Assessment of Early Kangaroo Mother Care Coverage and Associated Factors Among Low-Birth-Weight Neonates in Selected Hospitals in Northwest Ethiopia: A Multicenter Convergent Parallel Mixed-Method Study

Abstract

Background: In 2020, ∼13.4 million newborns were born preterm worldwide, with 65% occurring in sub-Saharan Africa and Southern Asia. In Ethiopia, fewer than 10% of eligible newborns received Kangaroo Mother Care (KMC) in 2021, despite WHO endorsement. This study evaluated effective early KMC (EeKMC) coverage and associated factors in northwest Ethiopia. Methods: A facility-based cross-sectional study with a convergent parallel mixed-methods design was conducted from October 2024 to November 2025. Quantitative data were extracted from existing hospital records (secondary data) for 713 low-birth-weight neonates (<2,000 g). EeKMC was defined as ≥8 hours of skin-to-skin contact combined with exclusive breastfeeding within 24 hours of birth. Qualitative data were collected through in-depth interviews ( n = 14) and observations to identify barriers and facilitators. Bivariate and multivariate logistic regression were used for quantitative analysis; thematic analysis was used for qualitative data. Results: Of the 713 newborns, only 4.6% (33/713; 95% confidence interval [CI]: 3.2–6.4%) received EeKMC, whereas 55.5% (396/713) were exclusively breastfed within 24 hours. Newborns in incubators were less likely to receive EeKMC (adjusted odds ratio = 0.07; 95% CI: 0.015–0.34). Barriers included inadequate infrastructure, skill gaps, and cultural norms, while facilitators involved quality improvement initiatives and maternal willingness. Conclusion: EeKMC coverage is critically low at 4.6%, with incubator use identified as a significant barrier. Qualitative findings revealed barriers, including inadequate infrastructure, skill gaps among health care workers, cultural norms, and maternal fears. The cross-sectional design limits causal interpretation of the identified associations. Comprehensive interventions addressing health care infrastructure, provider training, family engagement, and cultural acceptance are urgently needed.