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Effect of Kangaroo Mother Care on Survival of Low-Birth-Weight Infants in Nigerian Hospitals

Abstract

Low birth weight remains an important public health concern and a major contributor to neonatal morbidity and mortality, particularly in low- and middle-income countries. Low-birth-weight infants are at increased risk of hypothermia, infection, feeding difficulties, respiratory complications, poor growth, and death, especially when appropriate newborn care is unavailable. Kangaroo Mother Care (KMC) is a supportive newborn-care intervention involving prolonged skin-to-skin contact between a mother or caregiver and a newborn, together with appropriate breastfeeding support, early discharge when clinically suitable, and continued follow-up. KMC provides an opportunity to promote thermal regulation, breastfeeding, bonding, and early recognition of newborn complications while reducing some of the challenges associated with conventional neonatal care. In Nigeria, barriers such as inadequate neonatal facilities, shortages of healthcare workers, limited access to specialized newborn care, financial constraints, and insufficient awareness of evidence-based newborn interventions may affect the survival of low-birth-weight infants. Strengthening KMC services within Nigerian hospitals may therefore provide an effective and relatively low-cost approach to improving outcomes among vulnerable newborns. Against this background, this study investigates the effect of Kangaroo Mother Care on the survival of low-birth-weight infants in Nigerian hospitals. The study will be anchored on Attachment Theory, the Health Systems Framework, and the Theory of Planned Behaviour. Attachment Theory emphasizes the importance of early physical contact between caregivers and infants and provides a basis for understanding the potential physiological and psychological benefits of skin-to-skin contact. The Health Systems Framework emphasizes service delivery, health workforce, essential medicines and technologies, health information, financing, and access to appropriate healthcare as important components of effective neonatal care. The Theory of Planned Behaviour provides a framework for understanding caregivers' adoption and continued practice of KMC based on behavioural intentions and perceived control. Collectively, these theoretical perspectives provide a suitable framework for explaining how KMC implementation may influence the survival of low-birth-weight infants in Nigerian hospitals. The study will adopt a quantitative retrospective or prospective cohort research design, depending on the availability and quality of hospital records. Data will be collected from mothers and low-birth-weight infants receiving neonatal care in selected public and private hospitals across selected locations in Nigeria. A multistage sampling technique will be used to select states, hospitals, neonatal units, and eligible mother-infant pairs. Kangaroo Mother Care will be assessed using indicators such as initiation of skin-to-skin contact, timing of KMC initiation, duration of daily skin-to-skin contact, frequency of KMC sessions, breastfeeding support, caregiver participation, monitoring of infant temperature and weight, KMC education, continuity of KMC, and follow-up after discharge. Infant survival will be assessed using indicators such as survival to hospital discharge, survival within a specified post-discharge period, neonatal mortality, length of hospital stay, weight gain, and occurrence of major neonatal complications. Data will be obtained from neonatal records, KMC registers, maternal interviews, and hospital records where appropriate. Descriptive statistics will be used to summarize participants' characteristics, KMC utilization, and infant survival patterns. Inferential statistical techniques, including chi-square tests, survival analysis, correlation analysis, and regression analysis, will be used to determine the effect of KMC on the survival of low-birth-weight infants. Diagnostic tests will also be conducted to assess the reliability and robustness of the findings. The study is expected to find that appropriate and consistent Kangaroo Mother Care has a significant positive effect on the survival of low-birth-weight infants in Nigerian hospitals. Infants who receive regular KMC are expected to demonstrate improved survival compared with infants who receive limited or no KMC. Prolonged skin-to-skin contact may promote thermal stability, improve breastfeeding and feeding practices, support weight gain, reduce physiological stress, and strengthen early mother-infant interaction. KMC may also facilitate closer monitoring of vulnerable newborns and promote earlier recognition of danger signs requiring clinical intervention. Conversely, inadequate KMC implementation, limited caregiver education, insufficient privacy or space, shortages of trained healthcare personnel, poor hospital infrastructure, and inconsistent follow-up may reduce its effectiveness. However, KMC alone may not fully determine infant survival because birth weight, gestational age, neonatal complications, infection, respiratory problems, availability of neonatal intensive care, quality of clinical management, and timing of treatment may also influence survival outcomes. The study is expected to contribute to the literature on Kangaroo Mother Care, low-birth-weight infants, neonatal survival, newborn health, maternal and child health, neonatal nursing, paediatrics, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, neonatal units, paediatric and nursing departments, maternal and newborn health programme managers, healthcare professionals, development partners, and policymakers regarding strategies for improving neonatal survival. The study will also provide evidence-based recommendations for expanding KMC programmes, training healthcare workers, educating mothers and caregivers, establishing appropriate KMC spaces within hospitals, strengthening breastfeeding support, ensuring adequate monitoring of low-birth-weight infants, improving neonatal referral systems, and integrating KMC into routine newborn and neonatal care services across Nigerian hospitals.

Keywords: Kangaroo Mother Care, low-birth-weight infants, neonatal survival, Nigeria, newborn health, maternal and child health, skin-to-skin contact, neonatal care, breastfeeding, neonatal mortality, paediatrics, public health.