Int
ern
at
i
onal
Journ
al of
P
u
bli
c Hea
lt
h
Sc
ie
nce (IJPH
S)
Vo
l.
7
, No
.
2,
J
un
e
201
8
, pp.
91
~
96
IS
S
N: 22
52
-
8806,
DOI: 10
.11
591/ij
phs.
v7
i
2.
1
26
32
91
Journ
al h
om
e
page
:
https:
//
ww
w.i
aesco
re
.c
om
/j
our
nals/
ind
ex.
php/IJP
H
S
The Effe
ct of K
an
garoo Moth
er
Care M
eth
od
tow
ar
d
Weight
Gain an
d Length
of
St
ay
am
ong
Low Bir
th Wei
gh
t Baby
Muliani,
Li
sn
awat
i
Hea
lt
h
Pol
y
tech
nic
in
Palu
,
D
ep
art
m
ent
of
Midw
ife
r
y
,
Indone
si
a
Art
ic
le
In
f
o
ABSTR
A
CT
Art
ic
le
history:
Re
cei
ved
A
pr
11
, 201
8
Re
vised
Jun
5
,
201
8
Accepte
d
J
un
14
, 201
8
I
nfa
nt
m
orta
lit
y
nee
ds
to
get
seri
ous
at
te
nti
on
.
Special
eff
orts
ar
e
rel
a
ti
v
e
l
y
ea
s
y
and
ine
xpe
nsive
in
the
han
dli
ng
and
ca
r
e
is
through
tre
at
m
e
nt
m
et
hods
ca
n
improve
the
stabi
li
t
y
of
Ka
ngar
oo
Mother
Care
(
KMC
)
for
babi
es
and
bre
astfeedi
ng
.
T
he
eff
or
t
hop
efu
l
l
y
will
con
tri
but
e
to
weight
ga
in
which
ta
k
e
eff
e
c
t
on
th
e
dur
at
ion
of
treatme
nt
.
Th
e
stud
y
de
sign
was
Quasi
Expe
riment
with
Prepost
o
ne
group
design.
Sam
ple
s
were
mot
her
s
with
a
histor
y
of
low
birt
h
weigh
t
de
li
ver
i
es,
wi
th
sam
ple
select
ion
te
chn
ique
in
conse
cutive
sam
pli
ng
and
sam
ple
num
ber
3
6
babi
es.
Th
e
sam
ple
s
cri
teria
were
infa
n
ts
birt
h
weight
b
e
twee
n
1,
000
-
2,
1
00
gr,
weight
of
infa
n
t
whe
n
KM
C
wa
s
start
ed
be
tween
900
-
2,
100
gr,
weight
o
f
infa
nts
post
KM
C
were
1,
300
-
2,
500
gr
,
babi
es
born
wit
h
pre
m
at
ure
or
sm
al
l
per
iod
of
pre
gnan
c
y
.
KM
C
m
et
hod
has
the
pote
n
ti
a
l
t
o
improve
th
e
W
ei
ght
on
Low
Birt
h
W
ei
gh
t
(
LBW
)
.
D
ura
t
io
n
of
KM
C
has
n
o
eff
e
ct
on
weig
ht
gai
n
but
ca
n
a
cc
e
le
r
at
e
the
le
ngth
of
LBW
in
hospita
l.
Th
e
longe
r
do
KM
C,
the
shorter
dura
ti
on
of
hospita
l
LBW
in
hospita
l.
LBW
should
be
tre
ate
d
KM
C
to
ac
ce
l
era
t
e
weight
gai
n
and
r
educ
in
g
the l
engt
h
of
h
ospita
liza
ti
on.
Ke
yw
or
d:
Kanga
roo
M
oth
er
Care
Len
g
th
of stay
Lo
w birth
wei
gh
t
Copyright
©
201
8
Instit
ut
e
o
f Ad
vanc
ed
Engi
n
ee
r
ing
and
S
cienc
e
.
Al
l
rights re
serv
ed
.
Corres
pond
in
g
Aut
h
or
:
Muli
ani
,
Healt
h
P
olyt
echn
ic
i
n
Pal
u,
Dep
a
rt
m
ent o
f M
idwife
ry, In
done
sia
.
Em
a
il
:
m
ur
id_
le
wa@ya
hoo.
c
o.
id
1.
INTROD
U
CTION
First
ye
ar
of
li
fe
is
t
he
m
os
t
im
po
rtant
pe
rio
d
as
a
ti
m
e
of
grow
t
h
a
nd
de
velo
pm
ent
of
c
hildr
e
n
will
go
w
it
h
the
im
m
ense
influ
e
nc
e
on
t
he
f
or
m
at
ion
o
f
t
he
qual
it
y
of
li
fe
of
chi
ldre
n
in o
r
der
t
o
be
a
ble
to
act
and
functi
on
opti
m
al
ly
.
It
is
necessary
ad
j
ust
m
e
nts
to
li
fe
as
a
process
of
tra
ns
it
ion
is
a
cri
ti
cal
ph
ase
f
or
the
bab
y'
s li
fe from
intrauteri
ne t
o
ext
rau
te
rine.
Bi
rth
of
LB
W
infan
ts
,
espe
ci
al
ly
pr
e
m
at
ur
e
birt
hs
entir
e
organ
i
n
th
e
body
is
no
t
functi
on
i
ng
op
ti
m
al
l
y,
includi
ng
su
c
king
and
swall
owin
g
re
flexes
a
re
sti
ll
weak
an
d
ver
y
dep
e
nden
t
on
gestat
ion
a
l
age.
Lack
of
body
f
at
reserves
an
d
syst
e
m
of
regulat
ion
of
body
tem
per
at
ur
e
in
infa
nts
im
mature
to
m
ake
a
ba
by
sh
oul
d
be
treat
ed
inc
ubat
or
/
box
with
li
ghts
war
m
ers,
s
o
th
e
m
e
tho
d
KM
C
thr
ough
the
arm
s
on
the
m
oth
e
r'
s
chest
in
direct
con
ta
ct
s
kin
of
the
m
oth
er
with
the
ba
by'
s
ski
n
is
co
ns
i
der
e
d
ef
fecti
ve
e
no
ugh
t
o
he
lp
the
ba
by
sta
y
war
m
,
so
can
pr
e
ve
nt
e
ne
rg
y
l
os
s
due
t
o
e
xcessi
ve
lo
s
s
of
body
heat.
This
th
us
pot
entia
ll
y
increas
e
the
nu
t
riti
on
al
inta
ke
(
br
east
m
il
k)
as
well
as
hel
p
incr
ease
wei
gh
t
im
pacti
ng
on
i
ncr
easi
ng
l
y
sh
ort
ene
d
tre
atm
ent
per
i
od.
The
m
et
ho
d
of
Kanga
roo
M
ot
her
Ca
re
(
KMC)
is
ve
ry
us
e
f
ull:
1)
th
e
inf
a
nt
can
retu
rn
hom
e
fr
om
the
hosp
it
al
ea
rly
;
2)
su
c
cesf
uln
ees
of
e
xcl
us
ive
br
ea
stfee
ding
.
KMC
is
al
so
as
basic
interve
ntio
ns
in
the
nursing
ca
re
unit
of
th
e
Ne
onat
al
In
te
ns
ive
Ca
re
U
nit
(NICU)
t
he
chil
d
is
to
support
sel
f
-
c
onfide
nc
e
and
par
e
ntal com
petence, e
ducat
e
and pr
ov
i
de
se
rv
ic
es t
o
e
nh
a
nc
e the
b
on
ds
of b
a
bies
op
ti
m
ally [1
]
.
Ba
sed
on
the
r
eport
by
the
W
or
l
d
Healt
h
Organ
iz
at
io
n
(
WH
O
)
est
im
at
ed
that
ove
r
20
m
il
li
on
ba
bie
s
bor
n
are
low
bi
rth
weig
ht
(L
B
W
)
as
m
uch
as
15.5
%
of
al
l
birth
s
an
d
95%
in
dev
el
op
i
ng
co
un
t
ries,
w
hile
for
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
91
–
96
92
Asian
c
ount
ries
reac
hed
18.
3
LB
W
birt
hs
%
of
the
77
,
490
ba
bies
bor
n
al
ive
as
well
as
4
m
il
li
on
ne
on
at
al
deaths
28
%
w
ere
pr
et
e
rm
birth
.
Sim
il
arly
,
pr
et
erm
infan
t
m
or
ta
lity
is
still
hig
h
in
de
ve
lop
in
g
co
untrie
s
su
ch
as
Indonesia
and
acc
ordin
g
to
the
w
or
ld
tha
t
pr
et
erm
birth
s
reach
e
d
75
-
80%
of
al
l
bab
ie
s
who
died
at
the
ag
e
of less t
ha
n 2
8 days [
2].
Ba
sed
on
the
r
eport
of
WHO
(20
15
a
)
for
a
per
i
od
of
tw
o
decad
e
s
that
t
he
li
ve
bi
rth
rate
increase
d
from
the
ye
ar
2000
am
ounted
to
12
7.7
m
illi
on
to
13
7.7
m
il
li
on
in
2013.
O
f
tha
t
nu
m
ber
th
er
e
wer
e
6.3
m
il
l
io
n
de
at
hs
of
child
re
n
<
5
ye
a
rs
(
46/1
,
000
li
ve
bi
rths)
a
nd
44
%
of
t
hem
are
in
ne
on
at
al
m
or
ta
li
ty
.
The
m
ai
n
cause
of
deat
h
was
com
plica
ti
on
s
of
prem
at
ur
e
bi
rth
by
17%
of
al
l
deaths,
and
21
/1
,
00
0
li
ve
birth
s
occur i
n dev
el
op
i
ng cou
ntrie
s,
pa
rtic
ularly
i
n
S
outheast
As
ia
r
egi
on r
eac
he
d 13
/
1
,
000
li
ve
b
irt
hs
[3
]
.
Neonatal
m
or
ta
li
ty
rate
is
predict
ed
to
incr
ease
fr
om
45%
in
2015
to
52%
in
2030,
there
fore
there
are
63
co
untrie
s
w
hich
s
hould
acce
le
rate
the
process
of
ac
hi
evin
g
t
he
ta
r
ge
t
SDGs
t
hat
i
s
12
/
1
,
000
li
ve
bi
rths
in
2030
[4
]
.
N
at
ion
al
ly
Ce
ntr
al
Su
la
wesi
inc
reased
I
nf
a
nt
Mortal
it
y
Ra
te
(I
MR
)
from
52
to
60
pe
r
1
,
000
li
ve
birth
s
,
so
t
hat
IMR
ranks
thi
r
d
hi
gh
e
st
after
W
est
Su
la
wes
i
(74/1
,
000
li
ve
birth
s
)
a
nd
Nu
sa
Ten
ggar
a
Ba
rat
(72/1
,
00
0
li
ve
bir
t
hs
)
.
I
nfan
t
Mortal
it
y
Ra
te
pro
gr
am
m
atical
ly
pr
oble
m
in
Ce
nt
ral
S
ulawesi
nee
d
to
get
serio
us
at
te
ntio
n
because
it
ha
s
increa
sed
ab
out
15%
over
th
e
la
st
5
ye
ar
s.
The
sti
ll
hi
gh
I
MR
as
an
i
ndic
at
io
n
that
the
pro
ble
m
of
healt
h
a
nd
ge
neral
de
ve
lop
m
ent
in
Ce
ntr
al
S
ulawesi
prov
i
nce
re
qu
ires
a
sp
eci
al
effor
t.
Ca
us
e
highest
IMR
is
the
birt
h
of
lo
w
birt
h
weig
ht
and
as
phyxia
)
[
5]
.
Ba
sed
on
data
fro
m
the
Healt
h
Office
of
Ce
nt
ral
Su
l
awesi
Prov
i
nc
e
in
2013
li
ve
birth
rate
reac
hed
49
,
75
5
an
d
IMR
as
m
any
as
11
3
ba
bie
s
bei
ng
bor
n
low
birth
weig
ht
an
d
94
bab
ie
s
died
by
asph
y
xia,
2
014
increa
sed
by
li
ve
birth
s
49
.
756,
in
fa
nt
m
o
rtal
it
y
for
LB
W 117 i
n
fa
nts a
nd d
eat
h du
e
to
a
sphy
xia
11
6 bab
y
[
6]
.
Si
m
il
arly
,
the
birth
rate
in
ho
sp
it
al
Anutap
ura
Palu
in
2013
the
num
ber
of
li
ve
birt
hs
,
3.848
a
nd
223
su
c
h
birth
s
,
20
14
to
inc
rease
the
nu
m
ber
of
li
ve
birth
s,
4.0
60
a
nd
264
dia
ntra
nya
was
th
e
birth
of
low
birth
weig
ht,
bu
t
t
he
i
m
ple
m
entat
i
on
of
this
m
et
hod
has
not
be
en
a
pp
li
ed
in
hosp
it
al
s
op
ti
m
al
l
y
and
for
m
s
of
so
ci
al
iz
at
ion
ha
s
no
t
bee
n
f
ully
received
a
po
sit
ive
res
pons
e
f
ro
m
the
m
oth
ers,
so
it
te
nd
s
to
re
j
ect
the
app
li
cat
io
n
of
the
m
et
ho
d,
beca
us
e
of
the
la
ck
of
s
ta
nd
a
rd
ope
ra
ti
ng
proce
dur
es
that
s
uppo
rt
the
i
m
p
lem
entat
io
n of t
he KMC
m
et
ho
d)
[
7]
.
Re
su
lt
s
of
the
stud
y
are
rand
om
iz
ed
con
tr
olled
tria
l
(RCT)
betwee
n
the
KMC
m
et
ho
d
is
direct
sk
in
con
ta
ct
with
th
e
bab
y'
s
m
oth
er
with
co
nv
e
nt
ion
al
m
e
tho
ds
incu
bato
r
to
the
ph
ysi
cal
sta
bili
t
y
at
1
,
200
-
2
,
199
gr
am
s
birth
w
ei
gh
t
infa
nts,
i
nd
ic
at
in
g
that
sk
in
c
on
ta
ct
w
it
h
the
sk
in
in
pr
et
erm
infan
t
s
is
an
al
te
rn
at
ive
the
first
w
el
l
in
li
f
e
after
birt
h
[
8
].
Seve
ral
stu
di
es
show
that
t
reatm
ent
with
KMC
m
et
ho
d
pro
vid
es
a
pos
it
ive
eff
ect
on
brea
stfeedin
g
(
br
e
ast
m
il
k)
an
d
bab
y'
s
gro
wth
com
par
ed
t
o
treatm
ent
with
an
i
ncubato
r
as
in
researc
h
Hurst
that
t
he
inc
reas
ed
vol
um
e
of
m
il
k
per
day
in
4
wee
ks
a
nd
exclusi
ve
brea
st
resp
ect
ively
of
647
m
l
and
37%
i
n
the
KMC
gr
oup
was
530
m
l
and
6%
in
the
co
ntr
ol
gro
up.
Sim
il
arl
y,
the
RC
T
stud
y
by
Char
pak
or
pa
rtia
ll
y
exclusiv
e
br
ea
stfeedi
ng
f
or
3
m
on
th
s
up
to
82%
i
n
t
he
KMC
gr
oup
a
nd
75%
in
the
con
t
ro
l
group,
a
nd
Ca
tt
ane
o
i
n
WHO
sho
w
s
exclusi
ve
brea
stfeedin
g
a
fter
discha
rg
e
88%
in
the
KMC
gro
up
and 70%
in
t
he
contr
ol grou
p [9
]
.
Re
search
Syst
e
m
at
ic
rev
ie
w
s
ind
ic
at
e
that
treat
the
m
ot
her
'
s
sk
in
co
nt
act
with
bab
y'
s
sk
in
i
s
ver
y
eff
ect
ive
in
preven
ti
ng
hypotherm
ia
in
pr
et
erm
infan
ts
or
low
bi
rth
wei
ght
and
t
he
Re
la
ti
ve
Ri
sk
(RR)
0.0
9;
95%;
CI
0.01
to
0.64
;
Nu
m
ber
Nee
ded
to
Treat
(NNT
)
2;
2
-
4
m
eans
that
ever
y
seco
nd
LB
W
in
fan
t
s
w
ho
wer
e
t
reated
with
the
m
et
h
od
s
of
KMC
will
p
re
ve
nt
the
bab
y
on
th
e
incide
nce
of
hypothe
rm
ia
[10]
a
nd
regularly
inc
re
asi
ng bo
dy w
ei
gh
t
pe
r day
unt
il
d
isc
harge
[
11]
.
On
e
ad
va
ntage
of
the
m
et
ho
ds
of
KMC
is
t
he
e
ff
ect
on
th
e
ba
by'
s
gro
wth
as
the
res
ult
of
resea
rc
h
that
infa
nts
w
ho
we
re
treat
ed
with
the
m
et
ho
ds
of
KMC
sig
nificantl
y
gro
w
bette
r
by
the
end
of
the
stu
dy,
i
n
wh
ic
h
a
sm
al
l
bab
y
with
K
MC
occurre
d
sign
ific
a
ntly
great
er
im
pr
ov
e
m
ent
on
Weig
ht,
b
ody
le
ngth,
hea
d
sircum
fer
ence
(2
,
38
8
gram
s,
47.
8
cm
,
33.4
cm
)
tha
n
f
ro
m
the
ba
by
with
t
he
conve
ntio
nal
m
et
ho
d
(2
,
06
5
gram
s,
46.4
cm
,
32
.
1
c
m
)
at
t
he
en
d
of
t
he
m
on
it
or
i
ng
with
p
<
0.05.
A
nother
posit
ive
ef
fect
sho
rteni
ng
the
pe
rio
d
of
ho
s
pital
iz
at
ion
with
a
n
ave
r
age
(m
ean
±
SD
)
at
KMC
CM
C
1
2.7
8±6
.72
an
d
12.
86±
5.7
7
(p=
0.9
3)
.
KM
C
m
et
ho
d
can
al
so
exten
d
th
e
dura
ti
on
of
breast
fee
ding,
st
abili
zi
ng
m
i
lk
pro
du
ct
io
n,
in
crease
the am
ou
nt
of
nu
t
rients eac
h day, a
nd enha
nc
e com
petence
in breast
feed
i
ng
m
oth
ers [1
2]
.
The
resu
lt
s
of
ano
t
her
stu
dy
of
50
in
fan
ts
(
weig
ht
<2
,
00
0
g)
at
28
-
32
we
eks
gestat
ion,
who
receive
d
the
KMC
m
eth
od
for
at
le
ast
4
-
6
ho
ur
s/
da
y
sh
owed
an
i
ncr
ease
i
n
wei
gh
t
(gram
s)
(m
ean
±
S
D)
29±
3.5
2;
Ho
s
pital
treat
m
ent
durati
on
(m
ean
±
S
D)
of
15.
5
±
11.
3
da
ys;
ag
e
at
discharge
(m
ean
±
SD)
23.6±
3.5
2
days,
wh
il
e
20
of
them
infan
ts
w
ho
we
re
f
ollo
wed
f
or
8
we
eks
a
fter
disc
harge
si
gnific
antly
increase
d
weig
ht
1.135
±
0.1
21 a
nd only
m
oth
er
s who d
o KMC
m
e
tho
d at
hom
e after goi
ng
ou
t
of RS
[
13
]
.
Likewise,
the
resu
lt
s
of
res
e
arch
on
t
hat
si
gn
i
ficantl
y
the
re
are
sig
nifica
nt
di
ff
e
ren
ce
s
betwee
n
t
he
m
ean
diff
e
ren
c
e
of
BB
ba
by
at
ho
m
e
un
ti
l
t
he
ne
xt
re
-
visit
du
ri
ng
the
th
r
ee
visit
s
that
hav
e
bee
n
cat
eg
or
iz
e
d
in
the
durati
on
of
KMC
≥4ja
m
/
day
with
ea
ch
inc
rem
ent
of
the
a
ve
rag
e
i
ncr
ease
in
body
weig
ht
(
80.7
gr
am
s;
297.5
g;
400.4
gr
am
s)
with
a
confide
nce
in
te
rv
al
(CI
)
95%
(fro
m
5
7.6
to
103.8;
241.4
to
353.5;
29
7
.
8
t
o
502.9
)
an
d
eac
h
p
-
value
0.001
, wit
h
the
res
ults of
t
he
a
naly
sis (X
2)
on
re
peat v
isi
ts I
-
II
I
, th
at
the
KMC bab
ie
s
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Th
e
Eff
ect
o
f K
angaroo
Mot
he
r Care
Meth
od (K
MC)
o
n
W
ei
gh
t
Ga
i
n
and Len
gth of
Sta
y
In Low…
(
Mul
ian
i
)
93
≥4
hours/
day
hav
e
a
posit
iv
e
ef
fect
≥30
gra
m
bab
y'
s
wei
gh
t
gai
n/
day
f
or
2
tim
es
gr
eat
to
visit
the
seco
nd
ann
i
ver
sa
ry
of
the
KMC
in
fa
nts
<4
hours
/
day.
I
n
the
firs
t
and
sec
ond
vi
sit
there
sign
i
f
ic
ance
in
cl
ini
cs
an
d
with less
sta
ti
st
ic
al
p
-
value
<
0.0
5 [14].
2.
RESEA
R
CH MET
HO
D
This
re
searc
h
i
s
an
a
naly
ti
c
stud
y desig
n
Quasi
Ex
per
im
ent
with
P
re
po
st
a
ppr
oach
one g
r
oup
desig
n.
The
ta
r
get
popula
ti
on
in
t
his
stud
y
are
al
l
m
oth
e
r
-
in
fa
nt
pa
irs
with
LB
W
birth
s
a
nd
sam
ples
are
al
l
ov
er
the
m
oth
ers
of
in
f
ants
with
lo
w
birth
wei
ght
birth
histor
y
both
m
at
ur
e
an
d
prem
at
ur
el
y
treat
ed
at
Hospita
l
Perinatal
Lo
unge
A
nu
ta
pura
Palu
an
d
will
ing
to
car
ry
out
the
treatm
ent
with
the
KMC
m
et
ho
d.
Th
e
total
sam
ple
of
36
infa
nts,
wer
e
s
el
ect
ed
by
consecuti
ve
sam
pl
ing
.
T
he
co
nfoun
ding
var
ia
bles
was
co
ntr
olli
ng
us
in
g
sel
ect
ed
crit
eria
with
i
nf
ants
birth
wei
gh
t
betwee
n
1
,
000
-
2
,
10
0
gr,
wei
ght
of
in
fa
nt
w
he
n
KMC
was
sta
rted
betwee
n
900
-
2
,
100
gr
,
wei
gh
t
o
f
in
f
ants
post
KM
C
wer
e
1
,
300
-
2
,
500
gr
,
bab
ie
s
bor
n
with
pre
m
at
ur
e
or sm
all p
erio
d o
f pr
e
gn
a
ncy
.
3.
RESU
LT
S
A
ND AN
ALYSIS
Of
whole
KM
C
bab
ie
s
do
c
are
the
ave
rage
bab
y
inc
reas
es
exceedi
ng
BB
Go
ld
Sta
ndar
d
of
the
World
H
eal
th
Orga
nizat
io
n
(
BB
increase
in
aver
a
ge
≥15
g/
day.
The
res
ul
ts
can
be
seen
in
the
un
i
var
ia
t
e
and
biv
a
riat
e
analy
sis
in
the
form
of
pai
red
sam
ples
te
st
on
a
gro
up
of
data
pa
irs
with
no
rm
al
it
y
te
st
bef
orehand
,
and I
ndepe
nde
nt S
am
ples test
grou
p unpaire
d data.
T
able
1
s
hows
that
the
birth
of
a
ba
by
with
low
bi
rt
h
wei
gh
t
cat
eg
or
ie
s
and
eac
h
LB
W
i
nf
a
nts
18
infa
nts
(50.0%
),
in
fan
ts
who
gain
wei
gh
t
a
s
m
uch
as
21
infa
nts
(58.3%
)
an
d
15
in
fant
s
(41.7%)
we
re
not
increase
d weig
ht.
Tab
le
1.
C
har
a
ct
erist
ic
s o
f I
nfants
Who
Re
ce
ive Tr
eat
m
ent Met
hods
KMC
Paired
sam
ples
t
-
te
st
was
do
ne
to
te
st
the
resu
lt
s
of
the
i
m
ple
m
entat
i
on
of
the
KM
C
m
et
ho
d
of
weig
ht
gain
in
infan
ts
be
f
or
e
and
after
the
KMC
m
et
ho
d.
Pr
ior
to
the
a
naly
sis
of
pair
ed
sam
ples
t
-
t
est
was
first
te
ste
d
no
m
m
a
li
ta
s
and
s
ho
we
d
norm
al
distrib
ution
of
data
with
a
p
-
va
lue>
0.0
5,
f
or
weig
ht
befor
e
KMC
0.335
an
d
body
weig
ht
a
fter
KMC
0
.
05
0
ba
sed
on
te
st
S
ha
pir
o
-
W
il
k
acc
ordin
g
t
o
c
rite
ria
of
t
he
num
ber
o
f
sam
ples is less t
han
50
bab
y.
To
see
w
hethe
r
there
is
any
pote
ntial
for
K
MC
m
e
tho
d
t
o
increase
le
ngth
of
sta
y
fo
r
K
MC
ho
s
pital
,
an
d determ
ine
the av
era
ge
we
igh
t dif
fer
e
nce
befor
e
KMC t
o
assess the w
ei
gh
t at
hom
e as
well
as the
incr
eas
e
in
the
a
ve
rag
e
weig
ht
/day
.
Ta
ble
2
s
hows
t
ha
t
there
is
an
increase
in
body
weig
ht
wa
s
s
ign
ific
a
ntly
ba
sed
on
the
te
st
res
ults
of
pr
e
-
post
w
ei
gh
t
befo
r
e
a
nd
afte
r
the
K
MC
to
gain
w
ei
gh
t
188.7
5
gram
s
and
a
sta
nd
a
r
d
dev
ia
ti
on
of 16
6
.
6
a
nd in
digo
p
-
value
0.
000
.
KMC m
et
ho
d has t
he po
te
ntial
to
inc
rease
weig
ht g
ai
n
i
n LB
W
.
Table
2
.
Paire
d Sam
ples Test wit
h
a m
ean
diff
e
ren
ce
I
m
pr
ovem
ent
Weig
ht Lo
ss
Be
fore a
n
d A
fter
KMC o
n
LB
W
KMC
Metho
d
N
Mean ±
SD
Δ
CI 95
%
t
-
test co
u
n
t
p
-
va
lu
e
W
eig
h
t bef
o
re
KM
C
36
1
,
5
5
5
±
3
2
7
.0
8
1
8
8
.75
±
1
6
6
.66
1
3
2
.4
-
2
4
5
.1
6
.79
5
0
.00
0
W
eig
h
t af
ter
KMC
36
1
,
7
4
3
±
2
3
6
.0
3
In
t
his
stu
dy
a
lso
sho
ws
the
resu
lt
s
of
a
n
a
naly
sis
of
pote
ntial
m
et
ho
ds
of
KMC
on
L
B
W
to
t
he
le
ng
th o
f
us
in
g
Indep
e
ndent
a
naly
sis
of
te
st
sam
ples
as
in
t
he
Table
3.
Th
is
ta
ble
inform
s
that
the
lon
g
da
y
on
Ch
arac
teristics
bab
y
Frequ
en
cy
(n=3
6
)
Percentag
e
(%)
Birth
weig
h
t
1
,00
0
-
1,
5
0
0
gra
m
1
.50
1
-
2
.100 g
ra
m
18
18
5
0
.0
5
0
.0
W
eig
h
t bef
o
re
KM
C
900
-
1
,
5
0
0
gra
m
1
,
501
-
2
,
1
0
0
gra
m
20
16
5
5
.6
4
4
.4
W
eig
h
t af
ter
KMC
1
,
300
-
1
,
5
0
0
gra
m
1
,
501
-
2
,
1
0
0
gra
m
9
27
2
5
.0
7
5
.0
W
eig
h
t chan
g
es
Increase
N
o
t increased
21
15
5
8
.3
4
1
.7
LBW
by
p
regn
an
c
y
S
m
all f
o
r
g
estatio
n
al age
A
ccord
in
g
to th
e ges
tatio
n
7
29
1
9
.4
8
0
.6
Evaluation Warning : The document was created with Spire.PDF for Python.
IS
S
N
:
2252
-
8806
IJPHS
V
ol.
7
,
No.
2
,
J
une
20
18
:
91
–
96
94
the
dura
ti
on
of
ho
s
pital
iz
at
ion
KMC
on
LB
W
i
nf
a
nts
each
with
a
durati
on
<
4
hours/d
ay
ow
n
(Mea
n
±
SD
)
8:46±
7:15
t
od
a
y
an
d
≥4
ho
ur
s
/day
6:
50±4
:
24
to
day
with
p
-
v
al
ue=
0133
,
th
e
res
ults
of
the
analy
sis
s
how
ed
no
sta
ti
sti
cal
sign
ific
ance.
Table
3
.
Inde
pe
nd
e
nt
Sam
ple Test
on
Day C
are
Old KMC
with
D
urat
io
n of
KMC i
n
LB
W
Du
ration
of
KM
C
N
Mean ±
SD
CI 95
%
t
-
test
co
u
n
t
p
-
va
lu
e
Lon
g
day
car
e K
M
C
<4
h
o
u
rs /
d
ay
28
8
.50
±
7
.15
7
.39
-
3
.46
0
.73
6
0
.13
3
≥4
h
o
u
rs /
d
ay
8
6
.50
±
4
.24
Dif
f
erence in weig
h
t gain
<4
h
o
u
rs /
d
ay
28
1
.99
±
1
8
0
.45
1
8
1
.87
-
9
1
.87
0
.66
8
0
.18
7
≥4
h
o
u
rs /
d
ay
8
1
.54
±
1
0
7
.16
Si
m
il
arly
,
the
durati
on
of
K
MC
to
weigh
t
gain
by
the
di
ff
ere
nce
in
w
ei
gh
t
gai
n
is
relat
ively
no
t
exp
e
rience
d
si
gn
i
ficant
di
ff
e
r
ence.
I
t
is
pro
ve
d
that
the
dur
at
ion
of
<
4
ho
ur
s/
day
ha
d
a
n
aver
a
ge
weig
ht
gain
(m
ean±
SD)
1.99±
180.4
5 g a
nd ≥4
hours/
da
y wit
h
a
n
a
ver
a
ge wei
ght gai
n 1:5
4±
107.1
6
a
nd p
-
value
0
.
187
.
4.
DISCU
SSI
ON
Kanga
roo
M
oth
er
Ca
re
a
s
one
sim
ple
treatm
ent
at
LB
W
i
n
fo
ste
rin
g
bette
r
healt
h
by
im
pr
ov
in
g
t
he
eff
ect
ive
ness
of
the
c
on
tr
ol
body
te
m
per
at
ur
e
an
d
bondin
g
bab
y'
s
m
oth
er,
excl
us
ive
brea
stfeedin
g,
to
pr
even
t
infecti
on.
Ca
ring
f
or
a
ba
by
with
KMC
m
e
thod
c
on
ti
nu
ously
by
direct
c
on
ta
ct
with
the
sk
in
an
d
help
s
ski
n
com
plete
ly
exclusive
breast
f
eedin
g.
KMC
m
et
ho
d
can
be
sta
rted
in
hosp
it
al
a
nd
co
ntinu
e
d
at
ho
m
e.Th
is
researc
h
is
try
ing
t
o
integ
rate
with
the
vie
w
to
increa
se
t
he
po
te
ntial
of
KMC
m
e
tho
d
w
ei
ght
an
d
le
ngth
of
treatm
ent at t
he
tim
e LBW KM
C
m
et
ho
d f
or care
in h
ospit
al
.
4.1.
Th
e
P
ot
e
n
tial
Ap
pli
ca
tio
n of the
KM
C
M
e
thod
to I
n
crease BB
L
ow
Bi
rth
We
ig
ht
(LBW)
Ov
e
rall
the
st
ud
y
s
ubje
ct
s
wer
e
36
i
nf
a
nts.
T
he
r
esults
of
t
he
a
naly
sis
of
no
rm
ality
te
st,
norm
al
distrib
ution
of
data
so
t
hat
it
can
pr
oceed
wi
th
the
a
naly
sis
Paired
sam
ple
te
st
by
m
easuri
ng
th
e
wei
gh
t
pr
i
or
to
m
e
tho
ds
of
KMC
an
d
co
nt
inu
e
d
with
t
he
i
m
ple
m
entat
io
n
of
KMC
e
ve
ry
day
f
or
at
le
ast
2
hours/
pe
r
iod
s
,
and
weig
h
the
bab
y
e
ver
y
da
y
in
the
m
or
ni
ng
un
ti
l
ba
by
oth
e
rw
ise
m
eet
the
crit
eria
of
return.
Ne
xt
cal
culat
e
the av
e
ra
ge we
igh
t
gain o
f
the
b
a
bies
durin
g t
reat
m
ent
m
et
ho
ds KMC
.
The
te
st
res
ul
ts
sh
ow
that
bab
ie
s
gai
n
weig
ht
duri
ng
t
reatm
ent
m
et
ho
ds
KM
C
aver
a
ge
of
188.7
5±
166.6
gr
am
s
with
a
p
-
value
of
0.0
00
i
n
the
ra
ng
e
of
132.4
-
24
5.1
CI
95%
.
The
res
ult
m
e
ans
that
sta
ti
sti
cally
sign
ific
antly
K
M
C m
e
tho
d ap
pl
ic
at
ion
has t
he
po
te
ntial
to
inc
rease
weig
ht on
LB
W.
KMC
as
a
n
inter
ven
ti
on
m
et
hod
sim
ple
and
easy
t
o
i
m
ple
m
ent
and
rea
dily
acce
pt
ed
by
m
os
t
m
oth
ers
du
rin
g ho
s
pital
iz
at
ion
which
pro
vide
s
m
any b
enef
i
ts and
r
e
du
ce t
he
risk of
h
y
potherm
ia
w
it
ho
ut
side
eff
ect
s.
It
al
s
o
gi
ves
im
po
rta
nt
im
plica
t
ion
s
in
t
he
tre
at
m
ent
of
lo
w
bir
th
weig
ht
in
de
velo
ping
c
ou
ntries
wh
e
re
c
onve
ntion
al
treat
m
ent
with
e
xp
e
ns
iv
e
facil
it
ie
s
are
no
t
a
vaila
ble
in
al
l
places
[
15
]
.
Ba
by
care
with
KMC m
e
tho
d ca
n
be
intr
oduc
ed
du
rin
g
the
m
oth
er in
the hosp
it
al
for
f
ur
t
her
a
ppli
ed
at
ho
m
e u
ntil
the
bab
y i
s
urge
d
to
c
om
e
ou
t
or
feel
un
com
fo
rtable
a
nym
or
e
w
hich
us
ua
ll
y
too
k
40
-
41
wee
ks
of
age
c
orrect
ed.
S
om
e
stud
ie
s
do
m
eth
ods
of
KMC
at
ho
m
e
with
t
he
s
hortest
per
i
od
of
2
-
4
ho
urs/
day
sho
wed
t
he
bab
y'
s
co
nd
it
ion
is
sta
ble [16
]
.
It
can
be
co
ncl
ud
e
d
that
t
he
ba
by'
s
birth
LB
W
will
ha
ve
a
po
sit
ive
e
ff
ect
if
done
tre
at
m
e
nt
m
e
tho
ds
KMC
since
in
ho
s
pital
un
ti
l
the
ba
by
ho
m
e
and
c
on
ti
nue
d
at
ho
m
e
is
m
i
ni
m
a
l
with
the
sh
ort
est
per
i
od
of
2
hours
/
day
a
nd
it
s
durati
on
can
be
inc
rea
sed
gr
a
dual
ly
to
m
ai
ntain
st
abili
ty
of
the
bab
y'
s
co
nd
it
ion
a
nd
weig
ht
gai
n
a
de
qu
at
e
body.
KMC
m
et
ho
d
i
m
ple
m
entat
ion
can
be
done
w
it
ho
ut
disru
pting
the
daily
ac
ti
viti
es
of
the
m
oth
er,
bu
t
re
q
uire
ha
bituati
on
a
nd
pe
rsev
e
ra
nce
m
oth
e
r
an
d
fam
i
ly
su
pport
.
It
is
al
so
suppo
rted
by
a
stud
y
by
the
KMC
m
e
thod
al
so
inc
reases
the
wei
gh
t
of
the
ba
by
after
discha
r
ge
co
m
par
ed
to
the
con
t
rol
gro
up
by
3.6
ti
m
es,
CI
95
%
in
the
inter
val
f
ro
m
0.8
to
6.4
cl
inica
l
ly
m
ea
ningf
ul
[
12]
.
I
m
ple
m
entat
ion
of
the
KMC
m
et
ho
d
in
the
UK
28
-
32
wee
ks
,
a
t
le
ast
4
-
6
ho
ur
s/
day
showe
d
a
sign
i
fi
cant
ly
increased
weig
ht
1.135
±
0.1
21
f
or
m
oth
er
s
who
perform
the
m
et
ho
d
KMC
at
ho
m
e
[13].
Re
su
lt
s
of
othe
r
stu
dies
with
direc
t
sk
in
contac
t o
f
m
oth
er and ba
by sho
w
a
n
i
nc
rease in
t
he a
ve
rag
e
w
ei
gh
t
of
30 gram
s/
day
[17
]
.
4.2.
Th
e
Du
r
ati
on o
f
K
M
C Met
hod t
o
L
ong
D
ay Care I
nf
ant
Low Bi
r
th
W
ei
ght
(LBW)
The
res
ults
of
the
analy
sis
in
Table
3
sho
w
s
that
the
old
da
ys
of
th
e
dura
ti
on
of
treat
m
e
nt
KMC
on
LB
W
infa
nts,
wer
e
no
t
sta
ti
sti
cal
ly
s
ign
ific
a
nt
with
p
-
value
0.
13
3.
Sim
il
ar
ly
,
the
durati
on
of
KMC
to
weig
ht
gain
by
the
diff
e
ren
ce
i
n
we
igh
t
gai
n
was
relat
ively
sign
i
ficant
di
ff
e
rence
s,
it
is
pr
oved
that
the
du
rati
on
<4
hours/
day
had
a
n
ave
ra
ge
weigh
t
ga
i
n
(
m
ean±
S
D)
1.9
9±
180.4
5
g
and
≥
4
ho
ur
s/
day
w
it
h
an
a
ver
a
ge
weig
ht g
ai
n 1:
54±
107.1
6
a
nd p
-
val
ue
0.187
.
Evaluation Warning : The document was created with Spire.PDF for Python.
IJPHS
IS
S
N: 22
52
-
8806
Th
e
Eff
ect
o
f K
angaroo
Mot
he
r Care
Meth
od (K
MC)
o
n
W
ei
gh
t
Ga
i
n
and Len
gth of
Sta
y
In Low…
(
Mul
ian
i
)
95
Th
us
th
e d
urat
ion
of K
MC
<
4
hours/
day
are
m
or
e
li
kely
to g
ai
n
wei
gh
t
t
ha
n
of
≥
4
hours/
day, b
ut
the
su
pe
rio
rity
dur
at
ion
of
KMC
≥
4
hours/
day
co
ntaine
d
in
the
le
ngth
of
sta
y
of
6.5
da
ys
sho
rter
tha
n
t
he
durati
on
<
4
hour
s/
day
the
le
ngth
of
sta
y
to
8.5
days.
T
his
m
eans
that
th
e
longe
r
the
durati
on
of
a
ba
by
in
KMC
gr
eat
er
t
he
oppo
rtu
nity
to
sh
ort
en
the
le
ng
th
of
sta
y,
wh
ic
h
will
fu
rt
her
lo
wer
t
he
cost
of
car
e
.
T
he
aver
a
ge
t
reatm
ent
du
rati
on
of
direct
c
on
ta
c
t
of
sk
i
n
t
o
s
ki
n
on
t
he
ba
by
gro
up
KMC
sho
wed
a
te
ndency
le
ng
th
of
sta
y
i
n
ho
s
pital
is
shorter
(
8.6
days
)
com
par
e
d
with
Co
nventi
on
a
l
Me
tho
d
Ca
re
(CMC
)
with
le
ng
t
h
of stay
(9.
3 da
ys)
[
15
]
.
Si
m
il
arly
,
oth
er
s
tud
ie
s
sho
w
the
m
et
ho
d
K
MC
,
as
a
m
eans
of
heati
ng
an
d
can
sho
rten
the
le
ng
t
h
of
sta
y
in
ho
s
pital
,
so
it
do
es
not
require
a
la
rg
e
fee
al
so
s
howe
d
wei
ght
gain
a
nd
decr
e
ase
the
incide
nce
of
hypothe
rm
ia
c
om
par
ed
t
o
in
fan
ts
w
ho
did
not
receive
the
m
et
ho
d
of
KMC
[
18
]
.
I
n
li
ne
with
rese
arch
i
n
Bogota
that
t
he
us
e
of
KMC
do
m
inant
s
how
m
or
e
ef
fecti
ve
resu
lt
s
a
gai
ns
t
w
ei
ght
gai
n
wer
e
13.
11±
10.04
gm
at
KMC
gro
up
com
par
ed
with
15.81±
3.3
3
gm
in
the
co
ntr
ol
gro
up
by
va
lue
(
p
-
value
<
0.0
01
).
Sim
il
arl
y
Ruiz
in
20
16
,
the
incide
nce
of
hy
po
the
rm
ia
(14.6%)
in
t
he
con
t
ro
l
gro
up
and
(
5.1
%
)
in
the
gro
up
of
KMC
(p
-
val
ue=
00
48),
durati
on
of hosp
it
al
stay
is s
horter
(
p
-
value
=0.015
)
as
wel
l as savi
ngs
.
The
resea
rch
r
esults
prov
e
th
at
the
i
m
ple
m
e
ntati
on
of
the
KMC
m
et
ho
d
hav
e
a
n
incre
a
sing
im
pact
on
LB
W
BB
≥30
g
/
day
with
a
durati
on
≥4
ho
ur
s/
day
for
at
le
ast
2
hours
/
per
i
ods
KMC,
pote
nt
ia
lly
a
m
ou
ntin
g
t
o
3.5
ti
m
e
s
gr
eat
er
tha
n
the
KMC
<4
hours/
day
,
C
I
95
%
(
1.2
to
9.8
).
S
om
e
bab
ie
s
feel
com
fo
rtable
w
i
th
KMC
m
et
ho
d
s
o
the
wei
ght
is
>
2
,
50
0
g
with
an
up
rig
ht
bo
dy
posit
io
n
[14].
Othe
r
stud
ie
s
hav
e
s
how
n
th
at
so
m
e
m
oth
ers
feel
sad
,
gu
il
ty
,
scared,
an
xious,
insec
ure
and
he
sit
ant
wh
e
n
rec
omm
end
e
d
sta
rt
KMC,
bu
t
after
carryin
g
ou
t
the
m
et
ho
d
KMC
m
oth
ers
find
m
or
e
po
s
it
ive
eff
ect
s
of
direct
sk
in
c
onta
ct
,
feel
the
lo
ve
a
nd
af
fecti
on
of
tou
c
h,
breast
f
eedin
g,
a
nd
w
om
en
are
m
or
e
co
nf
ide
nt
in
carin
g
f
or
he
r
bab
y
.
Fivetee
n
w
ome
n
w
ho
par
ti
ci
pated
in
this
s
tud
y
of
14
w
om
en
are
m
or
e
confide
nt
af
te
r
carryin
g
out
the
m
et
ho
d
KMC
and
to
14
w
om
en
will
co
ntinu
e
KMC
m
eth
od
at
ho
m
e
and
seve
n
of
th
e
m
carrying
out
the
m
et
ho
d KMC
m
oth
ers
after
di
scharge
up to
>
4 week
s [1
9]
.
5.
CONCL
US
I
O
N
The
resu
lt
s
of
t
his
stu
dy
can
be
co
nclu
ded
t
ha
t
there
is
a
po
te
ntial
m
et
ho
d
of
Ka
ng
a
r
oo
Mother
Ca
re
(K
MC
)
to
the
increased
we
igh
t
an
d
le
ng
t
h
of
t
he
Infa
nt
Low
Bi
rth
Weig
ht
(LB
W)
in
Palu
A
nu
ta
pura
Ho
s
pital
.
T
o
im
pr
ov
e
the
sta
bili
ty
con
diti
on
of
LB
W
infa
nts
a
nd
acc
el
erate
weig
ht
gain
a
nd
re
duce
t
he
durati
on
of
ho
sp
it
al
ba
by
in
a
hosp
it
al
,
it
c
an
be
s
uggest
ed
that
t
he
hosp
it
al
or
poli
cy
-
ma
ker
s
to
r
un
th
e
Stand
a
r
d Op
e
r
at
ing
P
r
ocedure
(
S
OP) fo
r
ea
ch baby
with a
histor
y
of lo
w birth
w
ei
gh
t
bi
rths.
REFERE
NCE
S
[1]
Johns
on,
AN
.
,
“
Kanga
roo
Holdi
ng
be
y
ond
the NICU
”
,
Journal
of
Pe
d
iat
ric
Nurs
ing
,
31(1);
53
-
56
,
2005.
[2]
W
HO
,
“
Low
Birt
hweight
:
Countr
y
,
Reg
iona
l
and
Glo
bal
Esti
m
at
e
s”,
Unic
ef,
New
York,
2004.
[3]
W
HO
,
“
W
orld
Hea
lt
h
Statis
ti
cs
2015
”
,
Luxe
m
bo
urg
,
2015a
.
[4]
W
HO
,
“
Le
vel
s
&
Tr
ends
in
Chil
d
Mortalit
y
,
Rep
ort
2015
”,
Uni
cef,
New York
,
20
15b.
[5]
Data
and
Inform
at
ion
C
enter
Mi
nistr
y
of
He
al
th
RI
(PU
SD
ATIN
Kem
enke
s
RI
)
,
“
Exe
cut
iv
e
Sum
m
ar
y
,
Hea
l
th
Da
ta
and
Inform
at
i
on
of
Cent
r
al Sula
w
esi
Provinc
e
(
in Baha
sa)
”
,
2013
.
[6]
Public
Hea
lt
h
O
ffic
e
of
Mid
Sulawesi
Province
,
“
Hea
lt
h
profil
e
of
Mid
Sulawesi
Province
”
,
UP
T
Survail
ans,
Dat
a
and
Inform
at
i
on
,
2015.
[7]
Anutapur
a
Pa
lu
Hos
pit
al
,
“
Repor
t
of labor
and
inf
ant
b
irt
h
in
2013
-
2014
”,
201
5.
[8]
Kenne
l
JH
.
,
“
Randomize
d
controlle
d
trial
of
skin
-
to
-
skin
con
t
ac
t
from
birt
h
ver
sus
conve
nst
iona
l
inc
ub
at
or
for
ph
y
siolog
ic
a
l
st
a
bil
izati
on
in
120
0
to
2
199
gra
m
newborn
”
,
Acta
Pe
diat
ri
ca
95
:
15
-
16
,
2006
.
[9]
W
HO
,
“
Kanga
roo
Mother
C
are: a
Prac
t
ic
a
l
Guid
e
”
,
G
ene
va
,
2003
.
[10]
McCal
l
EM.
,
Al
der
dice
FA
.
,
H
alliday
HL
.
,
Jenki
ns
JG
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