KANGAROO MOTHER CARE TO PREVENT INFANT MORTALITY

低出生体重（LBW）使婴儿面临威胁生命的呼吸和胃肠道疾病的更大风险，这些疾病是婴儿早期死亡的主要原因。在发展中国家儿童存活率显著改善的同时，在降低婴儿死亡率方面取得的成功有限。袋鼠式母亲护理（KMC）方法，即在医院出生的稳定的低体重新生儿被放置在直立位置，24小时皮肤对皮肤接触母亲的乳房，已被证明可显著降低危及生命的发病率。然而，它从来没有被改编为以社区为基础的执行，在社区中，它可能被证明是非机构稳定和大大降低新生儿和婴儿死亡率的最佳手段。这在发展中国家至关重要，因为只有不到50%的妇女在卫生机构分娩。我们将使KMC适应社区应用，并对3200名婴儿进行随机对照群集试验，以确定其降低新生儿和婴儿死亡率的有效性。人口理事会将与孟加拉国农村发展委员会（BRAC）在孟加拉国开展这项研究，孟加拉国95%的新生儿在家中出生，全国50%的新生儿是低出生的，在锡尔赫特，低出生率和低出生率分别为13.8%和8.5%，是孟加拉国最高的。BRAC在Sylhet有一个广泛的社区发展项目，包括护士和社区工作人员，他们可以接受培训成为KMC讲师，并在该地区建立了一个持续的定期家庭数据收集系统。项目区护士将培训BRAC社区工作人员指导KMC实验研究区的乡村妇女。所有同意在项目第一年分娩的妇女都将被纳入研究。出生体重将在48小时内测量。受试者的特征信息将通过入组时的访谈获得，报告的发病率、母乳喂养、皮肤接触、新生儿和婴儿死亡率以及臂围测量将在每个婴儿一周岁之前每隔3个月收集一次。数据将直接记录在掌上电脑上，以加快数据处理、初步分析和一致性检查，以便在数据收集的同时立即解决问题。双变量比较和调整后的Cox比例风险分析将通过治疗意向和接收及KMC依从性进行。

Low birth weight (LBW) puts infants at greater risk of life-threatening respiratory and gastrointestinal conditions that account for much of the mortality in early infancy. Dramatic improvements in child survival in developing countries, there is limited success in reducing infant mortality. The Kangaroo Mother Care (KMC) method, whereby hospital-born stabilized LBW newborns are placed in an upright position in twenty-four hour skin-to-skin contract on the mother's breast has been shown to significantly reduce the incidence of life-threatening morbidity. Yet it has never been adapted for community-based implementation, where it could prove to be the best means of non-institutional stabilization and significantly reduce neonatal and infant mortality. This is critical in developing countries where fewer than 50% of women give birth in health facilities. We will adapt the KMC for community-based application and conduct a randomized controlled cluster trial of 3,200 infants to determine its effectiveness to reduce neonatal and infant mortality. The Population Council will conduct this study with the Bangladesh Rural Advancement Committee (BRAC) in Bangladesh where 95% of births occur at home and 50% of births nationally are LBW, in Sylhet where IMR and NMR are 13.8% and 8.5%, the highest in Bangladesh. BRAC has an extensive community development program in Sylhet, including nurses and community-based workers that can be trained to be KMC instructors, and has an ongoing periodic household data collection system in the area. Project area nurses will train BRAC community-based workers to instruct village women in the experimental study area in KMC. All consenting women expected to deliver within the first year of the project will be enrolled in the study. Birth weight will be measured within 48 hours. Information on subject characteristics will be obtained by interview at enrollment, and reported morbidity, breastfeeding, skin-to-skin contact, neonatal and infant mortality, and arm circumference measurement will be collected at 3- month intervals through each infants first birthday. Data will be directly recorded into handheld computers to speed data processing, preliminary analyses, and consistency checks for immediate resolution simultaneous to data collection. Bivariate comparisons and adjusted Cox proportional hazards analyses will be conducted by intent-to-treat and by receipt of and KMC compliance.