth weight <2000 g born during March–December 2018 in Koppal district of Karnataka state, India, to estimate the incidence, risk and HRs of neonatal mortality associated with KMC.Initiation and maintenance of KMC.Neonatal mortality.Among 23 667 live births, 1152 (4.9%) had birth weight <2000 g; the birth weight was <1500 g in 24% and <1000 g in 4%. Among them, 213 (18%, 95% CI 16% to 21%) babies died during the neonatal period, with 56% of the mortality occurring in the first 3 days of life and risk of mortality decreasing with higher birth weight. Overall, KMC was initiated in 816 (71%) babies; KMC-initiated babies had a substantially lower risk of neonatal mortality (risk ratio 0.07 (95% CI 0.05 to 0.09)). In a subset of 705 babies ‘eligible-for-KMC’ after exclusion of deaths, referrals or ‘terminal discharges’ (leaving against medical advice) in the first 3 days of life, and whose mother was a resident of the study area, 88% (95% CI 85% to 90%) were initiated on KMC. The RR of mortality among KMC-initiated babies remained low at 0.05 (95% CI 0.03 to 0.08) after adjusting for covariates and propensity-score adjusted analysis to address selection bias. Among 874 babies with follow-up data till 29 days of life, neonatal mortality rate was 24.4% (95% CI 21.6% to 27.3%); it was 6.4% (95% CI 4.7% to 8.6%) among KMC-initiated babies and 74.8% (95% CI 67.8% to 79.1%) among non-initiated babies (n=233).KMC implementation across a district was associated with substantial reduction in neonatal mortality. Scaling up KMC coverage across large geographies could facilitate achieving global child survival targets.","PeriodicalId":117861,"journal":{"name":"BMJ Public Health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight <2000 g in a district in southern India: a prospective cohort analysis\",\"authors\":\"Tinku Thomas, Arin Kar, Suman P N Rao, Swaroop Narayana, Maryann Washington, Shashidhar Rao, K. Jayanna, Prabhu Deva Gowda, M. Lakkappa, P. Mony\",\"doi\":\"10.1136/bmjph-2023-000349\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"To assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Within an implementation research setting, analysis of a prospective birth cohort of babies with birth weight <2000 g born during March–December 2018 in Koppal district of Karnataka state, India, to estimate the incidence, risk and HRs of neonatal mortality associated with KMC.Initiation and maintenance of KMC.Neonatal mortality.Among 23 667 live births, 1152 (4.9%) had birth weight <2000 g; the birth weight was <1500 g in 24% and <1000 g in 4%. Among them, 213 (18%, 95% CI 16% to 21%) babies died during the neonatal period, with 56% of the mortality occurring in the first 3 days of life and risk of mortality decreasing with higher birth weight. Overall, KMC was initiated in 816 (71%) babies; KMC-initiated babies had a substantially lower risk of neonatal mortality (risk ratio 0.07 (95% CI 0.05 to 0.09)). In a subset of 705 babies ‘eligible-for-KMC’ after exclusion of deaths, referrals or ‘terminal discharges’ (leaving against medical advice) in the first 3 days of life, and whose mother was a resident of the study area, 88% (95% CI 85% to 90%) were initiated on KMC. The RR of mortality among KMC-initiated babies remained low at 0.05 (95% CI 0.03 to 0.08) after adjusting for covariates and propensity-score adjusted analysis to address selection bias. Among 874 babies with follow-up data till 29 days of life, neonatal mortality rate was 24.4% (95% CI 21.6% to 27.3%); it was 6.4% (95% CI 4.7% to 8.6%) among KMC-initiated babies and 74.8% (95% CI 67.8% to 79.1%) among non-initiated babies (n=233).KMC implementation across a district was associated with substantial reduction in neonatal mortality. 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引用次数: 0
摘要
在实施研究环境中，对印度卡纳塔克邦科普帕尔县2018年3月至12月期间出生体重＜2000克婴儿的前瞻性出生队列进行分析，以估计与袋鼠妈妈护理相关的新生儿死亡率的发生率、风险和HRs。在 23 667 名活产婴儿中，有 1152 名（4.9%）出生体重＜2000 克；出生体重＜1500 克的占 24%，＜1000 克的占 4%。其中，213 名婴儿（18%，95% CI 16% 至 21%）在新生儿期死亡，56% 的死亡发生在出生后的头 3 天，死亡风险随着出生体重的增加而降低。总体而言，816 名（71%）婴儿开始接受 KMC；开始接受 KMC 的婴儿的新生儿死亡风险大大降低（风险比为 0.07（95% CI 0.05 至 0.09））。在剔除了出生后 3 天内死亡、转诊或 "临终出院"（不听医嘱离院）的 705 名 "符合 KMC 条件 "的婴儿中，88%（95% CI 85%至 90%）的母亲是研究地区的居民，这些婴儿开始接受 KMC 治疗。经过协变量调整和倾向分数调整分析以解决选择偏差问题后，开始接受 KMC 治疗的婴儿的死亡率仍保持在 0.05（95% CI 0.03 至 0.08）的较低水平。在874名随访至出生后29天的婴儿中，新生儿死亡率为24.4%（95% CI 21.6%至27.3%）；接受KMC治疗的婴儿死亡率为6.4%（95% CI 4.7%至8.6%），未接受KMC治疗的婴儿死亡率为74.8%（95% CI 67.8%至79.1%）（n=233）。在大范围内扩大KMC的覆盖面有助于实现全球儿童生存目标。
Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight <2000 g in a district in southern India: a prospective cohort analysis
To assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Within an implementation research setting, analysis of a prospective birth cohort of babies with birth weight <2000 g born during March–December 2018 in Koppal district of Karnataka state, India, to estimate the incidence, risk and HRs of neonatal mortality associated with KMC.Initiation and maintenance of KMC.Neonatal mortality.Among 23 667 live births, 1152 (4.9%) had birth weight <2000 g; the birth weight was <1500 g in 24% and <1000 g in 4%. Among them, 213 (18%, 95% CI 16% to 21%) babies died during the neonatal period, with 56% of the mortality occurring in the first 3 days of life and risk of mortality decreasing with higher birth weight. Overall, KMC was initiated in 816 (71%) babies; KMC-initiated babies had a substantially lower risk of neonatal mortality (risk ratio 0.07 (95% CI 0.05 to 0.09)). In a subset of 705 babies ‘eligible-for-KMC’ after exclusion of deaths, referrals or ‘terminal discharges’ (leaving against medical advice) in the first 3 days of life, and whose mother was a resident of the study area, 88% (95% CI 85% to 90%) were initiated on KMC. The RR of mortality among KMC-initiated babies remained low at 0.05 (95% CI 0.03 to 0.08) after adjusting for covariates and propensity-score adjusted analysis to address selection bias. Among 874 babies with follow-up data till 29 days of life, neonatal mortality rate was 24.4% (95% CI 21.6% to 27.3%); it was 6.4% (95% CI 4.7% to 8.6%) among KMC-initiated babies and 74.8% (95% CI 67.8% to 79.1%) among non-initiated babies (n=233).KMC implementation across a district was associated with substantial reduction in neonatal mortality. Scaling up KMC coverage across large geographies could facilitate achieving global child survival targets.
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