Safety, Effectiveness and Barriers to Follow-up Using an 'Early Discharge' Kangaroo Care Policy in a Resource Poor Setting

Methods: Prospective descriptive study of all 272 babies admitted to a Kangaroo Care Ward in Malawi from November 2003 to May 2004. Infants were discharged to outpatient care once weighing over 1300 g and gaining weight. Follow-up was carried out until 2500 g. Results: Infants [201 of 272 (73.9%)] reached a weight > 2500 g; 46 out of 272 (16.9%) died; outcome was unknown in 25 of 272 (9.2%). Outpatient mortality was higher amongst discharges weighing under 1500 g [RR = 2.41(1.25-4.63) P = 0.01]. Discharge below birth weight did not affect mortality [RR = 0.77(0.40-1.46) P = 0.42]. Barriers identified to seeking healthcare post-discharge included transport problems and late recognition of illness. Conclusions: Early discharge is safe and feasible, but issues regarding access to healthcare need to be addressed. Future research is needed to determine how best high mortality can be reduced in specific subgroups: notably infants < 1500 g.