Safety, effectiveness and barriers to follow-up using an 'early discharge' Kangaroo Care policy in a resource poor setting.
OBJECTIVE
To describe the outcomes of low-birth-weight babies using an 'early discharge' Kangaroo care policy and to identify barriers to their follow-up.


METHODS
Prospective descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004. Infants were discharged to outpatient care once weighing over 1300 g and gaining weight. Follow-up was carried out until 2500 g.


RESULTS
Infants [201 of 272 (73.9%)] reached a weight >2500 g; 46 out of 272 (16.9%) died; outcome was unknown in 25 of 272 (9.2%). Outpatient mortality was higher amongst discharges weighing under 1500 g [RR = 2.41(1.25-4.63) P = 0.01]. Discharge below birth weight did not affect mortality [RR = 0.77(0.40-1.46) P = 0.42]. Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness.


CONCLUSIONS
Early discharge is safe and feasible, but issues regarding access to healthcare need to be addressed. Future research is needed to determine how best high mortality can be reduced in specific subgroups: notably infants <1500 g.
Blencowe
Hannah
H
College of Medicine of Malawi, Paediatric Department, P/Bag 360, Blantyre, Malawi. hblencowe@gmail.com
Kerac
Marko
M
Molyneux
Elizabeth
E
D003906:Developing Countries; D005500:Follow-Up Studies; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008295:Malawi / Q000453:epidemiology; D009034:Mother-Child Relations; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012449:Safety; D015430:Weight Gain