Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia

Background: Each year, 2.3 million neonates die, with over one million of these deaths occurring within the first 24 hours of birth. Preterm birth is contributing to over 50% of all neonatal deaths. Initiating Kangaroo Mother Care (KMC) immediately after birth, rather than waiting for stabilization, can reduce neonatal mortality by 25%. However, in Ethiopia, as of 2021, only 5%-10% of eligible premature newborns received any form of KMC. If the utilization of effective KMC remains low, mortality rates among preterm and low birth weight (LBW) infants are likely to remain higher than optimal. Methods: A cross-sectional study design was conducted using existing data to determine effective early KMC (eKMC) coverage. A total of 599 eligible low-birth-weight newborns were included in the data analysis. Bivariate and multivariate logistic regression analyses were applied, with a significance level set at p < 0.05. Result: The study included 599 of 705 neonates with birth weight <2,000g born or referred to selected hospitals between March 2017 and March 2019, all alive and not referred out within 24 hours. Among these eligible neonates, only 8.9% received effective eKMC, 20.5% received early any skin-to-skin (STS) care, and 64.6% were exclusively breastfed. Caesarean section delivery was associated with lower odds of effective eKMC compared to vaginal delivery (AOR ‘adjusted odd ratio’ = 0.2; 95% CI: 0.05-0.89), with birth order, multiple births, gestational age at time of delivery, birth weight, delivery mode, household income, and religion adjusted. Infants with very low birth weight (VLBW) (<1,500g) had significantly lower odds of receiving effective eKMC compared to those with LBW (1,500-2,000 grams) (AOR=0.099 ;95% CI: 0.022-0.44), while infants born at nine months or later and single births were more likely to receive effective eKMC compared to premature and multiple births (twins or triplets), with (AOR = 3.35; 95% CI: 1.17-9.6) and (AOR = 4.4; 95% CI: 1.8-11.1), respectively. Conclusion: Our study found a low coverage of effective eKMC. Household income, mode of delivery, birth weight, gestational age at the time of delivery, and multiple births were significantly associated with uptake of effective eKMC.