AbstractBackground: Kangaroo Mother Care (KMC) is recommended for small and preterm infants, yet adherence often declines after hospital discharge. Leveraging community health workers (CHWs) to support continuation at home may sustain practice and improve early outcomes.
Objective: To evaluate whether a structured, CHW-supported post-discharge package increases KMC adherence and exclusive breastfeeding and improves early growth compared with standard counselling.
Methods: We conducted a pragmatic, parallel-arm cluster randomized pilot across 24 primary-care catchments (12 per arm) including 240 stable low-birth-weight infants (1500-2499 g) initiated on KMC in facility care and discharged home. Clusters were randomized 1:1 to CHW-supported continuation (home visits on days 1, 2, 3, 5, 7, 10, 14; tele-check-ins to 6 weeks; on-call referral) or standard post-discharge counselling. Primary outcomes were mean KMC hours/day during days 1-14 and exclusive breastfeeding at 6 weeks. Secondary outcomes were growth velocities to 6 weeks, anthropometric z-scores at 6 and 12 weeks, illness episodes, and readmissions. Analyses were intention-to-treat using mixed-effects models accounting for clustering.
Results: Baseline characteristics were balanced. The intervention achieved higher mean KMC duration than control (7.8 vs 3.6 hours/day; adjusted mean difference 4.2 hours; 95% CI 3.6-4.8; p<0.001) and greater exclusive breastfeeding at 6 weeks (78.3% vs 61.7%; adjusted OR 1.95; 95% CI 1.15-3.32; p=0.013). Growth outcomes favored the intervention: weight gain +4.4 g/day (95% CI 2.7-6.1; p<0.001), length gain +0.6 mm/week (95% CI 0.2-0.9; p=0.004), head-circumference gain +0.5 mm/week (95% CI 0.2-0.7; p=0.001), with higher WAZ at 6 weeks (Δ 0.19; p=0.014) and 12 weeks (Δ 0.27; p=0.002). Illness and readmission trends favored the intervention but were not statistically significant; no safety concerns emerged.
Conclusion: A protocolized CHW package sustained KMC practice beyond discharge, increased exclusive breastfeeding, and improved early growth under routine conditions. Embedding post-discharge KMC support within existing community newborn programs appears feasible and scalable. A fully powered trial is warranted to confirm clinical endpoints and cost-effectiveness.
