Effect of ‘kangaroo mother care’ training on knowledge, attitude and practice of health care providers in selected district hospitals in North Rift region, Kenya

Abstract

While kangaroo mother care (KMC) has been effectively used for managing low birth weight (LBW) infants since 1978, particularly even in resource abundant settings, only few areas in resource poor setting of sub-Saharan Africa, have it practiced in their health facilities routinely. Training healthcare providers has been recommended by WHO as an approach for scaling up KMC practice in low income settings. The effect of training health care providers on their knowledge, attitude and practice is not fully understood in many settings in Africa, including Kenya. Objective The study sought to determine the effect of training health care providers on KMC on their knowledge, attitude and practice (KAP). Methodology The study was a pre-post test design done in four district hospitals (Koibatek, Iten, Nandi North and Nandi South), where a one day training of health-care providers on KMC using WHO essential newborn care course manual was carried out as an intervention. The four district hospitals were randomly selected, while convenience sampling was used in selection of health-care providers. A paired test was used to determine the minimum sample of 85 subjects to be able to detect medium effect size of 0.3, with a power of 80% and 0.05 level of significance. The level of KAP on KMC was assessed using a pre-tested self administered questionnaire in the pre and post training. Eighty eight health-care providers completed the pre and post training survey, their data was entered on excel spread sheet and analysed using STATA 10.0. Mcnemars and paired t-test was used to assess any difference between outcomes of interest. Results Eighty eight (88) health care providers completed the study. They included 54 nurses, 28 clinical officers and 5 doctors. The knowledge on KMC was high (95.5%) among all the healthcare workers. There was a change in the knowledge about the relationship between KMC and, breastfeeding (28.6%, p=0.000) and early discharge (21.5%, p=0.003) after the training. Their attitude towards KMC remained the same before and after training (p=0.189). The practice of KMC increased in terms of supporting mothers physically to initiate it (12%, p=0.031), but there was an insignificant increase in encouraging (3%, p=0.727) and providing information (8%, p=0.146) to, the mothers. Conclusions and Recommendations There was good initial KAP on KMC. The knowledge about the relationship between KMC and, breastfeeding and early discharge increased after training. More health care providers assisted mothers to initiate KMC, although no change in attitude observed after the training. Therefore, promotion of KMC practice should continue. Other modes of training that will promote appropriate attitude towards KMC need to be explored.