Promoting specialised and access to quality care for premature babies through the establishment and decentralization of Kangaroo Mother Care Units in Zambia

Background  The Neonatal unit at the Women and Newborn Hospital (WNH), University Teaching Hospital (UTH), Lusaka is a tertiary level referral hospital which receives neonates needing specialised care from all areas of Zambia. In 2021, daily patient census was in excess of 80 - 90 babies, stretching beyond the facility’s optimal occupancy as equipment, infrastructure and human resource capacity is only designed to accommodate 40 neonates at a time. Overcrowding of the facility led to suboptimal care as well as increased mortality due to cross infections. To decongest the neonatal unit and out-patient follow up clinics and reduce out of pocket costs for the families (who are often required to stay long distances from home for days or weeks at a time), we set up satellite Kangaroo Mother Care (KMC) units in some of the key delivery sites in Lusaka District that refer preterm babies to WNH. KMC, where preterm babies are carried by their mothers in direct skin to skin contact, remains a proven intervention in saving lives of preterm babies both in health care facilities and in the community, and in most cases reduce the need for an incubator which in the Zambian setting are largely inaccessible. Methods This innovation took a two pronged approach. Firstly, the identification of health facilities that had the required space. Most of the facilities chosen had recently undergone refurbishment through Ministry of Health and Japan International Cooperation Agency (JICA) support. Secondly, training was conducted for health workers identified to oversee these new satellite KMC facilities, thereby enabling care to be brought closer to home, and reducing the amount of referrals to Women and Newborn Hospital. Funding for training and implementation was carried out using funds from the ICATCH grant. Post training, the staff from WNH engaged with the implementation phase through weekly mentorship and supervision. Stable preterm babies would be transported from WNH to the satellite KMC facilities closest to their homes to continue KMC. Results Since commencing the transfer of premature babies from the tertiary hospital to the district hospitals in May 2021 to October 2022, a total of 233 patients were referred back to the new satellite KMC units from Women and Newborn Hospital. The total admissions to these facilities which included in-house admissions was 255. The average weight of the patients referred to the satellite sites was 1.544kg (weight range 1.18 -2.2kg). The mothers were mostly young mothers with an average age of 26 (age range 19 to 35) years. There was no mortality recorded during the hospital stay at the satellite facilities. We saw a reduced average length of stay in the hospital at the Women and Newborn Hospital KMC unit from 4-6 weeks to 2-3 weeks, a 33% reduction. The numbers of the premature babies being reviewed weekly in the outpatient clinic at the tertiary hospital dropped by 50 % from 40-60, to 20 - 30 patients per week over a six-month period. Additionally, the numbers of premature babies reviewed weekly in the district hospitals increased, with 1-9 patients being reviewed in each satellite facility per week, and total reviews of 60 patients in all the facilities over the six-month period. Conclusion The decentralisation of KMC neonatal units is a promising development in the efforts to achieve neonatal survival targets in Zambia. This KMC project has demonstrated that, even on a small scale and with limited resources, the health system can be strengthened. With upskilling of staff and redesign of services delivered close to home we have seen a reduction in morbidity related to hospital stay and a reduction in neonatal mortalities. This family centered care in the form of KMC closer to home and community has advanced equitable access to quality care services for premature neonates.