Background & Goals
Ethiopia is the second most populous African country with a population of nearly 103 million. Within Ethiopia, Amhara is a regional state with nearly one-quarter of the country’s population and roughly 84% of Amhara residents living in rural communities. Within the region, nearly a quarter of the newborns are born with a low birth weight (LBW). Improving newborn and LBW survival is critically important for Ethiopia and East Africa.
Despite a 75% reduction in Ethiopia’s under-5 mortality from 1990-2016, the neonatal mortality reduction was less than half. And as under-5 mortality has decreased, newborn mortality has grown to account for over half of all deaths among Ethiopian children under 5 years old. In particular, LBW infants are much more susceptible to sepsis and mortality compared to their normal birth weight counterparts.
KMC was formerly known as Kangaroo Mother Care when it was first developed in 1978. KMC is a feasible, high-impact and low-cost intervention for increasing survival among LMW infants. There is vast evidence to support KMC’s benefits for survival, yet fewer than 5% of eligible infants globally receive this type of care. The Collaborative KMC model uses transdisciplinary collaboration and co-creation strategies to expand access and use.
The Collaborative KMC model was designed, tested, implemented, and evaluated within Ethiopia’s health system to maximize sustainability and scalability. The model was optimized using one specialized, one general, and three primary hospitals in the Amhara region. It was developed collaboratively with the government health system and delivered by workers who were part of the health system, with inputs from the nurse-scientists research team. Further, biannual KMC performance review meetings in Amhara allowed front-line KMC nurses/clinicians, hospital leaders, implementation scientists, and regional government officials to jointly review KMC performance and co-create action strategies for increasing KMC. As a result of bi-directional learning, the Amhara Regional Health Bureau recruited additional nurses dedicated to KMC care.
Evidence of Success
The implementation of the Collaborative KMC model has resulted in high KMC coverage (63% of eligible infants at the population level), high KMC quality (16 hours of SSC) and 87% overall survival among KMC-initiated infants. These population-level, clinically-relevant impacts are particularly notable when baseline provision of any KMC (regardless of quality) was <5% at baseline in the region.
According to the national government’s 2020/21 annual administrative performance report for the Amhara region, 62.4% of LBW newborns received KMC care.
In a costing manuscript commissioned by the World Health Organization, costs associated with the Collaborative KMC Care model were estimated and demonstrated. The Collaborative KMC model costs were 55.5% of NICU-based care.