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Impact of Kangaroo Mother Care Education on Kangaroo Mother Care Practices among Healthcare Workers in Nigeria

Abstract

Kangaroo Mother Care (KMC) is an important evidence-based intervention for improving the survival, growth, thermal regulation, breastfeeding, and developmental outcomes of preterm and low-birth-weight newborns. Healthcare workers play a critical role in the successful implementation of KMC because they are responsible for identifying eligible newborns, educating parents and caregivers, initiating and supporting skin-to-skin contact, promoting appropriate breastfeeding, monitoring newborns, and providing continued guidance throughout KMC. Kangaroo Mother Care education provides healthcare workers with knowledge and practical skills relating to the principles and benefits of KMC, eligibility criteria, skin-to-skin positioning, duration and continuity of KMC, breastfeeding support, thermal protection, newborn monitoring, infection prevention, identification of danger signs, parental counselling, documentation, and appropriate referral or escalation of care. Kangaroo Mother Care practices refer to the actions undertaken by healthcare workers in implementing and supporting KMC, including identifying eligible newborns, initiating and maintaining appropriate skin-to-skin contact, supporting breastfeeding, monitoring newborn condition, educating parents or caregivers, maintaining infection prevention measures, documenting KMC activities, and providing appropriate follow-up and referral. In Nigeria, inadequate KMC training, limited availability of dedicated KMC spaces, shortages of healthcare workers, high workloads, inadequate equipment, limited parental awareness, and inconsistent implementation of newborn care guidelines may affect KMC practices among healthcare workers. Effective KMC education may improve healthcare workers' knowledge, practical skills, confidence, and adherence to recommended KMC procedures. Against this background, this study investigates the impact of Kangaroo Mother Care education on Kangaroo Mother Care practices among healthcare workers in Nigeria. The study is anchored on Social Cognitive Theory, the Knowledge-Attitude-Practice framework, and Experiential Learning Theory. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, behavioural capabilities, social influences, and environmental conditions in shaping healthcare workers' clinical practices. The Knowledge-Attitude-Practice framework provides a basis for examining how improved knowledge and attitudes resulting from KMC education may influence KMC practices. Experiential Learning Theory emphasizes learning through practical experience, demonstration, reflection, and application, making it particularly relevant to skills-based KMC education. Collectively, these theoretical perspectives provide a suitable framework for explaining how KMC education may influence KMC practices among healthcare workers in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from healthcare workers providing maternal and newborn care in selected public and private healthcare facilities in Nigeria using a structured self-administered questionnaire, KMC knowledge assessment, and an observational KMC practices checklist. A multistage sampling technique will be employed to select states, local government areas, healthcare facilities, maternity or neonatal units, and eligible healthcare workers. Where feasible, selected healthcare facilities or healthcare worker groups will be assigned to intervention and comparison groups. Healthcare workers in the intervention group will receive structured KMC education covering the principles and benefits of KMC, identification of eligible preterm and low-birth-weight newborns, appropriate skin-to-skin positioning, duration and continuity of KMC, breastfeeding support, thermal protection, newborn monitoring, infection prevention, recognition of danger signs, parental counselling, documentation, and referral procedures. KMC practices will be assessed using indicators such as identification of eligible newborns, correct initiation and positioning of skin-to-skin contact, support for breastfeeding, monitoring of newborn condition, parental and caregiver education, infection prevention measures, documentation of KMC activities, and appropriate follow-up and referral. Direct observation will be prioritized where feasible to reduce reliance on self-reported practices. Descriptive statistics will be used to summarize healthcare workers' sociodemographic and professional characteristics, previous KMC training, KMC knowledge, exposure to education, and KMC practice scores. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of KMC education on KMC practices. Where appropriate, pre-intervention and post-intervention practice scores will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that KMC education has a significant positive impact on KMC practices among healthcare workers in Nigeria. Healthcare workers exposed to structured KMC education are expected to demonstrate improved knowledge and greater adherence to recommended KMC procedures. Education may improve identification of eligible newborns, initiation and maintenance of skin-to-skin contact, breastfeeding support, newborn monitoring, parental counselling, infection prevention, documentation, and appropriate referral practices. It may also improve healthcare workers' confidence in supporting parents and caregivers to participate actively in KMC. However, education alone may not guarantee sustained KMC practices because healthcare workers may continue to face barriers such as inadequate KMC spaces, insufficient staffing, high workloads, limited equipment, inadequate privacy, weak institutional support, and limited awareness among parents and caregivers. Consequently, KMC education is expected to be most effective when supported by dedicated KMC facilities, adequate staffing, appropriate newborn-care equipment, supportive supervision, regular refresher training, clear clinical guidelines, and active involvement of parents and caregivers. The study is expected to contribute to the literature on Kangaroo Mother Care, neonatal health, preterm and low-birth-weight newborn care, maternal and child health, healthcare worker education, newborn survival, clinical practice, and public health in Nigeria by providing empirical evidence on the impact of KMC education on KMC practices among healthcare workers. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nursing and Midwifery Council of Nigeria, state ministries of health, hospitals, neonatal units, maternity facilities, nursing and midwifery training institutions, maternal and newborn health programmes, professional associations, development partners, and policymakers regarding strategies for strengthening KMC implementation. The study will also provide evidence-based recommendations for integrating KMC education into healthcare worker training and continuing professional development, expanding dedicated KMC facilities, strengthening supportive supervision, improving availability of essential newborn-care resources, increasing parental involvement, and promoting effective KMC practices for preterm and low-birth-weight newborns in Nigeria.

Keywords: Kangaroo Mother Care education, Kangaroo Mother Care practices, healthcare workers, preterm newborns, low-birth-weight newborns, neonatal care, newborn health, maternal and child health, skin-to-skin care, breastfeeding support, healthcare worker education, neonatal health, public health, Nigeria.