Effect of kangaroo mother care initiated in community settings on financial risk protection of low-income households: a randomised controlled trial in Haryana, India

Abstract

Introduction: Many families in low-income and middle-income countries have high out-of-pocket expenditures (OOPE) for healthcare, and some face impoverishment. We aimed to assess the effect of Kangaroo Mother Care initiated in community setting (ciKMC) on financial risk protection estimated by healthcare OOPE, catastrophic healthcare expenditure (CHE) and impoverishment due to healthcare seeking for low birthweight infants, using a randomised controlled trial design.

Methods: We included 4475 low birthweight infants randomised to a ciKMC (2491 infants) and a control (1984 infants) arm, in a large trial conducted between 2017 and 2018 in Haryana, India. We used generalised linear models of the Gaussian family with an identity link to estimate the mean difference in healthcare OOPE, and Cox regression to estimate the HRs for CHE and impoverishment, between the trial arms.

Results: Overall, in the 8-week observation period, the mean healthcare OOPE per infant was lower (US$20.0) in the ciKMC arm compared with the control arm (US$25.6) that is, difference of -US$5.5, 95% CI -US$11.4 to US$0.3, p=0.06). Among infants who sought care it was US$8.5 (95% CI -US$17.0 to -US$0.03, p=0.03) lower in the ciKMC arm compared with the control arm. The HR for impoverishment due to healthcare seeking was 0.56 (95% CI 0.36 to 0.89, p=0.01) and it was 0.91 (95% CI 0.74 to 1.12, p=0.37) for CHE.

Conclusion: ciKMC can substantially reduce the cost of care seeking and the risk of impoverishment for households. Our findings show that supporting mothers to provide KMC to low birthweight infants at home, in addition to reducing early infant mortality, may provide financial risk protection.

Trial registration number: CTRI/2017/10/010114.

Keywords: Child health; Health economics; Health policy.

Figure 1

Trial profile. Note: The data safety and monitoring board stopped the trial before the last enrolled child could complete 180 days follow-up. Hence, at the time the trial ended, we missed eight weeks of information on care seeking expenditures if the child was younger than 28 days, 4 weeks if the child was younger than 90 days, and 2 weeks if the child age was younger than 180 days old. ciKMC, Kangaroo Mother Care initiated in community setting.

Figure 2

Pen’s parade graph of the distribution of total household expenditure and the net of healthcare OOPE for the ciKMC and control arm households. ciKMC, Kangaroo Mother Care initiated in community setting; OOPE, out-of-pocket expenditures.