1. N. Charpak / Mantoa Mokhachane/….etc Please put your name
Training workshop
N. Charpak / Mantoa Mokhachane/….etc Please put your name

2. Participants
Colombia / USA / Canada / Finland / South Africa / Bhutan / Phillipines / Indonesia /Ghana / Algeria / France / Vietnam / Slovenia / Iran / Madagasgar
Paediatrician / neonatologist / doctor/ midwife / nurse / UNICEF / KMC trainers / university medical and nursing educators / advisor to MoH
Wide range of experience – mostly from teaching / tertiary hospitals
Most countries already performed KMC training and implemented KMC

3. Objectives Define levels of health care
What Knowledge on KMC is needed for each level
Indicators for effective KMC training
Training for KMC for transfer
Training the mothers on how to practise KMC antenatally and after delivery
Description of the content of KMC training at 3, 2 and 1 level is not included in this presentation

4. Level 1 health care Definition:
Community level births at home +/- community worker
Community health centre
primary health centre
People to be trained:
TBA’s, Mothers, CHW, public health nurses, some doctor and nurse in primary health centre

5. Mother KMC training for the mother and a family member include:
How to practise KMC
The value of KMC emphasized
Show them how to help the baby breathe
Alarm signs in KMC position

6. KMC training of the TBA (part of level 1) should include the following
Identify pregnant women in the community and refer
How to identify risk
In the pregnant women
In the infant
Opportunity to integrate Essential Newborn Care in the training
resuscitation (Helping babies breath)
Immediate thermal control - good drying, hat, immediate Kangaroo position
Recognition of a small baby
Weighing the baby
Feeding the baby
Transferring the baby to the nearest health care centre
In KMC position
Follow-up of mother and baby in the community if not transferred

7. KMC training to health workers at this Level 1 must include:
Identify pregnant / labouring woman having a risk of premature delivery
refer the mother before the baby is born ( in utero transfer)
Opportunity to integrate Essential Newborn Care in the training
resuscitation (Helping babies breath)
Immediate thermal control - good drying, hat, immediate Kangaroo position
Recognition of a small baby
Assessment of gestational age
Kangaroo mother care - put baby in a good position, secure well with wrapper, insulate
Early feeding to prevent hypoglycaemia - teach mother to express colostrum, try baby at breast, spoon or syringe feeding with expressed colostrum, milk, donor milk, sugar water,
Recognition of instability / warning signs of severe illness
Referral to the nearest level of care with health worker, in the case of community delivery or level 2 of care
Transport with mother in kangaroo position. If the mother cannot carry the baby, the father or other member of the family can carry the baby

8. Ideas of Indicators for effective KMC training at level 1
Mortality (including cause of death)
Number of baby’s referred in KMC position
Number of baby’s who arrive at referral centre with hypothermia
Number of baby’s who arrive at referral centre with hypoglycaemia
How many arrive at the referral centre with the mother
How long was the baby and mother separated
Number of baby's receiving breastfeeding within 1hr after birth
Rates of breastfeeding at 6 weeks
Rates of breastfeeding at 3 months

9. Discussion points
Insulation against babys’ back – placenta (USA), blankets, plastic bag
Most appropriate initial fluid to give baby – colostrum/donor milk/sugar solution (5%/10%)
How to give initial fluid – spoon, syringe
Need for mother to be transported with baby and challenges of achieving this in some settings.
Emphasis on keeping mother with baby at all possible.

10. KMC training at Level 2 care
Defined: District hospital, provincial, regional with or without NNU
Doctors (general, paediatric, neonatal), midwives, obstetrician

11. Level 2 KMC training All training for level 1
Assessment of gestational age  for all health care workers. Use of a simple tool as the Usher(??) tool to evaluate gestational age
Full KMC training if setting not able to take care of complications of prematurity ( jaundice, sepsis, respiratory distress, extreme prematurity)
Initial management of immediate complication of prematurity
Warning signs for illness / deterioration
Referral if unstable
Implementation of a KMC Follow up or refer for appropriate for follow-up (ophthalmology, neuro etc)

12. Ideas of Indicators for effective training at level 2
Mortality (including cause of death)
Length of stay of preterm babies
Breast feeding rates (number of babies exclusive breast feeding)
Dose of KMC (number of hours/number of days)
Infection rates during admission
Hypothermia rates at referral hospital
Follow up – referral rates

13. Discussion points Transport Jaundice treatment availability
Father can be used to transport baby in kangaroo position especially if the mother delivered by Caesarean section
Jaundice treatment availability
If available KMC baby is not referred
Accurate assessment of gestational age is important (different outcomes/management). Simplified tool like USHER can be used.

14. KMC training at Level 3 Defined – teaching / University hospital
Neonatal intensive care / Neonatal units
CPAP – advanced ventilation

15. KMC training for level 3 workers
Full KMC : Kangaroo position, Kangaroo nutrition, KMC discharge policies with follow up
Start in delivery room/ ICU
What physiological changes to expect with KMC
How to transfer a critically ill baby from an incubator into KMC position
Written protocol
video
Which babies can be transferred back to 2nd level care after 40 weeks for high risk follow up
KMC Follow-up and KMC data collection

16. Ideas of indicators for effective training level 3
Mortality in the unit and in the KMC ward and in the follow up
How many babies arrive referred in KMC position
Hypothermia rates at admission
Breastfeeding
How many babies put to breast within 1 hr
Breastfeeding rates at discharge, 3 months, 6 months and 12 months corrected age
Infection rates during hospital stay
Duration of hospital stay and number of readmission
Pattern of alimentation during hospital stay and at discharge and during the follow up

17. Discussion points
Think about where mother will stay to continue KMC (shelters/KMC ward) before eventual transfer to level 2
Important to teach medical students / paediatric trainees / nutritional students / nursing students / midwife students
Good relationship with university and Health Ministry