THE KANGAROO MOTHER CARE (KMC)

ACCELERATION TO REDUCE NEONATAL

MORTALITY: A GLOBAL, NATIONAL &
RESEARCH NEED PERSPECTIVES
Hadi Pratomo
Faculty of Public Health, Univ Indonesia

Presentation at the Asia Pacific Conference for Public Health,

Bandung, West Java, October 21 2015.
This material was modified for the General Lecture on Current
MCH Issues ,FPH Unair, September 29, 2016
 Introduction:
Where are we now?
1. Understanding the problem (Global,
national):
• Where? When? Why? What can be done?
Where do we go from here?
2. Finding the solutions: What interventions
work and what effect (evidence-based
interventions) ? What are the lessons
learned? Review of past studies and what
kind of research issues faced to day
relevant to newborn health (global and
national)? 2
 Basic terms:
Stillbirth :death of a fetoes (<500 gr) before
complete expulsion
Perinatal death: death during 1st week of life
Neonatal death: death of a live-born infant from birth-28 days (early
and late neonatal death)
Infant death : death of infant < 1 yr
Under 5 death : death of chld < 5 yrs

Two-thirds formula Infant mortality:

• 2/3 of infant death: 1st month of life
• 2/3 of died in 1st month: 1st week of life
• 2/3 of those died in 1st week: 1 st in 24 hrs
of life
3
 Why?
Causes of 4 million newborn deaths – mostly
due to preventable conditions

Indirect effects
of preterm &
small for
gestational age?

4
Source: Lawn JE, Cousens SN, Zupan J Lancet 2005. based on cause specific mortality data and estimates for 192 countries
 What do children die of today?

– Most deaths are due to a handful of conditions.

– Causes vary among regions.
– Effective, affordable interventions: available, but coverage too
low.
– Need to move towards universal access to meet SDGs.

5
 When do 4 million newborn deaths occur?
Up to 50%
of neonatal
deaths are in
the first 24 hours

75% of neonatal
deaths are in
the first week –
3 million deaths

6
Source: Lawn JE et al Lancet 2005, Based on analysis of 47 DHS datasets (1995-2003), 10,048 neonatal deaths)
1

There is a critical need to address newborn and preterm births

Neonatal mortality is not dropping as fast as

under‐five mortality 2010 Childhood Mortality
40%
40% NNeonatal
t l PPeriod
i d
Mortality per 1,000 live births
Preterm is the #1 cause of neonatal mortality
100
Under 5 Mortality Neonatal Mortality
(100% of Childhood Deaths) (40% of Childhood Deaths)
75
Pneumonia

Meningitis 14 14%
50
2
Malaria 7 40 Neonatal
25 MDG 4 target 9%

18
Other
0 conditions 2 11% Injuries Diarrhea
2000 HIV/AIDS 6% 1 10
Year 1990 1995 2005 Measles
2009 2015
Under-5 mortality rate (UN)
Neonatal mortality rate (UN) 2011
Under
Preterm

Average annual
Under‐five rate
mortality of reduction
rate 1990–2010
2.2% 2000–2010
2.5%
Infection
Children 1–59
Intrapartum
months mortality rate 12.5% 2.9% Neonatal mortality rate
Other
1.8% 59 2.1%
th t lit t 2 9%
Source: UNData UN Population Division; Born Too Soon Report (2012); Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes, "Preterm Birth: Causes,
Consequences, and Prevention" National Academies Press, 2007.

© 2012 Bill & Melinda Gates Foundation | 6

1

There are 1.1 million preterm deaths each year

> 125 deaths per hour

C i l liliner crashing
= Commercial hi every 33 hhours

© 2012 Bill & Melinda Gates Foundation | 77

9
10
 Estimated causes of newborn
deaths in Indonesia
Tetanus
Congenital 1% Diarrhoea
7% 1%
Other
9% Infection
20%
Low
birth
weight
rate 9%
Asphyxia
30%

Preterm
32%

Source: Lawn JE, Cousens SN, Zupan J IJE 2006, based on cause specific mortality data and estimates for 192 countries
 Proporsi Penyebab Kematian Neonatal
Post matur Kel kongenital
3% 1%
Kelainan
darah/ikterus
6%

Hipotermi SIDS
Defisiensi nutrisi
3%
7% 3%
Gangg pernapasan Tetanus
3%
37% Sepsis, 20.5%
Cedera lahir
3%
Kuning
3%

Sepsis
12% Prematuritas
14%

Kel kongenital
19%

Prematuritas RDS
14%
34%

Pneumonia

0 – 6 hari
17%

7 – 28 hari
12
RISKESDAS, 2007
 Proporsi Penyebab Kematian

Lain-lain
(Malnutrisi,
TB, Cam pak)
Tetanus
5% Lain-lain (TB,
3%
Sepsis Malaria,
Kel Jantung
4% Leukemia), 9.7
kongenital &
hidrosefalus
6% Tenggelam, 4.9 Diare, 25.2
Diare
Kel Sal
42%
pencernaan
7% Campak, 5.8

Meningitis/en
sefalitis DBD, 6.8
9%

Meningitis/ense Pneumonia,
falitis, 8.8 15.5
Pneum onia NEC, 10.7
24%

29 hari – 11 bulan 1-4 tahun

RISKESDAS, 2007
13
 Integrated packages to reduce newborn deaths
Skilled obstetric and immediate newborn care
(hygiene, warmth, breastfeeding) & resuscitation
Clinical
Emergency newborn care for illness,
especially sepsis management and
care of very low birth weight babies

Emergency obstetric care to manage complications including Kangaroo Mother Care

care

such as obstructed labour and hemorrhage

Antibiotics for preterm rupture of membranes#

Corticosteroids for preterm labour#

Folic Antenatal
Focused 4-visit antenatal Intrapartum Postnatal
Postnatal
care to support healthy
acid # package including practices
• tetanus immunisation,
• detection & management of
Outreach

Family
services

Early detection and referral of

Plann- 8%
syphilis, other infections,
27 % 29 %
complications
10 - 30%
• pre-eclampsia, etc
ing NMR
(6 –therapy*
presumptive 9%)
Malaria intermittent
(18 – 35%) (17 – 39%) reduction
reduction
Detection and treatment
of bacteriuria#
reduction reduction
of NMR of NMR of NMR
Counseling and preparation Clean delivery by Healthy home care including
for newborn care and traditional birth breastfeeding promotion, hygienic
community

breastfeeding, emergency attendant (if no skilled cord/skin care, thermal care, promoting
Family-

preparedness attendant is available) demand for quality care 15 - 32%

Simple early Extra care of low birth weight babies
NMR
newborn care reduction
Case management for pneumonia

Pre- pregnancy Pregnancy Neonatal period 14Infancy

Birth
# For health systems with higher coverage and capacity
 KMC Definition:
• A universally available and
biologically sound method of care
for all newborns but in particular
for premature babies with 3
components:
• Skin-to-skin contact,
• Exclusive breastfeeding, and
• Support to mother-infant dyad
Http://www/kangaroomothercare.
com/whatis01.htm
 DAMPAK TERHADAP KEMATIAN BAYI BARU LAHIR
Pediatrics, Maret 2006 (Edmond et al.)

Inisiasi dini pemberian ASI dalam 1 jam setelah

kelahiran
dapat mengurangi kematian BBL sebesar 22%!
Why are we making a case for acceleration of KMC?
Over the past year, it has become increasingly evident that KMC implementation is
something that needs to be explored and acted upon

1 Newborn health is a major global health issue – "Born Too Soon" highlighted need
to specifically address preterm mortality

2 KMC iis a critical

i i l iintervention
i that
h can help
h l address
dd this
hi iissue

3 Although universal coverage of KMC could avert ~450,000 deaths / year, there has
been very little work on KMC coverage or indicators at the national level

The case for acceleration is clear: we are here together to

examine the options and align on the principles to move forward

© 2012 Bill & Melinda Gates Foundation | 4

 1

KMC has to be part of an integrated solution to MNCH

Every Newborn working across
Many key stakeholders and projects working to improve 9 newborn health
maternal and newborn health interventions, including KMC

Policymakers / Ministry of Health

(KMC policies)
 Management of PTB
Professional  Skilled care at birth
assoc'ns/ key Community
opinion
 Basic emergency obstetric care
leaders
 Comprehensive emergency
Mother / infant obstetric care
Secondary / dyad
Family and very  Basic newborn care
tertiary health
close friends  Neonatal resuscitation
personnel  Kangaroo Mother Care
 Treatment of severe infections
Implementing  Inpatient supportive care for
Primary health care
Researchers partners (e.g. sick / small newborns
personnel
NGO's)

Source: www.everynewborn.org

© 2012 Bill & Melinda Gates Foundation | 5

-GAPS AND POTENTIAL
BREAKTHROUGH ON KMC RESEARCH

October 21 & 22
3

KMC could avert ~450,000 deaths / year if near‐universal

coverage achieved
achieved, but several challenges to achieving this goal
Potential deaths averted by KMC in 75 Countdown to 2015 priority countries

Potential 500
deaths averted (K)
400

300

200
450

100

PT infants with PT infants born Infants born Total access to KMC

in facilities outside of
without access facilities
to KMC
Source: Born Too Soon Report; LiST tool; BCG analsyis
Note: Assumes 95% coverage of KMC by 2015.
© 2012 Bill & Melinda Gates Foundation | 10
 KMC and morbidity outcomes
(KF document that can be downloaded for free)
• Evidence-based statements have been formulated and
consensus
has been achieved for
– KMC and Thermal regulation: (+++) 4 RCT,1Cross Over Study,6 PrePostest (PPT),1Observational Study

– KMC and Physiological stability: (+++) after stability 3Cross Over Study,1PPT,1Observational Study (FC, FR, Apneas) , 2 RCT (-) before stability

– KMC and Apnea: Analogy (++)

5RCT,5PPT,3Observational Study,

– KMC and Gastro-esophageal reflux: Analogy (++) 3Cross Over Study,1PPT,1Observational Study,

– KMC and Bonding and attachment and neurodevelopment: 7 RCT,3PPT,1Observational Study, 1 Historical Study,1Case Control Study, (+++)

– KMC and neonatal transport: (+), Experts' opinion 1Observational Study,

– KMC and pain control: (++) 1Cross Over Study, 2 PTP,

– KMC and growth: (+) Head Circumference

6RCT

– KMC and the dying infant: (+), Experts' opinion No evidences,

– KMC and successful breastfeeding (++) 6 RCT,

– KMC and early discharge 2 RCT, (++)

– KMC and empowerment of the family

– KMC and staff and parents satisfaction
– KMC and cost utility of the KMC intervention maturation ex
– KMC and utero of the brain

21
 Our task is not impossible...

...but achieving meaningful scale in KMC implementation

willillbe
b difficult.
diffi lt

Let's use this convening to

decide on how the synergies
across all of our work will help us accelerate effective implementation at scale.

© 2012 Bill & Melinda Gates Foundation | 16

It will take all of us to accelerate implementation of KMC

Programming

Research
Mothers

P li
Policy KMC implementation

Evaluation

Funding

Advocacy

Critical to integrate perspectives – while recognizing differing views – so KMC implementation

can take off within Every Newborn and country newborn efforts
© 2012 Bill & Melinda Gates Foundation | 19
 KMC is not the only public health intervention to have slow
uptake
uptake, but it is time to "bend the curve" for KMC
% coverage of health intervention in low and middle income countries

Coverage (%)
75 Skilled birth attendance‐
HepB Vaccine –
measured starting from
starting from NNRTI ARV's – measured measured
Safe Motherhood
approval in 1981
Initiativefrom
starting in 19871
ORS – measured starting
approval in 19973
50 from Bangladesh rollout
in 19802
Exclusive breastfeeding
– measured starting
from Baby‐Friendly
25 Hospital Initiative in
19921

KMC (illustrative) –
Originally introduced in
Colombia in 1978
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Years from availability of intervention

I Introduction
t d ti fof
intervention

1. Skilled birth attendance and breastfeeding are ancient intervention. Introduction of SBA is measured from 1987, when the Safe Motherhood Initiative was launched. Exclusive breastfeeding measured from 1992, when Baby-
Friendly Hospital Initiative was launched. 2. Average of 49 countries reporting ORS rates 1999-2005, weighted by population under 15 years old 4. NRTIs were first approved in 1987. NNRTIs were approved in 1997 while PIs were
approved in 1995. © 2012 Bill & Melinda Gates Foundation | 14
Source: WHO/UNICEF; World Bank; Mahy et al., 2010); BCG analysis
 Declaration of Istanbul on Kangaroo Mother Care
(KMC), 2014

On Oct 21–22, 2013, stakeholders in newborn health convened in Istanbul, Turkey, to

discuss how to accelerate the implementation of kangaroo mother care (KMC)
globally. Focused attention on newborn deaths, which now account for 44% of under-
5 mortality, is required to accelerate progress towards Millennium Development Goal
(to reduce child mortality by two-thirds) and beyond. KMC has been proven to reduce
newborn mortality, but only a very small proportion of newborns who could benefit
from KMC receive it. The Istanbul convening was assembled to accelerate the uptake
of this life-saving intervention.

Reported in The Lancet

Global Convene for Acceleration of
the KMC to reduce NMR,
Istanbul, 20-23 Oct 2014
 Key Challenges
 Ensuring continuous KMC is practiced and babies
fed adequately in health facilities with trained staff
 Utilization of data for quality of care improvement
 Providing support for continuous KMC to be
practice at home after discharge
 Reducing the high post-charge dropout rate
 Getting MOH to budget to expand KMC services

Getting MOH to budget to expand KMC

 Key Lessons Learned
 Most countries have had some limited experience with
KMC – it is important to build on that experience
 Most Pediatricians and MOH officials are supportive of
scaling-up KMC services
 Integration of KMC into other existing training materials
must ensure acquisition of KMC competencies are not
compromised
KMC service establishment is more than
policies an58d training
 FUTURE RESEARCH

■ Use of early onset continuous KMC in unstabilized

or relatively stabilized LBW infants in low-income
settings

■ Report of long term neurodevelopmental outcomes

■ Cost-effectiveness studies

■ RCTs of community-based KMC

■ RCTs that evaluate the use of continuous or

intermittent KMC in high-income settings
 FUTURE RESEARCH

■ Changing norms caring the newborn, universal skin to skin

contact for all newborn

■ Communication aspect of the Kangaroo Mother Care (health

provider/ professionals- health providers; health providers –
mothers and family; mothers or families with other mothers
and families; community leaders – mothers and husbands and
families)
 Scale-up project in 13 hospitals in
three provinces on the island of Java
• 2 teaching hospitals
• 5 regional / district hospitals
• 1 mother and child hospital
• 1 maternity hospital
• 4 district hospitals
 Progress in implementation
100
95 6. Sustainable
Training
90 practice (15)
85 ●
centres
● 5. Evidence of routine &
80
75
70
● ● integration (20)

● ●●● 4. Evidence of practice (20)

65
60

●
55
50
45
40 Hospital not
35 implementing 3. Taking ownership (25)
30
25
●
20
15 2. Adopting the concept (8)
10
5 1. Creating awareness (12)
0
 “Istilah” KMC (Semantik) utk
KOMUNIKASI LOKAL:

1. Bedako (OKU, Sumsel)

2. Kadukui-Bugis), Makaleppe-Makassar
(Maros, Sulsel)
3. Perawatan Bayi Tegak, Perawatan Bayi
Tempel (Kendal), Kekepan (Garut)
4. Metoda Kussu (Kuskus), Maluku Tengah
Di daerah anda?
 BARRIERS
Needs strong commitment of relevant
stakeholders
• Revisit of clients (transport, economic
reason, distance etc)
• It is a change process and needs time
and Continuous Monitoring & Evaluation
• Requires policy advocacy to relevant
stakeholders
 Progress To Date
• KMC could be implemented in the hospitals
• Initiated an integration of KMC in the selected
teaching/ district hospitals
• Trained technical and management of hospital as a
team
• Built hospital as a model of KMC services prior to
the community
 Development of A Referral System
Using Kangaroo Mother Care
(KMC) Intervention for Low Birth
Weight (LBW) Babies

Fakultas Kesehatan Masyarakat, Universitas Indonesia

PEER Project – USAID
 List of team member

1. Prof. dr Hadi Pratomo, MPH Dr PH (Peneliti

Utama)
2. Dr Asri Adisasmita, M Phil, Ph D (Co-PU)
3. Yulia Izati, SKM, Mkes
4. dr. Fransiska E. Mardiananingsih, MPH
5. Farahdibha Tenrilemba, Mkes
6. Tiara Amelia, SKM, MKes
7. Septyana Choirunisa, SKM
 TIM AHLI DAN KONSULTAN

• Prof dr Rulina Suradi, Sp A (K), IBCLC, Jkt

• Dr dr Rinawati Rohsiswatmo, Sp A (K), Jkt
• dr Ekawaty L. Haksari, Sp A (K), MPH, IBCLC, Yogya
• Prof dr Dadang Syarif, Sp A (K), Ph D, Bandung
• dr Setyadewi Lusyati, Sp A (K), Ph D, Jkt
• Dr dr Risa Etika, Sp A (K), Srby
 Latar Belakang PENELITIAN

• Sistem rujukan kesehatan telah

dikembangkan oleh Kemenkes
• Implementasi layanan rujukan kesehatan ini
belum melibatkan BBLR.
• Koordinasi dan tindak lanjut dari layanan
rujukan setelah keluar dari rumah sakit
sangat lemah
• Terdapat kesempatan untuk merevisi dan
memperkuat sistem kesehatan rujukan
termasuk BBLR, melalui kebijakan pelayanan
universal saat ini (BPJS)
 Tujuan Umum

• Untuk membandingkan kualitas pelaksanaan

PMK pada bayi dengan berat lahir rendah
sebelum dan sesudah intervensi
• Untuk membandingkan outcomes dari
pelaksanaan PMK sebelum dan sesudah
intervensi
• Untuk mengembangkan dan menilai
pelaksanaan rujukan dengan menggunakan
metode PMK pada bayi dengan berat lahir
rendah yang dilahirkan di Rumah Sakit dan
pulang ke rumah.
 Tujuan Khusus
• Luaran utama (primary outcome) dari penelitian ini yang akan diperoleh
dengan membandingkan sebelum dan sesudah intervensi yaitu dengan
menilai peningkatan kualitas outcome dari bayi BBLSR:
– Peningkatan berat badan rata-rata per hari atau pada saat keluar RS
– Peningkatan proporsi bayi yang mengalami kenaikan berat badan 15 gram /
hari
– Penurunan rata-rata lama tinggal di rumah sakit
– Proporsi yang mencapai termostabilitas (tidak hipotermi dalam 3 hari)
– Sudah dapat menghisap ASI (pengukuran outcome memerlukan expert
judgement)
• Peningkatan tingkat kelangsungan hidup BBLR dan BBLSR
• Penurunan tingkat morbiditas secara keseluruhan, BBLR & BBLSR
• Penurunan case fatality rate (CFR) (penurunan % penyebab spesifik
kematian), misalnya akibat pneumonia, kejang, apnea
 Year-1 Year-2 Year-3

FORMAT INTERVENTION
SITE BASELINE IMPLEMENTATION
IVE 3 bln ENDLINE FINAL
SELECT ASSESSM 7 bln & FOLLOW
RESEARC Pendampingan ASSESSMENTS
ION ENTS UP RESULTS
H 1 bln

Recruitment of sample Recruitment of sample

6 months retrospective + 6 months prospective

Situational Analysis Quantitative Study with study  Implementation study Quantitative study with study
population: with study population: population:
Qualitative study 220 Infants with birth-weight  70 Infants with  220 Infants with birth-weight
with respondents: >1,200 and < 2,200 gram who birth-weight >1,200 and < 2,200 gram who
 DHO were born in hospitals within >1,250 and < were born in the hospitals after
 Hospital 6 months prior to 2,000 gram who completion of PMK and PMK
management commencement of baseline were born in the Referral Training for hospitals
 Pediatrician, data collection hospitals will be and 1st level health providers.
midwives and follow-up at Qualitative study
nurses at Hospital data on : home maximum 2 Knowledge, Attitude, and Practice on
hospitals Number of staff trained and months or KMC
 GPs, midwives oriented on PMK services graduate with respondents:
and nurses at Supplies an dequipment for  Pediatrician, midwives and
1st level health caring LBWI and PMK services nurses at hospitals
facilities  GPs, midwives and nurses at 1st
Quantative and Quali level health facilities and
(Baseline) community level
Knowledge, Attitude, and
Practice on KMC
1. Formative Research

ACTIVITY PICTURES

Home visit to one of LBW newly discharged from Koja Hospital

 Pendekatan SIKLUS HIDUP
Intervensi Intervensi
pada masa kehamilan, Perawatan bayi baru lahi
persalinan,
kelahiran bayi
dan setelah lahir

Kesehatan bayi dan ana

&
Perkembangan

Kesehatan Reproduksi

Yankes remaja

Dukungan nutrisi
Strategi mengurangi
kemiskinan
Kesehatan lingkungan
Dukungan sosial
44
 Newborn Health Program for Indonesia
MOH (Eradication of Advocacy
(Pratomo and Taylor, 2005)
Communicable Diseases,
Medical Services, Health
Research & Development,
Activities RESULTS
Health Promotion,
Community Health) Coordination, Networking
Donor
NATIONAL
Technical Agencies
Policies, Resources,  Clean cord care by the
NGOs Supporting Leadership family
Ministry of Women Emp. replication Advocacy
Professional Organization
Parliament  skilled attendance
Internal Affairs Dept. PROVINCE at birth
Family Planning Board Strategy and Policy Technical Input,
Family Welfare Resources, Policy, Exclusive Breast Feeding
Implementer Systems Advocacy, Facilitating
Organization
Journalist Strengthe
Technical s ning  utilization of health
Support Dis. Health Off. (Training, facilities for 4 ANC visits
DISTRICT
Local Gov. Supervisio Effective Services, Systems
(District Dev.
n, and Advocacy  recognition,
Monitoring & Board, BPM, rapid referral of
Community Monitorin

↓Neonatal Mortality
Evaluation g, Etc danger signs in
Welfare, Fam. HEALTH FACILITIES
Planning PHC, Integrated Post mothers and
Advocacy Board, (Posyandu), Midwives newborns
 neonatal tetanus
Religions Dept.)
Hospitals
Management of infection in
P2KP Community
Com. Org. mother and child
Supporting Mobilization COMMUNITY
(Family Prevention and
replication Enabling Environment
Welfare Org., management of
among
BKMRF, MUI,
Technical districts birth asphyxia
Fathayat)
Input Village FAMILY
Midwives Support  death and squel from
UNIVERSITY Technical
Midwives Ass., asphyxia
Propinsi support
Physicians Ass.,
(guidelines,
Pediatricians  LBW (low birth weight)
etc.) Services and
Resources Ass., Obgyn
Ass. Counseling Mother and
 Quality postnatal visit
PHC Child within 7 days
Faculty Providing  management of LBW
resources Healthy
Advocacy & Behaviors Preventing and managing
Research hypothermia

Monitoring &
Evaluation

45
 PMK INTERMITEN

PMK dimulai sejak bayi masih Ibu dapat duduk atau berdiri.
dirawat di unit Neonatal Tidak ada tempat tidur untuk ibu
PMK terus menerus (continue)
PBL/KMC di pelayanan Tk II
RSUP Dr Sardjito
Ruang KMC/Ibu
KMC/ Perawatan bayi lekat RSUP Sardjito 2005
SOCIALIZATION KMC AMONG TBA
 COMMUNITY LEVEL

PREGNANT MOTHER
CLASS

MATERIAL:
•MATERNAL NUTRITION
•MATERNAL EXCERCISES
•PREGNANCY CARE
•SIGN OF IMPENDING
DELIVERY AND HIGH RISK
PREGNANCY
•KMC
 … RSUD Dr. SOETOMO SURABAYA

• Div Neonatologi : 6 Staf (1 guru besar, 3 konsultan, 2 Sp.A)

12 PPDS
69 Paramedis (untuk 5 ruang perawatan)

• Ruang Perawatan Neonatal :

• Ruang Rawat Gabung ( RB I , RB II & ROI Neo IRD )
• Ruang Intermediate
• Ruang NICU ( ROI Neo IRD dan GBPT )

53
“JEJARING” PENELITIAN PMK DI
TINGKAT GLOBAL (1)
Kerjasama dan networking para peneliti
terkait PMK di 30-35 negara, pertemuan
reguler 2 tahunan.
1. First International Workshop on KMC,
Trietze, Italy, 1996.

2. Second International Workshop on

KMC, Bogota, Kolombia, 1998 (alm Prof
A. Suryono, Sp A (K); alm dr Siti
Dhyanti, Sp OG dan Prof dr Hadi
Pratomo, MPH, Dr PH)
“JEJARING” PENELITIAN PMK DI
TINGKAT GLOBAL (2)

3. 3.3. Third International Workshop on KMC,

Yogyakarta, Indonesia, 2000. Sesudah
KONAS Perinasia di SEMARANG (Alm
Prof Achmad Suryono)
Keterlibatan banyak Center dari UKK
Perinatologi

4. Fourth International Workshop on KMC,

Capetown, South Africa, 2002.
“JEJARING” PENELITIAN PMK DI
TINGKAT GLOBAL (3)

5. Fifths International Workshop on KMC,

Rio de Janeiro, Brazilia, 2004.

6. Sixth International Workshop on KMC,

Cincinati, Ohio, USA, 2006.

7. Seventh International Workshop on KMC,

Upsalla, Swedia, 8-11 Oktober, 2008.
Tema: KMC in Hi Tech Setting (NICU)
“JEJARING” PENELITIAN PMK DI
TINGKAT GLOBAL (4)
8. 8. 88, The 8th KMC Conference Theme:
KMC in Hi Tech Setting (NICU)
Quebec, Canada, 2010
9. The 9th KMC Internatl Conference,
Ahmedabad, Mumbai, India, 2012
10. The 10th Internatl Conference KMC,
Kigali, Rwanda, Africa
11. The 11 th Internatl Conference KMC,
Trieste, Italy, 14-17 November 2016
“JEJARING” PENELITIAN PMK DI
TINGKAT GLOBAL (6)
WEBBSITE terkait KMC:
Kangaroo.javeriana.edu.co (Canguro
Foundation, Bogota, Kolombia)
WWW.kangaroomothercare.com (Nils
Bergmann, Afrika Selatan)
www.akademikonferens.uu.se/kmceurope08
(Upsalla, Swedia)
www.pepcourse.co.za/background.html
(Capetown, South Africa)
www. Perinasia.com
RESEARCH OPPORTUNITY
(Future challenges)
• Development of a hospital-household continuum of KMC
(network development of urban hospitals and Public Health
Centers and community workers)
• Development model of both teaching and district hospitals
integrating KMC
• Dissemination of information of newborn care including KMC
to the public
• Integrating of KMC into pre service training of health
personnel
Quality Research for
Quality KMC!
 References:

 Perinasia and HSP/USAID, An Intervention for

Implementing Kangaroo Mother Care (draft),
Unpublished report.

 Perinasia and HSP/USAID, Progress in the

Implementation of Kangaroo Mother Care in Ten
Hospitals in Indonesia, Unpublished report.

 Pratomo, Hadi. Review of the Kangaroo Mother Care

(KMC) in Indonesia, 1997-2014, Report of Save
Newborn Life Grant, Jakarta, 2015.

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• Ruiz-Pelaez, Juan Gabriel; Charpak, Nathalie dan
Cicervo, Louis Gabriel. “Kangaroo Mother Care,
an example to follow from Developing Countries,
BMJ 2004, 329: 1179-1181 (November 13).
• WHO, Unicef & Bill Gates Foundation. Global
Workshop on Acceleration of KMC to Reduce
Neonatal Mortality, Istanbul, October 20-22,
2014.
• http://kangaroomothercare.com/html.whatis
downloaded November 21, 2010
• http://en.wikipedia.org/wiki/Philosophy
downloaded November 21, 2010.

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 PERTANYAAN DISKUSI KMC:

1. Identifikasi isu riset terkait KMC (lokal)

2. Individu yang berminat dan kontak number

(S2/S3)

3. Pelatihan yang diperlukan untuk penguatan

kapasitas riset institusi terkait KMC
Video youtube:
KMC MOV RSUD Dr Soetomo (9.15)
Video KMC RSUD Dr Soetomo (15.24)
Caring premature babies through KMC (Philippine, 2.58)