When a mother gives birth to a low-birthweight baby in Nepal, she is advised by the health care provider to use a “wrap” to carry the baby for skin-to-skin care. This practice is a key feature of kangaroo mother care (KMC)—a proven intervention to help small babies survive by increasing the baby’s weight and regulating the baby’s body temperature. However, the traditional cloth that is commonly used to wrap the baby poses challenges, making it difficult for mothers and families to practice KMC.
As one mother stated, “The family member trained in the hospital for tying the traditional wrap is not always available at home, and when we seek help from other untrained relatives or neighbors, they cannot tie the wrap securely.”
Globally, 60%–80% of newborn deaths are low-birthweight babies. In Nepal, there are 81,000 premature/low-birthweight babies born annually, with approximately 10,400 infant deaths due to premature/low-birthweight complications. KMC can prevent many of these deaths, but it is not widely used in Nepal. Nepal has worked to reduce newborn mortality, but knows there is still more to do.
A recent Jhpiego study in Nepal, which aims to increase the use of KMC, offers hope for families to more easily practice this lifesaving intervention for their babies. Funded by Laerdal Global Health, the study trained nurse-midwives in KMC at two Nepalese hospitals using a Jhpiego-developed training package. After nurse-midwives were equipped with the necessary skills, they counseled, trained, supported and provided follow-up to families with stable, low-birthweight babies. Families were offered a choice between taking home a traditional wrap or a new wrap known as CarePlus and designed by Laerdal Global Health.
Over a period of five months, nurse-midwives enrolled 96 women with low-birthweight babies. Of those, 82 women chose the CarePlus wrap and 14 women chose the traditional wrap. Results showed that mothers who selected the CarePlus wrap performed skin-to-skin contact for about 77 hours more than traditional wrap users.
In focus group discussions and in-depth interviews, mothers who selected the CarePlus wrap said it was easy to tie and could be tied without the help of another person. They found the wrap secure for the baby, more comfortable, easy to carry and rest with the baby, and family members preferred the new wrap.
Mothers who chose the traditional wrap reported challenges, such as having difficulty tying the wrap, being fearful that the baby would fall and be injured, and feeling uncomfortable. Fathers were also more reluctant to practice KMC with the traditional wrap because it is a cloth worn by women.
“My husband … had carried the baby during hospital stay, but as I chose the traditional wrap, he avoided carrying the baby in the traditional wrap at home,” reported one mother who did not practice KMC at home.
All of the mothers who chose the CarePlus wrap performed household chores while practicing KMC with the baby; however, none of the mothers who chose the traditional wrap performed household chores while practicing KMC.
The results of this study offer promise for Nepal to increase utilization of KMC and prevent more newborn deaths. The study found that building capacity of nurse-midwives and providing the CarePlus wrap resulted in increased KMC practice. Scale-up of the intervention, including the preferred CarePlus wrap, by the Ministry of Health could help Nepal advance its efforts to decrease newborn deaths.