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Introducing Kangaroo Care in an urban district hospital of Bonassama – Cameroon.

Author(s) Danièle Kedy Koum1, Cristina Exhenry2, Riccardo Pfister3.
Affiliation(s) 1Paediatrics, District Hospital Bonassama, Douala, Cameroon, 2none, noen, Geneva, Switzerland, 3Neonatology and Intensive Care Services , Geneva University Hospitals, Geneva, Switzerland.
Country - ies of focus Cameroon
Relevant to the conference tracks Women and Children
Summary In sub-Saharan Africa neonatal mortality in LBWI (<2500g) is one of the highest worldwide. Kangaroo Care (KC) is an alternative to incubators recommended by the WHO. However, most published reports originate from central reference hospitals. In low-resource countries, a large proportion of LBWI remain at district level such that KC at this level seems an obvious necessity. We have successfully introduced KC in the urban district hospital of Cameroon. At one year, 30 LBWI were included. Mortality was 3%, considerably lower than previous years (14.5%). Parental acceptability was subject to social and financial circumstances that are potentially more easily solved at the district level.
Background In Douala, Cameroon's economic capital of 2 million people, some 20,000 of 100,000 new-borns are low birth weight infants (LBWI)
Objectives To implement Kangaroo Care in an urban district hospital in order to reduce neonatal mortality and morbidity in a low resource setting. An additional aim was to study the implementation of this method, anticipating an extension to other peripheral structures initially in the same district.
Methodology In July 2012, we launched a pilot project introducing Kangaroo Care in the urban district hospital Bonassama. It is a two year project approved by the ethics committee of the Ministry of Health of Cameroon and the University Hospitals of Geneva (HUG), with the following main steps: 1. Identifying local site management; 2. Obtaining support of the local health authorities and ethics committees (ownership); 3. Public and private funding; 4. Functional reorganization of the neonatal unit; 5. Staff training; 6. Patient recruitment; 8. Patient follow-up of until the age of 2 years; 9. Data analysis (particularly data referring to difficulties in introduction of Kangaroo Care).
Results The project is under the direction of a Cameroon physician trained at HUG. The site has been restored and reorganized with funding from the Ministry of Health of Cameroon, the political district authorities and HUG. Twelve staff members, mostly nurses, were trained in Kangaroo Care during one week. Recruitment of LBWI began 9/25/2012 with 30 LBWI included at one year. The mortality rate was 3%, considerably lower than the average of the previous two years (14.5%). The inclusion rate was 40% of potentially eligible patients. Parental refusal, often resulting in hospital dismissal against medical advice, was the main cause of non-inclusion.
Conclusion Kangaroo Care has been successfully introduced and is practiced in a district hospital with limited resources. Its decentralisation, closer to the families, is an advantage. However, many obstacles remain and require new strategies. The acceptability of Kangaroo Care, little known to the public, requires a community-based communication emphasizing its undeniable benefits. A unique hospital package and financing alternatives for the poorest could increase acceptability. Finally, maternal work, often vital for the family, requires early relocation of Kangaroo Care to the family household, with local support more readily available in the district.

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