Date of Defense:
July 2, 2012
Background: Between 4% and 6.5% of infants in Ukraine are born low birth weight (LBW) and/or preterm each year. Breast milk is especially critical for LBW and preterm infants because it has been found to reduce the risk of serious morbidities and improve long-term developmental outcomes. Despite the importance of breast milk for these vulnerable infants, barriers such as a lack of confidence, perceived insufficient milk supply, a lack of support, and a lack of access to electric breast pumps, can prevent some Ukrainian mothers of LBW and preterm infants from initiating breastfeeding, or for breastfeeding as long and as exclusively as recommended. Kangaroo Mother Care (KMC), or skin-to-skin contact between a caregiver and an infant, is associated with increased maternal confidence and higher breastfeeding rates. In 2010, Ukraine’s National Pediatric Hospital, “Okhmatdet,” became the first facility in the country to adopt a KMC program. The aim of this exploratory study was to evaluate Okhmatdet’s KMC program to determine its impact on the breastfeeding confidence and breastfeeding initiation, exclusivity, and short-term duration rates of mothers of LBW and/or preterm infants.
Recruitment: An attempt was made to enroll all eligible mothers of stable, LBW infants born at <38 weeks’ gestation who were breastfeeding or who expressed a desire to breastfeed and who were admitted to Okhmatdet Hospital’s residential KMC program in Kyiv, Ukraine between January 29 and March 19, 2012. Forty mothers met the eligibility criteria; five declined to participate; 11 were lost to follow-up, resulting in a sample size of 24 participants for analysis.
Methods: We used a one group, pre-/post-test design using Dr. Cindy-Lee Dennis’ 18-item Breastfeeding Self-Efficacy Scale for Ill and/or Preterm Infants (BSES-PT) to measure the breastfeeding confidence of program participants. We used a paired t-test to determine if there was a significant increase in participants’ breastfeeding self-efficacy scores after three weeks in the program. We calculated breastfeeding initiation, exclusivity, and short-term duration rates by examining the percentage of participants who were breastfeeding pre- and post- KMC program. We performed a thematic analysis on one qualitative question that was added to the survey, about what KMC meant to the participants.
Results: Overall BSES-PT scores increased but not significantly (pre-test mean=67.75, post-test mean=71.29, p=.13). Participants who practiced KMC for seven or more hours a day had the highest BSES-PT scores at pre-test (mean=77.85) and post-test (mean=84.57) and experienced the greatest increase in breastfeeding self-efficacy of all four groups analyzed (p=.059.)Breastfeeding initiation increased 25%, breastfeeding exclusivity increased by 17%, and all participants who initiated breastfeeding by the pre-test or during the study period were still breastfeeding by post-test. Nearly all participants (92%) viewed KMC positively, with the two most common themes being that KMC helps an infant to recover faster, and KMC is personally satisfying to the caregiver.
Conclusion: The BSES-PT could be a useful identification tool for Okhmatdet’s KMC program staff, to help determine which program participants may be more at risk for breastfeeding problems and in need of extra breastfeeding support. Program recommendations include achieving earlier initiation of KMC, encouraging more frequent and longer sessions of KMC, providing access to a hospital-grade electric breast pump, encouraging more relatives to participate in the program, and conducting future evaluations at six months and one year postpartum to assess long-term breastfeeding exclusivity and duration rates.