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Impact of Kangaroo Mother Care Training on Knowledge of Preterm Infant Care among Mothers in Nigeria

Abstract

Preterm birth remains an important public health and maternal and child health concern in Nigeria, as preterm infants may require specialized care because of their increased vulnerability to hypothermia, feeding difficulties, infection, respiratory complications, and other neonatal problems. Mothers of preterm infants may experience difficulties in providing appropriate care because of limited knowledge, anxiety, inadequate practical training, restricted access to neonatal-care information, and insufficient postnatal support. Kangaroo Mother Care (KMC), which emphasizes prolonged skin-to-skin contact, appropriate breastfeeding or breast-milk feeding, and close monitoring of preterm or low-birth-weight infants, provides an important approach to supporting the care and wellbeing of vulnerable newborns. KMC training provides mothers with practical knowledge regarding positioning, skin-to-skin contact, feeding, thermal protection, hygiene, monitoring, and recognition of conditions requiring professional care. Against this background, this study investigates the impact of Kangaroo Mother Care training on knowledge of preterm infant care among mothers in Nigeria. The study will be anchored on the Health Belief Model, Social Cognitive Theory, and Health Systems Framework. The Health Belief Model explains how mothers' perceptions of the vulnerability of preterm infants, perceived severity of neonatal complications, perceived benefits of KMC, perceived barriers, self-efficacy, and cues to action may influence their knowledge and care practices. Social Cognitive Theory emphasizes observational learning, practical demonstration, behavioural modelling, self-efficacy, reinforcement, and social support in developing mothers' competence in caring for preterm infants. The Health Systems Framework highlights the importance of service delivery, trained healthcare personnel, health information, appropriate equipment, financing, accessibility, referral systems, and continuity of care in supporting effective KMC programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how KMC training may influence mothers' knowledge of preterm infant care in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers of preterm infants receiving care or residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, hospitals, neonatal units, and eligible mothers. KMC training will be assessed using indicators such as exposure to KMC training sessions, frequency and duration of training, explanation of KMC principles, skin-to-skin positioning, appropriate infant positioning, thermal protection, breastfeeding and breast-milk feeding, expressing and storing breast milk where necessary, hygiene practices, monitoring of infant temperature and feeding, recognition of danger signs, safe sleeping and positioning considerations, duration and continuity of KMC, discharge preparation, follow-up arrangements, and communication with healthcare professionals. Knowledge of preterm infant care will be assessed using indicators such as understanding of preterm infant characteristics, thermal protection, appropriate feeding, breastfeeding support, infection prevention, skin-to-skin care, hygiene, recognition of respiratory difficulties, poor feeding, abnormal temperature, lethargy, colour changes, and other danger signs, appropriate healthcare-seeking, medication safety, follow-up care, and safe home care. Data will be collected using structured questionnaires, standardized KMC knowledge assessment tools, scenario-based questions, maternal and neonatal-care records where ethically and practically accessible, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, infant characteristics, previous exposure to KMC education, sources of neonatal-care information, and knowledge levels. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of KMC training on knowledge of preterm infant care. Where a quasi-experimental design is adopted, knowledge scores before and after the KMC training intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that KMC training has a significant positive impact on knowledge of preterm infant care among mothers in Nigeria. Mothers exposed to structured, practical, evidence-based, and supervised KMC training are expected to demonstrate greater knowledge of appropriate preterm infant care than mothers without comparable training. Training may improve mothers' understanding of skin-to-skin contact, thermal protection, breastfeeding and breast-milk feeding, hygiene, infection prevention, monitoring of feeding and temperature, recognition of newborn danger signs, and appropriate healthcare-seeking. Practical demonstrations and supervised practice may also improve maternal confidence and reduce uncertainty about caring for preterm infants after discharge from healthcare facilities. However, inadequate staffing, limited KMC facilities and equipment, financial constraints, cultural beliefs, lack of family support, transportation difficulties, insufficient follow-up services, and limited access to trained healthcare professionals may reduce the effectiveness of training alone. The study therefore expects accessible, practical, culturally appropriate, repeated, and sustained KMC training, supported by functional neonatal and postnatal services, to contribute significantly to improved knowledge of preterm infant care among mothers in Nigeria. The study is expected to contribute to the literature on Kangaroo Mother Care, preterm infant care, neonatal health, maternal health education, maternal competence, low-birth-weight infant care, breastfeeding support, neonatal infection prevention, postnatal care, 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, primary healthcare centres, nurses, midwives, paediatricians, community health workers, maternal and newborn health programmes, development partners, and policymakers regarding strategies for strengthening KMC implementation and maternal education. The study will also provide evidence-based recommendations for integrating standardized KMC training into neonatal and postnatal services, strengthening practical maternal demonstrations and supervised practice, improving access to KMC facilities and trained healthcare personnel, strengthening discharge counselling and follow-up systems, engaging families in supporting KMC, and developing sustainable maternal and newborn-health programmes that improve the quality of preterm infant care across Nigeria.

Keywords: Kangaroo Mother Care training, preterm infant care, maternal knowledge, preterm infants, neonatal health, low-birth-weight infants, maternal health education, skin-to-skin care, breastfeeding, postnatal care, Nigeria, public health.