# embeddings_queue

created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\KMC-PPT.pdf", "file_path": "pdfs\\KMC-PPT.pdf", "page": 17, "total_pages": 20, "Title": "KANGAROO MOTHER CARE (KMC)", "Author": "Intel", "CreationDate": "D:20230119170728+05'30'", "ModDate": "D:20230119170728+05'30'", "Producer": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "Creator": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "chunk_index": 285, "chroma:document": "District Level activities\n\u2022 Carry out civil work/refabrication necessary\nfor ensuring KMC.\n\u2022 Conduct orientation/refresher trainings of\ncounsellors and health providers\n\u2022 Identify high case load facilities for ensuring\nKMC services.\n\u2022 Ensure record keeping and timely reporting at\nfacilities"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\KMC-PPT.pdf", "file_path": "pdfs\\KMC-PPT.pdf", "page": 18, "total_pages": 20, "Title": "KANGAROO MOTHER CARE (KMC)", "Author": "Intel", "CreationDate": "D:20230119170728+05'30'", "ModDate": "D:20230119170728+05'30'", "Producer": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "Creator": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "chunk_index": 286, "chroma:document": "Developing a KMC Unit\nInfrastructure;\n\u2022 KMC Unit of 8-10 beds recommended for every hospital with\nSNCU.\n\u2022 KMCU must be the integral part of the existing/new upcoming\nSNCUs/MCH wings/Postnatal wards & NBSU\n\u2022 The neonatal units at all Medical Colleges to be strengthened to\nprovide appropriate newborn care including KMC.\nHuman Resource; Available regularly with most SNCUs. Therefore,\nutilize from regular supply and may budget, if required.\nCapacity Building; The existing training modules for F-IMNCI and\nFBNC may be used for orientation.\nSpecifications; Refer to guidelines for detailed budget calculations\n\u201cHowever, provision of KMC should not wait for the establishment of KMCU\u2019"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\KMC-PPT.pdf", "file_path": "pdfs\\KMC-PPT.pdf", "page": 19, "total_pages": 20, "Title": "KANGAROO MOTHER CARE (KMC)", "Author": "Intel", "CreationDate": "D:20230119170728+05'30'", "ModDate": "D:20230119170728+05'30'", "Producer": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "Creator": "Microsoft\u00ae Office PowerPoint\u00ae 2007", "chunk_index": 287, "chroma:document": "Thanks\nFor details;\nChild Health Division,\nMOHFW, Government of\nIndia, Nirman Bhavan, New\nDelhi"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 0, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 289, "chroma:document": "Kangaroo mother care\nImplementation strategy for scale-up\nadaptable to different country contexts\nHEALTH\nFOR ALL"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 1, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 290, "chroma:document": "european foundation for\nthe care of newborn infants\nCover photo credits (from top clockwise): \u00a9Lund-Malm\u00f6 NIDCAP Center/Stina Klemming; \u00a9Safdarjung Hospital/\nHarish Chellani; \u00a9LD Photography/Idowu Olamide; \u00a9WHO/Gato Borrero; \u00a9Lund-Malm\u00f6 NIDCAP Center/Stina Klemming"}


created_at: 2025-05-02 10:00:24
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created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 3, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 292, "chroma:document": "Kangaroo mother care: implementation strategy for scale-up adaptable to different country contexts\nISBN 978-92-4-007163-6 (electronic version)\nISBN 978-92-4-007164-3 (print version)\n\u00a9 World Health Organization 2023\nSome rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO\nlicence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).\nUnder the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the\nwork is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses\nany specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you\nmust license your work under the same or equivalent Creative Commons licence. If you create a translation of this work,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 3, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 293, "chroma:document": "you should add the following disclaimer along with the suggested citation: \u201cThis translation was not created by the World\nHealth Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English\nedition shall be the binding and authentic edition\u201d.\nAny mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of\nthe World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/).\nSuggested citation. Kangaroo mother care: implementation strategy for scale-up adaptable to different country contexts.\nGeneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.\nCataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.\nSales, rights and licensing. To purchase WHO publications, see https://www.who.int/publications/book-orders. To submit"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 3, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 294, "chroma:document": "requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright.\nThird-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures\nor images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from\nthe copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests\nsolely with the user.\nGeneral disclaimers. The designations employed and the presentation of the material in this publication do not imply\nthe expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or\narea or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps\nrepresent approximate border lines for which there may not yet be full agreement."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 3, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 295, "chroma:document": "represent approximate border lines for which there may not yet be full agreement.\nThe mention of specific companies or of certain manufacturers\u2019 products does not imply that they are endorsed or\nrecommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted,\nthe names of proprietary products are distinguished by initial capital letters.\nAll reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the\npublished material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the\ninterpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.\nDesign by Green Ink Publishing Service Ltd."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 4, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 296, "chroma:document": "Contents\nAcknowledgements v\nAbbreviations vii\nGlossary viii\nIntroduction 1\n\u2013 Global vision and position on kangaroo mother care 1\n\u2013 Rationale for an implementation strategy for kangaroo mother care scale-up 2\n\u2013 Purpose of the implementation strategy 4\n\u2013 Audience for the implementation strategy 4\n\u2013 Process of development of the implementation strategy 4\nThe case for KMC 7\n\u2013 Saves lives, advances human capital 7\n\u2013 Humanizes care, empowers and benefits the mother 7\n\u2013 Springboard to improve delivery of quality small and/or sick newborn and maternal care 8\n\u2013 Cost-effective intervention plus long-term economic benefits 9\n\u2013 Promotes sustainable development 9\nConsiderations for designing a KMC implementation strategy 11\n\u2013 Lessons learned from national efforts to scale up KMC 11\n\u2013 Evidence from implementation research 17\nGuiding principles for KMC implementation 21\n\u2013 Recognize the mother\u2019s role as primary caregiver 21\n\u2013 Meet the needs of the mother 22"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 4, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 297, "chroma:document": "\u2013 Recognize the mother\u2019s role as primary caregiver 21\n\u2013 Meet the needs of the mother 22\n\u2013 Implement KMC as the foundation of small and/or sick newborn care 22\n\u2013 Deliver KMC at all levels of facility care and in the community 24\n\u2013 Adapt implementation by country-income settings and health system contexts 25\n\u2013 Align with World Health Organization guidelines 26\n\u2013 General programmatic principles 27\niii"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 5, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 298, "chroma:document": "Implementation strategy to achieve scale-up 31\n\u2013 Engage political leadership and develop KMC-supportive policies with a national\nKMC implementation plan 31\n\u2013 Increase availability, capacity and motivation of health-care providers 33\n\u2013 Reorganize service delivery to fulfil the needs of mothers and infants simultaneously 34\n\u2013 Upgrade infrastructure and design of maternal\u2013newborn care to create a conducive\nenvironment for KMC 35\n\u2013 Develop robust data systems and use data for quality improvement 36\n\u2013 Create a functional network of care and improve referral transport 39\nOperationalizing the implementation strategy 41\n\u2013 National planning and coordination of KMC implementation 41\n\u2013 Subnational-level planning and implementation 42\nPath forward 47\nReferences 48\nBoy Arkestal, born nine weeks preterm, in immediate\nKMC, Lund-Malm\u00f6 NIDCAP Center, Stockholm.\niv\nKangaroo\nmother\ncare:\nImplementation\nstrategy\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 6, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 299, "chroma:document": "Acknowledgements\nWHO extends sincere appreciation to the Kangaroo Mother Care (KMC) Working Group convened by\nthe WHO Strategic and Technical Advisory Group of Experts (STAGE) for Maternal, Newborn, Child and\nAdolescent Health and Nutrition (MNCAH&N), listed below. All the participating organizations endorsed\nthe position paper.\nSTAGE MNCAH&N KMC Working Group\nChairs: Gary Darmstadt, Prematurity Research Center, Department of Pediatrics, Stanford University\nSchool of Medicine, Stanford, California, United States of America; Betty Kirkwood, London School of\nHygiene and Tropical Medicine (LSHTM), United Kingdom of Great Britain and Northern Ireland\nCountry MNCAH programme managers: Queen Dube, Ministry of Health, Malawi; Sumita Ghosh,\nMinistry of Health, India\nBilateral agencies: Meena Gandhi, United Kingdom Foreign, Commonwealth and Development Office\n(UK-FCDO); Lars Gronseth, Norwegian Agency for Development Cooperation (NORAD); Aya Hasegawa"}


created_at: 2025-05-02 10:00:24
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created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 6, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 301, "chroma:document": "Nurses (COINN); Steve Wall, Save the Children\nParent groups and organizations: Tasmin Bota (Preemie Connect), South Africa; Viviana Fernandez,\nFundaci\u00f3n para Padres de Ni\u00f1os Prematuros (FUNDAPREMA), Costa Rica; Silke Mader, European\nFoundation for the Care of Newborn Infants (EFCNI), Germany\nUnited Nations organizations: Kim Dickson, Tedbabe Degefie Hailegebriel and Luwei Pearson (UNICEF);\nRajiv Bahl and Shuchita Gupta (WHO; served as the Secretariat for the working group); Mickey Chopra\n(World Bank)\nSpecialized agencies/partnerships: Teesta Dey, Partnership for Maternal, Newborn and Child\nHealth (PMNCH)\nvv"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 7, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 302, "chroma:document": "vvviii\n\u00a9WHO/Yoshi\nShimizu\nInternational experts and scientists: Ebunoluwa Adejuyigbe, Obafemi Awolowo University, Ile-Ife,\nNigeria; Zulfiqar Bhutta, Centre for Global Child Health, Canada and Aga Khan University, Pakistan;\nHarish Chellani, Vardhman Mahavir Medical College and Safdarjung Hospital, India; Nicholas Embleton,\nneonatal paediatrician, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United\nKingdom; Abiy Seifu Estifanos, School of Public Health of Addis Ababa University, Ethiopia; Joy Lawn,\nLSHTM; Jan Lucas Ket, paediatrician and past director, Rotary International; Sarmila Mazumder,\nSociety for Applied Studies, India; Peter Waiswa, Makerere University School of Public Health,\nUganda; Dilys Walker, University of California, San Francisco, United States; Bjorn Westrup, Karolinska\nInstitutet, Sweden\nShuchita Gupta (WHO) led the writing of the document with substantial guidance and input to writing"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 7, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 303, "chroma:document": "Shuchita Gupta (WHO) led the writing of the document with substantial guidance and input to writing\nand review from Rajiv Bahl (WHO), Gary Darmstadt and Betty Kirkwood. Linda Vesel (consultant) helped\nin preparing the first draft.\nMembers of the WHO STAGE for MNCAH&N provided input and reviewed and approved the final\ndocument on their or their organization\u2019s behalf. Many other stakeholders who participated in the\nregular STAGE meetings and Anayda Portela (WHO) also provided valuable inputs on the content.\nHealth workers attending a mother with newborn in KMC at a hospital in Mongolia.\nKKaannggaarroooo\nmmootthheerr\nccaarree::\nIImmpplleemmeennttaattiioonn\nssttrraatteeggyy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 8, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 304, "chroma:document": "Abbreviations\n24/7 24 hours a day, seven days a week\nCI confidence interval\nDHIS2 a health management information platform (formerly known as\nDistrict Health Information Software 2)\nENAP Every Newborn Action Plan\nHMIS health management information system\nKMC kangaroo mother care\nLBW low birth weight\nMNCAH&N maternal, newborn, child and adolescent health and nutrition\nSDG Sustainable Development Goal\nSTAGE WHO Strategic and Technical Advisory Group of Experts\nUNICEF United Nations Children\u2019s Fund\nUSAID United States Agency for International Development\nWHO World Health Organization\nvii"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 9, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 305, "chroma:document": "Glossary\nEvery Newborn Action Every Newborn Action Plan (ENAP) is a global framework to end preventable\nPlan (ENAP) maternal and newborn deaths and stillbirths. The plan sets an action and\nmeasurement agenda for integration within national newborn health plans\nbased on the latest epidemiology, evidence, global and country learning. Led by\nWHO and UNICEF, its preparation was guided by the advice of experts, partners,\nand the outcome of several multistakeholder consultations. The final plan was\nendorsed by 194 Member States at the 67th session of the World Health Assembly\nin May 2014, who committed to put the recommended actions in practice. The\nWHO Director-General has been requested to monitor progress towards the\nachievement of the global targets and report periodically to the World Health\nAssembly until 2030 (1).\nHealth management A health management information system is the system of routine data"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 9, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 306, "chroma:document": "Health management A health management information system is the system of routine data\ninformation system collection, processing, reporting, analysis and use in health-care facilities and\nin the community. It provides essential information for national policy-makers,\ndistrict health managers, facility administrators and health workers across\nhealth-system levels, serving as the backbone of national health service delivery\nprogrammes (2).\nKangaroo mother care The care of preterm or low-birth-weight infants in continuous and prolonged\n(KMC) (i.e. 8\u201324 hours per day, for as many hours as possible) skin-to-skin contact\ninitiated immediately after birth unless the newborn is critically sick, with\nsupport for exclusive breastfeeding or breast-milk feeding (3). An additional\nfeature of KMC, when initiated in health-care facilities, is timely discharge from\nthe neonatal intensive or special care unit to a lower level of care within the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 9, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 307, "chroma:document": "the neonatal intensive or special care unit to a lower level of care within the\nfacility or at home, with continued skin-to-skin contact and close monitoring (4).\nLow-birth-weight infant An infant who weighs less than 2500 g at birth, irrespective of gestational age.\nNewborn mortality Death of a newborn in the first 28 days after birth. Reported as neonatal mortality\nrate (i.e. newborn deaths in the first 28 days after birth per 1000 live births).\nPreterm infant An infant who is born before 37 completed weeks of gestation.\nSick newborn A newborn who requires medical care.\nSmall and/or sick The package of facility-based, inpatient care for small and/or sick newborns\nnewborn care comprising interventions to deal with complications arising from preterm birth\nand/or low birth weight, and neonatal infections (sepsis, meningitis, pneumonia\nand those causing diarrhoea) (5).\nviviiiii\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9ec9e2d4-1558-476e-a401-2b3800aa3e42
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 10, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 308, "chroma:document": "Small and/or sick\nType of care\nnewborn care (continued) Level Standards of care and evidence-based interventions\nprovided\nPrimary Essential Immediate newborn care (thorough drying, skin-to-skin contact\nnewborn of the newborn with the mother, delayed cord clamping, hygienic\ncare cord care); neonatal resuscitation (for those who need it); early\ninitiation and support for exclusive breastfeeding; routine care\n(Vitamin K, eye care and vaccinations, weighing and clinical\nexaminations); prevention of mother-to-child transmission of HIV;\nassessment, management and referral of bacterial infections,\njaundice and diarrhoea, feeding problems, birth defects and\nother problems; pre-discharge advice on mother and baby care\nand follow-up.\nSecondary Special Thermal care; comfort and pain management; kangaroo mother\nnewborn care; assisted feeding for optimal nutrition (cup feeding and\ncare nasogastric feeding); safe administration of oxygen; prevention"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1556cc7d-ce1b-4798-a748-9efb21591149
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 10, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 309, "chroma:document": "care nasogastric feeding); safe administration of oxygen; prevention\nof apnoea; detection and management of neonatal infection;\ndetection and management of hypoglycaemia, jaundice,\nanaemia and neonatal encephalopathy; seizure management;\nsafe administration of intravenous fluids; detection and referral\nmanagement of birth defects.\nTransition to intensive care: continuous positive airway pressure;\nexchange transfusion; detection and management of necrotizing\nenterocolitis (NEC); specialized follow-up of infants at high risk\n(including preterm).\nTertiary Intensive Advanced feeding support (e.g. parenteral nutrition); mechanical/\nnewborn assisted ventilation, including intubation; screening and\ncare treatment for retinopathy of prematurity; surfactant treatment;\ninvestigation and management of birth defects; paediatric surgery;\ngenetic services.\nWHO Strategic and An external advisory group of technical experts that provides strategic and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: cf736a95-4da5-4021-9760-63634d03dca8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 10, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 310, "chroma:document": "WHO Strategic and An external advisory group of technical experts that provides strategic and\nTechnical Advisory Group technical advice to WHO on matters relating to maternal, newborn, child\nof Experts (STAGE) for and adolescent health and nutrition. Its scope includes global priorities\nMaternal, Newborn, Child and emerging issues for which policies, strategies, recommendations and\nand Adolescent Health intervention packages should be developed or updated to help Member States\nand Nutrition (MNCAH&N) in reaching relevant Sustainable Development Goal targets. The group reports\ndirectly to the Director-General of WHO (6).\nReferences for glossary\n1. Every newborn: an action plan to end preventable deaths. Geneva: World Health Organization; 2014\n(https://apps.who.int/iris/handle/10665/127938).\n2. Every newborn progress report 2019. Geneva: World Health Organization and United Nations Children\u2019s Fund (UNICEF); 2019"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9736f28b-3ce6-4362-96a6-78a2deab12d1
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 10, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 311, "chroma:document": "(https://resourcecentre.savethechildren.net/document/every-newborn-progress-report-2019/, accessed 30 November 2022).\n3. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: World Health Organization; 2015\n(https://apps.who.int/iris/handle/10665/183037).\n4. Charpak N, Ruiz-Pel\u00e1ez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants \u22642000 grams:\na randomized, controlled trial. Pediatrics. 1997;100(4):682\u20138. doi:10.1542/peds.100.4.682\n5. Survive and thrive: transforming care for every small and sick newborn. Geneva: World Health Organization; 2019\n(https://apps.who.int/iris/handle/10665/326495)\n6. Strategic and Technical Advisory Group of Experts (STAGE). Handbook on maternal, newborn, child, adolescent health & nutrition.\nGeneva: World Health Organization; 2022 (https://cdn.who.int/media/docs/default-source/mca-documents/stage/stage-mncahn-\nhandbook-final.pdf, accessed 21 April 2023).\nix"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 04bee1b5-5bae-4f8b-a456-87c449b7a895
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 11, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 312, "chroma:document": "x\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming\n1\nBoy Laike was born five weeks preterm and very sick with hyperthyroidism, needing treatment for\nmany weeks. After initial short stabilization he had early KMC and his parents kept up continuous\nskin-to-skin contact throughout his hospitalization. Lund-Malm\u00f6 NIDCAP Center, Stockholm."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8f15ece5-4783-4ec3-9b7c-7ee2b1690eda
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 313, "chroma:document": "Introduction\nGlobal vision and position on kangaroo mother care\nKangaroo mother care (KMC) is the care of preterm or low-birth-weight (LBW) infants in continuous\nand prolonged (i.e. 8\u201324 hours per day, for as many hours as possible) skin-to-skin contact starting\nimmediately after birth,a with support for exclusive breastfeeding or breast-milk feeding. An additional\nfeature of KMC, when initiated in health-care facilities, is timely discharge from the neonatal intensive\nor special care unit to a lower level of care within the facility or at home, with continued skin-to-skin\ncontact and close monitoring (1,2).\nThe global Kangaroo Mother Care Working Group convened by the WHO Maternal, Newborn, Child and\nAdolescent Health and Nutrition (MNCAH&N) Strategic and Technical Advisory Group of Experts (STAGE)\nenvisions that the mother and infant receive respectful care and are enabled to remain together from"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bf6b0b4d-d69d-4c55-8748-f4767d699671
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 314, "chroma:document": "birth, irrespective of their clinical condition, unless either of them are critically sick. Every preterm\nor LBW infant in low-, middle- and high-income settings should receive KMC immediately after birth\nalong with other essential evidence-based interventions to improve their survival, growth, health\nand development.\nThe KMC Global Position Paper puts forward this vision and the joint position of the KMC Working Group\non implementing KMC as an integral component of small and/or sick newborn care within national\nmaternal, newborn and child health programmes (1,2). It emphasizes the importance of KMC for all\npreterm (gestational age at birth < 37 weeks) or LBW (birth weight < 2.5 kg) infants, both well and sick\n(1). It also highlights new evidence of its myriad benefits for infants, mothers and families, and calls for\nglobal collaborative action to implement KMC at scale for global impact. It reinforces the unique value"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 528fbac7-db0b-4c69-a090-d0120679b03f
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 315, "chroma:document": "of KMC in humanizing the care of infants by providing cost-effective, high-quality care, regardless of\ntechnological or resource gaps, empowering and building the confidence of mothers and caregivers to\nlead the physical and emotional care of their infants, and improving the survival, health and well-being\nof mothers and infants alike.\nAchieving KMC implementation at scale requires:\n\u2022 a system-wide perspective and structural changes to place mothers and infants at the centre of care\nby keeping and caring for them together after birth;\n\u2022 a commitment by political and programme leadership to implement KMC as the foundation of small\nand/or sick newborn care;\n\u2022 a dedicated budget for implementing KMC as part of small and/or sick newborn care in national\nmaternal, newborn and child health programmes; and\n\u2022 developing and implementing a monitoring and evaluation framework to track progress."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6d77a1a4-6f36-4a11-b7fe-a67d0bb099fb
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 12, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 316, "chroma:document": "\u2022 developing and implementing a monitoring and evaluation framework to track progress.\na After initial care at birth for facility births, unless the infant is unable to breathe spontaneously even after resuscitation, is in\nshock or requires mechanical ventilation; and immediately after birth for home births, unless the infant has any danger signs or\nis below the country cut-off for gestational age or birth weight for admission to a newborn care unit.\n1"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a3c988ae-50d9-41e3-a9f1-9217596c721d
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 13, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 317, "chroma:document": "Implementing immediate KMC for small and/or sick newborns\nis the optimal approach to save newborn lives in all settings.\nIt should not be seen as a low-resource strategy; indeed, it is\nsuperior to current high-tech strategies (1).\nRationale for an implementation strategy for kangaroo\nmother care scale-up\nCoverage gap despite World Health Organization guidelines and national policies\nThere are few published studies on population-based coverage of KMC, but it is known that KMC\ncoverage is low worldwide, despite long-standing WHO guidelines, country-level policies, and\ncontinued advocacy and efforts by global organizations. In 2019, only 32% of the 90 countries that\nreported progress on the Every Newborn Action Plan (ENAP) had an updated policy or guideline on\nKMC (3). Even in countries with policies or guidelines on KMC, these are often not translated into\nprogrammatic implementation because of multiple implementation bottlenecks (4,5). Increases in"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fe3c3328-ddcd-4b78-8213-4c433b1af6fc
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 13, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 318, "chroma:document": "programmatic implementation because of multiple implementation bottlenecks (4,5). Increases in\nKMC coverage at national or subnational levels have been documented in only a few countries, with\ndiverse implementation approaches and encouraging but suboptimal results. For example, in the\nPhilippines, following a national-level scale-up effort starting in 2015, some 53% of preterm or LBW\ninfants (< 2000 g/< 36 weeks) received KMC in a sample of 45 hospitals in 2019 (6). In Bangladesh,\nnational efforts to scale up KMC starting in 2016 led to 22% of preterm or LBW infants (< 2000 g) in the\nnational dataset for KMC within the DHIS2 data platform receiving KMC in 2020 (7). Malawi developed\na national KMC policy and incorporated KMC into the Ministry of Health workplan and in its essential\nhealth-care package for maternal and neonatal health in 2005\u20132006; yet in 2017, only 22% of potentially"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d79d05b4-73a7-43e8-b4c3-e89754952f08
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 13, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 319, "chroma:document": "eligible infants were initiated on KMC nationally (8,9). Similarly, in Colombia, where KMC became part of\nGovernment policy in 2009, approximately 63% of eligible babies had access to KMC in 2021 (10).\nVariable understanding of the intervention and how to implement it\nThere is variability among different stakeholders in their understanding of the KMC intervention and\nhow to implement it. Studies implementing or evaluating KMC often either do not define it or the\ndefinition varies in terms of components such as skin-to-skin contact alone or with support for exclusive\nbreastfeeding, as well as the number of hours of KMC per day required for effectiveness (11,12). The\nmechanisms through which KMC has been introduced and scaled up in different country settings have\nalso varied, and governments have used different programmatic approaches for KMC implementation\n(4,13,14). Health-care facilities at different levels of care provide KMC across countries, and there is"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4a84425b-45c5-4125-ace3-7b7a5d0730fb
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 13, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 320, "chroma:document": "variability in the practices, coverage, type, and quality of services and data availability and quality.\nNew evidence and guidelines are now available that facilitate consensus on the implementation\naspects of KMC. In addition, lessons learned and evidence are available on health system intervention\nstrategies that have successfully achieved high population coverage of continuous and prolonged\nKMC (15,16). Having consensus on the implementation strategy adaptable to diverse country contexts\nwill help country programme managers and health workers to implement KMC for all preterm or LBW\ninfants at all levels of facility care and in the community.\n2\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0ec2d90b-aaac-4cf5-b055-b4e801581629
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 14, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 321, "chroma:document": "Opportunity to integrate with small and/or sick newborn care scale-up\nKMC is a complex intervention, both as individual practice and as a programmatic component of\nsmall and/or sick newborn care. On one hand, specific behaviours are required from the infant's\nmother and family to carry and feed their preterm or LBW infant for a prolonged period. On the other\nhand, the health system needs to be ready to provide essential clinical interventions and supportive\nservices that promote respectful and quality care for both mother and infant as a unit in one place, to\nenable the mother and family to practise KMC. Thus, KMC implementation requires the co-location\nof maternal and infant care so that mother and infant can remain together after birth, even when a\npreterm or LBW infant is sick and needs care in a newborn special or intensive care unit. KMC calls for\nclose collaboration between paediatric and maternal care providers and promotes family involvement"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6e0ffef3-5e48-4c76-91c7-1d58a5490ba0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 14, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 322, "chroma:document": "close collaboration between paediatric and maternal care providers and promotes family involvement\nin maternal\u2013newborn care, with the mother as the primary caregiver for her newborn, even when the\ninfant is preterm, LBW or sick. Thus, the KMC implementation strategy defines the fundamental model\nfor envisioning, redesigning and implementing optimal care of all preterm or LBW infants, both well\nand sick, using KMC as the fulcrum.\nWith renewed interest and investment in the prioritization and scale-up of small and/or sick newborn\ncare in the past few years, there is a window of opportunity to emphasize and integrate the evidence-\nbased practice of KMC as the foundation for strengthening small and/or sick newborn care within\nmaternal, newborn and child health programmes (18,19). While the focus of small and/or sick newborn\ncare strengthening is likely to be at secondary or level-2 facilities, the renewed vision around KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 102f6b00-502e-4952-9eae-049390965fa3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 14, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 323, "chroma:document": "scale-up provides an opportunity to reorganize and strengthen service delivery for preterm or LBW\nnewborns at all levels of care.\nIntroduction 3\n\u00a9WHO/PAHO.\nCountry:\nColombia"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 60e1e264-2cb3-4272-bb78-d662b8831871
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 15, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 324, "chroma:document": "Purpose of the implementation strategy\nThe purpose of developing the implementation strategy is to:\n\u2022 guide countries in implementing KMC for all preterm or LBW infants, both well and sick, as the\nfoundation of small and/or sick newborn care at different levels of care in the facility and community,\naccording to their specific health system and cultural or social contexts;\n\u2022 enunciate the programmatic principles for implementing KMC as an integral component of small\nand/or sick newborn care and the ways and means to achieve them.\nAudience for the implementation strategy\nThe KMC implementation strategy targets a broad audience. These include policy-makers and\nprogramme managers at national, regional and local levels, government and nongovernmental\norganizations working in the area of maternal and newborn care, global and national professional\nassociations, public and private hospital management at all levels of care, and facility- and community-\nbased maternal and infant care providers."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6be3e12c-f121-4411-98b4-532f9a71335f
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 15, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 325, "chroma:document": "based maternal and infant care providers.\nProcess of development of the implementation strategy\nThe preparation of the KMC implementation strategy was led by the World Health Organization, with\ninputs from a designated KMC working group, convened by the WHO STAGE for MNCAH&N (20). (See\nAcknowledgements for details of working group composition.)\nIn accordance with WHO procedures for declarations of interests (DOIs) (21), all external experts\nacting in their individual capacity were asked to declare in writing any competing interests (whether\nacademic, financial or other) using the standard WHO DOI form. The WHO Secretariat reviewed all\nDOI forms to determine whether any conflicts of interest existed. For this work, none of the experts\nhad any conflicts of interest that could pose any risk to the document development process or reduce\nits credibility.\nIndependent, renowned global experts were appointed as chairs and WHO served as the Secretariat for"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 77e5432f-bc54-4017-ae8a-3784f2d30a79
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 15, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 326, "chroma:document": "Independent, renowned global experts were appointed as chairs and WHO served as the Secretariat for\nthe Working Group. Brainstorming sessions and online consultations were organized with all members\nto develop the first draft, using the existing evidence syntheses available from the systematic reviews\ncommissioned for the WHO Guidelines for the care of preterm or LBW infants (1). New systematic\nreviews were commissioned where required. The chairs and all the Working Group members reviewed\nand provided their feedback on the outline and content of the draft document. Any differences in\nopinion were discussed among the Working Group members in regular online group meetings.\nAdditional meetings were organized with individual members and the Working Group chairs to address\nspecific concerns when required. The aim of the meetings was to reach consensus on the contents,\nincluding terminology and strategies."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 873f5fbf-ac07-4363-9615-5af3a41df950
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 15, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 327, "chroma:document": "including terminology and strategies.\nThe secretariat collated feedback from all participants and finalized the content of the document.\nOrganizational nominees discussed the document within their organizations to provide their\norganizations\u2019 views and endorsement. The final adoption of the content of the document was done by\nconsensus, defined as full agreement among all Working Group members. The implementation strategy\nwas endorsed by all participating organizations and approved by the WHO STAGE for MNCAH&N, which\nreports directly to the WHO Director-General.\n4\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1db50a6f-9f73-468b-b3dc-12d0b8fe3f77
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 16, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 328, "chroma:document": "Introduction 5\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming\nPersson Pettersen, born eight weeks preterm, in KMC with his mother. He was\ninacontinuous KMC for his first week of life. Lund-Malm\u00f6 NIDCAP Center, Stockholm."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6b48edb8-8c61-4092-a366-46d1e75acdb8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 17, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 329, "chroma:document": "66\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming\n2\nBoy Rajai, born via caesarean section almost 12 weeks preterm, received\nimmediate skin-to-skin contact with the aunt (sister of the mother) since the father\ncould not make it from work in time. Lund-Malm\u00f6 NIDCAP Center, Stockholm."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2c8574aa-1798-42a3-8535-f34c0570eba4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 330, "chroma:document": "The case for KMC\nSaves lives, advances human capital\nRich evidence from diverse settings highlights the utility of KMC in helping preterm or LBW infants\nto survive and thrive. The numerous benefits include: a 32% reduction in neonatal mortality; a 25%\nreduction in mortality by six months of age; a 68% reduction in hypothermia at discharge or by 28\ndays after birth; a 15% reduction in severe infections or sepsis; a 48% increased duration of exclusive\nbreastfeeding at facility discharge, as well as improvements in growth (22). Thus, KMC directly\ncontributes to Sustainable Development Goals (SDG) target 3.2 to reduce neonatal mortality to at least\nas low as 12 per 1000 live births and and under-five mortality to at least as low as 25 per 1000 live births\nby 2030 (23).\nPreterm or LBW infants are also at increased risk of adverse long-term outcomes. These include\nincreased risk of chronic diseases involving various organ systems, and neurodevelopmental and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6002603b-e0fd-4582-b9f9-dc887100e81b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 331, "chroma:document": "increased risk of chronic diseases involving various organ systems, and neurodevelopmental and\ncognitive disorders persisting from childhood into adulthood or manifesting in adulthood, which can\nsubstantially impact human capital and hence the economy of a country (24). Preventive interventions\nfor preterm birth are few at present and have limited impact. KMC not only improves survival but\nalso has long-lasting social and behavioural benefits. Preterm or LBW infants who received KMC\nhave reduced school absenteeism, hyperactivity, aggressiveness and externalization disorders. As\nadults, they are more protective and nurturing parents, receive higher hourly wages, and are less\nlikely to engage in socio-deviant conduct (24). Twenty-year-olds who received KMC as infants also\nhad significantly larger brains and improved brain function (e.g. intelligence, attention, memory\nand coordination) (25). Thus, KMC contributes to long-term health and well-being, and longer-term\nhuman capital."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ca2ab1bf-97fc-42c0-bbb5-30d0ee589ece
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 332, "chroma:document": "human capital.\nHumanizes care, empowers and benefits the mother\nWell-intentioned designs of health systems and service delivery mechanisms have marginalized and\ndisempowered mothers from participating more actively in their own and their infant\u2019s care, especially\nwhen the infant is born preterm or with LBW and is sick. KMC allows the mother to take a central role in\nher and her infant\u2019s care, reversing the power imbalance between mothers and health-care providers\nor health systems. It facilitates respectful maternal care and empowers new mothers as primary\ncare providers, even when an infant is preterm or LBW and sick. KMC builds mothers\u2019 confidence\nto care for their infants; enhances satisfaction with the quality of care provided to them and their\ninfant; and improves bonding and attachment (12,26\u201328). Additionally, it has several physiological\nand psychological health benefits for mothers. Mothers who practise KMC have a 24% lower risk"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3155651c-76b2-4892-9026-7ea164a59542
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 18, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 333, "chroma:document": "and psychological health benefits for mothers. Mothers who practise KMC have a 24% lower risk\nof moderate to severe depressive symptoms with consistently lower scores related to postpartum\nmaternal stress and anxiety, and a trend towards better general psychosocial well-being (28). Studies\nsuggest that skin-to-skin contact immediately after birth may also decrease the duration of the third\nstage of labour (29) and may reduce postpartum haemorrhage (30).\n7"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 80877deb-d7c6-4ac3-a849-08fe3f9cb5cd
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 334, "chroma:document": "Springboard to improve delivery of quality small and/\nor sick newborn and maternal care\nENAP has proposed new coverage targets for small and/or sick newborn care for 2020\u20132025 (18). The\nnew global target is that 80% of countries should have a national implementation plan in place in at\nleast half of the country, with an adequate number of functional level-2 inpatient units linked to level-1\nunits for small and/or sick newborns, with family-centred care. The national and subnational targets\nare that 80% of districts (or equivalent subnational units) should have at least one level-2 inpatient unit\nto care for small and/or sick newborns, with respiratory support including the provision of continuous\npositive airway pressure (18). Functional referral linkages from lower to higher levels of care are\nalso required.\nIt is envisaged that countries achieve this coverage with quality defined using WHO standards (31). The"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4453083b-7c38-4f44-a27d-4ba820ff3660
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 335, "chroma:document": "WHO standards for improving the quality of maternal and infant care in health-care facilities specify\nthat every woman and infant receive routine, evidence-based care and management of complications\nduring the postnatal period, according to WHO guidelines, with respect and preserving their dignity.\nThe standards further stipulate that preterm or LBW infants should stay with their mothers or carers,\nwith minimal separation, and receive KMC as soon as possible after birth. All mothers, carers or families\nshould be able to participate actively in their infant\u2019s care, decision-making, exercising the right to\ninformed consent, and making choices in an environment where their socioeconomic, emotional and\ncultural needs are respected and supported (31).\nEvidence-based interventions for small and/or sick newborn care include KMC alongside other\ninterventions such as: assisted feeding; safe administration of oxygen; detection and management"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d03c76d3-af33-43b9-916f-3aba74cc832e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 336, "chroma:document": "interventions such as: assisted feeding; safe administration of oxygen; detection and management\nof neonatal infection, neonatal jaundice, neonatal encephalopathy and congenital abnormalities;\nand management of preterm respiratory distress with continuous positive airway pressure (1,19). Any\nwell-equipped level-2 inpatient newborn care unit can provide all these interventions. However, the\nexperience of care for mothers and infants depends on keeping and caring for them together after\nbirth and ensuring family involvement in care (31). Therefore, enabling the mothers and infants to\nremain together and caring for them as a unit in one place while practicing KMC from birth becomes\nthe default standard of care for preterm or LBW infants, even when they are sick. This model of care\nallows high-quality medical care for the mother and infant while ensuring thermal protection, exclusive\nbreastfeeding, and improved interaction between mother or carer and infant, all of which contribute to"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5ed5f961-2370-4865-af2f-0f11b9e755e9
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 19, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 337, "chroma:document": "nurturing neurodevelopmental care. Direct and active involvement of the father or partner and families\nin maternal\u2013newborn care also leads to better preparedness for discharge and opportunities for better\nemotional and social support for the mother.\nHence, the scale-up of small and/or sick newborn care with KMC at its core will promote the\nimplementation of all essential quality parameters and help improve the delivery of quality maternal\nand small and/or sick newborn care across all settings. However, it is important to note that KMC can be\nimplemented even by countries that do not have well-established small and/or sick newborn care. KMC\ncould be the tip of the spear for establishing small and/or sick newborn care in such settings.\n8\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 467ed136-edd7-403c-8db8-981082c622f6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 338, "chroma:document": "Cost-effective intervention plus long-term economic benefits\nKMC is a highly cost-effective intervention; the cost of providing KMC in a health-care facility is lower\nthan that of conventional newborn care and it is more effective in improving short- and long-term\ninfant outcomes. The incremental cost\u2013utility ratio of KMC compared with conventional care is\nestimated to be US$ 1546 lower per extra quality-adjusted life year gained (32). The costs for successful\nscale-up of KMC are also affordable. The total incremental cost of scaling up KMC (i.e. cost of KMC over\nand above other small and/or sick newborn care) across a district was US$ 59 in Ethiopia and US$ 72 in\nIndia per eligible infant in the population (33). The efficiencies of care, human resources and reduced\ndependency on high-cost equipment achieved with immediate KMC could result in even higher cost\u2013\neffectiveness. KMC is also likely to result in long-term economic benefits owing to better long-term"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 291fed40-ab68-4e40-83d0-5b045b4e3ff5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 339, "chroma:document": "outcomes for infants and the restructuring of health systems for more efficient combined maternal and\ninfant service delivery. Therefore, while the implementation and scale up of KMC, especially immediate\nKMC, will require dedicated investment at the start, it will yield a high return on this investment in time\nto come.\nPromotes sustainable development\nBesides saving lives and contributing to enhanced human capital for a strengthened economy, KMC\npromotes sustainable development in multiple ways.\nKMC empowers the mother to take a central role in her infant\u2019s care as the primary caregiver and is\nfundamental to the SDG target 5.1 of ending all forms of discrimination against all women everywhere\nto achieve gender equality and empower all women. It lays the foundation for the reorganization\nof service delivery for maternal\u2013newborn care that is people-centred and follows a primary health\ncare approach rather than relying on advanced technology and energy-heavy solutions such as"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c103be2e-55ca-44c7-b811-e36c5675df66
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 340, "chroma:document": "care approach rather than relying on advanced technology and energy-heavy solutions such as\nincubators and radiant warmers. Hence, it can also contribute to SDG target 7.3 to improve global\nenergy efficiency and ensure access to affordable, reliable, sustainable and modern energy by cutting\nwaste. Additionally, KMC calls for infrastructure modifications for the combined care of mother\u2013infant\ndyads by cross-disciplinary providers, through innovative design approaches that are likely to be more\nefficient, sustainable and resilient. It ensures high-quality care for the mother\u2013infant dyad at all levels\nof health-care facilities and in the community, with attendant benefits of improving survival and long-\nterm health and development. Hence, delivered as part of universal health coverage, KMC will promote\nSDG target 9.1 to develop quality, reliable, sustainable and resilient infrastructure to support economic"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7a87b88c-07d9-45e0-9163-088758c6da94
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 20, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 341, "chroma:document": "development and human well-being, focused on affordable and equitable access for all.\nThe global efforts to scale up KMC with country buy-in are likely to promote multistakeholder\npartnerships to mobilize and share knowledge, expertise, technology and financial resources for\nachieving related SDGs in all countries, particularly developing countries (target 17.16). Monitoring and\nevaluating KMC implementation will require strengthening existing health data systems, and ongoing\nconsultative and capacity-building processes for developing and measuring indicators for KMC and\nsmall and/or sick newborn care.\nKMC reduces infant deaths, improves maternal well-being and\nparental experience of care, enhances human capital, promotes\nsustainable development and is highly cost-effective (1).\nThe case for KMC 9"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: aacd7739-7e18-4902-a0cf-56fba2ddd713
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 21, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 342, "chroma:document": "3\nNew mothers with their infants at Felege\nHiwot Hospital in Bahir Dar, Ethiopia.\n1100\n\u00a9WHO/Blink\nMedia\n-\nHilina\nAbebe"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bfbd4621-f444-4cb1-adc9-752ccbf087cd
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 22, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 343, "chroma:document": "Considerations for designing a\nKMC implementation strategy\nThis section summarizes the findings from two systematic syntheses of literature for programmatic\nactions and health system interventions that could promote high coverage, which guided the design of\nthe implementation strategy for KMC scale-up.\nThe first synthesis of grey literature identified reports of programmatic implementation of KMC, with\nan objective to understand the population-based coverage of KMC, availability of KMC services at\nnational and subnational levels, programmatic approaches to scale, and health system actions that\nmay influence KMC scale-up (14) (Box 1). The findings of this review were supplemented with additional\nstructured searches of both grey and published literature to cover sources beyond the scope of this\nreview. The second review documented the findings from research studies evaluating health system\nintervention strategies for KMC implementation that increase its coverage among preterm or LBW"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3d745eb3-3433-4c5f-8c34-93da5d7605ab
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 22, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 344, "chroma:document": "intervention strategies for KMC implementation that increase its coverage among preterm or LBW\ninfants conducted at various scales (16).\nLessons learned from national efforts to scale up KMC\nSummary of lessons learned from programmatic implementation\nBox 1.\nof KMC at national or subnational levels\nEighteen countries (Bangladesh, Brazil, Colombia, Ethiopia, Ghana, India, Indonesia, Islamic\nRepublic of Iran, Malawi, Mali, Nepal, Nigeria, the Philippines, Rwanda, South Africa, Uganda,\nthe United Republic of Tanzania and Viet Nam) had information about the implementation\nof KMC at national or subnational levels. National-level population-based KMC coverage was\navailable from only seven countries (Colombia, 63%; the Philippines, 53%; Ethiopia, 46%;\nBangladesh, 22%; Malawi, 22%; India, 13%; Viet Nam, 8%) and subnational-level coverage from\ntwo countries (Rwanda, 58%; Mali, 41%). Information on the availability of KMC services was\nscarce and fragmented, with no information on their quality."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8bb3f660-a9c1-4287-b6d5-6a0bdb856849
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 22, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 345, "chroma:document": "scarce and fragmented, with no information on their quality.\nCountries for which information on KMC implementation was available shared common\nhealth systems actions such as: KMC being part of national policy; recognition of KMC as a\npriority newborn health intervention; strong advocacy by champions at all levels; dedicated\ninvestments for KMC, in some cases covered by insurance; capacity-building and\nmotivation among health workers; dedicated space for KMC with equipment and\nsupplies; support for practising KMC; and data collection and use (14).\n11"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d760e74f-eb44-4b8b-b262-adce49803320
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 23, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 346, "chroma:document": "Only a few countries have implemented KMC at a national or subnational scale. Until around 2012,\nthere was little movement towards implementing KMC on a large scale in most countries. While 28\ncountries that provided data for ENAP reported having an updated national policy or guideline on KMC\nin 2019 (3), only a few have implemented it in programme settings. The grey literature synthesis found\ninformation suggesting that only 18 countries implemented KMC at a national or subnational level (see\nBox 1). There were few data on the programmatic implementation of KMC in high-income countries.\nInformation on the availability of KMC services is scarce and fragmented. There was little information\non the availability of KMC services at national or subnational levels, and the availability of services\nclosely reflect coverage. For example, KMC is provided in all departments of Colombia (2021) and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dbe95f6d-a97e-44f8-b559-3745c944a058
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 23, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 347, "chroma:document": "closely reflect coverage. For example, KMC is provided in all departments of Colombia (2021) and\nacross 43% of national, regional and provincial hospitals in the Philippines (2019), both of which report\nhigh coverage. In other countries that are expanding KMC services (e.g. Bangladesh, where KMC was\navailable across 108 sub-district health complexes and higher-level facilities in both urban and rural\nareas in 2021), the coverage of KMC is increasing (34). However, it is also important to note that facilities\nand hospitals reporting the provision of KMC services may not be ready to provide and sustain the\nservice due to a lack of staffing, guidelines, equipment and infrastructure, and other constraints. For\nexample, a 2014 assessment covering all 87 hospitals in the 22 districts of Malawi reported that, while\n79% reported providing inpatient KMC service, only 67% met the basic readiness parameters in terms of\nstaff, space for KMC and a functional infant weighing scale (35)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 57c65fab-ad9c-4d18-92f4-19f4cb2d3505
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 23, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 348, "chroma:document": "staff, space for KMC and a functional infant weighing scale (35).\nThere was little information on KMC scale-up in high-income countries. A policy survey around 2012 on\nfamily involvement from eight European countries showed that even among the units offering so-called\nkangaroo care (either skin-to-skin or not), not all responding units were offering skin-to-skin contact by\nmothers or fathers or partners. While 90% of units in the Kingdom of the Netherlands and 89% of units\nin Spain offered skin-to-skin contact by mothers, the figure was 78% for Denmark, 66% for Italy, 40%\nfor Belgium, 36% for France and 31% for the United Kingdom (36). Other reports from national surveys\nin Italy and Spain provide slightly different figures for the proportion of level-3 neonatal intensive\ncare units that offer KMC: 71% in Spain (2018) (37) and 94% in Italy (2021) (38). This could be due to\ndifferences in the responding units, definitions used for reporting, or the reporting period. However,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9e998d86-064b-4ca4-b2c8-0853d56d342b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 23, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 349, "chroma:document": "even in these settings, restrictions to implementation were reported; for example, in most units in Italy,\nKMC was limited to specific times.\nKMC coverage estimates are lacking in most countries. Data on KMC coverage are lacking even from\ncountries that have implemented KMC at a national or subnational scale. National-level population-\nbased data on KMC coverage were available from only seven countries, as follows.\n\u2022 In the Philippines, 53% of preterm or LBW infants (< 36 weeks or < 2000 g) received KMC in 2019,\nbased on 478 postpartum maternal interviews from a sample of 45 national and subnational\nhospitals (6).\n\u2022 In Colombia, KMC coverage data available from 24 cities/departments covering approximately 80%\nof the population suggest KMC coverage is close to 60% for all surviving preterm or LBW infants (10).\n\u2022 In Ethiopia, 46% of all LBW infants born in the 3804 health-care facilities providing delivery care\nservices in Ethiopia were initiated on KMC in 2016 (39)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ee3cb4a0-5c65-41cc-b405-74197ae2d882
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 23, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 350, "chroma:document": "services in Ethiopia were initiated on KMC in 2016 (39).\n\u2022 In Bangladesh, 6410 of the 64 426 (i.e. 10% of) infants weighing under 2000 g born over four years\n(2016\u20132020) received KMC; the KMC coverage was approximately 22% in 2020 (34).\n\u2022 In Malawi, 16 000 cases nationally were initiated on KMC in health-care facilities in 2017, an\nestimated 21% of expected cases, assuming that 10% of all live births would need KMC (8,40).\nHowever, a recent report suggests that fewer than 10% of preterm or LBW infants in Malawi received\nfacility-based KMC in 2021, according to data extracted from maternity reports within the DHIS2 (4).\n12\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 34998ba2-673d-4f98-a61d-12e499840672
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 351, "chroma:document": "\u2022 In India, 50 959 of the 800 000 infants treated in special newborn care units (13.2%) received KMC\nbetween 1 January 2015 and 31 July 2017, with the proportion varying from 0 to 31% between\nstates (41).\n\u2022 In Viet Nam, according to routine national data from 2015, 5050 of 61 825 LBW infants received\nKMC (8%), while data from 7 provincial hospitals implementing KMC showed that 2013 of 9153 LBW\ninfants received KMC (22%) in the same year (42).\nSubnational (i.e. regional-, state- or district-level) data on KMC coverage were available from Mali and\nRwanda. In Mali, 41% of infants < 2500 g were initiated on KMC in three regions in October 2018 to\nSeptember 2019 (43). In Rwanda, facility-level KMC admission rates of LBW infants in 10 districts were\n55%, 68%, 61% and 46%, respectively, for the four quarters in 2016 (44).\nOnly a handful of countries have included KMC indicators in their national health management"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d0409fca-6f39-4d09-9932-3e007fb222ba
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 352, "chroma:document": "Only a handful of countries have included KMC indicators in their national health management\ninformation systems (HMIS), but the information collected is inadequate, and the reporting is\ninconsistent. Even where the availability of KMC services has increased in terms of the number of\nhealth-care facilities providing KMC services, such as in Malawi, coverage continues to be difficult to\nestimate (4).\nProgrammatic actions for KMC implementation at scale. Table 1 presents the main programmatic\nactions for KMC implementation in seven countries for which sufficient information was available on\nlarge-scale KMC implementation efforts. The actions could have occurred at national or subnational\nlevels and are classified by health system building blocks. Countries for which information on KMC\nimplementation was available shared common health systems actions, such as: KMC being part of\nnational policy; recognition of KMC as a priority newborn health intervention and strong advocacy by"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 37ba5c2b-a620-4ffd-a0ed-bbd8a0d246d8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 24, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 353, "chroma:document": "champions at all levels; dedicated investments for KMC, in some cases covered by insurance; capacity-\nbuilding and motivation among health workers; dedicated space for KMC with equipment and supplies;\nsupport for practising KMC; and data collection and use (14).\nConsiderations for designing a KMC implementation strategy 13\n\u00a9WHO/PAHO.\nCountry:\nColombia."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4c6f03b1-496f-4226-928d-2804152acc7c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 354, "chroma:document": "Table 1. Programmatic actions taken by countries that have made efforts towards\nKMC implementation at scale classified by health system building blocks\nCountry\nHealth system Programmatic actions for\nbuilding block KMC implementation\nBan Bra Col Ind Mal Phil SA\nPolicy, governance Adoption of KMC in national or subnational\n+ + + + + + +\nand leadership policy and guidelines\nAdvocacy by champions (e.g. professional\norganizations and political leaders) at national\n+ + + + + +\nand subnational levels and linkage with\ninternational KMC networks\nRecognition of the value of KMC as a priority\n+ + + +\nnewborn health intervention\nUtilization of service readiness surveys or\nsituational analyses to inform the planning + +\nof scale-up\nTarget setting for KMC coverage + +a\nHealth system Dedicated funding/investments for KMC from\n+ + + + + + +\nfinancing government and/or donors\nInclusion of KMC as an essential maternal\nand newborn health service covered under + + + + +\ninsurance (partially or fully)"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f09221ba-4787-48df-b620-6e659e825a80
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 355, "chroma:document": "and newborn health service covered under + + + + +\ninsurance (partially or fully)\nHealth workforce Capacity-building of health workforce\nincluding pre-service and in-service training + + + + + + +\nand sensitization on KMC\nMotivation of staff and creating a network of\n+ + + +\nhealth-care professionals\nFacility staff serving as champions and\n+ + +\nmotivators\nHealth service Integration of KMC into small and/or sick\ndelivery newborn care, comprehensive newborn care, + + + + +\nand/or maternal and newborn care packages\nProvision of family-centred care + + + + + +\nClarity about KMC and its practice (e.g.\nprotocols, counselling board, tools, job aids) + + + + +\nat each levels of care\nCentres of excellence and/or champions for\nKMC in tertiary and secondary level facilities + + + + +\n(i.e. coaches to train others)\nContinuity of care within the health system\nand between the facility and community + + +\n(including referral system)\nPost-discharge follow-up at a health facility or\n+ + + + +"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e22d7b02-eea0-4d5f-ac3e-b1e87903cf16
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 25, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 356, "chroma:document": "(including referral system)\nPost-discharge follow-up at a health facility or\n+ + + + +\nin the community\n14\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6039837f-0a3e-41cb-a709-b513e30cb523
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 26, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 357, "chroma:document": "Country\nHealth system Programmatic actions for\nbuilding block KMC implementation\nBan Bra Col Ind Mal Phil SA\nHealth infrastructure Dedicated space for KMC with equipment and\n+ + + + + +\nand supplies supplies\nHealth management Monitoring KMC through HMIS using specific\n+ + + +\ninformation systems indicators\nCreation of a data collection platform (not\nnational level) with specific indicators for + +\naccess and outcomes\nPutting in place data management systems\nfor data use and sharing to ensure data quality + + +\nand utilization of data for action\nCapacity-building on data collection, analysis\n+ +\nand interpretation\nCommunity Social and behaviour change communication\nownership and initiatives and community awareness building + + + +\npartnership\nUse and orientation of existing community\nhealth workers and support groups for referral + +\nand post-discharge follow-up\nEngagement of community structures and\ncommunity health workers for community- +\nbased provision of KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6a9521ab-7aa7-4ee0-b96d-dd75c965853e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 26, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 358, "chroma:document": "community health workers for community- +\nbased provision of KMC\nCountries: Ban: Bangladesh; Bra: Brazil; Col: Colombia; Ind: India; Mal: Malawi; Phil: Philippines;\nSA: South Africa.\nAbbreviations: HMIS: health management information system; KMC: kangaroo mother care.\nNo information found in the documents\n+ Found in a least one document\navailable for review\nSource: Berg et al. (2023) (14); a Sumita Ghosh, Ministry of Health and Family Welfare, Government of India,\npersonal communication.\nConsiderations for designing a KMC implementation strategy 15"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 71c4c6c1-3806-427f-8073-158eb826384e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 27, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 359, "chroma:document": "It is of note that, in the same country, implementation success at subnational levels may vary,\ndepending on the prioritization of small and/or sick newborn care and various contextual,\ngeographical, social, economic and political factors beyond the health system building blocks.\nIndia has advanced very rapidly with the programmatic implementation of KMC. Figure 1 shows the\nkey programmatic milestones that led to the scale-up of KMC as part of facility-based small and/or sick\nnewborn care in India.\nFigure 1. KMC in India: programmatic milestones\nKMC included in\nIndia Newborn\nAction Plan with National guidelines\ncoverage targets of on family All functional SNCU/\nKMC Network of 75% by 2025 and participatory care NICUs are providing\nIndia established 90% by 2030 released KMC services\n1994 2003 2011 2014 2017 2018 2022\nGuidelines to revise\nexisting SNCU\nKMC included in layout to create\nOperational\nnational guidelines additional space\nguidelines for KMC"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0689d363-7f3a-42d4-b2aa-fe05f4f66124
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 27, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 360, "chroma:document": "Operational\nnational guidelines additional space\nguidelines for KMC\nKMC introduced for facility-based to accommodate\nreleased\nnewborn care mother and baby\ntogether\nKMC: kangeroo mother care; NICU: neonatal intensive care unit; SNCU: special newborn care unit.\nSource: developed in collaboration with the Government of India.\n16\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 570a25d9-de05-4e0a-810d-7206e563b6f4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 361, "chroma:document": "Evidence from implementation research\nThe second review synthesizes evidence from research on health system intervention strategies for\nKMC implementation that increase its coverage, irrespective of country income, facility or community\nsetting (16). Sixteen studies evaluated 15 health system intervention strategies for KMC implementation\napplied in one or more building blocks and reported KMC coverage. Two studies implemented and\nevaluated the same intervention package in two countries (Nepal and Uganda), resulting in two\npublications. Two were community-based cluster randomized controlled trials, one was a mixed-\nmethods study done across the facility\u2013community continuum, two were quality-improvement studies\n(one facility- and one community-based), nine were uncontrolled before\u2013after facility-based studies,\nand two were national-level programmatic scale-ups. Thirteen studies were from lower-middle- or low-"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 89a7996e-7c91-4115-96ec-3ed9cae64475
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 362, "chroma:document": "income country settings (Bangladesh, India, Ethiopia, Ghana, Nepal, Philippines, Uganda), and three\nwere from a high-income setting (United States of America).\nEight of the 16 studies achieved increased coverage, defined as an increase in KMC coverage by at\nleast 25% from baseline and final coverage of more than 50%, of which four also achieved skin-to-skin\ncontact of at least 8 h/day. On analysing the health system interventions applied by studies that did\nor did not achieve high coverage (increase in KMC coverage by < 25% from baseline or final coverage\n< 50%), the main lessons were as follows.\nBreadth of health system interventions (i.e. number of health system building blocks in which\ninterventions were delivered). A higher proportion of studies that applied interventions across\nmore health system building blocks achieved increased coverage, with some variability. Of the 16\nincluded studies:"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 84750ebd-7f35-44ce-915b-2ffe9da7e7fa
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 363, "chroma:document": "included studies:\n\u2022 all three studies (100%) that applied interventions across five to six building blocks achieved\nincreased coverage;\n\u2022 two of the four studies (50%) that applied interventions across three to four building blocks achieved\nincreased coverage;\n\u2022 three of the nine studies (33%) that had interventions across one to two building blocks attained\nincreased coverage.\nThe studies that did not achieve increased coverage had interventions primarily focused on the health\nworkforce and service delivery, and were weak on leadership and governance, financing and health\ninformation systems.\nIntensity of health system interventions (i.e. how much and how well the interventions were\napplied). Studies that included high-intensity intervention in at least one health system building block\nwere more likely to achieve increased KMC coverage than those that did not.\n\u2022 All three studies (100%) that achieved increased KMC coverage along with mean skin-to-skin contact"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 12dee29f-263d-4066-bdfc-d819edac3853
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 28, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 364, "chroma:document": "for at least 8 h/day had high-intensity interventions in at least one health system building block.\n\u2022 Three of the five studies (60%) that achieved increased KMC coverage but where mean skin-to-skin\ncontact was fewer than 8 h/day or not reported had high-intensity interventions in at least one health\nsystem building block.\n\u2022 Three of the eight studies (38%) studies that did not achieve increased KMC coverage had high-\nintensity interventions in at least one health system building block.\nThe review findings suggest that high-intensity interventions across multiple health system building\nblocks should be used for equitable scale-up of KMC that achieves skin-to-skin contact for at least\n8 h/day. The interventions should be integrated into small and/or sick newborn care and adapted to the\nlocal context.\nConsiderations for designing a KMC implementation strategy 17"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c1782fe7-cf01-44c2-9340-4608e4bdda04
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 365, "chroma:document": "Types of health system interventions (i.e. what interventions were applied). The types of interventions\nimplemented by the studies that achieved increased KMC coverage are summarized in Table 2 along\nwith some important barriers.\nTable 2. Health systems barriers identified and interventions that were effective in\nimproving KMC coverage (16)\nHealth system Key interventions that were\nImportant barriers identified\nbuilding block effective in improving KMC coverage\nLeadership and \u2022 Lack of priority and leadership support \u2022 High-level leadership engagement\ngovernance or within the health system. (national/provincial/district policy-\npolicy \u2022 Policy changes not accompanied makers and programme managers\nby system-based efforts to secure and facility leadership).\nhospital introduction of KMC. KMC was \u2022 KMC-supportive policies (create\nrecommended in national guidelines conditions to enable mothers to be\nbut not practised in district and with their infants [i.e. by providing"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a34adf1f-4f1d-4491-a703-2681748e3cea
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 366, "chroma:document": "but not practised in district and with their infants [i.e. by providing\nlower-level facilities. a bed, food, water, toilet, etc.];\n\u2022 Male family members are not allowed allow the family to support the\ninside wards to practise or support KMC. mother in providing KMC), and\nregulations (incorporate KMC in\nlicensing standards for health-care\nfacilities and pre-service education\nof doctors and nurses).\nHealth financing \u2022 No specifically allocated financial \u2022 Costs for establishing KMC wards,\nresources to cover implementation costs human resources and running\nof expanding infant care to include KMC costs are included in national and\nfor preterm or LBW infants within health- subnational plans and budgets.\ncare facilities; costs not included in local \u2022 Expanded health insurance to cover\ngovernment planning. care for small and/or sick infants.\nHealth workforce \u2022 Shortage of nursing staff leading to an \u2022 Adequate nursing staff with"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6564fb55-3fbd-464d-9f16-f531ef73aeca
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 367, "chroma:document": "Health workforce \u2022 Shortage of nursing staff leading to an \u2022 Adequate nursing staff with\nincreased workload for the existing nurses; strengthened competency and\nno dedicated KMC nurses and counsellors; motivation to support KMC.\nresident doctors, interns and nurses not \u2022 Engagement of professional\noriented on practical aspects of KMC. organizations, KMC\n\u2022 Nurses unable to spend time on KMC champions, maternal\u2013neonatal\ncounselling due to frequent rotations and staff collaboration.\nmultiple tasks.\n\u2022 Resource-limited setting with low doctor-\nto-patient and nurse-to-patient ratios;\ndouble the resources required in case\nof twins; lack of confidence and training\nof staff.\n\u2022 Health-care staff, including nurses,\nconsider KMC inferior to incubator care;\nstaff reluctance to change old practices;\nconcerns about the safety of preterm or\nLBW infants; fear of complications; and\nfears about giving care responsibilities to\nmothers and other caregivers.\n18\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2ba09762-d4d9-4c52-8307-6197e760b22a
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 29, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 368, "chroma:document": "mothers and other caregivers.\n18\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f0de032a-3496-418b-b412-64f48effb5fd
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 30, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 369, "chroma:document": "Health system Key interventions that were\nImportant barriers identified\nbuilding block effective in improving KMC coverage\nService delivery \u2022 Lack of counselling of mothers and \u2022 KMC wards with a conducive\nrelatives in labour wards, postnatal wards; environment (infrastructure,\nconsequently, no early initiation of KMC. support and counselling).\n\u2022 Lack of interest from mothers and \u2022 Community engagement to\npoor support from family; early promote KMC.\ndischarge demands. \u2022 Early identification and facilitated\nreferral of LBW infants.\nHealth \u2022 No documentation of KMC, lack of regular \u2022 Recording KMC (clinical registers)\ninformation audit of KMC practices and documentation using KMC-specific indicators in\nsystems in registers. routine data systems.\n\u2022 KMC registers not well maintained, data\nentry not consistent.\nSupplies \u2022 Non-availability of KMC bags and binders, \u2022 KMC beds, chairs and\nshortage of KMC chairs and beds. garments/binders.\nKMC: kangeroo mother care; LBW: low birth weight."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1e1d096e-3bb4-436e-b00a-fad3186f2799
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 30, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 370, "chroma:document": "KMC: kangeroo mother care; LBW: low birth weight.\nFather providing KMC in Da Nang Hospital for\nWomen and Children, Da Nang, Viet Nam.\nConsiderations for designing a KMC implementation strategy 19\n\u00a9WHO/Gato\nBorrero"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7e544435-60d7-4633-9cc2-171996bb1b05
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 31, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 371, "chroma:document": "Adebowale Seun, 32, providing skin-to-skin care to her preterm baby in the combined\nmaternal\u2013newborn care unit, Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria.\n2200\n\u00a9LD\nPhotography/Idowu\nOlamide\n4"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4288d537-3bcd-4fc5-a65c-e9a83cac6727
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 372, "chroma:document": "Guiding principles for KMC\nimplementation\nRecognize the mother\u2019s role as primary caregiver\nRespecting, empowering and supporting mothers as primary caregivers is critical for successful KMC\nimplementation. Respectful maternity care is an essential prerequisite for quality infant care. Mothers\u2019\ntrust in health-care providers and engagement in the care of their infants is often dependent on how\nthey are treated in the health-care facility after birth (26,27). A key component of respectful maternal\ncare is creating the best possible conditions for mothers to stay with their newborns, which is essential\nfor implementing immediate KMC. This involves keeping the mother and the infant together from\nbirth until facility discharge, even when the infant is preterm or LBW and sick or the mother herself\nis sick, unless either the mother or infant is in a critical condition. It requires close collaboration and\ncoordination between maternal and infant health-care providers (45,46)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 27e816af-e73f-4e5c-a391-828284500dea
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 373, "chroma:document": "coordination between maternal and infant health-care providers (45,46).\nThe WHO Immediate KMC Study Group has shown that it is possible to keep LBW infants (weighing at\nleast 1.0 kg, but less than 1.799 kg, requiring admission to the newborn care unit) with their mothers\nimmediately after birth, regardless of gestational age, type of delivery, or singleton or twin status. The\nstudy started skin-to-skin contact for these infants at a median of 1.3 hours after birth, which decreased\ninfant mortality by 25% compared with conventional KMC (i.e. care in an incubator or by a radiant\nwarmer until their condition stabilized and KMC thereafter) (46). This was achieved by integrating\nmaternal and infant care starting in the labour room. A paediatrician remained in the delivery room\nwith the obstetrics team, particularly when a preterm or LBW infant was expected. If the preterm or LBW\ninfant required admission to the special or intensive care unit, skin-to-skin contact with the mother"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9925c294-d09e-4fd1-a4ad-f3d5abdcfd2f
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 374, "chroma:document": "or surrogate was maintained during transfer, whenever possible. Mothers were asked to identify one\nor two adult women who could act as surrogate providers of KMC immediately after birth for a few\nhours until the mother could take over. The mother had a bed inside the infant care unit beside the\nradiant warmer/incubator so she could stay with her infant on a 24 hours a day, seven days a week\n(24/7) basis. The study called this new infrastructure a mother\u2013newborn care unit, which would be a\nplace of combined care for both the mother and the infant. KMC (skin-to-skin contact and support for\nbreastfeeding or breast-milk feeding) was started within two hours after birth, and the mother\u2013infant\ndyad was cared for together in the mother\u2013newborn care unit through close collaboration between\ninfant and maternal care providers.\nBesides the infrastructural redesign to provide combined maternal\u2013newborn care, health-care"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 52d9eadf-051b-496c-8575-91e0241cff2e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 375, "chroma:document": "Besides the infrastructural redesign to provide combined maternal\u2013newborn care, health-care\nproviders have a pivotal role in empowering and enabling mothers and families to be at the centre of\ntheir infant\u2019s care. It is critical that health-care providers gradually transfer the responsibility for the\ncare of the infant to the parent and do not take over. Health-care providers should take time to listen,\nprovide support respectfully and sensitively, and be cognizant of the existing power dynamic between\nthem and the mother, realizing the vulnerability of new mothers in the difficult first days of a preterm\nor LBW infant\u2019s life. As a result, mothers will gain the confidence and self-reliance needed to care for\ntheir infants. KMC establishes parents as change agents for their infant\u2019s care. However, they need an\nenabling facility environment and resources, favourable staff attitudes and interactions, support with"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8218a969-9acf-4502-a8cb-a10a19a56ae6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 32, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 376, "chroma:document": "practising KMC, and information about KMC and their infant\u2019s health to be able to practise it (47\u201350).\n21"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bd6a8fca-4c83-4656-8a51-6dcb24f249b6
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 33, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 377, "chroma:document": "Meet the needs of the mother\nThe mother is at the centre of KMC provision, so addressing her needs is critical. While mothers stay\nwith their preterm or LBW infants to practise KMC, they need adequate support to meet their own\nphysical and mental health needs within a conducive service delivery model. The mothers should\nhave access to basic amenities such as a toilet, bathroom, clean drinking water and hygienic food.\nThey should receive routine postnatal or necessary medical care for any special needs, counselling\nand support for their mental well-being, and training and supervision to care for their infants and to\npractise KMC.\nInvolving the father or partner and other family members in the mother\u2019s and infant\u2019s care with\nadequate counselling and support is also crucial. Support from family members and friends facilitates\nKMC practice. Support from family during their active participation in infant care will allow the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7ed0244a-040b-439b-8cfb-63ff8c805106
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 33, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 378, "chroma:document": "KMC practice. Support from family during their active participation in infant care will allow the\nmothers time for self-care and adequate rest while the infant can continue to receive continuous and\nprolonged skin-to-skin contact. Peer support (e.g. information, motivation and mentorship on KMC to\nnew mothers from other community members) also facilitates maternal confidence, acceptance and\nprovision of KMC (47\u201350).\nKMC benefits maternal mental health, however, mothers should have access to support services if they\nface any issues, especially as the global prevalence of postpartum depression among mothers is high\n(51\u201353). Many low- and middle-income countries will need to develop such support systems for effective\nmaternal\u2013newborn care.\nImplement KMC as the foundation of small and/or sick\nnewborn care\nKMC is recommended for all preterm or LBW infants, whether they are well or are sick (1). It should be"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 975efeab-376a-49c9-aef6-d7e7a73ca984
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 33, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 379, "chroma:document": "implemented as part of small and/or sick newborn care within maternal, newborn and child health\nprogrammes rather than as a stand-alone intervention or programme. Thus, KMC adoption and\nimplementation must be scaled-up alongside other essential interventions for preterm or LBW infants.\nKMC is recommended for all preterm or LBW infants whether\nthey are well or are sick. It should be provided at all levels\nof facility care starting immediately after birth and in the\ncommunity for preterm or LBW newborns who do not need\nadmission to a newborn care unit (1).\n22\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1ce1d67d-9d80-4ba9-8366-08f5cce3d93d
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 380, "chroma:document": "Stable preterm or LBW infants can readily be kept with their mothers in the maternity/postnatal wards\nand receive immediate KMC. However, the risk of separation increases when either the infant or the\nmother is sick and needs special or intensive care. For every preterm or LBW infant to receive KMC\nimmediately after birth, even when sick, it is imperative to first make sure that mothers and infants\nare able to remain together after birth, even when one of them is sick. The current scenario in most\nsettings is that if the infant requires admission to the newborn care unit, the mother can only visit the\ninfant intermittently, for example for breastfeeding and KMC. The Immediate KMC study showed that\nhaving the mother stay inside the newborn special or intensive care unit 24/7 achieved earlier initiation\nand longer duration of skin-to-skin contact per day, unlike the approach in which the mother is merely"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4a4e259b-de12-477f-81b2-d7eb69b0d4dc
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 381, "chroma:document": "a visitor to the newborn special or intensive care unit. Countries can use this or other innovative\narrangements to keep mothers and infants together. For example, if the mother is sick, especially if she\nrequires intensive care, the infant can be cared for and provided KMC by the father, partner or other\nfamily members in the maternity ward or at home, until the mother recovers. If both infant and mother\nare sick, the location and arrangements for care can be adapted to the specific setting/context to keep\nthe mother and infant together as much as possible. Several innovations in service design and delivery\nto provide combined medical care to mothers and infants may be feasible and effective, for example\nlevel-2 newborn care units with beds for mothers of admitted preterm or LBW infants, or common\nspecial care areas for maternal and newborn care.\nENAP (2020\u20132025) has set a specific target for the availability of small and/or sick newborn care in at"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 01fe9fe9-07ca-4c19-9be1-b48629e98691
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 382, "chroma:document": "least 80% of districts in each country (18). Some low- and middle-income countries have already started\nsetting up new units at the district level, alongside strengthening small and/or sick newborn care,\nwhile others are at an early stage of developing national plans and strategies. This offers a tremendous\nopportunity to set up new units with the infrastructure and service delivery organized around the\ncombined care of mother and infant right from the start.\nThe integrated maternal\u2013newborn service delivery model with increased participation of mothers,\nfathers or partners and families might require a potentially higher investment at the start for building\nnew units or redesigning existing units. In the long run, however, it will increase the efficiency of care,\nimprove the quality and experience of care, improve long-term outcomes, and reduce health-care costs.\nElsa Samuelsson, born via caesarean section, received immediate"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 34, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 383, "chroma:document": "Elsa Samuelsson, born via caesarean section, received immediate\nskin-to-skin contact with the father until her mother arrived in the NICU,\nwhen the mother took over. Lund-Malm\u00f6 NIDCAP Center, Stockholm.\nGuiding principles for KMC implementation 23\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3dab693c-d68a-467e-8bf9-2b2b25ec1232
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 384, "chroma:document": "Deliver KMC at all levels of facility care and in the community\nKMC should be provided at all levels of facility care and in the community for all preterm or LBW\ninfants, both well and sick. Figure 2 illustrates how to operationalize KMC within existing newborn care\npackages at different levels of facility care and in the community. It also suggests when and where to\nstart KMC for preterm or LBW infants requiring different levels of care.\nFigure 2. Guidance on KMC within ENAP levels of care and newborn care packages (19)\nPreterm or LBW infants who need intensive care*\n\u2022 Intensive newborn Initiate KMC immediately after birth and continue in newborn\ncare\nintensive care unit, where the mother can stay with the \u2022 Special newborn care\nnewborn on a 24/7 basis.**\n\u2022 Essential newborn care\n(Plus provide KMC to other preterm or LBW infants who do not\n\u2022 Postnatal care\nneed intensive care)\n24\ndna\nlarrefeR\nlevel-yraitret\nytilicaf\nPreterm or LBW infants who need special newborn care*"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 52026763-76db-4150-8422-96b8773380ff
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 385, "chroma:document": "24\ndna\nlarrefeR\nlevel-yraitret\nytilicaf\nPreterm or LBW infants who need special newborn care*\nInitiate KMC immediately after birth and continue in newborn\nspecial care unit, where the mother can stay with the newborn\non a 24/7 basis.**\n(Plus provide KMC to other preterm or LBW infants who do not\nneed special care)\nytilicaf\nlevel-dnoceS\n\u2022 Special newborn care\n\u2022 Essential newborn care\n\u2022 Postnatal care\nKMC: kangaroo mother care; LBW: low birth weight.\n* Unless the newborn is unable to breathe spontaneously even after resuscitation, is in shock, or requires\nmechanical ventilation.\n** If the mother is sick, father or partner or other family member could stay with the newborn on 24/7 basis till mother recovers.\nThere must be a functional referral system in place connecting care at various levels, as well as strong\nlinkages between the facility and the community, to ensure continuity of care. KMC could also be"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 48c39019-9881-4927-942d-13881abaa468
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 35, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 386, "chroma:document": "linkages between the facility and the community, to ensure continuity of care. KMC could also be\nprovided during transfer from home to newborn care unit, from one level of care to another, and from\nnewborn care unit to home after discharge.\nlevel-tsriF\nytinummoC\nytilicaf\nPreterm or LBW infants who do not need special newborn\n\u2022 Essential newborn care care\n\u2022 Postnatal care Initiate KMC immediately after birth in delivery room/postnatal\nward.**\nHome births: preterm or LBW infants\nInitiate KMC immediately after birth and refer those with\ndanger signs or below country threshold for low birth weight\n\u2022 Essential newborn care\nto hospital.\nfor home births\n\u2022 Postnatal home visits\nfor mothers and\nnewborns Facility births: preterm or LBW infants after discharge\nContinue KMC at home for all infants who received KMC in the\nfacility; initiate KMC if not already started in the facility.\nIn either case with close monitoring and follow up.\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c951eaab-d792-4ca8-b74e-105b8d0478f8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 387, "chroma:document": "Adapt implementation by country-income settings and\nhealth system contexts\nCountries may tailor this KMC implementation strategy to their health system contexts based on their\nneeds, priorities, service delivery models and available resources. The main implementation challenges\nappear similar in low- and high-resource settings. A recent systematic review reported the main\nlimitations for KMC adoption in the United Kingdom to be a lack of national guidance and guidelines,\nlack of coherent policies, and lack of routine training for health-care professionals and families to\nimprove their knowledge and confidence in practising KMC. Many neonatal care units are not fit for KMC\nimplementation owing to a lack of private spaces, reclining chairs, beds and other infrastructure that\nfacilitates KMC (54). Studies on KMC scale-up in low-resource settings in Ethiopia and India highlighted\nthe same limitations (15), and hence similar solutions may apply across countries or contexts."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f79a1e61-083e-4864-99c2-5349156ec7a8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 388, "chroma:document": "the same limitations (15), and hence similar solutions may apply across countries or contexts.\nEven so, the service delivery models might differ by setting according to the health system\u2019s structure\nand capacity, both between countries and within the same country. In lower-resource settings, a higher\nproportion of preterm or LBW infants may be delivered at home or discharged early after a facility birth;\ncommunity-initiated KMC might therefore need equal focus as immediate facility-initiated KMC. In\nhigher-resource settings \u2013 where it is exceptional for women to deliver in settings other than hospitals\n\u2013 with the capacity to provide highly specialized care, greater focus will be required on post-discharge\nfollow up, with continued support for KMC at home alongside immediate initiation of KMC in facilities\nwith continued KMC till discharge.\nApart from the programmatic aspects, health-care providers in high-income settings have raised"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8b456b79-e5fd-4af1-97d0-5222ed8ac3e7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 389, "chroma:document": "Apart from the programmatic aspects, health-care providers in high-income settings have raised\nsome practical considerations for KMC implementation. These include KMC practice by mothers after\ncaesarean section, difficult delivery, under the effect of anaesthetics or drugs or during sleep, and\nensuring a patent airway for preterm or LBW newborns. All the providers practicing KMC have faced\nand easily addressed these issues by using a surrogate to provide KMC until the mother\u2019s condition\nimproves or when she needs to rest, and by using a binder to secure the infant to the mother\u2019s chest\nand maintain a patent airway. None of the providers report an event of the infant falling out of bed or of\nsmothering (55).\nThe other issue raised by experts from high-income settings is a potential contradiction with safe\nsleeping recommendations. Robust randomized controlled trials show that overall mortality is lower"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2c797027-cf36-43c1-96d0-17a2d86ddac1
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 36, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 390, "chroma:document": "sleeping recommendations. Robust randomized controlled trials show that overall mortality is lower\namong preterm or LBW infants who receive KMC compared with those who receive conventional care\n(12,22). Moreover, in a recent large randomized controlled trial on immediate KMC, the proportion of\nsudden deaths was lower among LBW infants who received immediate KMC compared with those who\nreceived conventional care (1.0% versus 1.3%; relative risk 0.80, 95% CI 0.41\u20131.53) (46). The protective\neffect of KMC for sudden deaths did not reach statistical significance due to low numbers, but it\nprovides assurance that KMC is unlikely to increase the baseline risk of sudden deaths.\nThe implementation strategy may be tailored to different\ncountry-income settings and health system contexts based\non their needs, priorities and service-delivery models.\nGuiding principles for KMC implementation 25"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fb124c6b-5d2a-4219-95d8-1c57689aba70
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 37, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 391, "chroma:document": "26\n\u00a9WHO/PAHO.\nCountry:\nColombia\nAlign with World Health Organization guidelines\nCountries should provide KMC as part of a comprehensive package of essential, evidence-based\ninterventions or services for small and/or sick newborns.\nThe relevant guidelines that may be considered when planning KMC implementation include WHO\nguidelines for the care of preterm or LBW infants (1), postnatal care of mothers and infants (56),\nhospital care for children (57) and antenatal steroids (58). Other relevant guidelines for programmatic\nimplementation include WHO guidelines on health promotion interventions for maternal and infant\nhealth (59). These include the involvement of fathers or partners and other family members, which is\ncritical for KMC because it allows the mother time to rest and for her own care, while allowing the father\nor partner and other family members to participate in the care of the infant. Another recommendation"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5eacdf60-5efb-4444-ab88-af8d35ed0ef6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 37, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 392, "chroma:document": "is to allow a companion of choice during labour. The labour companion could support the mother in\ninitiating KMC in the labour room and continue it until after discharge. Similarly, the recommendation\non partnership with traditional birth attendants provides an opportunity to start KMC immediately\nafter birth for preterm or LBW infants born at home who do not require admission to a newborn unit\n(59). Community participation in quality-improvement processes and programme planning and\nimplementation could increase buy-in at the community level for KMC initiation and continuation, and\nhelp remove the stigma around preterm birth.\nAdditionally, WHO\u2019s human resource strategies to improve newborn care in health-care facilities\nin low- and middle-income countries include guidelines for improving and standardizing neonatal\ncare training for existing health workers, of which KMC is a part (60). Additionally, role optimization"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 87a45c6b-d534-4ed5-addd-fbceb46c9e35
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 37, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 393, "chroma:document": "guidelines recommend that lay health workers can promote KMC for LBW infants, while auxiliary\nnurses and midwives may support the initiation and maintenance of KMC (61). However, new evidence\nsuggests that if provided with proper training, community health workers can successfully educate and\nsupport mothers in initiating and practicing KMC at home (62,63).\nWe urge countries to constantly update their maternal\u2013newborn care packages in line with the latest\nevidence-based guidelines and provide KMC as part of these packages for optimal outcomes.\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dd378da2-a188-4e0f-ae4e-13acf410175c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 394, "chroma:document": "General programmatic principles\nEquity and access. Countries should consider approaches to ensure that all mothers and infants have\naccess to essential health services, including KMC. Some strategies that may improve service access\nor utilization, especially among the poor, include: free medical care or health insurance for pregnant\nwomen and their preterm or LBW infants through national health programmes (64,65); no or reduced\nuser charges (66); additional days of leave from work and additional financial payments to address the\nspecial needs of mothers, fathers or partners and other primary caregivers of preterm or LBW infants\n(1), improving geographical access to maternal and newborn care units, including rural and hard-to-\nreach areas (67\u201369); and community-based health worker programmes in which these workers are\npart of the care delivery team, have been recruited, paid and supported to ensure long-term retention,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f26ddb1f-a6da-4118-8d38-cdc09574b9f7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 395, "chroma:document": "are adequately trained, linked to the health system and have a manageable scope of work (70\u201372).\nPolicy-makers should consider quantifying inequalities in service coverage as a function of several risk\nfactors to identify left-behind populations who might benefit from targeted policy or programmatic\ninterventions (73).\nFragility and emergencies. The Roadmap to accelerate progress for every newborn in humanitarian\nsettings 2020\u20132024 outlines the delivery of appropriate care for small and/or sick newborns and\nthe strengthening of care for the mother\u2013infant dyad by expanding access to dignified and quality\ncare during pregnancy, delivery, and postpartum as two of the 10 key action areas (74). The existing\nhumanitarian health service delivery guidelines and minimum standards in humanitarian response\ncould incorporate guidance on operationalizing KMC as part of small and/or sick newborn care in\nsuch settings (75,76). Besides these approaches, specific interventions such as multistakeholder"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 15c12a87-9c02-413d-b200-cc2beb98b333
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 396, "chroma:document": "such settings (75,76). Besides these approaches, specific interventions such as multistakeholder\ncollaboration, introducing new technology or systems innovations, and staff training can also facilitate\nthe implementation of KMC as part of small and/or sick newborn care in such settings (77).\nValue and ownership. Promoting and ensuring ownership of KMC at national and subnational levels\nin public and private facilities and in the community is a complex process that needs contextualization.\nThe process is likely to be facilitated by enabling health systems to routinely track health outcomes,\nincluding quality and patient-reported outcomes in relation to costs. Patients may perceive increased\nvalue in health services if they are engaged in the service design, delivery and monitoring, and\nperceive that these focus on their preferences, comfort and convenience (78). Health-care providers\ncan be encouraged to strive towards patient-centred service provision through educational activities,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0a73b34e-66f7-4e58-9507-e53175d41eaf
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 397, "chroma:document": "behaviour change communication and service delivery innovations that improve efficiency and reduce\nworkload. Private sector engagement will require strategic planning, particularly in settings where it\ncaters substantially to health care. Some options could be to include KMC promotion for all preterm\nor LBW infants as part of small and/or sick newborn care as a licensing standard and/or accreditation\ncriterion for health-care facilities (79) and include KMC in the health insurance reimbursement packages\nfor newborn care.\nSustainability and accountability. Essential health interventions and services for preterm or LBW\ninfants, including KMC, should have separate, non-negotiable budget heads in the financial planning\nand budgeting for health at national, subnational and facility levels. Governments and administrators\nshould earmark these services as critical to the population\u2019s health so that their budget is not diverted"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1768c409-661e-4c88-a948-4bb75d3b38d8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 38, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 398, "chroma:document": "to other services in emergencies such as the coronavirus disease 2019 (COVID-19) pandemic (80).\nBringing such services under universal health coverage will help ensure long-term sustainability. There\nis little evidence on how to ensure accountability in health systems. Stakeholders at different levels\ncan foster a culture of accountability by making learning and development a continuous process,\nincreasing collaboration and coordination across all levels of care, and leveraging regular monitoring\nfor improving performance, with supportive supervision and feedback mechanisms.\nGuiding principles for KMC implementation 27"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8350b96f-4aa4-4121-ab93-36ce03b4fab1
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 399, "chroma:document": "Father practices skin-to-skin contact with his LBW newborn in the KMC\nward of Dr Jose Fabella Memorial Hospital, Manila, the Philippines.\nBroad partnerships. A commitment to work together to support country-led implementation efforts\nby diverse partners through existing and new alliances can maximize the programmatic impact of\nKMC. The many successful examples of such partnerships include: private\u2013public partnerships for\nprimary health care to facilitate access to health services, especially in remote areas (81); integration\nof services across different levels and types of care (82); collaborations between in-country research\ninstitutions; coordination between local health departments and implementing partners, such as\nthe global small and/or sick newborn care Community of Practice and Every Newborn network; and\nscale-up of initiatives such as the Baby Friendly Hospital Initiative and respectful maternity care. As a"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: abd4ab20-e3b1-4dae-ae81-b189d84c762e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 400, "chroma:document": "core component of family-centred care, partnerships between professional organizations in obstetrics,\npaediatrics, nursing and midwifery, and collaborations between these professional cadres, and mothers\nand families are instrumental in KMC implementation (83,84).\nSystems and integration. Health services should respond to the needs of all mothers and infants and\ndeliver quality essential maternal and newborn care services, including KMC, at all levels of facility care\nand in the community. The broad framework of implementing KMC at different levels of care\n(see Fig. 2, under \u201cConsiderations for designing a KMC implementation strategy\u201d) serves as the basis\nfor designing integrated systems and services. Health systems should be easy for parents and families\nto navigate and should strive towards standardized care delivery at different levels. This can be done by\nclearly identifying the roles and responsibilities in interprofessional teams (e.g. for infant and maternal"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3a552705-388b-4f32-8571-41a6661bf27b
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 39, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 401, "chroma:document": "health teams within a facility), defining care pathways (e.g. to which facility a community health worker\nshould refer a preterm or LBW infant born at home), and using shared protocols and decision-making\ntools for a smooth transition of patients with continuity of care (e.g. for a referral from a lower- to a\nhigher-level facility) (85,86).\nThe health information system should also be designed so that patient information (clinical,\nregistration and scheduling, etc.) is accessible across the different health-system levels to facilitate\nseamless communication between care providers (e.g. through recording of community KMC in\nhome-based records).\n28\nKangaroo\nmother\ncare:\nImplementation\nstrategy\n\u00a9WHO/Yoshi\nShimizu"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 79ccf548-0eec-4bf7-b295-742441a7626b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 40, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 402, "chroma:document": "Evidence-based and data-driven. Governments should undertake a situation analysis of small and/\nor sick newborn care in their country and use existing data and evidence to decide changes to the\ninfrastructure and service design and delivery for programmatic implementation of KMC within\nmaternal, newborn and child health programmes. Implementation research with social and behavioural\ncomponents can generate the necessary evidence to drive continual improvement in national\nimplementation and scale-up with quality (87). Governments should actively support, strengthen and\nutilize a network of local researchers who can examine the programme data and highlight the gaps,\nknow about the evidence-based informed approaches for improvement, and may undertake research\nto address local context-specific issues where required.\nResearch and innovation. Implementation research can identify and address context-specific"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ad0948d6-8d60-476e-91af-b18fb8d57802
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 40, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 403, "chroma:document": "Research and innovation. Implementation research can identify and address context-specific\nchallenges and fill the know-do gap in real-world settings to improve maternal and infant health,\ninform policy design and implementation, strengthen health service delivery, and empower\ncommunities and beneficiaries (88). Innovations in the design and delivery of services can improve the\ncare for preterm or LBW infants and their mothers at various levels of care to meet their health and care\nneeds, enhance the experience of care for parents and families, and achieve better outcomes in diverse\ncontexts. Such innovations facilitate the creation of new value propositions that expand the previous\ntechnology-driven focus towards a human-centred and co-creative one (89\u201391). Ongoing research\nefforts \u2013 such as service readiness, quality- and experience-of-care surveys, situational analyses,\npriority-setting discussions, stakeholder workshops and community acceptability studies \u2013 can help"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 30159a03-267d-4e9d-af4c-e5849964c942
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 40, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 404, "chroma:document": "priority-setting discussions, stakeholder workshops and community acceptability studies \u2013 can help\nrefine implementation and allow for sociocultural adaptations, and should be part of the routine health\nsystems evaluation.\nTsehayensh, 25, holds her LBW baby wrapped closely to her chest to provide skin-to-\nskin contact, an integral part of KMC, at Felege Hiwot Hospital in Bahir Dar, Ethiopia.\nGuiding principles for KMC implementation 29\n\u00a9WHO/Blink\nMedia\n-\nHilina\nAbebe"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f3bc7bf9-c008-4d19-b0c0-b17195cde904
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 41, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 405, "chroma:document": "5\nTwins Hertzberg, born just over eight weeks preterm, in immediate\nand continuous KMC, Lund-Malm\u00f6 NIDCAP Center, Stockholm.\n3300\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8cebaec1-12d0-453f-88f5-4b2bab69e2de
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 42, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 406, "chroma:document": "Implementation strategy to\nachieve scale-up\nEngage political leadership and develop KMC-supportive\npolicies with a national KMC implementation plan\nNational political leaderships' commitment and engagement, supportive policies, legal or regulatory\nframework, and a national plan or strategy for implementing KMC alongside the scale-up and\nstrengthening of small and/or sick newborn care are critical to the successful implementation and\nscaling up of KMC.\nThe political leadership should recognize KMC as an instrument to restructure health systems and\nreorganize maternal\u2013newborn service delivery to enhance efficiency and improve survival, health,\nwell-being, and long-term human capital \u2013 yielding a high return on investment and benefitting the\noverall economy. They should include KMC as part of universal health coverage and create a supportive\npolicy and regulatory environment for implementing KMC at national and subnational levels in both"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: afa8852d-358a-449d-8cd2-1ce7641527bb
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 42, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 407, "chroma:document": "policy and regulatory environment for implementing KMC at national and subnational levels in both\npublic and private health sectors. Maternal\u2013newborn care policies should be updated to include KMC in\nthe pre-service curricula of all health-care providers, national licensure examinations, health insurance\npackages for maternal\u2013newborn care, and licensing standards for health-care facilities. Governments\nshould develop a national plan for implementing KMC at all levels of facility care and in the community,\nwith provision for combined, respectful care of the mother\u2013infant dyad and active participation of\nfamilies, even when the infant is preterm or LBW and sick.\nThe plan should include KMC for all preterm or LBW infants as a fundamental intervention during the\nscale-up and strengthening of small and/or sick newborn care. The plan should also set achievable and\ntime-bound goals and targets for coverage and quality of KMC implementation and scale-up as part of"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e46bdc3e-8429-4fde-aa68-ca9c096d69b6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 42, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 408, "chroma:document": "time-bound goals and targets for coverage and quality of KMC implementation and scale-up as part of\nsmall and/or sick newborn care at national and subnational levels.\nPolitical leadership should recognize KMC as an instrument to\nrestructure health systems and reorganize maternal\u2013newborn\nservice delivery for improved maternal and newborn health\noutcomes, and provide long-term benefits for the economy and\nhuman capital.\n31"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d070a4fa-389d-4a46-9eac-124694cccb45
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 43, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 409, "chroma:document": "Ensure adequate and sustainable financing\nPolitical leaderships' commitment to KMC implementation must accompany financial commitment\nreflected in national and subnational budgets for maternal, newborn and child health programmes\nthrough dedicated provisions for the implementation and scale-up of KMC as the foundation of small\nand/or sick newborn care. The finance ministry or departments should be involved in the planning,\nalong with maternal, newborn and child health programme managers from the ministry of health.\nThe main budget item will be the costs for infrastructure redesign for combined respectful care of the\nmother\u2013infant dyad with the involvement of families, and essential care interventions for all preterm\nor LBW infants (e.g. infection prevention and continuous positive airway pressure for those with\nrespiratory distress).\nKMC for preterm or LBW infants who are sick will require infrastructure arrangements in the newborn"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d5bbf48f-b6b3-4e36-8e76-f54e6f5eda54
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 43, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 410, "chroma:document": "KMC for preterm or LBW infants who are sick will require infrastructure arrangements in the newborn\ncare units to allow the mother, if she is well, to stay with the infant. These will include a bed beside the\nnewborn warmer/incubator, a toilet and bathroom attached to the unit, and other basic amenities such\nas clean drinking water, and food. Spaces for boiling utensils used for expressed breast-milk feeding\n(e.g. paladai, cup/spoon) and maternal examination for postnatal problems may also be required. KMC\nfor preterm or LBW infants will require arrangements for the mother\u2019s privacy, expressing breast-milk,\nKMC beds and chairs, and other amenities specified above.\nOther budget items include human resources and costs for in-service training, running costs for\nmaintenance and consumables, and regular programme monitoring for quality and coverage.\nGovernments should allocate resources for KMC implementation at all levels of facility care and in the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 14bbb630-88c0-4555-ac81-a39c5e706117
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 43, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 411, "chroma:document": "community, and use appropriate tracking mechanisms to ensure accountability.\nBudgetary considerations should also include removing the financial barriers to access, especially for\nthe poor, and covering families\u2019 expenditures on care, especially in settings where the private sector is\ndominant. Governments could consider different health finance and protection schemes and insurance\nmechanisms to cover the costs (expense) of care by the family. For example, the Philippines expanded\nthe benefits under the existing packages for mothers and infants to cover comprehensive services for\npreterm or LBW infants, including KMC (92). Many countries, such as Austria, Colombia, Germany, Haiti,\nIndia and Luxembourg also provide extended maternity and paternity leave in case of preterm or LBW\nbirth, and other countries may consider adopting this policy too (1).\nGovernments should commit dedicated financial resources for\nthe implementation of KMC including immediate KMC as the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f7f79fbc-7443-4946-9e9b-b992127f807f
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 43, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 412, "chroma:document": "the implementation of KMC including immediate KMC as the\nfoundation of small and/or sick newborn care within national\nand subnational budgets for maternal, newborn and child health\nprogrammes. Appropriate monitoring and tracking mechanisms\nshould be used to ensure accountability.\n32\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 27d1ee1e-9984-4a65-957d-6e2b2dfbc282
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 413, "chroma:document": "Domestic financial support for KMC implementation will be crucial to its sustainability. However,\nmost low- and lower-middle-income countries may achieve adequate financing for KMC only through\ncombined government funds and external investments by donors and partners. Governments in\nresource-restricted settings should reach out to donors, development and implementation partners,\nand United Nations agencies, and seek investment to support the domestic efforts to establish,\nstrengthen and scale up small and/or sick newborn care services with KMC. The sources and amounts\nof funds may vary by context. For example, Grand Challenges Canada supported the Government of\nCameroon in scaling up KMC across five regions through a development impact bond (93), and the\nGlobal Financing Facility in collaboration with Laerdal Global Health, a Norwegian non-profit-making\ncompany, supported the scale-up of KMC in four regions of Ethiopia (94). While sources and amounts"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 450e9fcc-5031-401a-8eb3-3fbec3af9127
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 414, "chroma:document": "company, supported the scale-up of KMC in four regions of Ethiopia (94). While sources and amounts\nof funds may vary, sustainable financing for KMC will require countries to mobilize and effectively\nmanage resources to support and develop priority interventions around special newborn care, while\ndemonstrating accountability and quality results.\nIncrease availability, capacity and motivation of\nhealth-care providers\nHealth-care providers are key to implementing KMC in all settings. The national KMC implementation\nplan and budget must provide for sufficient numbers of health workers of different cadres (e.g. doctors,\nnurses, midwives and community health workers) to achieve high coverage of KMC in health-care\nfacilities and communities. Governments should plan for adequate capacity-strengthening of all health-\ncare providers in small and/or sick newborn care with KMC for all preterm or LBW infants by including"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5e280e48-9404-46ff-9931-febfed755a87
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 415, "chroma:document": "it in pre-service education and in-service training and by providing on-the-job support and supportive\nsupervision. The education and training should encompass: counselling and communication skills to\nsupport mothers, fathers or partners and families; lactation support; promoting family participation;\nensuring smooth discharge planning and transition to home, including follow-up home visits, and\nsupporting maternal mental health as core components alongside KMC practice and quality preterm or\nLBW infant care.\nBesides having adequate numbers of health workers who are well educated and trained in KMC, it\nis vital that they accept, promote and practise KMC as the standard of care for all preterm or LBW\ninfants, both well and sick. Governments should engage professional organizations to accept, endorse,\npromote and implement a policy to keep and care for the mother and infant together after birth, with"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4c87f428-cd48-45f4-b4f1-e34a35bffc86
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 416, "chroma:document": "immediate, continuous and prolonged KMC as the standard of care for all preterm or LBW infants,\nboth well and sick. Specialists (paediatricians, neonatologists, obstetrician\u2013gynaecologists), general\npractitioners, nurses and midwives should lead by example by demonstrating a change in practice.\nThey can be KMC champions and work to develop and sustain the motivation and momentum of the\nhealth workforce through evidence sharing, continuous medical education and other mechanisms.\nAt the facility level, it is essential to have an interprofessional team engaged in ongoing educational\nactivities with hands-on training, regular refresher courses and supportive supervision. Facility\nadministrators should avoid rotating KMC-skilled staff to other areas. In the community, the outreach\nor community health workers will require intensive training in skin-to-skin contact and lactation\ncounselling with hands-on practice in health-care facilities that implement KMC to support mothers,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2bf47f70-decb-4d47-83b4-4409196c067c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 44, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 417, "chroma:document": "counselling with hands-on practice in health-care facilities that implement KMC to support mothers,\nfathers or partners and families in initiating and continuing KMC at home. A network of health-care\nprofessionals and community health workers can promote capacity-building and cross-learning.\nThe human resource strategy should align with the need for\noperationalizing KMC at all levels of health care in facilities and\nin the community, including plans for capacity-building in small\nand/or sick newborn care and KMC.\nImplementation strategy to achieve scale-up 33"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6ba72e17-bcd3-44ba-8e23-1ad019e2b797
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 418, "chroma:document": "Reorganize service delivery to fulfil the needs of mothers and\ninfants simultaneously\nCurrently, in many countries, if a preterm or LBW infant does not require admission to a newborn care\nunit,b the mother\u2013infant dyad stays together in the postnatal ward. On the other hand, if the preterm\nor LBW infant is below the country-specific gestational age or birth weight cut-off for admission to a\nnewborn care unit, or is sick, the infant is separated from the mother and kept in a special or intensive\ncare unit until the infant's clinical condition improves. The mother stays in the postnatal ward (or is\ndischarged) and visits the infant intermittently when advised. Fathers or partners and other family\nmembers also visit the infant during limited, specified hours. Mothers, fathers or partners and families\nare also usually not involved in the infant\u2019s care. This service-delivery model is not in the best interests"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 67b4d08c-d5ee-4b33-8fc2-18969e6cc12e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 419, "chroma:document": "of either the infant or the mother. Mothers\u2019, fathers\u2019 or partners\u2019, and families\u2019 involvement in the routine\ncare of their infants is essential, as it improves their short- and long-term health and development\noutcomes, and the overall care experience.\nThe services for mothers and infants should be combined at every level of care in the health system,\nstarting in the antenatal period. There is some evidence to show that breastfeeding counselling\ninterventions provided during both antenatal and postnatal periods are more effective in improving\nbreastfeeding outcomes than those provided during either of these periods alone (95). Similarly,\nKMC could be introduced during antenatal counselling alongside nutrition, contraception, birth\npreparedness, obstetric warning signs, etc. Now that WHO recommends that all preterm and LBW\ninfants receive KMC immediately after birth, more than 10% of all pregnant women are likely to benefit"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ab38502b-a203-40fc-8f1c-e548cf1db986
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 420, "chroma:document": "from antenatal counselling on KMC. It may also serve to increase overall provider and community\nawareness and may help in generating demand and uptake. Integrated maternal and infant service\ndelivery should continue during labour, childbirth and in the postnatal period, including referral\ntransport, in-facility care or post-discharge follow-up.\nNational policies should call for collaboration between maternal and infant care providers and the\nprovision of all postnatal maternal and newborn services together in the same place. Programmes\nshould align maternal and infant health services even during post-discharge follow-up to ensure that\nthe mother receives support for her physical and mental health along with KMC at home. Guidance\nfor the delivery of services at various levels of care should be clear and consistent. Ensuring high-\nquality service delivery through continuous improvement activities is paramount to enhancing parent"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 512a4c2a-f0d0-480f-8e2f-66576c1afb79
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 45, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 421, "chroma:document": "quality service delivery through continuous improvement activities is paramount to enhancing parent\nsatisfaction and ensuring a positive experience for all involved.\nb For example, if the newborn is above the country cut-off of gestational age or birth weight for admission to a newborn care unit\nand does not have any clinical complications.\n34\nKangaroo\nmother\ncare:\nImplementation\nstrategy\n\u00a9WHO/PAHO.\nCountry:\nColombia."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5d4aa123-1278-4903-944a-e3300b204c05
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 422, "chroma:document": "Mothers and newborns should be kept together after birth, even\nwhen the infant is sick and requires care inside the newborn\ncare unit. Both mother and newborn should receive respectful\ncare, together as a unit, in one place (17).\nUpgrade infrastructure and design of maternal\u2013newborn\ncare to create a conducive environment for KMC\nA fundamental health system requirement for implementing KMC is to keep and care for the mother\nand infant together after birth and allow the mother to take a central role in newborn care, supported\nby the father or partner and other family members. National policies and implementation plans for\nKMC should clearly and emphatically state this principle, and facility policies should be conducive for\nits implementation. Facility policies, infrastructure, environment and services should enable mothers\nand infants to remain together starting immediately after birth, irrespective of their clinical condition,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 484c6998-d9c4-4200-aefe-1370f9c1dc38
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 423, "chroma:document": "unless critically ill. This necessitates a shared space where mothers and infants can be kept and cared\nfor together even when preterm or LBW infants require admission to a special or intensive care unit,\nwith all the facilities and equipment for their care. The maternal and newborn health-care providers\nshould collaborate to care for the mother and the infant together. This dedicated space should also\nmeet all the medical and other needs of the mother, including food, water and hygiene, alongside\nthe infant.\nFor a preterm or LBW infant who is otherwise well, countries could consider having a separate area in all\npostnatal wards or assigning separate wards for these mother\u2013infant dyads. For preterm or LBW infants\nwho require special or intensive care, countries will need to put some thought and work into deciding\nthe arrangements that may work in their contexts. A recent study that had mothers reside 24/7 with"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 92e3f687-4521-4505-b3f9-2b263d9acc49
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 424, "chroma:document": "the arrangements that may work in their contexts. A recent study that had mothers reside 24/7 with\ntheir LBW infants by placing their beds inside the newborn intensive care unit achieved early initiation\nand longer duration of KMC (see Box 2). This or other innovative arrangements may be used when a\npreterm or LBW infant requires special or intensive care.\nCountries can set up new units that allow for combined maternal\u2013newborn care with KMC, or redesign\nexisting units to do the same. Design innovations will be required to convert existing newborn units to\naccommodate mothers inside the newborn care units while ensuring respectful medical and supportive\ncare for her; many designs and adaptations are possible in different settings. For example, maternal\nwaiting rooms adjacent to the newborn units may be combined into one large room with bed spaces\nfor mothers alongside radiant warmers/incubators with a central nursing station and attached toilet,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6e0a0e96-825e-4a5c-a52d-1df9fb0e9394
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 425, "chroma:document": "bathroom and maternal examination area. Alternatively, when the mother requires medical care,\naccommodation can be made to practise KMC in the maternal wards and provide newborn care with\nKMC in those wards with provisions to accommodate family members as surrogates to support the\nmother in doing KMC.\nOnce operationalized, keeping mothers and infants together may simplify infrastructure and service\ndelivery. In deciding to renovate existing structures or build new facilities, governments should\nconsider incorporating innovative design features that are environmentally sustainable, energy-\nefficient, easy to use, comfortable and promote the well-being of mothers, families and health workers.\nThe commodities (including KMC beds, chairs and garments) for KMC care are low cost and can be\npurchased locally or using bulk purchasing contracts. All items should be of good quality to ensure\nthe mother\u2019s comfort and the infant\u2019s safety, and adequate supplies should be available to ensure"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 64f479a9-fac0-4077-ae58-11838214b336
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 46, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 426, "chroma:document": "the mother\u2019s comfort and the infant\u2019s safety, and adequate supplies should be available to ensure\nuninterrupted care.\nImplementation strategy to achieve scale-up 35"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 694d578e-3f81-4606-bf3d-2314d8699f1b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 427, "chroma:document": "How were mothers and infants kept together in the\nBox 2.\nImmediate KMC study?\n\u2022 A new newborn intensive care unit was designed with space for mother\u2019s bed with\neach infant; this space was called a mother\u2013newborn care unit.\n\u2022 Additional infrastructure included a toilet, bathing area, kitchenette and clinical examination\ncubicle attached to the unit, for mothers.\n\u2022 All other equipment and care for the infant was as in conventional newborn intensive\ncare units.\n\u2022 Infants were moved from the labour room or operating theatre to the mother\u2013newborn care\nunit in the KMC position with the mother or a surrogate.\n\u2022 Mother or surrogate provided continuous KMC until the mother was moved to the unit.\n\u2022 Neonatal nurses provided essential maternal postnatal care after receiving training.\n\u2022 Obstetricians took daily rounds for mothers in the mother\u2013newborn care unit.\nSource: WHO Immediate KMC Study Group et al. (2021) (46).\nDevelop robust data systems and use data for\nquality improvement"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7bbe5307-3c36-4ec1-a3d8-395f397772e5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 428, "chroma:document": "Develop robust data systems and use data for\nquality improvement\nRecording KMC and small and/or sick newborn care delivery and practices using specific indicators as\npart of national routine health management information systems is vital for tracking and improving the\ncoverage and quality of these practices.\nFacility-level data collection (e.g. paper-based, digital or a combination) and use are fundamental\nto identifying problems early, triggering corrective actions, and supporting decision-making for\nimproving implementation. Home-based records and community-level data collection and use can help\nmonitor community-initiated KMC or the continuation of KMC after facility discharge.\nCountries should develop a national-level monitoring and evaluation framework and incorporate a few\npriority KMC indicators into their national health management information systems alongside other\nindicators for small and/or sick newborn care. WHO has recently refined the KMC coverage indicator in"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 69f3abc5-3d1f-43ab-b938-14c7db44d137
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 47, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 429, "chroma:document": "line with the updated WHO guidelines for care of preterm or LBW infants; it is easily measurable from\nregisters and tally sheets, and validated in the Every Newborn Birth Indicators Research Tracking in\nHospitals (EN-BIRTH) multicountry validation study (96, 97). The numerator is the number of newborns\n< 2500 g who are initiated on KMC (placed in skin-to-skin contact or kangaroo position) anywhere in\nthe facility, and the denominator is the number of admitted newborns (born in a hospital or referred\nfrom elsewhere) with birth weight < 2500 g (Box 3). A few quality parameters \u2013 duration of KMC (daily\nduration and the number of days), appropriate breast-milk feeding, and post-discharge care and follow-\nup \u2013 have also been agreed upon (97).\n36\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e598a73a-ad9d-4617-a154-e4086110f8f3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 430, "chroma:document": "WHO/ENAP proposed indicator for measuring KMC coverage\nBox 3.\nat the facility level*\nNo. newborns < 2500 g initiated on kangaroo position\nanywhere in the facility\nKMC coverage =\nNo. admitted newborns with birth weight < 2500 g\n* While simple and easy to measure in routine health systems, it may be confused with skin-to-skin contact\nin first hour after birth, which is recommended for all newborns\nIndicators related to other high-impact, evidence-based newborn care interventions were proposed\nby the ENAP in 2014 (Table 3). Of the ten core indicators proposed to achieve the mortality and\ncoverage targets to end preventable newborn deaths and stillbirths, seven are relevant to small and/\nor sick newborn care and KMC. However, only a few are currently being tracked as part of routine\nhealth systems.\nTable 3. ENAP core indicators of relevance for national monitoring for kangaroo mother\ncare and small and/or sick newborn care\nCurrent status Type of indicator Core ENAP indicators"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7d1ae286-37de-4ff2-8216-5addb1cb0621
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 431, "chroma:document": "care and small and/or sick newborn care\nCurrent status Type of indicator Core ENAP indicators\nDefinitions are clear, Impact 1. Stillbirth rate\nbut quantity and 2. Maternal mortality ratio\nconsistency of data 3. Neonatal mortality rate*\nare lacking\nContact point Coverage: 4. Skilled attendant at birth*\ndefinitions clear, but care for all mothers 5. Early postnatal care for mothers and infants*\ndata on content of and infants 6. Essential newborn care (tracer is\ncare are lacking early breastfeeding)*\nGaps in coverage Coverage: 7. Antenatal corticosteroids use\ndefinitions, and complications 8. Newborn resuscitation\nrequiring validation and extra care\n9. Kangaroo mother care\nand feasibility testing\nfor HMIS use \u2022 Coverage indicator has been defined\nfollowing validation work (2021)\n\u2022 Service readiness indicator defined and\nincorporated in health-care facility\nassessment tools (2015)\n10. Treatment of severe neonatal infections\n* Already being measured."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dd55f24a-8bdd-47c9-8307-7fd769ff394c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 48, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 432, "chroma:document": "assessment tools (2015)\n10. Treatment of severe neonatal infections\n* Already being measured.\nIndicators in purple are relevant to small and/or sick newborn care and KMC.\nSource: Adapted from Moxon et al. (2014) (98).\nImplementation strategy to achieve scale-up 37"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fe715fa3-e244-43f6-901c-e41688a19a2c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 433, "chroma:document": "In 2015, the ENAP proposed an indicator for measuring service readiness for KMC at the national level,\ndefined as the number of facilities with a designated space for KMC and at least one staff member\nwho has received KMC training within the last two years (98). It is now incorporated into the relevant\nlarge health-care facility assessment tools such as the Service Availability and Readiness Assessment,\nHarmonized Health Facility Assessment (99,100), Service Provision Assessment Survey (101) and\nHarmonized Health Facility Assessment (100,102). A KMC measurement framework has since been\ndeveloped with core indicators to track implementation and progress towards effective coverage of\nfacility-based KMC through a global consultative process (103). We have adapted these indicators to\nalign with the current recommendations (see Fig. 3).\nFigure 3. Indicators for measuring facility-based KMC\nNational-level\nFacility-level measurement\nmeasurement\nIdentification KMC coverage Follow-up"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fbebb611-2a41-4617-af21-daaaab46b390
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 434, "chroma:document": "National-level\nFacility-level measurement\nmeasurement\nIdentification KMC coverage Follow-up\nKMC service readiness of small in health-care support for\nnewborns facilities KMC at home\n1. National policy 4. Percentage of infants 5. Percentage of 6. Percentage of\nrecommends KMC weighed at birth newborns weighing infants who received\n2. Costed national < 2500 g initiated support for KMC in\nimplementation on KMC anywhere the community\nplans for maternal\u2013 in the facility (WHO/\nnewborn health ENAP coverage\ninclude KMC indicator, see Box 3)\n3. Number and\npercentage of\nfacilities with\noperational\nKMC (ENAP\nprocess indicator)\nENAP: Every Newborn Action Plan; KMC: kangaroo mother care.\nSource: Adapted from Guenther et al. (2017) (103).\nFurther work is required to agree on a clear framework with specific indicators aligned to the existing\nrecommendations on KMC and its measurement at national and subnational levels."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bc898c65-9cd9-4892-bb97-2f8aa9676163
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 49, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 435, "chroma:document": "recommendations on KMC and its measurement at national and subnational levels.\nNational coverage data are an essential step, but in due course these need to be linked to more detailed\ndata on quality of care, which is likely to require the development of a neonatal individually linked\ndata set covering KMC and also other small and/or sick newborn care parameters such as continuous\npositive airway pressure, safe oxygen use, infection management, and enabling follow-up tracking.\nGovernments may also consider putting programme learning and quality assurance mechanisms in\nplace to identify issues with implementation and provide insights for actions to improve programme\nimplementation and performance.\n38\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 9e2c8638-4c1a-455e-bb05-a7b47cd93481
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 50, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 436, "chroma:document": "Create a functional network of care and improve\nreferral transport\nGovernments should not implement KMC in isolation. Optimal outcomes for preterm or LBW infants\nrequire that essential small and/or sick newborn care services are available at all levels of care, with\nfunctional linkages between them. Networks of care with a functional referral system can facilitate care\nseeking and provision at the right level of care with reduced stress on the health system, health workers\nand patients, decreased costs of care, and improved outcomes.\nEmergency transportation support offered as part of a broader multicomponent intervention package\nthat included financial incentives, improved communication and community mobilization has been\nshown to increase facility deliveries and reduce newborn mortality (104). Programmes could consider\nsuch mechanisms to facilitate the timely transfer of small and/or sick newborns from a lower- to a"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1db4bb3f-fd7f-4c81-a03d-e3be6aed9671
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 50, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 437, "chroma:document": "such mechanisms to facilitate the timely transfer of small and/or sick newborns from a lower- to a\nhigher-level facility, while ensuring early initiation and continuation of KMC at different levels of care.\nFollow-up linkages between facilities and communities also need to be strengthened for adequate\nfollow-up and support for KMC at home after discharge of the mother\u2013infant dyad from the health-\ncare facility. Some approaches to promote these linkages could include community-based transport\ninitiatives (105,106), continuity of care (107,108) and mobile-health interventions (109).\nKMC cannot be implemented in isolation and optimal outcomes\nfor preterm or LBW infants require that essential services for\nsmall and/or sick newborn care are available at all levels of care,\nwith functional linkages between different levels of care.\nAdebisi Adejoke, 41, with her baby in KMC position and the assisting nurses in the mother\u2013"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6aacccf9-3c31-4bc2-b31e-47c99fca2c16
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 50, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 438, "chroma:document": "Adebisi Adejoke, 41, with her baby in KMC position and the assisting nurses in the mother\u2013\nnewborn care unit, Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria.\nImplementation strategy to achieve scale-up 39\n\u00a9LD\nPhotography/Idowu\nOlamide"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1e848461-c07a-4110-99f9-73870c03ad1d
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metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 51, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 439, "chroma:document": "6\nA father provides KMC for his premature baby at Setthathirath\nHospital, Vientiane, Lao People\u02bcs Democratic Republic.\n4400\n\u00a9WHO/Yoshi\nShimizu"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 77a7baf8-de98-49b1-99d9-0ffa2a97c421
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 440, "chroma:document": "Operationalizing the\nimplementation strategy\nNational planning and coordination of KMC implementation\nGovernments should constitute a national technical advisory group to carry out national-level\nplanning and coordination of KMC implementation, ensuring broad stakeholder participation. This\nadvisory group should include programme leadership at national and subnational levels; professional\norganizations and health-care professionals in paediatrics, obstetrics\u2013gynaecology, nursing and\nmidwifery from public and private sectors; public health and research organizations; academia;\nparent organizations and civil society representatives; and multilateral and bilateral development\npartners such as WHO, UNICEF and USAID. This advisory committee will help countries to conduct\nsituation analyses of small and/or sick newborn care, including KMC for all preterm or LBW infants, and\ncontextualize implementation planning to the country. This process will include setting achievable"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 441, "chroma:document": "contextualize implementation planning to the country. This process will include setting achievable\ngoals and timelines, developing or refining national and subnational implementation strategies\nand operational plans and guidelines (including standards and protocols), and regular monitoring\nand evaluation.\nBesides establishing the national technical advisory group, governments should set up strategic\npartnerships and collaborations with key stakeholders at national and subnational levels to create buy-\nin for implementation and scale-up at all levels. Additionally, centres of excellence can be instrumental\nin training and motivating staff and promoting the integration of KMC within existing initiatives and\nprogrammes. A national resource centre can develop strategic, clinical and operational guidelines\nand protocols and oversee the coordination, training and monitoring of KMC activities at national and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c2bfbb24-8420-4bdb-b2dd-7281eabec671
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 442, "chroma:document": "subnational levels. Governments can mobilize resources for implementation by creating memoranda\nof understanding with partners and donors, and combining global and private sector investments to\nsupport local implementation efforts.\nGovernments will need to develop a human resource strategy to align with the need for\noperationalizing KMC at all levels of health care in facilities and in the community, including plans for\ncapacity-building and training of both maternal and newborn health-care providers in small and/or\nsick newborn care, including KMC. KMC should be included in the pre-service education curricula and\nin-service education and training of health-care providers working in maternal and newborn health\nareas. For existing health cadres, a KMC training plan will be required to create master trainers at\nnational and subnational levels to support continued training and refreshers. Professional associations"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f70a93c3-a989-496c-aff7-77394c0842b0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 443, "chroma:document": "in paediatrics, obstetrics\u2013gynaecology, nursing and midwifery could facilitate continued in-service\ntraining and hands-on practice of relevant health workers. Governments should also use different types\nof mass communication approaches to create public awareness about KMC practice and its benefits.\nAnother critical action for governments is to operationalize a monitoring and evaluation system for\nsmall and/or sick newborn care and KMC, including indicator(s) related to KMC as part of the routine\nfacility and community health information systems (HMIS, District Health Information Software,\nand national surveys such as Demographic Health Surveys or Multiple Indicator Cluster Surveys).\nProgramme leadership should review the data regularly with the national technical advisory group and\nprovide feedback to the implementing teams and partners for mid-course corrections. Additionally,\nthey should work towards building and/or strengthening the capacity at the subnational and facility"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 65053104-0917-4ec4-9900-4147b46a7db9
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 52, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 444, "chroma:document": "they should work towards building and/or strengthening the capacity at the subnational and facility\nlevels to use data to analyse gaps and make continuous quality improvements at the local level.\n41"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d0d0a587-9079-41a5-b8fd-73748737f530
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 53, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 445, "chroma:document": "Subnational-level planning and implementation\nSubnational leadership plays a crucial role in the planning and implementation of KMC as the\nfoundation of small and/or sick newborn care, especially in a federal system of governance. Successful\nimplementation at the subnational level relies on: (1) proper use and allocation of regional/state\nbudgets; (2) development of standard operating procedures for operationalizing the implementation\nstrategy; (3) strengthening of service delivery at both facility and community levels; (4) ensuring\nfunctional referral links between different levels of care and the community to facilitate timely referrals\nand follow-up; (5) maintenance of a trained, multidisciplinary health workforce and capacity-building;\nand (6) regular monitoring of implementation across all districts with follow-up action in areas\nrequiring improvement.\nSubnational programme teams should be part of the national planning process. This involvement will"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f7d98da2-b806-490f-aa52-a1d87644322a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 53, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 446, "chroma:document": "Subnational programme teams should be part of the national planning process. This involvement will\nhelp them understand the principles of implementing a service delivery model of maternal\u2013newborn\ncare that ensures that mothers and their infants are kept and cared for together after birth in the same\nplace with KMC practice for all preterm and LBW infants, both well and sick. They must include a budget\nfor KMC activities in the district-level activity plans. They should provide strong leadership and engage\nwith facility administration and community processes to ensure commitment and buy-in by all local\nstakeholders. Some facilities may be designated as centres of excellence for practising, training and\npromotion of family-centred care, and can also serve as demonstration sites for best practices in small\nand/or sick newborn care, including KMC for all preterm or LBW infants. The subsequent actions at the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 14844458-625b-4a75-a1d8-3756a0ada04c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 53, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 447, "chroma:document": "subnational level should focus on enabling health-care facilities to initiate KMC for all preterm or LBW\ninfants even when sick, and strengthening services across the continuum of care to support the early or\nimmediate initiation and continuation of KMC. These actions are summarized below.\nTimely identification of preterm or low-birth-weight infants\nTimely identification of preterm or LBW infants in facilities at all levels of care and in the community\nis important for early initiation of KMC. This requires properly functioning digital weighing scales in\nfacilities for institutional births and with the community health workers for home births, training of\nhealth workers for examining infants for the presence of any danger signs, and facilitating the referral of\npreterm or LBW infants to an appropriate facility as per the country\u2019s birth weight and gestational age\ncut-off and other criteria (e.g. presence of specified danger signs) for admission to special or intensive"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e59c3ef8-c158-4d01-b81c-4293ec66807a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 53, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 448, "chroma:document": "newborn care units. KMC can be used during transport. Preterm or LBW infants born at home who do\nnot require admission to the newborn care unit may be initiated on KMC at home. Additionally, preterm\nor LBW infants who could not be initiated on KMC in the facility after birth can also be initiated on KMC\nat home after discharge.\nTimely identification of preterm or LBW\ninfants in the facility and community is\nimportant for early initiation of KMC.\n42\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b9e12b66-11d7-4180-9241-1688c9381db8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 54, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 449, "chroma:document": "Johnson Tolulope, 41, a surrogate KMC-mother providing KMC to her sister\u02bcs preterm baby in\nthe mother\u2013newborn care unit, Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria.\nFacility-level actions\n\u2022 Policies: The facility management should establish policies that facilitate keeping the mother and\ninfant together after birth and caring for them together as a unit in the same place, with means\nfor ensuring respectful care (medical care, beds, food and water, bathing, toilet, etc.) and KMC.\nAdditionally, fathers or partners and other family members should be allowed to visit the infant at\nany time and be supported in practising KMC along with the mother.\n\u2022 Infrastructure: Preterm or LBW infants requiring KMC may be well or sick. Those who are otherwise\nwell are usually cared for in the postnatal wards and arrangements can be made in these wards to\nkeep the mother and infant together, for example having a dedicated area for these mother\u2013infant"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fbc13d85-56c6-4256-b5e8-383b08287e92
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 54, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 450, "chroma:document": "keep the mother and infant together, for example having a dedicated area for these mother\u2013infant\ndyads in the postnatal wards. For preterm or LBW infants who are sick and need to be cared for inside\na special or intensive care unit, a common limitation is that many units only allow mothers to visit\ntheir infants intermittently to provide KMC. However, a recent study provided a bed for the mother\ninside the special or intensive newborn care unit so that she could reside with the infant on a 24/7\nbasis and was no longer a visitor (46). This strategy achieved early initiation (more than two thirds of\ninfants put in skin-to-skin contact within two hours after birth) and a longer duration of KMC (almost\n17 hours per day). This or other innovative arrangements should be used to ensure immediate,\nprolonged and continuous KMC for all preterm or LBW infants, even when sick.\n\u2022 Services: The maternal and newborn health service providers in the health-care facility should"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 05266c56-b044-4fac-b93d-33b04af2a42b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 54, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 451, "chroma:document": "\u2022 Services: The maternal and newborn health service providers in the health-care facility should\ncollaborate to provide care to the mother\u2013infant dyad together as a unit from birth to enable them\nto remain together even when the infant is preterm or LBW and sick, and practise immediate KMC.\nAdditionally, the mother should be provided the required medical care, counselling and support\nfor her own and her infant\u2019s care, with food and clean water, bathing and toilet facilities, etc., for\nrespectful care.\nOperationalizing the implementation strategy 43\n\u00a9LD\nPhotography/Idowu\nOlamide"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 43873447-b389-4517-bb92-7cd39301df98
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 452, "chroma:document": "\u2022 Health-care providers: It is important that health-care providers at all levels of the facility are\nconvinced of the advantages of keeping the mother and infant together from birth and caring for\nthem together in the same place with KMC as the standard of care, even when the infant is preterm\nor LBW and sick. They should be trained to counsel and demonstrate KMC to the mother, father or\npartner and other family members throughout the hospital stay; support them in carrying out KMC;\nand monitor their progress. Similarly, community-based health-care providers should understand\nthe importance of initiating KMC at home for preterm or LBW infants who do not need referral to a\nfacility, and continuing KMC in the post-discharge period for infants born in and initiated on KMC\nin facilities. They should also have adequate skills and confidence to support the mothers, fathers\nor partners and other family members in doing KMC and timely identification of any danger signs"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 74a61596-9342-4065-af07-7fdc20280205
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 453, "chroma:document": "or partners and other family members in doing KMC and timely identification of any danger signs\nrequiring referral to the hospital.\n\u2022 Follow-up linkages: Appropriate follow-up linkages between lower- and higher-level facilities and\nbetween hospital and home should be established or strengthened for early initiation of KMC and\ncontinued KMC practice post-discharge. Health-care providers should ensure that mothers and\nfamilies are confident in taking care of their preterm or LBW infant, including providing KMC at\nhome, before they are discharged from the hospital. Adequate support should be provided for the\nmother\u2013infant dyad, father or partner and other family members in the community after discharge\nto continue KMC; follow-up can be provided through telehealth, phone calls, home visits and/or\ncommunity-based health programmes or special high-risk programmes (if they already exist in the\ncountry) depending on the country context."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f58a768e-f808-480b-bc5f-ac0d843fc5b0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 454, "chroma:document": "country) depending on the country context.\n\u2022 Monitoring and continuous quality improvement: The delivery and uptake of KMC should be\nregularly monitored to ensure accountability and to promote the delivery of effective KMC as a part\nof ongoing quality improvement initiatives.\nMeasurement and monitoring of KMC implementation\nTo put the KMC indicator into practice in routine health systems, it is essential to ensure that\nappropriate data elements are included in patient notes, registers and tally sheets in the facility or\nhospital, for accurate and complete data availability. Home-based records are needed to document\nKMC in the community.\nHigh coverage of KMC can be achieved at the district level using context-adapted service-delivery\nmodels based on a mechanism to identify challenges and test solutions across the facility\u2013community\ncontinuum (15). Optimizing implementation will also require planning and costing tools, including floor\nplans and other aids at the district level.\n44"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d265d4d3-4f84-45ff-9c5a-83f881ea8806
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 55, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 455, "chroma:document": "plans and other aids at the district level.\n44\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 35fdd49f-cea5-486a-90f0-bd39bfeb4a46
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 56, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 456, "chroma:document": "Figure 4. Theory of change\nMission statement: Global scale-up of KMC as foundation of small and/or sick newborn care under\nuniversal health coverage (UHC)\nImmediate KMC after birth with other life-saving interventions for all mothers and their preterm or\nlow-birth-weight infants globally\nGlobal Position Paper and Implementation Strategy published with wide dissemination\nMultistakeholder discussions at regional and country levels\nPartnerships between government\nand partners for implementation at\nnational and subnational levels\nActivities Outputs Outcomes Impact\nHigh-level national KMC in national Increased KMC Increased newborn\nleadership engaged policy and coverage in facilities survival: newborn\nprogrammes for preterm or LBW mortality rate \u2264 12\nnewborns per 1000 live births in\nKMC budgeted in\nall countries by 2030\nnational plans as part\nachieved\nof UHC\nKMC provided in\npostnatal wards and\nEstablish small and/or in small and/or sick\nsick newborn care unit newborn care units"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 255d3703-687a-4b10-8216-84bc36afefe6
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 56, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 457, "chroma:document": "Establish small and/or in small and/or sick\nsick newborn care unit newborn care units\nin every district with\npolicies and provisions\nfor mother to stay with\nnewborn on 24/7 basis\nand immediate KMC\nInclude initiation and KMC initiated and High population-\ncontinuation of KMC at continued at home based coverage of\nhome in community- KMC\nbased health\nprogrammes or special\nhigh-risk programmes\nif they already exist in\nthe country\nInclude KMC indicators Data on KMC\nin routine health implementation and\ninformation systems quality is available\nContinuously monitor\nKMC coverage and\nquality and take\ncorrective actions\nOperationalizing the implementation strategy 45"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 11bed36c-4814-42db-a698-314742d5b0b1
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 57, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 458, "chroma:document": "7\nMother doing KMC in the neonatal care unit of Da Nang\nHospital for Women and Children, Da Nang, Viet Nam.\n4466\n\u00a9WHO/Gato\nBorrero"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f2c04323-beb8-4ad0-8b2d-e3a5e7366550
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 58, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 459, "chroma:document": "Path forward\nImplementation of KMC is central to achievement of the SDGs for the survival, health and well-being of\npreterm or LBW infants, both well and sick, through its successful scale-up at all levels of facility care\nand in the community. Based on the new evidence on successful scale-up of KMC in programmatic\nsettings from several countries, complemented by the joint wisdom and experience of global\nstakeholders, this implementation strategy is intended to guide the way forward for universal coverage\nof KMC for all preterm or LBW infants, both well and sick. This implementation strategy is meant to\ninspire a renewed vision in which mothers and infants are kept and cared for together from birth, and\nwhere parents and families play a central role in the care of their infants, thus humanizing health care\n(Fig. 4).\nKMC has been shown to be an essential intervention superior to standard radiant warmer/incubator"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fe2e255d-7935-44df-ac80-8f7328ea2f0f
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 58, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 460, "chroma:document": "KMC has been shown to be an essential intervention superior to standard radiant warmer/incubator\ncare in all settings. We hope that all countries, irrespective of their income setting and resource\navailability, will adapt this strategy to their health system contexts to realize the full impact of KMC in\nimproving the survival, health and well-being of mothers and preterm or LBW infants alike.\nKMC provides for humanized and cost-effective, yet high-quality\nmaternal and newborn care regardless of technological or\nresource gaps. It empowers mothers to lead the physical and\nemotional care of their infants, thus improving the health and\nwell-being of infants and mothers alike (1).\nGirl Samuelsson, born almost 10 weeks preterm, in KMC\nwith her mother, Lund-Malm\u00f6 NIDCAP Center, Stockholm.\n47\n\u00a9Lund-Malm\u00f6\nNIDCAP\nCenter/Stina\nKlemming"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 27729eb1-07df-4446-9986-5a892fb42827
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 59, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 461, "chroma:document": "References\n1. WHO recommendations on interventions to improve preterm birth outcomes. Geneva: World Health Organization;\n2015 (https://apps.who.int/iris/handle/10665/183037).\n2. Kangaroo mother care: a transformative innovation in health care. Global position paper. Geneva: World Health\nOrganization; 2023.\n3. World Health Organization, United Nations Children\u2019s Fund. Every newborn progress report 2019. Geneva: World\nHealth Organization; 2020 (https://resourcecentre.savethechildren.net/document/every-newborn-progress-\nreport-2019/, accessed 30 November 2022).\n4. Torres LM, Mazia G, Guenther T, Valsangkar B, Wall S. Monitoring the implementation and scale-up of a\nlife-saving intervention for preterm and small babies: facility-based kangaroo mother care. J Glob Health.\n2021;11(14001):14001. doi:10.7189/jogh.11.14001.\n5. Hailegebriel TD, Bergh AM, Zaka N, Roh JM, Gohar F, Rizwan S et al. Improving the implementation of kangaroo"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 59, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 462, "chroma:document": "mother care. Bull World Health Organ. 2021;99(1):69\u201371. doi:10.2471/BLT.20.252361.\n6. Calibo AP, De Leon Mendosa S, Silvestre MA, Murray JCS, Li Z, Mannava P et al. Scaling up kangaroo mother care in\nthe Philippines using policy, regulatory and systems reform to drive changes in birth practices. BMJ Glob Health.\n2021;6(8):e006492. doi:10.1136/bmjgh-2021-006492.\n7. Ehtesham Kabir A, Afroze S, Amin Z, Biswas A, Lipi SA, Khan M et al. Implementation research on kangaroo mother\ncare, Bangladesh. Bull World Health Organ. 2022;100(1):10\u20139. doi:10.2471/BLT.20.284158.\n8. Improving availability and quality of routine data for newborns: Malawi\u2019s experience with KMC. Lilongwe: Save The\nChildren Malawi; 2018 (www.healthynewbornnetwork.org/resource/improving-routine-data-for-newborns-malawi-\nexperience/, accessed 8 December 2022).\n9. Maternal and Child Survival Program, USAID. Kangaroo mother care in Malawi. Washington (DC): United States"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 59, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 463, "chroma:document": "Agency for International Development; undated (www.mcsprogram.org/wp-content/uploads/dlm_uploads/2019/01/\nMalawi-KAP-Summary-Sheet.pdf, accessed 9 January 2023).\n10. Nathalie Charpak (Kangaroo Foundation, Bogot\u00e1, Colombia). KMC mapping in Colombia: an example of KMC\ndiffusion at country scale. Presentation made at the 13th International Conference on Kangaroo Mother Care, Madrid,\n21\u201322 November 2022.\n11. Chan GJ, Valsangkar B, Kajeepeta S, Boundy EO, Wall S. What is kangaroo mother care? Systematic review of the\nliterature. J Glob Health. 2016;6(1):010701. doi:10.7189/jogh.06.010701.\n12. Conde-Agudelo A, D\u00edaz-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight\ninfants. Cochrane Database Syst Rev. 2016;2017(8):CD002771.\n13. Bergh A-M, de Graft-Johnson J, Khadka N, Om\u2019Iniabohs A, Udani R, Pratomo H et al. The three waves in\nimplementation of facility-based kangaroo mother care: a multi-country case study from Asia. BMC Int Health Hum"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 59, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 464, "chroma:document": "Rights. 2016;16(1):4. doi:10.1186/s12914-016-0080-4.\n14. Berg A-M, Gupta S, Rao S. Programmatic implementation of kangaroo mother care: a systematic synthesis of grey\nliterature. medRxiv [preprint]. doi:10.1101/2023.04.05.23288153.\n15. Mony PK, Tadele H, Gobezayehu AG, Chan GJ, Kumar A, Mazumder S et al. Scaling up kangaroo\nmother care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health.\n2021;6(9):e005905. doi:10.1136/bmjgh-2021-005905.\n16. Bergman N, Talej M, Rao PN S, Gupta S. Health system intervention packages on improving coverage of kangaroo\nmother care for preterm or LBW infants: a mixed-methods systematic review. medRxiv [preprint].\n4848\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 60, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 465, "chroma:document": "17. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization;\n2018 (https://apps.who.int/iris/handle/10665/260178).\n18. Ending preventable newborn deaths and stillbirths by 2030: moving faster towards high-quality universal\nhealth coverage in 2020\u20132025. New York: United Nations Children\u2019s Fund; 2020 (www.unicef.org/reports/ending-\npreventable-newborn-deaths-stillbirths-quality-health-coverage-2020-2025, accessed 30 November 2022).\n19. Survive and thrive: transforming care for every small and sick newborn. Geneva: World Health Organization;\n2019 (https://apps.who.int/iris/handle/10665/326495).\n20. Strategic and Technical Advisory Group of Experts (STAGE). Handbook on maternal, newborn, child, adolescent\nhealth & nutrition. Geneva: World Health Organization; 2022 (https://cdn.who.int/media/docs/default-source/mca-\ndocuments/stage/stage-mncahn-handbook-final.pdf?sfvrsn=ecbb99cd_1&download=true, accessed 26 April 2023)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 60, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 466, "chroma:document": "21. Guidelines for declaration of interests (WHO experts). [Geneva: World Health Organization]; undated.\n22. Sivanandan S, Sankar MJ. Kangaroo mother care for preterm or low birth weight infants: a systematic review and\nmeta-analysis. BMJ Glob Health. 2023 (in press).\n23. Resolution A/RES/70/1: Transforming our world: the 2030 Agenda for Sustainable Development. General Assembly,\n25 September 2015. New York (NY): United Nations; 2015 (www.un.org/en/development/desa/population/migration/\ngeneralassembly/docs/globalcompact/A_RES_70_1_E.pdf, accessed 6 January 2023).\n24. Crump C. An overview of adult health outcomes after preterm birth. Early Hum Dev.\n2020;150:105187. doi:10.1016/j.earlhumdev.2020.105187.\n25. Charpak N, Tessier R, Ruiz JG, Hernandez JT, Uriza F, Villegas J et al. Twenty-year follow-up of kangaroo mother care\nversus traditional care. Pediatrics. 2017;139(1):e20162063. doi:10.1542/peds.2016-2063."}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 60, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 467, "chroma:document": "versus traditional care. Pediatrics. 2017;139(1):e20162063. doi:10.1542/peds.2016-2063.\n26. Sacks E. Defining disrespect and abuse of newborns: a review of the evidence and an expanded typology of respectful\nmaternity care. Reprod Health. 2017;14(1). doi:10.1186/s12978-017-0326-1.\n27. Rao SPN, Minckas N, Medvedev MM, Gathara D, Y N P, Seifu Estifanos A et al. Small and sick newborn care during the\nCOVID-19 pandemic: global survey and thematic analysis of healthcare providers\u2019 voices and experiences. BMJ Glob\nHealth. 2021;6(3):e004347. doi.org/10.1136/bmjgh-2020-004347.\n28. Pathak BG, Sinha B, Sharma N, Mazumder S, Bhandari N. Effect of kangaroo mother care for low-birth-weight and\npreterm infants on maternal and paternal health: systematic review and meta-analysis. Bull World Health Org.\n2023 (https://cdn.who.int/media/docs/default-source/bulletin/online-first/blt.22.288977.pdf?sfvrsn=2cba99cf_3)."}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 60, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 468, "chroma:document": "29. Karimi FZ, Heidarian Miri H, Salehian M, Khadivzadeh T, Bakhshi M. The effect of mother-infant skin to skin\ncontact after birth on third stage of labor: a systematic review and meta-analysis. Iran J Public Health.\n2019;48(4):612\u201320. doi:10.18502/ijph.v48i4.982.\n30. Al-Alaa H, Al-Najjar H, Fouly H. Assess the effectiveness of using kangaroo mother care on reducing\npostpartum bleeding among laboring women: a randomized control trial. Women Health Care Issues.\n2021;4(6). doi:10.31579/2642-9756/092.\n31. Standards for improving the quality of care for small and sick newborns in health facilities. Geneva: World Health\nOrganization; 2020 (https://apps.who.int/iris/handle/10665/334126).\n32. Ruiz JG, Charpak N, Castillo M, Bernal A, R\u00edos J, Trujillo T et al. Latin American Clinical Epidemiology Network Series\n\u2013 Paper 4: Economic evaluation of kangaroo mother care: cost utility analysis of results from a randomized controlled"}


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created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 470, "chroma:document": "33. WHO KMC Scale Up Study Group. Incremental costs of scaling up kangaroo mother care: results from implementation\nresearch in Ethiopia and India. Acta Paediatr. 2022. doi:10.1111/apa.16490.\n34. Ehtesham Kabir A, Afroze S, Amin Z, Biswas A, Lipi SA, Khan M et al. Implementation research on kangaroo mother\ncare, Bangladesh. Bull World Health Organ. 2022;100(1):10\u20139. doi:10.2471/BLT.20.284158.\n35. Chavula K, Likomwa D, Valsangkar B, Luhanga R, Chimtembo L, Dube Q et al. Readiness of hospitals to provide\nkangaroo mother care (KMC) and documentation of KMC service delivery: analysis of Malawi 2014 Emergency\nObstetric and Newborn Care (EmONC) survey data. J Glob Health. 2017;7(2):020802. doi:10.7189/jogh.07.020802.\n36. Pall\u00e1s-Alonso CR, Losacco V, Maraschini A, Greisen G, Pierrat V, Warren I et al. Parental involvement and kangaroo\ncare in European neonatal intensive care units: a policy survey in eight countries. Pediatr Crit Care Med.\n2012;13(5):568\u201377. doi:10.1097/PCC.0b013e3182417959."}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 471, "chroma:document": "2012;13(5):568\u201377. doi:10.1097/PCC.0b013e3182417959.\n37. Morales Betancourt P, L\u00f3pez Maestro M, De la Cruz B\u00e9rtolo J, V\u00e1zquez Roman S, Alonso D\u00edaz C, Pall\u00e1s Alonso C. What\nwe talk about in NICUs when we talk about kangaroo care: a national survey in Spain [abstract]. 12th International\nConference on Kangaroo Mother Care, Bogot\u00e0, Colombia; 2018 (http://fundacioncanguro.co/wp-content/\nuploads/2018/11/What-we-talk-about-in-NICUs-When-we-talk-about-Kangaroo-Care.-A-National-Survey-in-Spain.pdf,\naccessed 6 January 2023).\n38. Artese C, Ferrari F, Perugi S, Cavicchioli P, Paterlini G, Mosca F et al. Surveying family access: kangaroo mother care\nand breastfeeding policies across NICUs in Italy. Ital J Pediatr. 2021;47(1):231. doi.org/10.1186/s13052-021-01164-8.\n39. Weldearegay HG, Medhanyie AA, Abrha MW, Tadesse L, Tekle E, Yakob B et al. Quality of kangaroo mother care services"}


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topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 472, "chroma:document": "in Ethiopia: implications for policy and practice. PLoS One. 2019;14(11):e0225258. doi:10.1371/journal.pone.0225258.\n40. Kondwani Chavula. Improving availability, quality and use of routine date for newborns: Malawi\u2019s experience with\nkangaroo mother care. Presentation made at the 29th International Pediatric Association Congress, Panama City,\nPanama, 21 March 2019.\n41. Vani SN, Banker D. Enablers and challenges of kangaroo mother care practices at different levels of newborn\ncare services in India. Document prepared for a working group, 11th Workshop and Congress of the International\nNetwork on Kangaroo Mother Care, Trieste, Italy, 14\u201317 November 2016 (https://fundacioncanguro.co/wp-content/\nuploads/2018/01/india.docx, accessed 9 January 2023).\n42. MCH Dept., Ministry of Health, KMC team Viet Nam. Kangaroo mother care in Viet Nam: an overview for\nimplementation and scaling up [abstract]. 11th Workshop and Congress of the International Network on Kangaroo"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 473, "chroma:document": "Mother Care, Trieste, Italy, 14\u201317 November 2016 (https://fundacioncanguro.co/wp-content/uploads/2018/01/\nvietnam.docx, accessed 9 January 2023).\n43. USAID Services de Sant\u00e9 \u00e0 Grand Impact. Improving the health of mothers and newborns in Mali through integrated\nprogramming. Mali: United States Agency for International Development; Services de Sant\u00e9 \u00e0 Grand Impact; Save\nthe Children; undated (https://resourcecentre.savethechildren.net/pdf/usaid-services-de-sante-a-grand-impact-\ncontext-improving-the-health-of-mothers-and-newborns-in-mali-through-integrated-programming-1.pdf/, accessed\n16 January 2023).\n44. Maternal and Child Survival Program, USAID. Updating Rwanda\u2019s health management information system (HMIS).\nWashington (DC): United States Agency for International Development; 2019 (https://pdf.usaid.gov/pdf_docs/\nPA00TX6Q.pdf, accessed 9 January 2023).\n45. Klemming S, Lilliesk\u00f6ld S, Westrup B. Mother-newborn couplet care from theory to practice to ensure zero separation"}


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topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 61, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 474, "chroma:document": "for all newborns. Acta Paediatr. 2021;110(11):2951\u20137. doi:10.1111/apa.15997.\n46. WHO Immediate KMC Study Group, Arya S, Naburi H, Kawaza K, Newton S, Anyabolu CH et al.\nImmediate \u201ckangaroo mother care\u201d and survival of infants with low birth weight. N Engl J Med.\n2021;384(21):2028\u201338. doi:10.1056/NEJMoa2026486.\n47. Cai Q, Chen D-Q, Wang H, Zhang Y, Yang R, Xu W-L et al. What influences the implementation of kangaroo mother\ncare? An umbrella review. BMC Pregnancy Childbirth. 2022;22(1):851. doi:10.1186/s12884-022-05163-3.\n48. Mathias CT, Mianda S, Ohdihambo JN, Hlongwa M, Singo-Chipofya A, Ginindza TG. Facilitating factors and barriers to\nkangaroo mother care utilisation in low- and middle-income countries: a scoping review. Afr J Prim Health Care Fam\nMed. 2021;13(1):e1\u201315. doi:10.4102/phcfm.v13i1.2856.\n50\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 62, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 475, "chroma:document": "49. Seidman G, Unnikrishnan S, Kenny E, Myslinski S, Cairns-Smith S, Mulligan B et al. Barriers and enablers of kangaroo\nmother care practice: a systematic review. PLoS One. 2015;10(5):e0125643. doi:10.1371/journal.pone.0125643.\n50. Kurniawati, Rustina Y, Budiati T. Peer support increases maternal confidence, kangaroo\nmother care implementation and weight gain in LBW infants. Compr Child Adolesc Nurs.\n2019;42(sup1):252\u201360. doi:10.1080/24694193.2019.1594457.\n51. Wubetu AD, Engidaw NA, Gizachew KD. Prevalence of postpartum depression and associated\nfactors among postnatal care attendees in Debre Berhan, Ethiopia, 2018. BMC Pregnancy Childbirth.\n2020;20(1):189. doi:10.1186/s12884-020-02873-4.\n52. Pradhananga P, Mali P, Poudel L, Gurung M. Prevalence of postpartum depression in a tertiary health care. JNMA J\nNepal Med Assoc. 2020;58(223):137\u201340. doi:10.31729/jnma.4805.\n53. Adeyemo EO, Oluwole EO, Kanma-Okafor OJ, Izuka OM, Odeyemi KA. Prevalence and predictors of postpartum"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 62, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 476, "chroma:document": "depression among postnatal women in Lagos, Nigeria. Afr Health Sci. 2020;20(4):1943\u201354. doi:10.4314/ahs.v20i4.53.\n54. Stefani G, Skopec M, Battersby C, Harris M. Why is kangaroo mother care not yet scaled in the\nUK? A systematic review and realist synthesis of a frugal innovation for newborn care. BMJ Innov.\n2022;8(1):9\u201320. doi:10.1136/bmjinnov-2021-000828.\n55. Personal communications with health providers who have been practising KMC for a long time: Helga Naburi,\nMuhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania; Harish Chellani,\nSafdarjung Hospital, Delhi, India; Ebunoluwa Adejuyigbe, Obafemi Awolowo University, Ile-Ife, Nigeria.\n56. WHO recommendations on maternal and newborn care for a positive postnatal experience. Geneva: World Health\nOrganization; 2022 (https://apps.who.int/iris/handle/10665/352658).\n57. Pocket book of hospital care for children. Guidelines for the management of common childhood illnesses, 2nd ed."}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 62, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 478, "chroma:document": "62. Mazumder S, Taneja S, Dube B, Bhatia K, Ghosh R, Shekhar M et al. Effect of community-initiated\nkangaroo mother care on survival of infants with low birthweight: a randomised controlled trial. Lancet.\n2019;394(10210):1724\u201336. doi:10.1016/S0140-6736(19)32223-8.\n63. Quasem I, Sloan NL, Chowdhury A, Ahmed S, Winikoff B, Chowdhury AMR. Adaptation of kangaroo mother care for\ncommunity-based application. J Perinatol. 2003;23(8):646\u201351. doi.org/10.1038/sj.jp.7210999.\n64. Dzakpasu S, Soremekun S, Manu A, Ten Asbroek G, Tawiah C, Hurt L et al. Impact of free delivery\ncare on health facility delivery and insurance coverage in Ghana\u2019s Brong Ahafo Region. PLoS One.\n2012;7(11):e49430. doi:10.1371/journal.pone.0049430.\n65. Wiysonge CS, Paulsen E, Lewin S, Ciapponi A, Herrera CA, Opiyo N et al. Financial arrangements for health systems in\nlow-income countries: an overview of systematic reviews. Cochrane Database Syst Rev. 2017;9:CD011084."}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 63, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 482, "chroma:document": "Roadmap+to+Accelerate+Progress+for+Every+Newborn+in+Humanitarian+Settings+2020-2025.pdf/, accessed\n6 January 2023).\n75. Inter-agency field manual on reproductive health in humanitarian settings. New York: Inter-agency Working Group on\nReproductive Health in Crises; 2018 (https://resourcecentre.savethechildren.net/pdf/iafm_on_reproductive_health_\nin_hs_2018.pdf, accessed 6 January 2023).\n76. The Sphere handbook: humanitarian charter and minimum standards in humanitarian response, 4th ed. Geneva:\nSphere Association; 2018 (https://spherestandards.org/wp-content/uploads/Sphere-Handbook-2018-EN.pdf,\naccessed 6 January 2023).\n77. Munyuzangabo M, Gaffey MF, Khalifa DS, Als D, Ataullahjan A, Kamali M et al. Delivering maternal and\nneonatal health interventions in conflict settings: a systematic review. BMJ Glob Health. 2021;5(Suppl\n1):e003750. doi:10.1136/bmjgh-2020-003750.\n78. Committee on the Learning Health Care System in America; Institute of Medicine; Smith M, Saunders R, Stuckhardt L"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 63, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 483, "chroma:document": "et al., editors. 7, Engaging patients, families, and communities. In: Best care at lower cost: the path to continuously\nlearning health care in America. Washington (DC): National Academies Press (US); 2013 (www.ncbi.nlm.nih.gov/\nbooks/NBK207234/, accessed 6 January 2023).\n79. Jadaun AS, Dalpath SK, Trikha S, Upadhyay RP, Bhandari N, Punia JS et al. Government-led initiative increased the\neffective use of kangaroo mother care in a region of north India. Acta Paediatr. 2022. doi:10.1111/apa.16376.\n80. Joint WHO-UNICEF-UNFPA Initiative for SRMNCAH Programme Officers from the ministries of health and UN\npartners. Impact of COVID-19 on SRMNCAH services, regional strategies, solutions and innovations: a comprehensive\nreport. New Delhi: World Health Organization, Regional Office for South-East Asia; 2021 (https://apps.who.int/iris/\nhandle/10665/338482).\n81. Joudyian N, Doshmangir L, Mahdavi M, Tabrizi JS, Gordeev VS. Public-private partnerships in primary health care: a"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 63, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 484, "chroma:document": "scoping review. BMC Health Serv Res. 2021;21(1):4. doi:10.1186/s12913-020-05979-9.\n82. Masotti P, Rivoire E, Rowe W, Dahl M, Plain E. Collaborative partnerships: managing increased healthcare demand\nwithout increasing overall system capacity. Healthc Q. 2006;9(2):72\u20136. doi:10.12927/hcq..18106.\n83. Kokorelias KM, Gignac MAM, Naglie G, Cameron JI. Towards a universal model of family centered care: a scoping\nreview. BMC Health Serv Res. 2019;19(1):564. doi:10.1186/s12913-019-4394-5.\n52\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 485, "chroma:document": "84. Hendricks-Mu\u00f1oz KD, Li Y, Kim YS, Prendergast CC, Mayers R, Louie M. Maternal and neonatal nurse perceived\nvalue of kangaroo mother care and maternal care partnership in the neonatal intensive care unit. Am J Perinatol.\n2013;30(10):875\u201380. doi:10.1055/s-0033-1333675.\n85. Suter E, Oelke ND, Adair CE, Armitage GD. Ten key principles for successful health systems integration. Healthc Q.\n2009;13 Spec No:16\u201323. doi:10.12927/hcq.2009.21092.\n86. Nicholson C, Jackson C, Marley J. A governance model for integrated primary/secondary care for the health-reforming\nfirst world \u2013 results of a systematic review. BMC Health Serv Res. 2013;13:528. doi:10.1186/1472-6963-13-528.\n87. Jackson D, Shahabuddin ASM, Sharkey AB, K\u00e4llander K, Mu\u00f1iz M, Mwamba R et al. Closing the know-do gap for child\nhealth: UNICEF\u2019s experiences from embedding implementation research in child health and nutrition programming.\nImplement Sci Commun. 2021;2(1):112. doi:10.1186/s43058-021-00207-9."}


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topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 486, "chroma:document": "Implement Sci Commun. 2021;2(1):112. doi:10.1186/s43058-021-00207-9.\n88. Sheikh K, Hargreaves J, Khan M, Mounier-Jack S. Implementation research in LMICs \u2013 evolution through innovation.\nHealth Policy Plan. 2020;35(Supplement_2):ii1\u20133. doi:10.1093/heapol/czaa118.\n89. Theobald S, Brandes N, Gyapong M, El-Saharty S, Proctor E, Diaz T et al. Implementation research: new imperatives\nand opportunities in global health. Lancet. 2018;392(10160):2214\u201328. doi:10.1016/s0140-6736(18)32205-0.\n90. Korper AK, Patr\u00edcio L, Holmlid S, Witell L. Service design as an innovation approach in technology startups: a\nlongitudinal multiple case study. Creat Innov Manag. 2020;29(2):303\u201323. doi:10.1111/caim.12383.\n91. Patr\u00edcio L, Grenha Teixeira J, Vink J. A service design approach to healthcare innovation: from decision-making to\nsense-making and institutional change. AMS Rev. 2019;9(1\u20132):115\u201320. doi:10.1007/s13162-019-00138-8."}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 487, "chroma:document": "sense-making and institutional change. AMS Rev. 2019;9(1\u20132):115\u201320. doi:10.1007/s13162-019-00138-8.\n92. The Z benefits for premature and small newborns. Pasig City: Philippines Insurance Corporation; 2017 (Philhealth\ncircular No. 2017-0009; www.philhealth.gov.ph/circulars/2017/circ2017-0009.pdf, accessed 6 January 2023).\n93. Cameroon Ministry of Public Health, Global Financing Facility for Women, Children and Adolescents (GFF), Grand\nChallenges Canada, Nutrition International, Fondation Kangourou Cameroun. Cameroon KMC Development\nImpact Bond 2018\u20132021. End of programme report. September 2021 (www.grandchallenges.ca/wp-content/\nuploads/2021/09/Cameroon-KMC-Development-Impact-Bond-Report-%E2%80%94-EN.pdf, accessed\n20 December 2022).\n94. Launching Saving Little Lives. In: Laerdal Global Health [website]. Stavanger, Norway; undated (https://\nlaerdalglobalhealth.com/Resources/news/launching-saving-little-lives/, accessed 20 December 2022)."}


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id: 00d5e875-40fc-4705-9341-d469b6b007f3
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 488, "chroma:document": "laerdalglobalhealth.com/Resources/news/launching-saving-little-lives/, accessed 20 December 2022).\n95. McFadden A, Siebelt L, Marshall JL, Gavine A, Girard L-C, Symon A et al. Counselling interventions to enable women\nto initiate and continue breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2019;14(1):42.\ndoi:10.1186/s13006-019-0235-8.\n96. Salim N, Shabani J, Peven K, Rahman QS-U, Kc A, Shamba D et al. Kangaroo mother care: EN-BIRTH multi-country\nvalidation study. BMC Pregnancy Childbirth. 2021;21(Suppl 1):231. doi:10.1186/s12884-020-03423-8.\n97. Allisyn Moran, Unit Head UHL/MCA/MAH, WHO, personal communication.\n98. Moxon SG, Ruysen H, Kerber KJ, Amouzou A, Fournier S, Grove J et al. Count every newborn; a\nmeasurement improvement roadmap for coverage data. BMC Pregnancy Childbirth. 2015;15 Suppl\n2(S2):S8. doi:10.1186/1471-2393-15-S2-S8.\n99. Service availability and readiness assessment (SARA): an annual monitoring system for service delivery. Reference"}


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id: a59c38fc-e9b2-4d2e-b2a5-43e97827ff17
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 64, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 489, "chroma:document": "manual. Geneva: World Health Organization; 2015 (WHO/HIS/HIS/2014.5 Rev.1; https://cdn.who.int/media/docs/\ndefault-source/service-availability-and-readinessassessment(sara)/sara_reference_manual_chapter3.pdf, accessed\n17 January 2023).\n100. Dimension 1. General service availability. In: HHFA indicator inventory, version 2 [website]. Geneva: World Health\nOrganization; 2022 (https://indicator-inventory.hhfa.online/, accessed 17 January 2023).\n101. Service provision assessment survey: inventory questionnaire. The DHS Program; 2022 (https://dhsprogram.com/\npubs/pdf/SPAQ8/SPA_Combined_QRE_EN_20April2022.pdf, accessed 17 January 2023).\nReferences 53"}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 65, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 490, "chroma:document": "102. Harmonized health facility assessment (HHFA) combine questionnaire (availability and readiness): core questions\nonly. Geneva: World Health Organization; 2022 (https://cdn.who.int/media/docs/default-source/world-health-data-\nplatform/hhfa/hhfa-questionnaire-combined_a-r_core_30.10.2022.pdf, accessed 17 January 2023).\n103. Guenther T, Moxon S, Valsangkar B, Wetzel G, Ruiz J, Kerber K et al. Consensus-based approach to develop a\nmeasurement framework and identify a core set of indicators to track implementation and progress towards effective\ncoverage of facility-based kangaroo mother care. J Glob Health. 2017;7(2):020801. doi:10.7189/jogh.07.020801.\n104. Alaofe H, Lott B, Kimaru L, Okusanya B, Okechukwu A, Chebet J et al. Emergency transportation interventions for\nreducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review. Ann Glob Health.\n2020;86(1):147. doi:10.5334/aogh.2934."}


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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 65, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 491, "chroma:document": "2020;86(1):147. doi:10.5334/aogh.2934.\n105. uddin Mian N, Malik MZ, Iqbal S, Alvi MA, Memon Z, Chaudhry MA et al. Determining the potential scalability of\ntransport interventions for improving maternal, child, and newborn health in Pakistan. Health Res Policy Syst.\n2015;13 Suppl 1(S1):57. doi:10.1186/s12961-015-0044-5.\n106. Onono MA, Wahome S, Wekesa P, Adhu CK, Waguma LW, Serem T et al. Effects of an expanded Uber-like transport\nsystem on access to and use of maternal and newborn health services: findings of a prospective cohort study in Homa\nBay, Kenya. BMJ Glob Health. 2019;4(3):e001254. doi:10.1136/bmjgh-2018-001254.\n107. Shibanuma A, Ansah EK, Kikuchi K, Yeji F, Okawa S, Tawiah C et al. Evaluation of a package of continuum of care\ninterventions for improved maternal, newborn, and child health outcomes and service coverage in Ghana: a cluster-\nrandomized trial. PLoS Med. 2021;18(6):e1003663. doi:10.1371/journal.pmed.1003663."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f09afe92-71fe-434a-9060-11218c9bcd44
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 65, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 492, "chroma:document": "randomized trial. PLoS Med. 2021;18(6):e1003663. doi:10.1371/journal.pmed.1003663.\n108. Okawa S, Gyapong M, Leslie H, Shibanuma A, Kikuchi K, Yeji F et al. Effect of continuum-of-care intervention package\non improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled\ntrial. BMJ Open. 2019;9(9):e025347. doi:10.1136/bmjopen-2018-025347.\n109. Cattaneo A, Amani A, Charpak N, De Leon-Mendoza S, Moxon S, Nimbalkar S et al. Report on an international\nworkshop on kangaroo mother care: lessons learned and a vision for the future. BMC Pregnancy Childbirth.\n2018;18(1). doi:10.1186/s12884-018-1819-9\n54\nKangaroo\nmother\ncare:\nImplementation\nstrategy"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5a427cbe-c510-4a97-9758-a74566dcdc4e
encoding: FLOAT32
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{"source": "pdfs\\kmc_demo_file.pdf", "file_path": "pdfs\\kmc_demo_file.pdf", "page": 67, "total_pages": 68, "CreationDate": "D:20230515092806+02'00'", "Creator": "Adobe InDesign 17.2 (Macintosh)", "ModDate": "D:20230515092825+02'00'", "Producer": "Adobe PDF Library 16.0.7", "Trapped": "False", "chunk_index": 493, "chroma:document": "For more information, please contact:\nWorld Health Organization\n20 Avenue Appia\n1211 Geneva 27\nSwitzerland\nDepartment of Maternal, Newborn, Child\nand Adolescent Health and Ageing 978-92-4-007163-6\nEmail: mncah@who.int\nWebsite: www.who.int/teams/maternal-newborn-\nchild-adolescent-health-and-ageing/"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 13edede7-b4d8-4ce9-8f3d-7ede71cd7308
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 0, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 494, "chroma:document": "k a n g a r o o\nmother care\nA p r a c t i c a l g u i d e\nDepartment of Reproductive Health and Research\nWorld Health Organization\nGeneva"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 53f66dcb-121f-4119-a23e-598b50726841
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 1, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 495, "chroma:document": "KANGAROO MOTHER CARE\n\u00a9 World Health Organization 2003\nAll rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination,\nWorld Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857;\nemail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications - whether for sale or\nfor noncommercial distribution - should be addressed to Publications, at the above address (fax: +41 22 791 4806; email:\npermissions@who.int).\nThe designations employed and the presentation of the material in this publication do not imply the expression of any\nopinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory,\ncity or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps\nrepresent approximate border lines for which there may not yet be full agreement."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d4115442-fd81-4058-afb4-59e1ad113cb8
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 1, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 496, "chroma:document": "represent approximate border lines for which there may not yet be full agreement.\nThe mention of specific companies or of certain manufacturers\u2019 products does not imply that they are endorsed or\nrecommended by the World Health Organization in preference to others of a similar nature that are not mentioned.\nErrors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.\nThe World Health Organization does not warrant that the information contained in this publication is complete and\ncorrect and shall not be liable for any damages incurred as a result of its use.\nPrinted in France"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 8be556d7-4cff-4e9b-8c8d-633fbbe02d85
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 2, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 497, "chroma:document": "TABLE OF CONTENTS\nGLOSSARY\nABBREVIATIONS\n1. Introduction 7\n1.1 The problem \u2013 improving care and outcome for low-birth-weight babies 7\n1.2 Kangaroo mother care \u2013 what it is and why it matters 8\n1.3 What is this document about? 9\n1.4 Who is this document for? 9\n1.5 How should this document be used? 9\n2. Evidence 11\n2.1 Mortality and morbidity 12\n2.2 Breastfeeding and growth 13\n2.3 Thermal control and metabolism 14\n2.4 Other effects 14\n2.5 Research needs 15\n3. Requirements 17\n3.1 Setting 17\n3.2 Policy 18\n3.3 Staffing 18\n3.4 Mother 19\n3.5 Facilities, equipment and supplies 19\n3.6 Feeding babies 22\n3.7 Discharge and home care 23\n4. Practice guide 25\n4.1 When to start KMC 25\n4.2 Initiating KMC 27\n4.3 Kangaroo position 27\n4.4 Caring for the baby in kangaroo position 29\n4.5 Length and duration of KMC 30\n4.6 Monitoring baby\u2019s condition 31\n4.7 Feeding 34\n4.8 Monitoring growth 41\n4.9 Inadequate weight gain 43\n4.10 Preventive treatment 44\n4.11 Stimulation 44\n4.12 Discharge 44"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d9f95eee-4644-4b08-aa9f-17ddbd573491
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 2, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 498, "chroma:document": "4.9 Inadequate weight gain 43\n4.10 Preventive treatment 44\n4.11 Stimulation 44\n4.12 Discharge 44\n4.13 KMC at home and routine follow-up 46\nREFERENCES 47"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d2c33f2d-30c3-45d9-84c7-9563539eedfc
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 3, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 499, "chroma:document": "KANGAROO MOTHER CARE\nANNEXES 51\nI Records and indicators 51\nII Birth weight and gestational age 53\nIII Constraints 54\nkK\nTABLES\n1. The effect of KMC on breastfeeding 14\n2. Amount of milk (or fluid) needed per day by birth weight and age 40\n3. Approximate amount of breast milk needed per feed by birth weight and age 40\n4. Mean birth weights with 10th and 90th percentiles by gestational age 53\n5. Implementing KMC 54\nILLUSTRATIONS\n1 Holding the baby close to the chest 20\n2 Carrying pouches for KMC babies 21\n3 Dressing the baby for KMC 21\n4a Positioning the baby for KMC 27\n4b Baby in KMC position 28\n4c Moving the baby in and out of the binder 28\n5 Sleeping and resting during KMC 30\n6 Father\u2019s turn for KMC 31\n7 Breastfeeding in KMC 36\n8 Tube-feeding in KMC 41\nABBREVIATIONS\nLBW Low birth weight\nKMC Kangaroo mother care\nRCT Randomized controlled trial\nRDS Respiratory distress syndrome\nkK\nGLOSSARY\nTerms in this glossary are listed under key words in alphabetical order.\nAge"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 23033d19-32ca-45bc-b79e-408d333aeb61
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 3, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 500, "chroma:document": "kK\nGLOSSARY\nTerms in this glossary are listed under key words in alphabetical order.\nAge\nChronological age: age calculated from the date of birth.\nGestational age: age or duration of the gestation, from the last menstrual period to birth.\nPost-menstrual age: gestational age plus chronological age.\nBirth\nTerm birth: delivery occurring between 37 and 42 weeks of gestational age.\nPreterm birth: delivery occurring before 37 weeks of gestational age.\nPost-term birth: delivery occurring after 42 weeks of gestational age."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e343c389-15d6-4ece-926a-28c63bacd8e9
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 4, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 501, "chroma:document": "Birth weight\nLow-birth-weight infant: infant with birth weight lower than 2500g (up to and including\n2499g), regardless of gestational age.\nVery low-birth-weight infant: infant with birth weight lower than 1500g (up to and\nincluding 1499g), regardless of gestational age.\nExtremely low-birth-weight infant: infant with birth weight lower than 1000g (up to\nand including 999g), regardless of gestational age.\nDifferent cut-off values are used in this guide since they are more useful for clinical purposes.\nBody temperature\nHypothermia: body temperature below 36.5\u00b0C.\nGrowth\nIntrauterine growth retardation: impaired growth of the foetus due to foetal disorders,\nmaternal conditions (e.g. maternal malnutrition) or placental insufficiency.\nMilk/feeding\nForemilk: breast milk initially secreted during a breast feed.\nHind milk: breast milk remaining in the breast when the foremilk has been removed (hind\nmilk has a fat content and a mean caloric density higher than foremilk)."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 06ea3e9e-3715-4e6b-ae29-b75032e22cf7
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 4, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 502, "chroma:document": "milk has a fat content and a mean caloric density higher than foremilk).\nAlternative feeding method: not breastfeeding but feeding the baby with expressed breast\nmilk by cup or tube; expressing breast milk directly into baby\u2019s mouth.\nPreterm/full-term infant\nPremature or preterm infant: infant born before 37 weeks of gestational age.\nPreterm infant appropriate for gestational age (AGA): infant born preterm with\nbirth weight between the 10th and the 90th percentile for his/her gestational age.\nPreterm infant small for gestational age (SGA): infant born preterm with a birth weight\nbelow the 10th percentile for his/her gestational age.\nFull-term infant small for gestational age (SGA): infant born at term with birth weight\nbelow the 10th percentile for his/her gestational age.\nSmall baby: in this guide, a baby who is born preterm with low birth weight.\nStable preterm or low-birth-weight infant: a newborn infant whose vital functions"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 30bafb9f-efe5-491f-a95c-8987fb2b6c4e
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 4, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 503, "chroma:document": "Stable preterm or low-birth-weight infant: a newborn infant whose vital functions\n(breathing and circulation) do not require continuous medical support and monitoring,\nand are not subject to rapid and unexpected deterioration, regardless of intercurrent disease.\nNote: Throughout this document babies are referred to by the personal pronoun \u201cshe\u201d or \u201che\u201d in\npreference to the impersonal (and inaccurate!) \u201cit\u201d. The choice of gender is random.\nkK"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 23026af8-d57c-4d57-bbd7-12da312af7d9
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 5, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 504, "chroma:document": "KANGAROO MOTHER CARE"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7e65027b-d9cb-4342-8125-bc4dac1a16c1
encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 6, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 505, "chroma:document": "1.\nIntroduction\n1.1 The problem \u2013 improving care and outcome for low-birth-weight babies\nSome 20 million low-birth-weight (LBW) babies are born each year, because of either\npreterm birth or impaired prenatal growth, mostly in less developed countries. They contribute\nsubstantially to a high rate of neonatal mortality whose frequency and distribution correspond\nto those of poverty.1, 2 LBW and preterm birth are thus associated with high neonatal and infant\nmortality and morbidity.3, 4 Of the estimated 4 million neonatal deaths, preterm and LBW\nbabies represent more than a fifth.5 Therefore, the care of such infants becomes a burden for\nhealth and social systems everywhere.\nIn affluent societies the main contributor to LBW is preterm birth. The rate has been\ndecreasing thanks to better socioeconomic conditions, lifestyles and nutrition, resulting in\nhealthier pregnancies, and to modern neonatal care technology and highly specialised and\nskilled health workers. 6-8"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 58a3bb0d-b804-4d89-89a5-ff567cfaad33
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 6, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 506, "chroma:document": "skilled health workers. 6-8\nIn less developed countries high rates of LBW are due to preterm birth and impaired\nintrauterine growth, and their prevalence is decreasing slowly. Since causes and determinants\nremain largely unknown, effective interventions are limited. Moreover, modern technology\nis either not available or cannot be used properly, often due to the shortage of skilled staff.\nIncubators, for instance, where available, are often insufficient to meet local needs or are not\nadequately cleaned. Purchase of the equipment and spare parts, maintenance and repairs are\ndifficult and costly; the power supply is intermittent, so the equipment does not work properly.\nUnder such circumstances good care of preterm and LBW babies is difficult: hypothermia\nand nosocomial infections are frequent, aggravating the poor outcomes due to prematurity.\nFrequently and often unnecessarily, incubators separate babies from their mothers, depriving\nthem of the necessary contact."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: aefee0b0-7166-49f1-96b4-0f76e0b9f3d8
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 6, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 507, "chroma:document": "them of the necessary contact.\nUnfortunately, there is no simple solution to this problem since the health of an infant is\nclosely linked to the mother\u2019s health and the care she receives in pregnancy and childbirth.\nFor many small preterm infants, receiving prolonged medical care is important. However,\nkangaroo mother care (KMC) is an effective way to meet baby\u2019s needs for warmth,\nbreastfeeding, protection from infection, stimulation, safety and love.\n1"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1310f923-378d-4898-bc6b-bceb85a8f914
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 7, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 508, "chroma:document": "KANGAROO MOTHER CARE\n1.2 Kangaroo mother care \u2013 what it is and why it matters\nKangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a\npowerful, easy-to-use method to promote the health and well-being of infants born preterm as\nwell as full-term. Its key features are:\n(cid:1) early, continuous and prolonged skin-to-skin contact between the mother and the baby;\n(cid:1) exclusive breastfeeding (ideally);\n(cid:1) it is initiated in hospital and can be continued at home;\n(cid:1) small babies can be discharged early;\n(cid:1) mothers at home require adequate support and follow-up;\n(cid:1) it is a gentle, effective method that avoids the agitation routinely experienced in a busy ward\nwith preterm infants.\nIt was first presented by Rey and Martinez,9 in Bogot\u00e1, Colombia, where it was developed as\nan alternative to inadequate and insufficient incubator care for those preterm newborn infants"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 7, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 509, "chroma:document": "an alternative to inadequate and insufficient incubator care for those preterm newborn infants\nwho had overcome initial problems and required only to feed and grow. Almost two decades\nof implementation and research have made it clear that KMC is more than an alternative to\nincubator care. It has been shown to be effective for thermal control, breastfeeding and\nbonding in all newborn infants, irrespective of setting, weight, gestational age, and clinical\nconditions.10, 11\nMost published experience and research concerning KMC comes from health facilities,\nwhere care was initiated with the help of skilled health workers. Once a mother was confident in\nthe care she gave her baby, she continued it at home under guidance and with frequent visits for\nspecialised follow-up.\nEvidence of the effectiveness and safety of KMC is available only for preterm infants without\nmedical problems, the so-called stabilised newborn. Research and experience show that:"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b57903ed-3e95-4fc2-b496-0e695246bef2
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 7, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 510, "chroma:document": "medical problems, the so-called stabilised newborn. Research and experience show that:\n(cid:1) KMC is at least equivalent to conventional care (incubators), in terms of safety and thermal\nprotection, if measured by mortality.\n(cid:1) KMC, by facilitating breastfeeding, offers noticeable advantages in cases of severe morbidity.\n(cid:1) KMC contributes to the humanization of neonatal care and to better bonding between mother\nand baby in both low and high-income countries.12, 13\n(cid:1) KMC is, in this respect, a modern method of care in any setting, even where expensive\ntechnology and adequate care are available.\n(cid:1) KMC has never been assessed in the home setting.\nOngoing research and observational studies are assessing the effective use of this method in\nsituations where neonatal intensive care or referral are not available, and where health workers\nare properly trained. In those settings KMC before stabilisation may represent the best chance\nof healthy survival. 14, 15"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d69730ab-d2b7-4d96-a0e3-f006d890bd2e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 7, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 511, "chroma:document": "of healthy survival. 14, 15\nThis guide will therefore refer to KMC initiated at a health facility and continued at home\nunder the supervision of the health facility (domiciliary KMC). KMC as described in this\ndocument recommends continuous skin-to-skin contact acknowledging that it might not be\npossible in all settings and under all circumstances. The principles and practice of KMC\noutlined in this document are also valid for intermittent skin-to-skin contact, provided\nadequate care is offered to LBW and preterm newborn infants when they are separated from\ntheir mothers. Such intermittent skin-to-skin contact has been shown to be beneficial,16 if\n2"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 756336ee-eb78-4f83-8da9-13deb419f24c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 8, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 512, "chroma:document": "complemented by proper incubator care. Guidance on skin-to-skin care may be used for\nrewarming newborn infants with hypothermia or keeping them warm during transportation\nto the referral facility.17\n1.3 What is this document about?\nThis document describes the KMC method for care of stable preterm/LBW infants (i.e.\nthose who can breath air and have no major health problems) who need thermal protection,\nadequate feeding, frequent observation, and protection from infection.\nIt provides guidance on how to organize services at the referral hospital and on what is\nneeded to introduce and carry out KMC, focusing on settings where resources are limited.\nEvidence for the recommendations is provided18 whenever possible. However, for many\nstatements, especially those related to secondary procedures, sound evidence is not available as\nin many other fields of health care. In these cases, the text reports the experience of health"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a9bc56e9-fbf8-436e-9b52-9015250df330
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 8, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 513, "chroma:document": "in many other fields of health care. In these cases, the text reports the experience of health\nprofessionals who have implemented KMC for many years, many of whom carefully revised\nprevious versions of this document.\nFor breastfeeding counselling and support, readers should refer to Breastfeeding Counselling:\nA Training Course -Trainer\u2019s Guide.19 For HIV and infant feeding, refer to HIV and Infant Feeding\nCounselling: A Training Course -Trainer\u2019s Guide.20\nManagement of medical problems of small babies is not part of this guide. Further guidelines\ncan be found in textbooks or the WHO document Managing newborn problems. A guide for\ndoctors, nurses and midwives.56\n1.4 Who is this document for?\nThis text has been prepared for health professionals in charge of LBW and preterm newborn\ninfants in first referral hospitals in settings with scarce resources.\nIt is not written for all potential care providers. Practical instructions (or protocols) adapted"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4be9e8af-cdd3-4553-a95e-c2cf21dfc4b4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 8, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 514, "chroma:document": "It is not written for all potential care providers. Practical instructions (or protocols) adapted\nto the categories of health workers available in different settings should be prepared locally.\nIt is also aimed at decision-makers and planners at national and local levels. They need\nto know whether KMC suits the needs of their health systems, whether it is practical and\nfeasible, and what is required to implement it successfully.\n1.5 How should this document be used?\nKMC guidelines have to be adapted to specific circumstances and available resources at\nnational or local level. This document can be used to develop national and local policies,\nguidelines and protocols from which training material can be developed. This document cannot,\nas it stands, be used for training purposes. Other training material and activities, especially on\nbreastfeeding support and counselling on HIV and infant feeding, are needed to acquire all the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 04dafbbb-91ce-41a7-916d-5aae0b912365
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 8, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 515, "chroma:document": "breastfeeding support and counselling on HIV and infant feeding, are needed to acquire all the\nnecessary skills. We hope that pre-service institutions will include those skills in their curricula.\nkK\n3"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: de21de1e-95ac-4900-b05a-182e72940736
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 9, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 516, "chroma:document": "KANGAROO MOTHER CARE\n4"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bfe68f54-9b6c-4274-9f40-2a2c1d4f63fb
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 10, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 517, "chroma:document": "2.\nEvidence\nThis chapter reviews the evidence on KMC, from both developing and developed countries,\nwith regard to the following outcomes: mortality and morbidity; breastfeeding and growth;\nthermal protection and metabolism, and other effects. The experience with KMC has been\nreviewed by several authors,12, 13, 16, 21, 22 and in a systematic review.23 We also present evidence\non the acceptability of the intervention for mothers and health-care staff.\nWhile reviewing the evidence, regardless of the outcome, it became clear that it was\nimportant to highlight two essential variables: time of initiation of KMC, and daily and overall\nduration of skin-to-skin contact.\nTime of initiation of KMC in the studies under consideration varied from just after birth\nto several days after birth. Late initiation means that the preterm/LBW infants have already\novercome the period of maximum risk for their health."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b02a6a62-15ea-4d07-bd6f-f88655ef777c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 10, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 518, "chroma:document": "overcome the period of maximum risk for their health.\nLength of daily and overall duration of skin-to-skin contact also varied from minutes (e.g. 30\nminutes per day on average) to virtually 24 hours per day; from a few days to several weeks.\nThe longer the care, the stronger the possible direct and causal association between KMC and\nthe outcome. Furthermore, when KMC was carried out over a long period of time, care was\npredominantly provided by the mother rather than the nursing staff or the conventional\nincubator.\nSome other variables that might have affected the outcome of KMC are:\n(cid:1) the position in which the baby was kept;\n(cid:1) the changes in the type and mode of feeding;\n(cid:1) the timing of discharge from the institution and the transition to home care;\n(cid:1) condition at discharge;\n(cid:1) the intensity of support and follow-up offered to mothers and families after discharge from the\ninstitution."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e3b96721-183e-465c-8d71-89c9a73ba0e4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 10, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 519, "chroma:document": "institution.\nMany other factors (e.g. social conditions, environment and health care, especially services\noffered for KMC) may be associated with the positive effects observed in KMC studies. It is\nvery important to separate the effects of these factors from those deriving from KMC. Below,\nin reviewing the evidence, we try to address those additional factors.\nNo published study on KMC was found in the context of high HIV prevalence among mothers.\n5"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a07971e0-c30f-4417-8ac2-659db5322626
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 11, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 520, "chroma:document": "KANGAROO MOTHER CARE\n2.1 Mortality and morbidity\nClinical trials\nThree published randomized controlled trials (RCT) comparing KMC with conventional\ncare were conducted in low-income countries.24-26 The results showed no difference in survival\nbetween the two groups. Almost all deaths in the three studies occurred before eligibility,\ni.e. before LBW infants were stabilised and enrolled for research. Infants weighing less than\n2000g were enrolled after an average period of 3-14 days on conventional care, in urban third-\nlevel hospitals. The KMC infants stayed in hospital until they fulfilled the usual criteria for\ndischarge, as the control infants did, in two of the studies,24, 26 while in the third study they were\ndischarged earlier and subjected to a strict ambulatory follow-up.25 The follow-up periods lasted\none,26 six24 and twelve months,25 respectively.\nThe RCT carried out in Ecuador by Sloan and collaborators showed a lower rate of severe"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 7c07e68b-54a6-46c3-b484-b3e7cdb3d02c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 11, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 521, "chroma:document": "The RCT carried out in Ecuador by Sloan and collaborators showed a lower rate of severe\nillness among KMC infants (5%) than in the control group (18%).24 The sample size required\nfor that study was 350 subjects per group for a total of 700 infants, but only 603 babies were\nrecruited. Recruitment, in fact, was interrupted when the difference in the rate of severe illness\nbecame apparent. The other controlled studies conducted in low-income countries revealed no\nsignificant difference in severe morbidity, but found fewer hospital infections and readmissions\nin the KMC group. Kambarami and collaborators from Zimbabwe also reported reduced\nhospital infections.27 High-income countries report no difference in morbidity. However, it is\nnotable that no additional risk of infection seems to be associated with skin-to-skin contact.24-27\nObservational studies showed that KMC could help reduce mortality and morbidity in"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c001e255-9470-45b9-bea9-16a7067cf436
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 11, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 522, "chroma:document": "Observational studies showed that KMC could help reduce mortality and morbidity in\npreterm/LBW infants. Rey and Martinez,9 in their early account, reported an increase in\nhospital survival from 30% to 70% in infants between 1000g and 1500g. However, the\ninterpretation of their results is difficult because numerators, denominators and follow-up in\nthe KMC group were different from those in the historical control group.28 Bergman and\nJ\u00fcrisoo, in another study with an historical control group conducted in a remote mission\nhospital without incubator care in Zimbabwe,14 reported an increase in hospital survival from\n10% to 50% in infants weighing less than 1500g, and from 70% to 90% in those weighing\nbetween 1500 to 1999g. Similar results are reported from a secondary hospital in nearby\nMozambique.15 The difference in survival, however, may be due to some uncontrolled variables.\nThe studies in Zimbabwe and Mozambique, conducted in hospitals with very limited resources,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b2011a71-2271-4734-a756-a64068d1611e
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 11, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 523, "chroma:document": "The studies in Zimbabwe and Mozambique, conducted in hospitals with very limited resources,\napplied KMC very early on, well before LBW and preterm infants were stabilized. In the early\nstudy by Rey and Martinez, KMC was applied later, after stabilization. In both cases the skin-\nto-skin contact was maintained virtually 24 hours a day.\nCharpak and collaborators, in a two-cohort study carried out in Bogot\u00e1, Colombia,29 found\na crude death rate higher in the KMC group (relative risk = 1.9; 95%CI: 0,6 to 5.8), but their\nresults reverted in favour of KMC (relative risk = 0.5, 95%CI: 0.2 to 1.2) after adjustment for\nbirth weight and gestational age. The differences, however, were not statistically significant.\nThe two cohorts recruited in two third-level hospitals, showed many social and economic\ndifferences. KMC was also applied after stabilization and 24 hours a day. In a controlled but\nnot randomized trial carried out in a tertiary-care hospital in Zimbabwe, there was a slight"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 480451f8-8f1c-49ff-8739-87252949c7d7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 11, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 524, "chroma:document": "not randomized trial carried out in a tertiary-care hospital in Zimbabwe, there was a slight\ndifference in survival in favour of the KMC infants, but this might have been due to differences\nin feeding.27\n6"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e5f69a2d-5682-43dc-98c5-f8f2828c0134
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 12, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 525, "chroma:document": "Conclusion\nOn balance the evidence shows that although KMC does not necessarily improve survival, it\ndoes not reduce it. After stabilization, there is no difference in survival between KMC and good\nconventional care. The hypothesis that KMC might improve survival when applied before\nstabilization needs to be further explored with well-designed studies. If such an effect on\nsurvival exists, it will be more evident and easier to demonstrate in the poorest settings, where\nmortality is very high.\nAs for morbidity, while there is no strong evidence of a beneficial effect of KMC, there is\nno evidence of it being harmful. In addition to the little evidence already published,14, 15 some\npreliminary results on a small number of newborn infants with mild respiratory distress seem to\nconfirm that very early skin-to-skin contact might have a beneficial effect.30 A word of warning\nabout discharge: KMC infants discharged during the cold season may be more susceptible to"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: d538dde0-91e2-433f-a06b-ba4371242d28
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 12, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 526, "chroma:document": "about discharge: KMC infants discharged during the cold season may be more susceptible to\nsevere illness, especially lower respiratory tract infections, than those discharged during the\nwarm season.31 A closer follow-up is needed in such cases.\nIt should be noted that all the studies so far have taken place in well-equipped hospitals,\nyet arguably the most significant impact of KMC will be felt in settings with limited resources.\nThere is an urgent need for further research in these settings. In the meantime, it seems that\nwhere poor conventional care is available, KMC offers a safe substitute, with little risk of raised\nmorbidity or mortality.\n2.2 Breastfeeding and growth\nBreastfeeding\nTwo randomized controlled trials and a cohort study carried out in low-income countries\nlooked at the effect of KMC on breastfeeding. All three studies found that the method increased\nthe prevalence and duration of breastfeeding.25, 26, 29 Six other studies conducted in high-income"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b82556ad-e251-411a-af05-94b3c49854ca
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 12, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 527, "chroma:document": "the prevalence and duration of breastfeeding.25, 26, 29 Six other studies conducted in high-income\ncountries, where skin-to-skin contact was applied late and only for a limited amount of time per\nday, also showed a beneficial effect on breastfeeding.32-37 The results of all these studies are\nsummarized in Table 1.\nIt appears that KMC and skin-to-skin contact are beneficial for breastfeeding in settings\nwhere it is less commonly used for preterm/LBW infants, especially if these are cared for in\nincubators and the prevailing feeding method is the bottle. Other studies have shown a positive\neffect of skin-to-skin contact on breastfeeding. It could therefore be expected that the earlier\nKMC is begun and the earlier skin-to-skin contact is initiated, the greater the effect on\nbreastfeeding will be.\nGrowth\nThe two-cohort study conducted in Colombia29 revealed slower weight gain in KMC\ninfants when compared with the control group, but the two cohorts also showed many social"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c4c3b1f7-fa51-4276-afad-6fe1200f9e2c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 12, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 528, "chroma:document": "infants when compared with the control group, but the two cohorts also showed many social\nand economic differences. In the subsequent RCT25 no difference in growth was observed at\none year of age. In another RCT,26 KMC infants showed a slightly larger daily weight gain while\nthey were cared for in hospital, but in the overall period of study their growth did not differ\nfrom that of the control group. Similar results in terms of daily weight gain were observed in\nZimbabwe.27\n7"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e6770809-155d-4a19-9e8e-a1626acad05a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 13, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 529, "chroma:document": "KANGAROO MOTHER CARE\nTable 1. The effect of KMC on breastfeeding\nStudy Author Year Ref. Outcome KMC Control\nRCT Charpak et al. 1994 29 Partial or exclusive breastfeeding at:\n1 month 93% 78%\n6 months 70% 37%\n1 year 41% 23%\nRCT Charpak et al. 1997 25 Partial or exclusive breastfeeding at 3 months 82% 75%\nRCT Cattaneo et al. 1998 26 Exclusive breastfeeding at discharge 88% 70%\nSchmidt et al. 1986 32 Daily volume 640 ml 400 ml\nDaily feeds 12 9\nWhitelaw et al. 1988 33 Breastfeeding at 6 weeks 55% 28%\nWahlberg et al. 1992 34 Breastfeeding at discharge 77% 42%\nSyfrett et al. 1993 35 Daily feeds (34 weeks of gestational age) 12 12\nBlaymore-Bier 1996 36 Breastfeeding at: discharge 90% 61%\net al. 1 month 50% 11%\nHurst et al. 1997 37 Daily volume at 4 weeks 647 ml 530 ml\nExclusive breastfeeding at discharge 37% 6%\n2.3 Thermal control and metabolism\nStudies carried out in low-income countries26 show that prolonged skin-to-skin contact"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bd08e02a-a105-44ec-aaf2-1c3549cb4043
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 13, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 530, "chroma:document": "Studies carried out in low-income countries26 show that prolonged skin-to-skin contact\nbetween the mother and her preterm/LBW infant, as in KMC, provides effective thermal\ncontrol and may be associated with a reduced risk of hypothermia. Fathers too can effectively\nconserve heat in newborn infants38 despite an initial report of worse performance of males in\nthermal control.39\nHeart and respiratory rates, respiration, oxygenation, oxygen consumption, blood glucose,\nsleep patterns and behaviour observed in preterm/LBW infants held skin-to-skin tend to be\nsimilar to or better than those observed in infants separated from their mothers.40-42 Contact\nbetween mother and child has other effects also. For instance, salivary cortisol, an indicator of\npossible stress, appears to be lower in newborn infants held skin-to-skin.43 This observation is\nconsistent with the reporting of significantly more crying in full-term healthy infants 90 minutes"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 44c2edcd-84b2-4bfa-afd9-ceb4ba653641
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 13, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 531, "chroma:document": "consistent with the reporting of significantly more crying in full-term healthy infants 90 minutes\nafter birth44, 45 and in LBW and preterm infants at 6 months33 of age when they are separated\nfrom their mothers.\n2.4 Other effects\nKangaroo care helps both infants and parents. Mothers report being significantly less stressed\nduring kangaroo care than when the baby is receiving conventional care. Mothers prefer\nskin-to-skin contact to conventional care26 and report an increased confidence, self-esteem,\nand feeling of fulfilment, also in high-income countries. They describe a sense of empowerment,\nconfidence and a feeling that they can do something positive for their preterm infants in\ndifferent settings and cultures.46-49 Fathers too said that they felt relaxed, comfortable and\ncontented while providing kangaroo care. KMC thus empowers mothers and increases their\nconfidence in handling and feeding their LBW and preterm infants. Tessier and collaborators,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3123c44f-8846-465c-9f45-b457afca892c
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 13, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 532, "chroma:document": "confidence in handling and feeding their LBW and preterm infants. Tessier and collaborators,\nusing data from the RCT conducted in Colombia, concluded that KMC should be encouraged\nas soon as possible after birth because it improves bonding and makes mothers feel more\ncompetent.50\n8"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 81ed3d29-db55-406f-840f-380e449c1d72
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 14, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 533, "chroma:document": "KMC is acceptable to health-care staff, and the presence of mothers in the ward does not\nseem to be a problem. Most health workers consider KMC beneficial. They may think that\nconventional incubator care allows better monitoring of sick LBW and preterm infants, but\nthey recognize that it increases the risk of hospital infections and it separates infants from their\nmothers. Health workers would prefer KMC for their own preterm/LBW infant.26\nLower capital investment and recurrent costs is yet another advantage of KMC and could\nbring about some savings to hospitals and health care systems in low-income countries.\nSavings may result from reduced spending on fuel, electricity, maintenance and repair of\nequipment26 as well as possible reduction in staffing costs, since mothers provide the greater\nproportion of care. Compared with conventional incubator care, Ecuador24 has reported lower\ncosts per infant, in part associated with a reduced rate of readmission to hospital. This may"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: eb4d50be-87d1-4b09-af95-b42784f65193
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 14, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 534, "chroma:document": "costs per infant, in part associated with a reduced rate of readmission to hospital. This may\npartly be due to a shorter length of hospital stay in KMC infants, reported from both low 25-27\nand high-income countries.33, 35, 46 Capital and recurrent savings may be more substantial in\ntertiary than in first-referral and small facilities in low-income countries.\n2.5 Research needs\nMore evidence of the advantages of KMC over other methods of care is needed, particularly\non:\n(cid:1) the effectiveness and safety of KMC before stabilization, in settings with very limited resources\n(i.e. without incubators and other expensive technologies);\n(cid:1) breastfeeding and feeding supplements in LBW infants less than 32 weeks of gestational age;\n(cid:1) simpler and reliable methods for monitoring the well-being of KMC infants, especially breathing\nand feeding;\n(cid:1) KMC in LBW infants weighing less than 1000g, and in newborn infants who are critically ill;"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 49b540bc-f99d-46ee-be84-fd723ccc1df3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 14, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 535, "chroma:document": "(cid:1) KMC in LBW infants weighing less than 1000g, and in newborn infants who are critically ill;\n(cid:1) KMC in very special circumstances, e.g. in very cold climates or in refugee camps;\n(cid:1) cultural and managerial barriers that may hinder the implementation of KMC, and\ninterventions that may foster it, particularly in settings with very limited resources;\n(cid:1) the implementation of KMC for LBW and preterm infants delivered at home without the help\nof trained personnel and without the possibility of referral to the appropriate level of care.\nThis last situation may well be the most important current source of perinatal and neonatal\nmortality and morbidity. The evidence about the benefits of KMC for LBW and preterm\ninfants relates to those born and assisted in health facilities or who can benefit from careful\nfollow-up at home, not to those delivered at home. Clear scientific evidence is needed to"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: faee4397-3a8a-448d-b562-0724aa37848a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 14, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 536, "chroma:document": "follow-up at home, not to those delivered at home. Clear scientific evidence is needed to\nestablish the safety and suitability of domiciliary KMC for babies born at home. However,\nthere is no evidence that such care would be harmful or less safe than current practice. It might\nbe reasonable, unless future research showed that other methods of home care were more\neffective, to recommend KMC for the home care of LBW and preterm infants born at home\nand who cannot be taken to hospital. Local culture and local activities to improve birth care at\nhome should be taken into account if such a recommendation were issued.\nkK\n9"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: cd553bb4-9175-47b0-8717-ada14cdf67d5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 15, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 537, "chroma:document": "KANGAROO MOTHER CARE\n10"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1a2f13a2-1e07-48dc-b43c-d98366bc57e3
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 16, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 538, "chroma:document": "3.\nRequirements\nThe most important resources for KMC are the mother, personnel with special skills and a\nsupportive environment. The requirements described in this chapter are formulation of policy,\norganization of services and follow-up, equipment and supplies for mothers and babies, and\nskilled providers for the facilities. Some common constraints faced when implementing KMC,\nand possible solutions, are discussed in Annex III.\nVery small newborn infants and those with complications are best cared for in incubators\nwhere they can receive the necessary attention and care. As soon as the general condition\nimproves and the baby no longer needs intensive medical care, but simply warmth, protection\nfrom infections and adequate feeding to ensure growth, KMC can be the method of choice.\n3.1 Setting\nKMC can be implemented in various facilities and at different levels of care. The most\ncommon settings where such care can be implemented, are described below:\nMaternity facilities"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: dfb57c58-2284-456e-8516-d797491d66a0
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 16, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 539, "chroma:document": "common settings where such care can be implemented, are described below:\nMaternity facilities\nSmall maternity units with several deliveries per day, these facilities are usually staffed by\nskilled midwives but often have no doctors and lack special equipment (incubators and radiant\nwarmers) and supplies (oxygen, drugs and preterm formula) for the care of LBW and preterm\nnewborn infants. If possible, such infants are transferred to a higher level of care; otherwise they\nare kept with their mothers and discharged early for home care. Hypothermia, infections,\nrespiratory and feeding problems contribute to high mortality rates among those infants.\nReferral hospitals\nThis category includes a wide range of special care units in district and provincial hospitals.\nA common feature is the availability of skilled personnel (specialized nurses and midwives,\npaediatricians, obstetricians, or at least experienced physicians) and basic equipment and"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a1144490-6771-45c7-b2e7-00dab393899a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 16, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 540, "chroma:document": "paediatricians, obstetricians, or at least experienced physicians) and basic equipment and\nsupplies for special neonatal care. However, in reality, staff and equipment are often in short\nsupply: competent physicians may be available a few hours per day only, small newborn infants\nare kept in large nurseries or wards, sometimes in contact with older patients. Mothers cannot\nstay with their infants and they have difficulty establishing and maintaining breastfeeding.\nMortality may also be high for the same reasons. Abandonment may be a common problem.\n11"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6b138c6d-f7fd-4875-9ef7-6489a99c61ad
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 17, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 541, "chroma:document": "KANGAROO MOTHER CARE\nThere is a range of institutions between the two types of facility mentioned above, where\nskilled health workers can provide KMC.\n3.2 Policy\nImplementation of KMC and its protocol will need to be facilitated by supportive health\nauthorities at all levels. These include the hospital director and the people in charge of the health\ncare system at district, provincial and regional levels.\nA national policy ensures a coherent and effective integration of the practice within\npre-existing structures of the health system and education and training.\nPreterm babies are best born in institutions that can provide the special medical care required\nfor managing their frequent complications. Thus, when a premature baby is expected, the\nmother should be transferred to such an institution before birth. If this is not possible, very\nsmall babies or small babies with problems should be transferred there as soon as possible."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 268af3a4-4bf7-4a2e-bc55-db6f39a408d5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 17, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 542, "chroma:document": "small babies or small babies with problems should be transferred there as soon as possible.\nThe referral system should be organized in such a way as to guarantee the safety of the baby.\nNational standards and protocols need to be developed for the care of small babies, including\nthose mentioned above, once they have overcome the initial problems. Standards must include\nclear criteria for monitoring and evaluation. These can best be developed by the appropriate\nprofessional groups with the participation of parents. Furthermore, local protocols will be easier\nto implement if national policies and guidelines are clearly set out.\nContinuous monitoring and regular evaluation according to established criteria will help\nimprove practice and design, and carry out research that may help refine the method.\nEach health facility that implements KMC should, in its turn, have a written policy and\nguidelines adapted to the local situation and culture. Such policies and guidelines will be more"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 59a42a8f-d97e-4dd3-9dc0-4c775fdabb78
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 17, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 543, "chroma:document": "guidelines adapted to the local situation and culture. Such policies and guidelines will be more\neffective if they are agreed on by consensus, involving all the staff, where possible, in developing\nlocal protocols based on national or international guidelines. The protocol should cover KMC\nas presented here, and should, of course, include follow-up. It could also be complemented by\ndetailed instructions on general problems (e.g. hygiene of staff and mothers) or on problems\ncommonly occurring in preterm infants (e.g. prevention and treatment of infection). After the\nintroduction of the KMC protocol, monthly meetings with the staff will be useful to discuss and\nanalyse data and problems, and to improve the protocol if necessary.\n3.3 Staffing\nKMC does not require any more staff than conventional care. Existing staff (doctors and\nnurses) should have basic training in breastfeeding and adequate training in all aspects of\nKMC as described below:"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2b5a6e42-4308-44b1-8671-bd8c5ff2dbbf
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 17, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 544, "chroma:document": "KMC as described below:\n(cid:1) when and how to initiate the KMC method;\n(cid:1) how to position the baby between and during feeds;\n(cid:1) feeding LBW and preterm infants;\n(cid:1) breastfeeding;\n(cid:1) alternative feeding methods until breastfeeding becomes possible;\n(cid:1) involving the mother in all aspects of her baby\u2019s care, including monitoring vital signs and\nrecognizing danger signs;\n(cid:1) taking timely and appropriate action when a problem is detected or the mother is concerned;\n12"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: ae48ae17-303c-463a-888e-4aeb683b8fda
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 18, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 545, "chroma:document": "(cid:1) deciding on the discharge;\n(cid:1) ability to encourage and support the mother and the family.\nEach institution should have a programme of continuing education in the area of KMC and\nbreastfeeding. Nursing and medical schools should include KMC in their curricula as soon\nas possible.\n3.4 Mother\nResearch and experience show that mothers like KMC once they have become familiar with\nit. KMC must therefore be discussed with the mother as soon as a preterm baby is born and\noffered to her as an alternative to the conventional methods when the baby is ready. Since\nKMC requires the continuous presence of the mother, it would be helpful to explain to her the\nadvantages of each method and discuss with her the possible options regarding baby care. She\nmust have time and opportunity to discuss the implications of KMC with her family, since this\nwould require her to stay longer in hospital, continue the method at home and attend follow-up"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 15f77a32-3232-46be-9008-dca919e12644
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 18, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 546, "chroma:document": "would require her to stay longer in hospital, continue the method at home and attend follow-up\nvisits. If obstacles arise, talk about them and try to find solutions with the family before\nabandoning KMC. The mother must also be fully supported by the health workers to gradually\ntake over the responsibility for the care of her small baby.\nIn theory it is possible to fully implement KMC with a surrogate mother (e.g. the grand-\nmother) but this is difficult to accomplish in practice.\n3.5 Facilities, equipment and supplies\nKMC does not require special facilities, but simple arrangements can make the mother\u2019s stay\nmore comfortable.\nMother\u2019s needs\nTwo or four-bed rooms of reasonable size, where mothers can stay day and night, live with\nthe baby, and share experience, support and companionship; at the same time they can have\nprivate visits without disturbing the others. The rooms should be equipped with comfortable"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 73a20031-7a72-4e1d-aa26-7b0a18313220
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 18, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 547, "chroma:document": "private visits without disturbing the others. The rooms should be equipped with comfortable\nbeds and chairs for the mothers, if possible adjustable or with enough pillows to maintain an\nupright or semi-recumbent position for resting and sleeping. Curtains can help to ensure pri-\nvacy in a room with several beds. The rooms should be kept warm for small babies (22-24\u00b0C).\nMothers also need bathroom facilities with tap water, soap and towels. They should have nutri-\ntious meals and a place to eat with the baby in KMC position. Another warm, smaller room\nwould be useful for individual work with mothers, discussion of private and confidential issues,\nand for reassessing babies. The ward should have an open-door policy for fathers and siblings.\nDaily shower or washing is sufficient for maternal hygiene; strict hand-washing should be\nencouraged after using the toilet and changing the baby. Mothers should have the opportunity\nto change or wash clothes during their stay at the KMC facility."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b06bc462-9d13-4026-87c6-401cbc734a41
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 18, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 548, "chroma:document": "to change or wash clothes during their stay at the KMC facility.\nRecreational, educational and even income-generating activities can be organized for\nmothers during KMC in order to prevent or reduce the inevitable frustrations of being away\nfrom home and in an institution. Noise levels should, however, be kept low during such\nactivities to avoid disturbing the small babies. Mothers should also be allowed to move around\nfreely during the day at the institution and, if possible, in the garden, provided they respect the\n13"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: b6863eaf-b90b-4e3d-bc29-fddcd8478a65
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 19, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 549, "chroma:document": "KANGAROO MOTHER CARE\nhospital schedules for patient care and regularly feed their babies. The staff should use the long\nperiod in hospital (and the frequent contacts after discharge) to carry out other educational\nactivities on infant and maternal health.\nMothers should be discouraged from smoking while providing KMC and supported in their\nanti-smoking efforts. Visitors should not be allowed to smoke where there are small babies, and\nthe measure should be reinforced if necessary.\nDuring the long stay at the facility visits by fathers and other members of the family should\nbe allowed and encouraged. They can sometimes help the mother, replacing her for skin-to-skin\ncontact with the baby so that she can get some rest.\nMothers, however, appreciate privacy while breastfeeding, taking care of their personal\nhygiene and during visits.\nFig.1 Holding the baby close to the chest\nClothing for the mother\nThe mother can wear whatever she finds comfortable and warm in the ambient temperature,"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4814a0c3-c88a-4de9-8e0a-d8e392e171d7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 19, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 550, "chroma:document": "The mother can wear whatever she finds comfortable and warm in the ambient temperature,\nprovided the dress accommodates the baby, i.e. keeps him firmly and comfortably in contact\nwith her skin. Special garments are not needed unless traditional ones are too tight.\nThe support binder\nThis is the only special item needed for KMC. It helps mothers hold their babies safely close\nto their chest (Fig.1). To begin with, use a soft piece of fabric, about a meter square, folded\ndiagonally in two and secured with a safe knot or tucked up under the mother\u2019s armpit. Later\na carrying pouch of mother\u2019s choice (Fig. 2) can replace this cloth. All these options leave the\nmother with both hands free and allow her to move around easily while carrying the baby skin-\nto-skin. Some institutions prefer to provide their own type of pouch, shirt or band.\n14"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 0cb4d797-0e04-4277-a145-ef1d415a1720
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 20, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 551, "chroma:document": "Fig.2 Carrying pouches for KMC babies\nBaby\u2019s needs\nWhen baby receives continuous KMC, he does not need any more clothing than an infant\nin conventional care. If KMC is not continuous, the baby can be placed in a warm bed and\ncovered with a blanket between spells of KMC.\nClothing for the baby\nWhen the ambient temperature is 22-24\u00b0C, the baby is carried in kangaroo position naked,\nexcept for the diaper, a warm hat and socks (Fig.3). When the temperature drops below 22\u00b0C,\nbaby should wear a cotton, sleeveless shirt, open at the front to allow the face, chest, abdomen,\narms and legs to remain in skin-to-skin contact with the mother\u2019s chest and abdomen. The\nmother then covers herself and the baby with her usual dress.\nFig.3 Dressing the baby for KMC\n15"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5b717349-e10b-487a-bb5d-05b2c97ca686
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 21, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 552, "chroma:document": "KANGAROO MOTHER CARE\nOther equipment and supplies\nThey are the same as for conventional care and are described below for convenience:\n(cid:1) a thermometer suitable for measuring body temperature down to 35\u00b0C;\n(cid:1) scales: ideally neonatal scales with 10g intervals should be used;\n(cid:1) basic resuscitation equipment, and oxygen where possible, should be available where preterm\nbabies are cared for;\n(cid:1) drugs for preventing and treating frequent problems of preterm newborn babies may\nbe added according to local protocols. Special drugs are sometimes needed, but are not\nrecommended in this guide. Treatment of medical problems is not part of this guide.\nRecord keeping\nEach mother-baby pair needs a record sheet to note daily observations, information about\nfeeding and weight, and instructions for monitoring the baby as well as specific instructions\nfor the mother. Accurate standard records are the key to good individual care; accurate"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: abb1054b-c5d9-4e7b-b480-39a5ce000c1b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 21, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 553, "chroma:document": "for the mother. Accurate standard records are the key to good individual care; accurate\nstandard indicators are the key to sound programme evaluation.\nA register (logbook) contains basic information on all infants and type of care received, and\nprovides information for monitoring and periodic programme evaluation. Annex I includes an\nexample of the type of record sheet that can be used for this purpose and adapted to different\nsettings. The data thus collected would also allow for regular calculation (e.g. quarterly and\nannually) of important indicators, listed also in Annex I.\n3.6 Feeding babies\nMother\u2019s milk is suited to baby\u2019s needs, even if birth occurred before term or the baby is\nsmall. Breast milk is thus the best food for preterm/LBW infants and breastfeeding is the best\nmethod of feeding.51, 52 Mother\u2019s milk should always be considered a nutritional priority due to\nthe biological uniqueness of the preterm milk, which adjusts itself to the baby\u2019s gestational age"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 3e994c68-6719-46df-9754-14aec65db579
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 21, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 554, "chroma:document": "the biological uniqueness of the preterm milk, which adjusts itself to the baby\u2019s gestational age\nand requirements.\nIn this guide only mother\u2019s milk is recommended for feeding her baby. Although pasteurized\nbreast milk from another woman or the milk bank can be used, recommendations on\npasteurization and milk banking are not included in this guide.\nBreastfeeding preterm and LBW infants is a difficult task, and is almost impossible if the\nhospital and home environment are not supportive of breastfeeding in general. The staff need\nto be knowledgeable about breastfeeding and alternative feeding methods, and skilled in helping\nmothers to feed their term and normal weight infants, before they can effectively help mothers\nwith LBW babies.\nThe ultimate goal is exclusive breastfeeding. KMC facilitates the initiation and establishment\nof breastfeeding in small infants. However, many babies may not breastfeed well at the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 6da62371-4224-45f0-9e47-c7151a8377b9
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 21, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 555, "chroma:document": "of breastfeeding in small infants. However, many babies may not breastfeed well at the\nbeginning or not at all, and need alternative feeding methods. Therefore the staff should\nteach and help the mother to express breast milk in order to provide milk for her baby and\nto maintain lactation, to feed the baby by cup and to assess the baby\u2019s feeding. They should\nknow how to assess the readiness of small babies for breastfeeding.\n16"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e91314a3-c886-49ba-a799-5c48b47e8a9a
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 22, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 556, "chroma:document": "Hand expression is the simplest way to express breast milk. It needs no appliances, so a\nwoman can do it anywhere at any time. Expressing breast milk by hand is recommended and\ndescribed in this document.\nMothers need containers for expressed breast milk: a cup, glass, jug or a wide-mouthed jar.\nDifferent kinds of breast pumps can also be used for expressing breast milk:\n(cid:1) rubber bulb or syringe pumps;\n(cid:1) mechanical or electrical pumps, either hand or foot operated.\nThese are particularly convenient for women who express breast milk several times a day\nover a long period. This is often the case when the baby is born long before term or requires\nprolonged intensive care (for more on breast pumps, see WHO breastfeeding counselling\ncourse19 ).\nCups, No. 5 to No. 8 French gauge feeding tubes and syringes are needed for feeding\nexpressed breast milk or formula milk. Other tools such as droppers, syringes and teaspoons"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 236a95e2-20ad-4402-9f2a-2268b969ab8d
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 22, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 557, "chroma:document": "expressed breast milk or formula milk. Other tools such as droppers, syringes and teaspoons\nhave been used instead of a cup. Traditional feeding devices, such as the \u201cpaladai\u201d in India, have\nbeen shown to be effective.53 A refrigerator also is needed for storing milk. Excess breast milk\ncan be frozen.\nPreterm formula must be available when breastfeeding is not adequate or for replacement\nfeeding.\nHealth workers must be familiar with local harmful cultural practices, such as refusal to give\ncolostrum or negative attitudes towards LBW and preterm infants (\u201cthey are ugly\u201d or \u201cthey\nwill not survive\u201d). They should be trained to discuss such practices and attitudes with the\nmother and her family and find ways to overcome them.\n3.7 Discharge and home care\nOnce the baby is feeding well, maintaining stable body temperature in KMC position and\ngaining weight, mother and baby can go home. Since most babies will still be premature at"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: cf9c7bdb-8643-4f88-b237-e74df8e6c425
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 22, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 558, "chroma:document": "gaining weight, mother and baby can go home. Since most babies will still be premature at\nthe time of discharge, regular follow-up by a skilled professional close to mother\u2019s home must\nbe ensured. Frequency of visits may vary from daily at the beginning, to weekly and monthly\nlater. The better the follow-up, the earlier mother and baby can be discharged from the facility.\nAs a guide, services must plan at least 1 visit for every preterm week. Those visits can also be\ncarried out at home.\nMothers also need free access to health professionals for any type of counselling and\nsupport related to the care of their small babies. There should be at least one home visit by\na public health nurse to assess home conditions, home support and ability to travel for\nfollow-up visits.\nIf possible, support groups in the community should be involved in the home (to provide\nsocial, psychological, and domestic work support). Mothers with previous KMC experience can"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 75cffa6d-d59c-45e0-a74c-25685a799273
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 22, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 559, "chroma:document": "social, psychological, and domestic work support). Mothers with previous KMC experience can\nbe effective providers of this kind of community assistance.\nkK\n17"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c7038023-4ddc-49e8-8061-652ed3769a44
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 23, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 560, "chroma:document": "KANGAROO MOTHER CARE\n18"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: edf1a6f7-9b98-4558-980d-8cec6157b08b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 24, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 561, "chroma:document": "4.\nPractice guide\nThis chapter describes how to practice kangaroo mother care in the institution where a\nsmall baby has been taken care of and when to begin. It describes each component: thermal\nprotection through the correct position, feeding, observing the baby, deciding when mother\nand baby can go home to continue KMC, and the follow-up needed to ensure adequate growth\nand to support the mother.\n4.1 When to start KMC\nWhen a small baby is born, complications can be expected \u2013 the more preterm and small\nfor gestational age the infant is, the more frequent the problems are. Initial care for infants with\ncomplications is provided according to national or institutional guidelines. KMC will have to be\ndelayed until the medical conditions improve. When exactly KMC can begin for those small\nbabies must be judged individually, and full account should be taken of the condition and status\nof each baby and his mother. However, the mother of a small baby can be encouraged to adopt"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 98167d0a-4add-42d6-ab1a-7cfc942be5a9
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 24, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 562, "chroma:document": "of each baby and his mother. However, the mother of a small baby can be encouraged to adopt\nKMC very early on. The birth weight ranges below are given as a guide.\nBabies weighing 1800g or more at birth (gestational age 30-34 weeks or more) may have\nsome prematurity-related problems, such as respiratory distress syndrome (RDS). This may\nraise serious concerns for a minority of those infants, who will require care in special units. In\nmost cases, however, KMC can start soon after birth.\nIn babies with birth weight between 1200 and 1799g (gestational age 28-32 weeks), prematurity-\nrelated problems such as respiratory distress syndrome (RDS) and other complications are\nfrequent, and therefore require some kind of special treatment initially. In such cases the delivery\nshould take place in a well equipped facility, which could provide the care required. Should\ndelivery take place elsewhere, the baby should be transferred soon after birth, preferably with the"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: db94901b-c332-47e4-9dc0-c31a3ecbf7f5
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 24, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 563, "chroma:document": "delivery take place elsewhere, the baby should be transferred soon after birth, preferably with the\nmother. One of the best ways of transporting small babies is keeping them in continuous skin-to-\nskin contact with the mother.10,54 It might take a week or more before KMC can be initiated.\nAlthough early neonatal mortality in this group is very high, mostly due to complications, most\nbabies survive and mothers could be encouraged to express breast milk.\nBabies weighing less than 1200g (gestational age below 30 weeks) incur frequent and severe\nproblems due to preterm birth: mortality is very high and only a small proportion survive\nprematurity-related problems. These babies benefit most from transfer before birth to an\ninstitution with neonatal intensive care facilities. It may take weeks before their condition\nallows initiation of KMC.\n19"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: f1414da2-7ef2-455d-be82-de4e21e61a36
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 25, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 564, "chroma:document": "KANGAROO MOTHER CARE\nNeither birth weight nor gestational age alone can reliably predict the risk of complications.\nTable 4 in Annex II shows how much the mean, and the 10th and the 90th weight percentiles,\nvary by gestational age for a population with mean birth weight of 3350g.55 When exactly to\ninitiate KMC really depends on the condition of the mother and the baby. Every mother should\nbe told about the benefits of breastfeeding, encouraged and helped to express breast milk from\nthe first day, to provide food for the baby and ensure lactation.\nThe following criteria will help determine when to suggest that the mother adopts KMC.\nMother\nAll mothers can provide KMC, irrespective of age, parity, education, culture and religion.\nKMC may be particularly beneficial for adolescent mothers and for those with social risk factors.\nCarefully describe the various aspects of this method to the mother: the position, feeding"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 72da4bfb-9e44-48a6-89af-6b37c59a26a7
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 25, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 565, "chroma:document": "Carefully describe the various aspects of this method to the mother: the position, feeding\noptions, care in the institution and at home, what she can do for the baby attached to her body\nand what she should avoid. Explain the advantages and the implications of such care for her\nand her baby, and always give the reasons behind a recommendation. Adopting KMC should\nbe the result of an informed decision and should not be perceived as an obligation.\nThe following points must be taken into consideration when counselling on KMC:\n(cid:1) willingness: the mother must be willing to provide KMC;\n(cid:1) full-time availability to provide care: other family members can offer intermittent\nskin-to-skin contact but they cannot breastfeed;\n(cid:1) general health: if the mother suffered complications during pregnancy or delivery\nor is otherwise ill, she should recover before initiating KMC;\n(cid:1) being close to the baby: she should either be able to stay in hospital until discharge or return"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a71104c2-8f76-410f-b84c-ee7285d7c2c9
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 25, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 566, "chroma:document": "when her baby is ready for KMC;\n(cid:1) supportive family: she will need support to deal with other responsibilities at home;\n(cid:1) supportive community: this is particularly important when there are social, economic\nor family constraints.\nIf the mother is a smoker, advise her on the importance of stopping smoking or refraining\nfrom it in the room where the baby is. Explain the danger of passive smoking for herself, other\nfamily members and small infants.\nBaby\nAlmost every small baby can be cared for with KMC. Babies with severe illness or requiring\nspecial treatment may wait until recovery before full-time KMC begins. During that period\nbabies are treated according to national clinical guidelines.56 Short KMC sessions can begin\nduring recovery when baby still requires medical treatment (IV fluids, low concentration of\nadditional oxygen). For continuous KMC, however, baby\u2019s condition must be stable; the baby"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1471e630-c35c-4bd5-8989-a9f8a308dc41
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 25, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 567, "chroma:document": "additional oxygen). For continuous KMC, however, baby\u2019s condition must be stable; the baby\nmust be breathing spontaneously without additional oxygen. The ability to feed (to suck and\nswallow) is not an essential requirement. KMC can begin during tube-feeding. Once the baby\nbegins recovering, discuss KMC with the mother.\nThese general recommendations on starting KMC should be adapted to the situation of the\nregion, health system, health facility, and individual. In settings with limited resources and when\nreferral is impossible, the decision on when to start KMC during recovery should be weighed\nagainst the alternatives available for thermal control, feeding and respiratory support.\n20"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a3b6abca-dffe-4c49-85e8-cbeacb95eedc
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 26, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 568, "chroma:document": "4.2 Initiating KMC\nWhen baby is ready for KMC, arrange with the mother a time that is convenient for her and\nfor her baby. The first session is important and requires time and undivided attention. Ask her\nto wear light, loose clothing. Use a private room, warm enough for the small baby. Encourage\nher to bring her partner or a companion of her choice if she so wishes. It helps to lend support\nand reassurance.\nWhile the mother is holding her baby, describe to her each step of KMC, then demonstrate\nthem and let her go through all the steps herself. Always explain why each gesture is important\nand what it is good for. Emphasize that skin-to-skin contact is essential for keeping the baby\nwarm and protecting him from illness.\n4.3 Kangaroo position\nPlace the baby between the mother\u2019s breasts in an upright position, chest to chest (as shown in\nFig. 4a).\nFig.4a Positioning the baby for KMC\nSecure him with the binder. The head, turned to one side, is in a slightly extended position. The"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 4f033809-8c8f-42c2-8d9f-cfdb81e25e84
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 26, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 569, "chroma:document": "Secure him with the binder. The head, turned to one side, is in a slightly extended position. The\ntop of the binder is just under baby\u2019s ear. This slightly extended head position keeps the airway\nopen and allows eye-to-eye contact between the mother and the baby. Avoid both forward\nflexion and hyperextension of the head. The hips should be flexed and extended in a \u201cfrog\u201d\nposition; the arms should also be flexed. (Fig. 4a)\nTie the cloth firmly enough so that when the mother stands up the baby does not slide out.\nMake sure that the tight part of the cloth is over the baby\u2019s chest. Baby\u2019s abdomen should not\nbe constricted and should be somewhere at the level of the mother\u2019s epigastrium. This way baby\nhas enough room for abdominal breathing. Mother\u2019s breathing stimulates the baby (Fig. 4b).\n21"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1557c898-2c44-4b2b-b8c1-a75e9b46f405
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 27, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 570, "chroma:document": "KANGAROO MOTHER CARE\nFig. 4b Baby in KMC position\nShow the mother how to move the baby in and out of the binder (Fig. 4c). As the mother gets\nfamiliar with this technique, her fear of hurting the baby will disappear.\nMoving the baby in and out of the binder:\n\uf8ff hold the baby with one hand placed behind the neck and on the back;\n\uf8ff lightly support the lower part of the jaw with her thumb and fingers to prevent the baby\u2019s\nhead from slipping down and blocking the airway when the baby is in an upright position;\n\uf8ff place the other hand under the baby\u2019s buttocks.\nFig. 4c Moving the baby in and out of the binder\n22"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: a75962bb-821d-45e6-8016-15a371c052fc
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 28, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 571, "chroma:document": "Explain to the mother that she can breastfeed in kangaroo position and that KMC actually\nmakes breastfeeding easier. Furthermore, holding the baby near the breast stimulates milk\nproduction.\nMother can easily care for twins too: each baby is placed on one side of her chest. She may\nwant to alternate the position. Initially she may want to breastfeed one baby at a time, later both\nbabies can be fed at once while in kangaroo position.\nAfter positioning the baby let mother rest with him. Stay with them and check baby\u2019s\nposition. Explain to the mother how to observe the baby, what to look for. Encourage her to\nmove.\nWhen introducing the mother to KMC also talk to her about possible difficulties. For some\ntime her life will revolve around the baby and this may upset her daily routine. Moreover, a\nsmall baby at first might not feed well from the breast. During that period she can express\nbreast milk and give it to the baby with a cup or other implements, but this will take longer"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: bbc1d069-8213-466e-b098-801922d18180
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 28, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 572, "chroma:document": "breast milk and give it to the baby with a cup or other implements, but this will take longer\nthan breastfeeding.\nEncourage her to ask for help if she is worried and be prepared to respond to her questions\nand anxieties. Answer her questions directly and honestly \u2013 she needs to be aware of the\nlimitations that KMC may put upon her daily activities as well as the benefits it can\nundoubtedly bring to her baby.\nExperience shows that most mothers are very willing to provide KMC, especially if they can\nsee other babies thriving. By sharing the same room for a long time, KMC mothers exchange\ninformation, opinions and emotions, and develop a sense of mutual support and solidarity.\nAfter a period of impotence and frustration during stabilization, they are empowered as the\nmain caretakers of their infants and reclaim their maternal role from the staff.\n4.4 Caring for the baby in kangaroo position\nBabies can receive most of the necessary care, including feeding, while in kangaroo position."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: fef6c0d6-0a45-4576-afc3-80243c13f63f
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 28, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 573, "chroma:document": "Babies can receive most of the necessary care, including feeding, while in kangaroo position.\nThey need to be moved away from skin-to-skin contact only for:\n(cid:1) changing diapers, hygiene and cord care; and\n(cid:1) clinical assessment, according to hospital schedules or when needed.\nDaily bathing is not needed and is not recommended. If local customs require a daily bath\nand it cannot be avoided, it should be short and warm (about 37\u00b0C). The baby should be\nthoroughly dried immediately afterwards, wrapped in warm clothes, and put back into the\nKMC position as soon as possible.\nDuring the day the mother carrying a baby in the KMC position can do whatever she likes:\nshe can walk, stand, sit, or engage in different recreational, educational or income-generating\nactivities. Such activities can make her long stay in hospital less boring and more bearable.\nShe has to meet, however, a few basic requirements such as cleanliness and personal hygiene"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 2b148152-fc2e-4b2a-9ea8-9edadf3818b4
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 28, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 574, "chroma:document": "She has to meet, however, a few basic requirements such as cleanliness and personal hygiene\n(stress frequent hand-washing). She should also ensure a quiet environment for her baby and\nfeed him regularly.\n23"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 1d2f279d-24eb-4c9d-b530-b29a3579a733
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 29, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 575, "chroma:document": "KANGAROO MOTHER CARE\nSleeping and resting\nMother will best sleep with the baby in kangaroo position in a reclined or semi-recumbent\nposition, about 15 degrees from horizontal. This can be achieved with an adjustable bed, if\navailable, or with several pillows on an ordinary bed (Fig.5). It has been observed that this\nposition may decrease the risk of apnoea for the baby.57 If the mother finds the semi-recumbent\nposition uncomfortable, allow her to sleep as she prefers, because the advantages of KMC are\nmuch greater than the risk of apnoea. Some mothers prefer sleeping on their sides in a semi-\nreclined bed (the angle makes sleeping on the abdomen impossible), and if the baby is secured\nas described above there will be no risk of smothering.\nA comfortable chair with adjustable back may be useful for resting during the day.\nFig.5 Sleeping and resting during KMC\n4.5 Length and duration of KMC\nLength\nSkin-to-skin contact should start gradually, with a smooth transition from conventional"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 5616171f-f1a4-4bfd-a0fe-f50f72831e57
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 29, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 576, "chroma:document": "Length\nSkin-to-skin contact should start gradually, with a smooth transition from conventional\ncare to continuous KMC. Sessions that last less than 60 minutes should, however, be avoided\nbecause frequent changes are too stressful for the baby. The length of skin-to-skin contacts\ngradually increases to become as continuous as possible, day and night, interrupted only for\nchanging diapers, especially where no other means of thermal control are available.\nWhen the mother needs to be away from her baby, he can be well wrapped up and placed\nin a warm cot, away from draughts, covered by a warm blanket, or placed under an appropriate\nwarming device, if available. During those breaks family members (father or partner, grand-\nmother, etc.), or a close friend, can also help caring for the baby in skin-to-skin kangaroo\nposition (Fig.6).\n24"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: c7f98989-430a-4ada-b972-dd719c66d927
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 30, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 577, "chroma:document": "Fig.6 Father\u2019s turn for KMC\nDuration\nWhen the mother and baby are comfortable, skin-to-skin contact continues for as long as\npossible, first at the institution, then at home. It tends to be used until the baby reaches term\n(gestational age around 40 weeks) or 2500g. Around that time the baby also outgrows the\nneed for KMC. She starts wriggling to show that she is uncomfortable, pulls her limbs out,\ncries and fusses every time the mother tries to put her back skin-to-skin. This is when it is\nsafe to advise the mother to wean the baby gradually from KMC. Breastfeeding, of course,\ncontinues. Mother can return to skin-to-skin contact occasionally, after giving the baby a bath,\nduring cold nights, or when the baby needs comfort.\nKMC at home is particularly important in cold climates or during the cold season and\ncould go on for longer.\n4.6 Monitoring baby\u2019s condition\nTemperature\nA well-fed baby, in continuous skin-to-skin contact, can easily retain normal body temperature"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 497b3b35-a16c-4cc9-8043-3910a3abee11
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 30, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 578, "chroma:document": "A well-fed baby, in continuous skin-to-skin contact, can easily retain normal body temperature\n(between 36.5\u00b0C and 37\u00b0C) when in kangaroo position, if the ambient temperature is not lower\nthan the recommended range. Hypothermia is rare in KMC infants, but it can occur. Measuring\nbaby\u2019s body temperature is still needed, but less frequently than when the baby is not in the\nkangaroo position.\n25"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 936025c3-cd9b-4646-b854-ea0ddf3a76de
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 31, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 579, "chroma:document": "KANGAROO MOTHER CARE\nWhen starting KMC, measure axillary temperature every 6 hours until stable for three\nconsecutive days. Later measure only twice daily. If the body temperature is below 36.5\u00b0C,\nrewarm the baby immediately: cover the baby with a blanket and make sure that the mother is\nstaying in a warm place. Measure the temperature an hour later and continue rewarming until\nwithin the normal range. Also look for possible causes of hypothermia in the baby (cold room,\nthe baby was not in KMC position before measuring the temperature, the baby had a bath or\nhas not been feeding well). If no obvious cause can be found and the baby continues to have\ndifficulty in maintaining normal body temperature, or the temperature does not return to\nnormal within 3 hours, assess the baby for possible bacterial infection.\nIf an ordinary adult-type thermometer does not record the temperature, assume there\nis moderate or severe hypothermia and act accordingly. Ways of identifying and treating"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: e45005b5-ade6-43fc-a581-5b6f3959d66b
encoding: FLOAT32
metadata:
{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 31, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 580, "chroma:document": "is moderate or severe hypothermia and act accordingly. Ways of identifying and treating\nhypothermia are described in detail in another WHO document.10 Rewarming can be\ncarried out through skin-to-skin contact.17\nHow to measure axillary temperature\n\uf8ff Keep the baby warm throughout the procedure, either in skin-to-skin contact with the\nmother and properly covered, or well covered on a warm surface;\n\uf8ff use a clean thermometer and shake it down to less than 35\u00b0C;\n\uf8ff place the thermometer bulb high up in the middle of the axilla; the skin of the axilla\nmust be in full contact with the bulb of the thermometer, with no air pockets between\nskin and bulb;\n\uf8ff hold the infant\u2019s arm against the side of the chest gently; keep the thermometer in\nplace for at least three minutes;\n\uf8ff remove the thermometer and read the temperature;\n\uf8ff avoid taking the rectal temperature since it is associated with a small but significant\nrisk of rectal perforation.\nObserving breathing and well-being"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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encoding: FLOAT32
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 31, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 581, "chroma:document": "risk of rectal perforation.\nObserving breathing and well-being\nThe normal respiratory rate of an LBW and preterm infant ranges between 30 and 60\nbreaths per minute, and breathing alternates with intervals of no breathing (apnoea). However,\nif the intervals become too long (20 seconds or more) and the baby\u2019s lips and face turn blue\n(cyanosis), his pulse is abnormally low (bradycardia) and he does not resume breathing\nspontaneously, act quickly: there is a risk of brain damage. The smaller or more premature\nthe baby is, the longer and more frequent the spells of apnoea. As baby approaches term,\nbreathing becomes more regular and apnoea less frequent. Research shows that skin-to-skin\ncontact may make breathing more regular in preterm infants41,58 and may reduce the incidence\nof apnoea. Apnoea appearing late may also indicate the beginning of an illness.\nThe mother must be aware of the risk of apnoea, be able to recognize it, intervene\nimmediately and seek help if she becomes concerned."}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 31, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 582, "chroma:document": "immediately and seek help if she becomes concerned.\n26"}


created_at: 2025-05-02 10:00:24
topic: persistent://default/default/f26ae22c-10bf-47f3-97c5-33d18eae1e5e
id: 48dc6b15-b479-4e88-9160-17eb5c145a3e
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{"source": "pdfs\\kmc_doc_file.pdf", "file_path": "pdfs\\kmc_doc_file.pdf", "page": 32, "total_pages": 54, "CreationDate": "D:20030227165252+01'00'", "ModDate": "D:20030616094854+02'00'", "Producer": "Acrobat Distiller 5.0.2 for Macintosh", "Subject": "KMCtextonly/pmkr7", "Creator": "Adobe PageMaker 7.0", "Title": "KMCtextonly/pmkr7", "Author": "Robert", "Keywords": "", "chunk_index": 583, "chroma:document": "What to do in case of apnoea\n\uf8ff Teach the mother to observe the baby\u2019s breathing pattern and explain the normal\nvariations;\n\uf8ff explain what apnoea is and what effects it has on a baby;\n\uf8ff demonstrate the effect of apnoea by asking the mother to hold her breath for a short\ntime (less than 20 seconds) and a long time (20 seconds or more);\n\uf8ff explain that if breathing stops for 20 seconds or more, or baby becomes blue (blue\nlips and face), this may be a sign of a serious disease;\n\uf8ff teach her to stimulate the baby by lightly rubbing the back or head, and by rocking\nmovements until the baby starts breathing again. If baby is still not breathing, she\nshould call staff;\n\uf8ff always react immediately to a mother\u2019s call for help;\n\uf8ff in case of prolonged apnoea, when breathing cannot be restarted through stimulation,\nresuscitate according to the hospital resuscitation guidelines;\n\uf8ff if apnoeic spells become more frequent, examine the baby: this may be an early sign"}


