Kangaroo Mother Care: Humanization of Neonatology

Of the almost 3 million of neonatal deaths occurring each year, 95% come from low- and middle-income countries and 30% of these deaths are related to prematurity and/or low birth weight. Caring for these infants is technologically challenging and poses a large economic burden. The use of the Kangaroo Mother Care method or KMC to complement neonatal care is affordable, decreases mortality and improves quality of the survival of these infants. WHO just published this new recommendation for all premature infants in the world. 

The Fundación Canguro or Kangaroo Foundation was established by a group of concerned health care professionals and researchers, in Bogotá, Colombia in 1994, as a means to study, enhance and broadcast the knowledge and skills that conform the KMC method, a multidisciplinary technique developed over 30 years ago in Colombia for premature and/or low birth weight infants. It is based on 3 components: (1) kangaroo position (i.e., continuous skin-to-skin contact between mother and infant as soon as possible, during as long as possible), which provides appropriate thermal regulation, among other benefits; (2) exclusive breastfeeding whenever possible; and (3) timely (early) discharge with close follow-up.

It has been scientifically shown that KMC reduces the negative effects of prematurity and low birth weight at short and long term even 20 years after, probably because it promotes the early establishment of a safe mother and child relationship. 

The Kangaroo Foundation (KF) was visionary since 1994 about the impact that this method could have on the well-being of these infants and their families. Since its beginning the KF has trained more than 80 teams from 40 developing countries in Bogota, Colombia. Major NGOs and international cooperation agencies have endorsed KMC with grants for these worldwide trainings. The KF has become an expert in teaching and broadcasting KMC method, in 2018-2020 we assembled a KMC e-learning platform and design courses with virtual and on-site components were different teams are trained for building of excellence centers in their countries and accelerate the KMC worldwide diffusion. It is also an instrument for the certification of professionals and technicians in KMC and its also used to certify KMC existing facilities. 

Nowadays it continues fighting for this method to be accessible to all premature and low birth weight babies. For this reason, the Kangaroo Foundation works daily for supporting this important mission and guarantee access to KMC to each of the 15 millions of candidates born each year worldwide to help them to survive with a better quality of life.  

KMC has emerged as a method especially suitable for enhancing the healthcare of low birth weight (LBW) infants in developing countries. KMC is evidence-based technology centered on the mother as the main provider of heat and stimulation (skin-to-skin contact), nutrition (breast milk), and close monitoring, after early discharge at home in the kangaroo position. The technology has been shown to alleviate the negative effects of LBW (such as mortality and morbidity) and, if correctly applied, it can be safely used in conjunction with equipment such as incubators, monitors, etc., to provide quality care and stabilize LBW infants at any level of care. KMC represents a step toward humanizing neonatal healthcare, and it promotes bonding and breastfeeding, two essential elements for LBW infants’ survival. While further research is needed, enough scientific evidence has demonstrated the benefits of KMC. 

WHO data evidenced that approximately 30% of all children under the age of five who die are newborns, and 60–80% of those newborns who die are premature and/or small for gestational age. Many of these deaths are preventable. Multiple studies have found that Kangaroo Mother Care Method (KMC) prevents up to half of them, when compared to incubators, KMC has been found to reduce the number of cases of severe infection/sepsis, nosocomial infection, hypothermia, lower respiratory tract disease, and length of hospital stay. Babies cared for using KMC show improved weigh, height, head circumference, breastfeeding and mother-infant bonding. Nevertheless, despite ample scientific evidence to support it, its diffusion has been slow and coverage is still insufficient even in Colombia, its country of creation.

At the present time in Colombia there are 69 KMC programs, with more than 159 doctors, attending approximately 34.931 children per year. We have also trained more than 40 countries specially from Latin-America, Asia and Africa, with 80 multidisciplinary health teams that serve more than 960.000 children. We have a national KMC guideline and work with the PAHO and WHO in creating methodologies and guidelines to spread knowledge around the world. KMC has brought a new reality to preterm care paradigm: Avoiding mother-infant separation from the very beginning of extrauterine life, involving her and the family deeply and early in the actual provision of care to the preterm infant.

It is estimated that 15 million babies are born prematurely each year and 20 million babies are born with low birth weight. This data represents more than 1 in 10 births worldwide, a vast majority of them born in low- and middle-income countries. WHO data evidenced that approximately 30% of all children under the age of five who die are newborns, and 60–80% of those newborns who die are premature and/or small for gestational age. Many of these deaths are preventable. Multiple studies have found that Kangaroo Mother Care Method (KMC) prevents up to half of them, when compared to incubators, KMC has been found to reduce the number of cases of severe infection/sepsis, nosocomial infection, hypothermia, lower respiratory tract disease, and length of hospital stay. Babies cared for using KMC show improved weigh, height, head circumference, breastfeeding and mother-infant bonding. 

The Kangaroo Foundation is a nonprofit organization, led by health professionals. Since 1989 when the KF adventure began, it has worked in a research line with more than 80 publications in high impact scientific journals. We depend on donations to be able to accomplish our objectives. We also obtain funds from grants received for organization and execution of Kangaroo Mother Care (KMC) trainings for health professionals’ team (pediatrician, nurse, and psychologist) around the world. All incomes are invested in new projects and research therefore constant fundraising is vital for the continuity of the work being carried out.  

The SOLVE will allow us to acquire more funds in order to continue our diffusion efforts in Colombia and the world, also helping us to gain more international recognition and visibility. We are grateful and extremely content with the goals we have reached during the last years. We have been fortunate to receive funds to achieve the goals that were set for 2021 and 2022 and we want to continue helping newborns around the world accomplishing KF main objective that is the humanization of neonatology. 

In 2022 the WHO published its most recent guidelines for care of the preterm or low-birth-weight infant where Kangaroo Mother Care is recognized as principal item in the preventive and promotive care improving shot and longer-term outcomes. 

KMC has been recognized by PNUD, OMS/WHO, USAID, BMGF, Save the children as a human-based technology, immediately available for decreasing neonatal mortality and improving survival of premature and LBW infants worldwide. KF is independent, is free from political agendas and conflicts of interest, has the scientific knowledge and the know-how to disseminate KMC. KF has successfully influenced global health policy and integration of KMC in national health care systems. KF needs access to appropriate funds facilitate the scale-up of KMC.

At the present time in Colombia there are 69 KMC programs, with more than 159 doctors, attending approximately 34.931 children per year. We have also trained more than 40 countries specially from Latin-America, Asia and Africa, with 80 multidisciplinary health teams that serve more than 960.000 children.

We depend on donations to be able to accomplish our objectives. We also obtain funds from grants received for organization and execution of Kangaroo Mother Care (KMC) trainings for health professionals’ team (pediatrician, nurse, and psychologist) around the world. All incomes are invested in new projects and research therefore constant fundraising is vital for the continuity of the work being carried out.

We are also currently in a stage of generational transition and this award would help us to train our new people in the presentation of projects, ideas and how to maintain the national and international leadership that the foundation already has. 

There will be different groups impacted by the KMC in each country:

• Low Birth Weight Infants (LBWI) and their families. Predicted percentage reduction mortality and morbidity in preterm and LBW infants is estimated to be 25 % and percentage of new preterm children that have access to KMC and improved health outcomes is estimated to be 30 %.  
• Health institutions and professionals caring for LBWI and their mothers. They will improve knowledge, attitude and behavior towards the importance to implementing KMC for LBWI. They will also increase their skills and their capacity for training other centers in KMC implementation.
• Parents and each country’s societies. Both the qualitative and the quantitative evidence demonstrate the high value that the intervention has in favoring the parent-child bond, despite the methodological limitations, the main findings are related to the development of the competence of the mother/father as the best caregivers of the baby. 

The 24-hour opening of neonatal units and the paradigm change in the role of parents during their stay in the neonatal unit – parents are not only visitors, they are part of the success of the child's treatment, they are co-actors in the care of this fragile child.

Kangaroo Mother Care is a transformative solution. KMC is a scientific method that save lives, in 2022 it appeared as the first WHO recommendation for this high risk infants. As the management of newborns changes, with the advances in science, neonatology now has more premature or low birth weight children and we must be prepared to ensure the best care but also the most humane for them and their families, allowing them to grow in a safe environment. KMC not only meets this objective but has been shown to improve brain growth, decrease mortality and infection rates and reduce hospitalization times.

Implementing a KMC, properly established, in any hospital of any country, generates savings of approximately 10 days of hospitalization per child. 

KMC will complement systematically neonatal care in low,  middle and high income countries in the future 5 years, the challenge is how to diffuse quickly KMC and with full quality of care. We believe that the Kangaroo foundation, with its experience is the best leader to conduct this dissemination. KMC is recognized by the government but we have problems with the implementation of the follow up. 

The Kangaroo Foundation wants to stimulate each country to build not only a KMC   excellence center  but a local registered NGO o association able  to diffuse KMC in their proper country , in an independent  and sustainable way.   

The last few years for the Kangaroo Foundation have been filled with great expectations and achievements in the fulfillment of its mission to humanize neonatology in favor of premature and/or low birth weight babies in Colombia and the world. With these activities we have achieved 

- Reduction of neonatal mortality and morbidity. 
- Improved mother-baby bonding: The skin-to-skin contact of the kangaroo position helps strengthen the bond, which has positive effects on cognitive and emotional development. 
- Promotion of breastfeeding: KMC has been shown to be an effective form of breastfeeding promotion, fundamental to health and development. 
- Reduced health care costs.
- Increased parental involvement and empowerment.

By the year 2022, breastfeeding counseling was carried out, a national mapping was created, finding a coverage in the country of 63.2% of high-risk follow-up with more than 30 thousand children attended, and the Kangaroo Law was passed.

KMC has changed the culture of neonatal care with three principal interventions; Kangaroo position with 24 hours a day skin-to-skin contact between mother and infant, Kangaroo nutrition with exclusive or nearly exclusive breastfeeding and Kangaroo discharge and follow-up policies up to 40 weeks. Its theory of change includes the following components:

1. Vision: The vision is to establish KMC as the standard of care for premature and low birth weight (LBW) infants globally, ensuring that every premature/LBW baby has access to this beneficial practice.

2. Outcomes: The desired outcomes of implementing KMC include improved infant survival rates, enhanced physical and cognitive development, reduced rates of infection and hospital-acquired complications, increased rates and duration of breastfeeding, and improved bonding between infants and caregivers.

3. Strategies: The strategies outlined in the theory of change focus on raising awareness, advocating for policy changes, and building capacity within healthcare systems to implement KMC effectively. This may involve training healthcare providers, educating families about the benefits of kangaroo care, integrating kangaroo care into clinical guidelines and protocols, and establishing supportive infrastructure within healthcare facilities.

4. Stakeholders: The theory of change identifies various stakeholders who play a role in advancing KMC, including healthcare professionals, policymakers, administrators, researchers, parents, and support organizations. Collaboration among these stakeholders is crucial for successful implementation.

5. Monitoring and Evaluation: The theory of change emphasizes the importance of monitoring and evaluating the implementation of kangaroo care to assess its impact and identify areas for improvement. This may involve tracking indicators such as the prevalence of KMC, adherence to best practices, health outcomes of infants, and caregiver satisfaction.

It helps to articulate the long-term goals, strategies, and actions needed to integrate KMC into routine neonatal care and improve outcomes for premature infants and their families.

The Kangaroo Foundation, focuses on promoting and implementing KMC as a standard practice in neonatal care. While KMC itself does not rely on specific technologies, the Kangaroo Foundation utilizes various core technologies and tools to support its mission. Some of these core technologies include:

1. Education and Training Materials: The Kangaroo Foundation develops educational materials, including manuals, guidelines, and training modules, to educate healthcare professionals, parents, and caregivers about the benefits and proper implementation of KMC. These materials may be available in print or digital formats.

2. Advocacy and Awareness Platforms: The Kangaroo Foundation leverages communication technologies, such as websites, social media platforms, and online forums, to raise awareness about KMC and advocate for its integration into healthcare systems worldwide. These platforms serve as information hubs, connecting individuals and organizations interested in promoting KCM.

3. Collaboration and Networking Tools: The Kangaroo Foundation utilizes communication and networking technologies to foster collaboration among stakeholders, such as healthcare professionals, policymakers, researchers, parents, and support organizations. These tools may include email, video conferencing, online collaboration platforms, and discussion forums, facilitating knowledge sharing and exchange of best practices.

4. Research and Data Analysis Tools: The Kangaroo Foundation engages in research activities to gather evidence on the benefits and effectiveness of KMC. This involves using various research methodologies and data analysis tools to evaluate outcomes, monitor progress, and identify areas for improvement. These tools may include statistical software, data management systems, and research databases.

5. Mobile Applications and Digital Solutions: The Kangaroo Foundation may develop or endorse mobile applications and digital solutions aimed at supporting KMC implementation. These tools can provide guidance, reminders, and tracking features for healthcare providers and parents, helping them implement kangaroo care effectively and monitor its progress.

It's important to note that the core technologies utilized by the Kangaroo Foundation are meant to support the implementation, education, and advocacy of kangaroo care, rather than being integral components of the practice itself. The primary focus of kangaroo care is the physical closeness and bonding between the infant and caregiver, with the use of technologies serving to enhance and facilitate the practice. 

The map of prematurity and LBW infants is the same than the map of poverty in the world. The Kangaroo Foundation team capacity as both academic researchers and founding members have produced and published research on optimization of the kangaroo feeding strategy, the protective effect of KMC on infants’ neurocognitive and emotional development, stress, the economic efficiency of the intervention, and on the long term effect (20 years after) of KMC on physical and emotional health, cognitive functions, social functioning, labor productivity and quality of life. We showed that KMC has a higher impact in the group of less educated mother and poorest population. The impact is also higher in the most frail group and persist at the age of 20 years.

The Kangaroo Foundation, being a non-profit organization focused on promoting kangaroo care, operates based on a non-profit business model. The primary goal of the foundation is to advance the implementation of Kangaroo Mother Care (KMC) as a standard practice in neonatal care, rather than generating profits. Here are some key aspects of the Kangaroo Foundation's business model:

1. Mission and Purpose: The Kangaroo Foundation's mission is centered around improving the health and well-being of premature infants through the promotion of KMC. The foundation's purpose is to advocate for policy changes, raise awareness, provide education and training, conduct research, and collaborate with stakeholders to achieve its goals.

2. Funding: The Kangaroo Foundation relies on a variety of funding sources to support its activities and initiatives. This may include grants from government agencies, philanthropic donations, corporate sponsorships, fundraising events, and partnerships with other organizations. These funds are used to cover operational expenses, develop educational materials, conduct research, and support advocacy efforts.

3. Partnerships and Collaborations: The Kangaroo Foundation collaborates with various stakeholders, including healthcare institutions, professional associations, academic institutions, non-governmental organizations (NGOs), and government agencies. These partnerships allow for shared expertise, resources, and networks, enabling the foundation to reach a wider audience and have a greater impact.

4. Education and Training Services: The Kangaroo Foundation provides educational materials, training programs, and workshops to healthcare professionals, parents, and caregivers. These services may be offered on-site at healthcare facilities, through online platforms, or as part of conferences and seminars. Revenue generated from these services, if any, is reinvested in the foundation's activities.

5. Advocacy and Awareness Campaigns: The Kangaroo Foundation engages in advocacy efforts to promote policy changes and raise awareness about the benefits of KMC. This may involve public campaigns, media outreach, participation in conferences and events, and collaboration with policymakers and advocacy organizations. These activities aim to generate support and create a favorable environment for the widespread adoption of kangaroo care.

6. Research and Knowledge Generation: The Kangaroo Foundation may conduct or support research studies to gather evidence on the effectiveness of KMC and its impact on premature infants. Research findings contribute to the foundation's knowledge base and are often disseminated through publications and conferences.

Overall, the Kangaroo Foundation's business model is focused on mobilizing resources, building partnerships, providing education and training, conducting research, and advocating for the integration of kangaroo care into neonatal care practices. The foundation operates with a social mission, aiming to improve the health outcomes and well-being of premature infants and their families.

As a non-profit organization, the Kangaroo Foundation's primary focus is on achieving its mission of promoting KMC rather than generating profits. However, financial sustainability is crucial for the foundation to continue its operations and effectively carry out its activities, applying: 

1. Fundraising and Donor Cultivation: The Kangaroo Foundation develops fundraising strategies and campaigns to engage supporters and donors. These include KMC Mothers day, KMC Christmas and others where people can donate kangaroo bands, scholarships for needy families or money that is then used to help people who have fewer resources. 

2. Grants and Project Funding: The Kangaroo Foundation pursue grants and project funding opportunities from governmental and non-governmental organizations that align with its mission.  

3. Training Programs: The Kangaroo Foundation offers fee-based services such as educational training programs, workshops, and consulting services related to KMC. By providing specialized knowledge and expertise, the Kangaroo Foundation generates revenues while also fulfilling its educational and capacity-building objectives.

Since our Foundation there are several grants that we have managed, in a satisfactory way. Examples are:

• DIB CAMEROUN, was a training process aimed at this country, which started in 2019. It had a duration of 14 months and a cost of USD 99,707 (implementation research).
• Feeding patterns and Growth during the first year of life in a cohort of preterm infants with Extra-uterine Growth Restriction (EUGR) at hospital discharge Followed in 2 KMC Programs in Bogotá-Colombia - USD 68,288, with a duration of 28 months. Started in June 2021. (basic research)
• Partnership Agreement 567-2017 with the Secretariat of Health of Cundinamarca, started in May 2017, with a duration of 12 months, with an amount of USD 91,484 (approx.). ( diffusion of KMC in the region of Cundinamarca)
• Partnership Agreement 828-2016 with the Secretariat of Health of Cundinamarca, started in October 2016, and had a duration of 6 months, with an approximate amount of USD 117,623 ( breastfeeding the premature infant in practice)
• Contract 1293 with the Saldarriaga Foundation, had a duration of 3 months, with an approximate amount of USD 78,415 (face to face training and evaluation visits in 20 KMC programs for KMC diffusion in Colombia).
• In 2015 and for 24 months, we coordinate a project funded by Grand Challenge Canada, for an amount of USD 800K, called Project to accelerate the dissemination of KMC in Mali and Cameroon (implementation research).
• During the 2021 period, we negotiated cooperation agreements for training processes for Kangaroo Programs in different parts of the world, for an amount of over USD 96,000.