44-30 WHAT EDUCATION OPPORTUNITIES CAN BE OFFERED IN A KANGAROO MOTHER CARE WARD?

The mother’s stay in a KMC ward provides an ideal opportunity for education. It is important that the nurses in the KMC ward are able to provide education, not only about giving KMC but also about other aspects of health. Talks, discussion groups, demonstrations and educational videos are used. Topics, which should be taught in the KMC ward, include:

1. How to give KMC correctly and provide exclusive breastfeeding.
2. How to give KMC after discharge home.
3. The importance of regular attendance at the follow up clinic.
4. The importance of the Road-to-health card.
5. The importance of immunizations for the infant.
6. How to cup feed an older child.
7. The giving of daily vitamins and iron to preterm infants.
8. A healthy diet and lifestyle for the mother.
9. How to avoid infection with HIV.
10. Family planning.

The main problems in a KMC ward are boredom and frustration. Other than education, activities such as knitting woolen caps, reading magazines and arts or crafts should be encouraged. A radio and television set with a video recorder are useful as are a kettle, toaster and microwave oven. Community groups can be invited to help with some of these activities. Smoking must not be allowed.

44-31 WHY MAY TEENAGERS NOT WANT TO STAY IN A KANGAROO MOTHER CARE WARD?

Teenagers are naturally rebellious and often do not easily accept any form of authority. An unhappy teenager may disrupt the normal routine in a KMC ward and they may require support and understanding from the staff. Weekends are often most difficult for teenagers who want to be with their friends. They may also be anxious about their boyfriend or partner.

Many mothers in both the lodger and KMC wards may need “time out” to go home for a few days. This is important for women who have other children at home. Some may have spent weeks or months in hospital. While she is away, her infant will have to go back into an incubator in the nursery. Mothers rarely stay away for more than a few days as most have already formed a strong bond with their infant during intermittent KMC. It gives them time to prepare for the infant’s arrival at home.

44-32 WHEN SHOULD MOTHERS AND INFANTS BE DISCHARGED FROM A KANGAROO MOTHER CARE WARD?

When the mother is able and confident to care for her infant at home. The weight and gestational age of the infant are less important than its maturity. Usually the infant is discharged from the KMC ward when both mother and infant are ready.

The following criteria should be met before the mother and infant are discharged from the KMC ward:

1. The mother must be able to provide KMC correctly and should be confident to look after her infant. Usually the infant is fully breast fed. The infant must be taking all feeds by mouth.
2. The infant and mother should be clinically healthy and the infant should be gaining weight at a rate of 20 g or more a day).
3. The home and family must be prepared for the mother and her infant.
4. Arrangements must be made for regular follow up at a local clinic.

Care in the KMC ward should be seen as a step between discharge from the nursery and discharge home. Most mothers only need to spend a few days in the KMC ward unless their infant is very small. Infants are usually discharged home when they are 1500 g or more. Many KMC wards discharge their mother when the infants reach 1800 g. Infants receiving KMC are often discharged a little later in the cold season. The better the follow up facilities, the sooner infants can be discharged home.

44-33 HOW EXPENSIVE IS A KANGAROO MOTHER CARE WARD?

Some funding is needed to establish a KMC ward. Thereafter, there is a small cost to the hospital for running a KMC ward, as the mothers need food and bedding. Sometimes mothers may have to bring their own food and bedding. The KMC ward has to be cleaned and staff are needed to supervise the mothers. However, there is a great financial saving because:

1. The mothers provide all the care for their infants.
2. Less formula is needed, as most of the infants are being breast fed.
3. The infants are discharged home earlier from the nursery.
4. There is also less infection in the nursery.
5. Less staffing is needed than with conventional incubator care.

A KANGAROO CARE MOTHER WARD MAKES A GREAT FINANCIAL SAVING FOR THE HOSPITAL

Similarly, it is cost efficient to run a lodging ward.

44-34 HOW CAN FUNDING BE OPTAINED FOR A KMC WARD?

Many hospitals have obtained funding for their KMC ward from private institutions, charity groups and service organisations.