Study area and period
The study was conducted in Eastern and Central zone of Tigray Regional state, North Ethiopia. Tigray is bordered by Eritrea to the North, Sudan to the west, Afar Region to the east and Amhara Region to the south. According to the projected census of 2007, the Region had a total population of 4,806,843 of these; 2,441158 (50.8%) were women. In Eastern Zone, there were total population of 755,343, of these, 395,705 were women. In central Zone, there were total population of 1,245,824, of these, 632,027 were women. In the two zones, there are six general hospitals . The study was conducted from March –August/2019 among the selected health facilities.
Study design and population
A facility based cross sectional study was employed. The source population for this study was all mothers who gave birth in all general hospitals of eastern and central zone of Tigray Regional state. All selected mothers who gave birth in the selected hospitals were also the study population. The inclusion criteria was mothers having low birth weight (LBW) baby of less than six months of age attending post natal care (PNC) visit and those who were critically ill during the study period and babies born to mothers with medically known; diabetes, hypertension, and records of incomplete data were the exclusion criteria.
Sample size calculation and Sampling technique
Sample size was calculated using single population proportion formula, by considering the proportion of KMC practice, p= 41.9%__42%, 95% level of confidence and 5% margin of error. By adding 10% of none response rate, the final sample size needed for the study was 411. From a total of six hospitals providing delivery services in Eastern and central zone of Tigray regional state, four hospitals were selected using simple random sampling technique namely wukro, Adigrat, Adwa, and Abieadi. Based on the total number of newborn babies taken from the respective office of the delivery registration book records, the calculated sample size was proportionally allocated to the selected hospitals. Accordingly a total of 411 study participants were selected using simple random sampling technique.
The outcome variable for this study was Kangaroo mother care practice (Yes/No) and Socio-demographic and economic factors like mother’s age, educational status, religion, occupational status, marital status and residence and Obstetric health care related variables were the independent variables.
Data collection tools and procedures
The data were collected using interviewed administered questionnaire and document review. The administrated questionnaire had socio demographic and economic conditions, obstetric health care services and practice related variables. The questionnaire was adapted from reviewing different literatures and considering the local situation of the study subjects.
Data quality control
The principal investigator trained the data collectors and supervisors for two consecutive days on instruction for the method; how to take informed written consent, how to approach participants, ethical procedure, and general information on KMC practice and the objective of the study. Ten health care providers who took the training and two MPH students were assigned as data collectors and supervisors respectively to check for the daily activity, consistency and completeness of the questionnaire and to give appropriate support during the data collection process. The principal investigator was checked on daily activities of supervisors and data collectors. The questionnaire was translated in to local language Tigrigna and back translated in to English by translators who were blind to the original questionnaire. The questionnaire was pre-tested on 5% of the study population in the non-selected institution to ensure clarity, wordings, logical sequence and skip patterns of the questions. After data collection, data were stored in a secured place to maintain confidentiality and backup of the data were stored in different areas not to lose the data. Each questionnaire was coded, entered and cleaning separately before analysis.
Data processing and analysis
The collected data was coded, entered, cleaned and analyzed using SPSS version 20. Descriptive statistics was used to describe KMC practice among postnatal mothers who gave birth to low birth weight baby. Frequencies and percentages were used to present categorical data. To select the candidate variables, crude ORs and their 95% CI with the P<0.2 were estimated in the bivariate logistic regression analysis to include in the multivariable logistic regression model. After adjusted for confounders odds ratio with 95% confidence interval and p-value <0.05 were considered to declare statistically significant. Before inclusion of predictors to the final logistic regression model, the multicollinearity was checked using variance inflation factor (VIF) <10/Tolerance tests>0.1. The goodness of fit of the final logistic model was tested using Hosmer and lemeshow test at a value of >0.05.
Operational definitions: Kangaroo mother care (KMC) - Early, continuous and prolonged skin-to-skin contact between the mother and the baby with exclusive breastfeeding and proper follow-up’ and it is initiated in the hospital and can be continued at home after early discharge until at least the 40th weeks of postnatal period . Low birth weight baby: infants with birth weight lower than 2500g, regardless of gestational age. KMC practiced: those mothers who scored points above or equal to the mean of KMC practice related questions; unless we consider them they did not practiced .