Original Article

Journal of Perinatology (2006) 26, 597–604. doi:10.1038/sj.jp.7211569; published online 17 August 2006

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

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.

G L Darmstadt1,2, V Kumar1, R Yadav3, V Singh3, P Singh3, S Mohanty3, A H Baqui1, N Bharti3, S Gupta3, R P Misra3, S Awasthi4, J V Singh5 and M Santosham1 the Saksham Study Group6

  1. 1Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
  2. 2Saving Newborn Lives Initiative, Save the Children-US, Washington, DC, USA
  3. 3Clinical Epidemiology Unit, King George's Medical University, Lucknow, India
  4. 4Department of Pediatrics, King George's Medical University, Lucknow, India
  5. 5Department of Social and Preventive Medicine, King George's Medical University, Lucknow, India

Correspondence: Dr GL Darmstadt, Department of International Health, E-8153, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA. E-mail: gdarmsta@jhsph.edu

6Saksham Study Group (in alphabetical order): RC Ahuja, Shally Awasthi, Abdullah H Baqui, Mahendra Bhandari, Netu Bharti, Gary L Darmstadt, Amit Gupta, Sanjay Gupta, Vishwajeet Kumar, Rajendra P Misra, Saroj Mohanty, MK Mitra, Mathuram Santosham, JV Singh, Pramod Singh, Vivek Singh, Peter J Winch, Ranjana Yadav

Received 3 February 2006; Revised 16 June 2006; Accepted 29 June 2006; Published online 17 August 2006.

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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 (35.9plusminus1.4°C, n=225) compared to greater than or equal to20°C (36.5plusminus0.9°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 0.4plusminus1.2°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.

Keywords:

behavior change, community mobilization, Kangaroo Mother Care, neonatal, skin-to-skin care, thermal care

Abbreviations:

ENC, essential newborn care; KMC, Kangaroo Mother Care; CKMC, community-based KMC; LBW, low birthweight; STSC, skin-to-skin care

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