In Malawi, 120,000 babies are born preterm (less than 37 weeks of gestation) each year, and over 5,000 children under 5 die due to direct preterm complications. Malawi has the highest rate of preterm birth in the world. In addition to these babies who are born too soon, 14% of babies are born too small – less than 2,500 grams. Babies born too early or too small are at particular risk for death or life-altering complications due to the fragile nature of their tiny bodies.

Fortunately, many of these babies can survive with basic warmth and feeding support. Malawi has been implementing Kangaroo Mother Care (KMC) for almost 20 years. KMC ensures continuous skin-to-skin contact with babies and facilitates breastfeeding and because these fragile newborns are kept close to their mothers or other family caretakers, they are also protected from life-threatening infections. The Ministry of Health (MOH) developed KMC guidelines in 2005, is implementing KMC in health centers, and has included KMC in pre-service education for medical and nursing students. Despite the MOH’s clear commitment, however, there are gaps in the quality of care provided to early and small babies in Malawi.

A woman holding her baby skin-to-skin in the KMC unit at Balaka District Hospital.
Photo by Judith Robb-McCord

To address these gaps, Every Preemie—SCALE, a USAID-funded project, worked with the Balaka District Health Office to develop the Family-Led Care model to improve the quality of KMC provided to inpatient early and small babies and to empower mothers and other family caretakers to actively care for their newborns both in the facility and once home post-discharge. The model is also designed to strengthen post-discharge follow-up care by ensuring that community-based health workers are checking on babies once they go home and encouraging families to take their babies to the health facility for important follow up care. Implementation of the model began in April 2017.

To measure the effect of the model, Every Preemie is supporting implementation research in Balaka district in collaboration with local partners: the University of Malawi, College of Medicine; and MaiKhanda Trust. This research will assess whether the model has achieved its expected outcomes including improved survival of newborns who are receiving KMC. The University of Malawi, College of Medicine is implementing a health care provider study which will measure health care providers’ competencies, attitudes, perceptions and practices as related to their experience implementing the Family-Led Care model. Concurrently, MaiKhanda Trust is implementing a caregiver study to measure parent and family knowledge, attitudes and care practices for early and small newborns based on the counseling and support they received while practicing KMC in targeted health facilities. Data collection is now underway for both studies. The results of these two studies, combined with ongoing data collection from MOH records at health facilities, will demonstrate the effect of the Family-Led Care model on quality of KMC in facilities, follow-up care, and family confidence in caring for their babies.

Irene Kamanga, Every Preemie’s Malawi Technical Advisor, stated, “through the Family-Led Care model, families take part in caring for their babies while in the hospital, making it easier for them to continue care at home – a potentially lifesaving difference.” If the implementation research indicates that Family-Led Care is a successful model for addressing the needs of early and small babies in Balaka district, it is poised for scale-up to the rest of the country.