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Observational Study
. 2025 Apr 9;25(1):283.
doi: 10.1186/s12887-025-05629-1.

Kangaroo mother care among hospitalised neonates: evaluation of the validity of duration measurement methods compared to observation linked to the OMWaNA trial in Uganda

Victor S Tumukunde  1   2 , Isaac Sekitoleko  3 , Charles Opondo  4 , Moffat Nyirenda  3 , Cally J Tann  3   5   6 , Joy E Lawn  5 , Melissa M Medvedev  5   7
Affiliations
Observational Study

Kangaroo mother care among hospitalised neonates: evaluation of the validity of duration measurement methods compared to observation linked to the OMWaNA trial in Uganda

Victor S Tumukunde et al. BMC Pediatr. .

Abstract

Background: Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates ≤ 2000 g in Uganda.

Methods: This observational study was embedded within the OMWaNA trial, which examined the impact of KMC on neonatal mortality before clinical stability. An independent observer (considered the gold standard) monitored neonates every 2 h to confirm KMC position, using an Android tablet-based application adapted from the EN-BIRTH study. The gold standard was compared to routine healthcare workers' charting and caregiver diary reports of KMC.

Results: Among 222 caregiver-newborn pairs, 219 initiated KMC. The mean daily KMC duration recorded by the gold standard was 8·4 h (SD 3·5). Healthcare workers reported an average of 8·5 h (SD 4·0), while caregivers reported 10·4 h (SD 3·8). The mean difference was 0·2 h less for healthcare workers (95% CI -0·3 to 0·6) and 1·7 h more for caregivers (-2·1 to -1·3) compared to the gold standard. Agreement rates for individual KMC episodes were 55·2% (95% CI 54·4-55·9) for healthcare workers and 58·2% (57·2-59·0) for caregivers. Participants with a helper (substitute KMC provider) had longer daily duration compared to those without (mean difference 1·89 h [0·89 - 2·84]; p < 0·001).

Conclusion: Healthcare worker records provide a reasonably accurate estimate of KMC duration at the population level, supporting the integration of KMC indicators into national health information systems to facilitate monitoring and evaluation. The presence of a helper increases KMC duration, underscoring the need for research to identify strategies to increase family involvement.

Keywords: Kangaroo mother care; Low-birth-weight; Neonate; Prematurity; Validation.

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Conflict of interest statement

Declarations. Consent for publication: The manuscript does not contain any person’s data that requires consent for publication. Competing interests: The authors declare no competing interests. Ethics approval and consent to participants: Informed consent was obtained from all participating mothers/caregivers before enrolment in the study. All data were collected and handled following strict confidentiality standards. This study was conducted in compliance with the ethical principles of the Helsinki Declaration and approved by the Research Ethics Committees of the Uganda Virus Research Institute (GC/127/21/05/825), the London School of Hygiene and Tropical Medicine (#26394), and the University of California San Francisco (#21-33657).

Figures

Fig. 1
Fig. 1
Mean daily KMC duration comparing observation with healthcare worker record and caregiver report
Fig. 2A
Fig. 2A
Mean difference in daily KMC duration between independent observers’ and healthcare workers’ records
Fig. 2B
Fig. 2B
Mean difference in daily KMC duration between independent observers’ and caregivers’ reports
See this image and copyright information in PMC

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