Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India

Abstract

Objective:

Two-thirds of women globally give birth at home, yet little data are available on use of skin-to-skin care (STSC) in the community. We describe the acceptability of STSC in rural Uttar Pradesh, India, and measured maternal, newborn, and ambient temperature in the home in order to inform strategies for introduction of STSC in the community.

Study design:

Community-based workers in intervention clusters implemented a community mobilization and behavior change communication program that promoted birth preparedness and essential newborn care, including adoption of STSC, with pregnant mothers, their families, and key influential community members. Acceptance of STSC was assessed through in-depth interviews and focus groups, and temperature was measured during home visits on day of life 0 or 1.

Results:

Incidence of hypothermia (<36.5°C) was high in both low birth weight (LBW) and normal birth weight (NBW) infants (49.2%, (361/733) and 43% (418/971), respectively). Mean body temperature of newborns was lower (P<0.01) in ambient temperatures <20°C (35.9±1.4°C, n=225) compared to 20°C (36.5±0.9°C, n=1450). Among hypothermic newborns, 42% (331/787) of their mothers had a lower temperature (range −6.7 to 0.1°C, mean difference 0.4±1.2°C). Acceptance of STSC was nearly universal. No adverse events from STSC were reported. STSC was perceived to prevent newborn hypothermia, enhance mother's capability to protect her baby from evil spirits, and make the baby more content.

Conclusion:

STSC was highly acceptable in rural India when introduced through appropriate cultural paradigms. STSC may be of benefit for all newborns and for many mothers as well. New approaches are needed for introduction of STSC in the community compared to the hospital.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Abbreviations

ENC:

essential newborn care

KMC:

Kangaroo Mother Care

CKMC:

community-based KMC

LBW:

low birthweight

STSC:

skin-to-skin care

References

  1. Rey E, Martinez H . Manejo racional del nino prematuro. Curso de Medicina Fetal 1983.

  2. Ruiz-Pelaez J, Charpak N, Cuervo L . Kangaroo mother care, an example to follow from developing countries. BMJ 2004; 329 (7475): 1179–1181.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kadam S, Binoy S, Kanbur W, Mondkar J, Fernandez A . Feasibility of kangaroo mother care in Mumbai. Indian J Pediatr 2005; 72: 35–38.

    Article  PubMed  Google Scholar 

  4. Worku B, Kassie A . Kangaroo mother care: a randomized controlled trial on effectiveness of early kangaroo mother care for the low birthweight infants in Addis Ababa, Ethiopia. J Trop Pediatr 2005; 51: 93–97.

    Article  PubMed  Google Scholar 

  5. Ibe O, Austin T, Sullivan K, Fabanwo O, Disu E, Costello A . A comparison of kangaroo mother care and conventional incubator care for thermal regulation of infants, 2000 g using continuous ambulatory temperature monitoring. Ann Trop Paediatr 2004; 24: 245–251.

    Article  CAS  PubMed  Google Scholar 

  6. Quasem I, Sloan NL, Chowdhury A, Ahmed S, Winikoff B, Chowdhury AM . Adaptation of kangaroo mother care for community-based application. J Perinatol 2003; 23 (8): 646–651.

    Article  PubMed  Google Scholar 

  7. Charpak N, Ruiz J, Zupan J, Cattaneo A, Figueroa Z, Tessier R et al. Kangaroo mother care: 25 years after. Acta Paediatr 2005; 94 (5): 514–522.

    Article  PubMed  Google Scholar 

  8. Lincetto O, Nazir AI, Cattaneo A . Kangaroo mother care with limited resources. J Trop Pediatr 2000; 46 (5): 293–295.

    Article  CAS  PubMed  Google Scholar 

  9. Bhutta Z, Darmstadt G, Hasan B, Haws R . Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: review of the evidence. Pediatrics 2005; 115: 519–617.

    Article  PubMed  Google Scholar 

  10. Charpak N, Ruiz-Pelaez J, Figueroa de C, Charpak Y . Kangaroo mother versus traditional care for newborn infants &lt;/2000 grams: a randomized controlled trial. Pediatrics 1997; 100: 682–688.

    Article  CAS  PubMed  Google Scholar 

  11. Charpak N, Ruiz-Pelaez J, Figueroa de C, Charpak Y . A randomized, controlled trial of kangaroo mother care: results of follow-up at 1 year of corrected age. Pediatrics 2001; 108: 1072–1079.

    Article  CAS  PubMed  Google Scholar 

  12. Ludington-Hoe SM, Swinth JY . Developmental aspects of kangaroo care. JOGNN 1996; 25: 691–703.

    Article  CAS  PubMed  Google Scholar 

  13. World Health Organization. Kangaroo Mother Care: a Practical Guide. WHO: Geneva, Switzerland, 2003.

  14. Anderson G, Moore E, Hepworth J, Bergman N . Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003; 2 (CD003519).

  15. Conde-Agudelo A, Diaz-Rossello J, Belizan J . Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev 2003; 2 (CD002771).

  16. Darmstadt G, Black R, Santosham M . Research priorities and postpartum-care strategies for the prevention and treatment of neonatal infections in less developed countries. Pediatr Infect Dis J 2000; 19: 739–750.

    Article  CAS  Google Scholar 

  17. Morley D, Blumenthal I . A neonatal hypothermia indicator. Lancet 2000; 355: 659–660.

    Article  CAS  PubMed  Google Scholar 

  18. Kambarami R, Chidede O, Pereira N . ThermoSpot in the detection of neonatal hypothermia. Ann Trop Pediatr 2002; 22: 219–223.

    Article  CAS  Google Scholar 

  19. Pejaver R, Nisarga R, Gowda B . Temperature monitoring in newborns using thermospot. Indian J Pediatr 2004; 71 (9): 795–796.

    Article  PubMed  Google Scholar 

  20. World Health Organization. Thermal protection in the newborn: a guide. WHO: Geneva, 1997 Report no.: WHO/RHT/MSM/97.2.

  21. Winch P, Alam M, Akther A, Afroz D, Ali A, Ellis A et al. Local understandings of vulnerability and protection during the newborn period in Sylhet district, Bangladesh: a qualitative study. Lancet 2005; 366: 478–485.

    Article  PubMed  Google Scholar 

  22. Johanson RB, Spencer SA, Rolfe P, Jones P, Malla DS . Effect of post-delivery care on neonatal body temperature. Acta Paediatr 1992; 81 (11): 859–863.

    Article  CAS  Google Scholar 

  23. Tafari N, Olsson EE . Neonatal cold injury in the tropics. Ethiop Med J 1973; 11 (1): 57–65.

    CAS  PubMed  Google Scholar 

  24. Christensson K, Ransjo-Arvidson AB, Kakoma C, Lungu F, Darkwah G, Chikamata D et al. Midwifery care routines and prevention of heat loss in the newborn: a study in Zambia. J Trop Pediatr 1988; 34 (5): 208–212.

    Article  CAS  Google Scholar 

  25. Dragovich D, Tamburlini G, Alisjahbana A, Kambarami R, Karagulova J, Lincetto O et al. Thermal control of the newborn: knowledge and practice of health professionals in seven countries. Acta Paediatr 1997; 86: 645–650.

    Article  CAS  Google Scholar 

  26. Kumar R, Aggarwal AK . Body temperatures of home delivered newborns in North India. Trop Doctor 1998; 28: 134–136.

    Article  CAS  Google Scholar 

  27. Bang A, Bang R, Reddy H, Deshmukh M, Baitule S . Reduced incidence of neonatal morbidities: effect of home-based neonatal care in rural Gadchiroli, India. J Perinatol 2005; 25: S51–S61.

    Article  PubMed  Google Scholar 

  28. Lincetto O, Vos E, Graca A, Macome C, Tallarico M, Fernandez A . Impact of season and discharge weight on complications and growth of kangaroo mother care treated low birthweight infants in Mozambique. Acta Paediatr 1998; 87: 433–439.

    Article  CAS  PubMed  Google Scholar 

  29. Cattaneo A, Davanzo R, Worku B, Surjono A, Echeverria M, Bedri A et al. Kangaroo mother care for low birthweight infants: a randomized controlled trial in different settings. Acta Paediatr 1998; 87 (9): 976–985.

    Article  CAS  PubMed  Google Scholar 

  30. Ramanathan K, Paul VK, Deorari AK, Taneja U, George G . Kangaroo mother care in very low birth weight infants. Indian J Pediatr 2001; 68 (11): 1019–1023.

    Article  CAS  Google Scholar 

  31. Affonso DD, Wahlberg V, Persson B . Exploration of mothers’ reactions to the kangaroo method of prematurity care. Neonatal Networks 1989; 7 (6): 43–51.

    CAS  Google Scholar 

  32. Ludington-Hoe SM, Hashemi MS, Argote LA, Medellin G, Rey H . Selected physiologic measures and behavior during paternal skin contact with Colombian preterm infants. J Dev Physiol 1992; 18 (5): 223–232.

    CAS  PubMed  Google Scholar 

  33. Tessier R, Cristo M, Nadeau L, Figueroa Z, Ruiz-Palaez J, Charpak N . Kangaroo mother care: a method for protecting high-risk low birth weight and premature infants against developmental delay. Infant Behav Develop 2003; 26: 384–397.

    Article  Google Scholar 

  34. Mondlane RP, de Graca AM, Ebrahim GJ . Skin-to-skin contact as a method of body warmth for infants of low birth weight. J Trop Pediatr 1989; 35 (6): 321–326.

    Article  CAS  PubMed  Google Scholar 

  35. Sloan NL, Camacho LW, Rojas EP, Stern C . Kangaroo mother method: randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Maternidad Isidro Ayora Study Team. Lancet 1994; 344 (8925): 782–785.

    Article  CAS  Google Scholar 

  36. Anderson GC . Current knowledge about skin-to-skin (kangaroo) care for preterm infants. J Perinatol 1991; 11 (3): 216–226.

    CAS  Google Scholar 

  37. Christensson K . Fathers can effectively achieve heat conservation in healthy newborn infants. Acta Paediatr 1996; 85 (11): 1354–1360.

    Article  CAS  PubMed  Google Scholar 

  38. Bergman NJ, Jurisoo LA . The ‘kangaroo-method’ for treating low birth weight babies in a developing country. Trop Doct 1994; 24 (2): 57–60.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the families and community members in Shivgarh for their willing participation. Support for the study was provided by The Office of Health, Infectious Diseases and Nutrition, Global Health Bureau, United States Agency for International Development (USAID) under the terms of Award GHS-A-00-03-00019-00, Global Research Activity Cooperative Agreement; the USAID India (New Delhi) Mission; and the Saving Newborn Lives initiative of Save the Children-US, through a grant from the Bill & Melinda Gates Foundation. We extend special thanks to Massee Bateman, director of Maternal and Child Health at USAID, New Delhi, for many fruitful discussions regarding the intervention program, and to Anne Tinker, director of Saving Newborn Lives, Save the Children-US for her support.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to G L Darmstadt.

Additional information

Presented in part at the First International Congress on Kangaroo Mother Care, Rio de Janeiro, November 10, 2004; CORE Annual Meeting, West Point, New York, April 20, 2005; Global Health Council 32nd Annual Conference, Washington, DC, June 2, 2005; Global Forum for Health Research, Mumbai, India, September 13, 2005; and Countdown to 2015: Tracking Progress in Child Survival, London, UK, December 14, 2005.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Darmstadt, G., Kumar, V., Yadav, R. et al. Introduction of community-based skin-to-skin care in rural Uttar Pradesh, India. J Perinatol 26, 597–604 (2006). https://doi.org/10.1038/sj.jp.7211569

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211569

Keywords

This article is cited by

Search

Quick links