Neonatal transport practices and feasibility of Kangaroo Mother Care transport in Ghana.

Background

Low- and middle-income countries (LMICs) carry a disproportionate burden of global neonatal health challenges, accounting for over 95% of low birth weight (LBW) neonates and 50-80% of neonatal deaths. Fragile health systems worsen this crisis, with shortages of ambulances and dedicated referral teams forcing vulnerable neonates into unsafe transfers, often worsening their condition before reaching specialised care. Kangaroo Mother Care (KMC) is an evidence-based, life-saving intervention defined by the World Health Organization (WHO) by its core components: early and prolonged skin-to-skin contact, exclusive breastfeeding, and a supported continuum of care from hospital initiation to post discharge follow-up. While KMC holds the potential to improve safety during neonatal transport, its application in this context is limited. This thesis advocates integrating KMC principles into existing neonatal transport protocols to reduce risks and lower mortality among high-risk neonates.

Aim

The primary objective of this thesis was to explore the feasibility of using KMC for neonatal transfer in a limited resource setting using available modes of transport.

Methods

Following a systematic literature review, a convergent parallel mixed-methods study was conducted. The quantitative component consisted of a non-randomised cluster feasibility study, comparing the inter-facility transfer of preterm/LBW infants using either KMC or conventional methods across eight peripheral units in Ghana to the Cape Coast Teaching Hospital. Concurrently, a qualitative component captured stakeholder perspectives via semi structured interviews with mothers and healthcare professionals. The two data sets were analysed separately and subsequently integrated through triangulation to form a cohesive narrative of the intervention's implementation.

Results

The systematic review identified systemic deficiencies—poor planning, resourcing, and coordination—in neonatal transport across Sub-Saharan Africa, noting a lack of studies on evidence-based, low-cost transport interventions. The quantitative findings demonstrated that KMC during transport is safe, with no adverse events, and potentially leads to improved neonatal arrival temperatures and reduced mortality upon discharge. Qualitatively, mothers highly accepted KMC transport, reporting empowerment and a stronger infant bond, despite some concerns about physical discomfort. The integration of both study phases revealed four critical themes for scaling: clinical benefits, social and cultural context, KMC as an empowerment intervention, and the necessity for education and awareness. In contrast, the conventional care cohort underscored persistent systemic transport inadequacies, advocating for enhanced ambulance availability, accompanied transfers, and improved communication to improve neonatal outcomes in Cape Coast.

Conclusion

KMC transport using available transport methods is feasible in Sub-Saharan Africa. Mothers and healthcare professionals largely supported the intervention. To advance large-scale research and implementation, a more inclusive strategy that educates mothers, healthcare professionals, and policymakers is essential.

Original contribution

This research contributes original knowledge by exploring the practicality of implementing an evidence-based, cost-effective intervention—specifically Kangaroo Mother Care—within the neonatal transport process in Sub-Saharan Africa. Additionally, a previously unreported study in this subregion confirms the intervention as both feasible and acceptable to mothers and healthcare professionals. Its feasibility is demonstrated through the utilisation of existing transport options, in the context of inadequate ambulances and the absence of specialised neonatal transport teams.