Community-based Kangaroo Mother Care in low-birth-weight infants: a quality improvement study in the urban slums of Kolkata, West Bengal

Background Kangaroo Mother Care (KMC) is recommended for low-birth-weight (LBW) infants in both facility and community, yet in India, KMC is largely confined to healthcare facilities. Evidence on the feasibility of implementing community-based KMC (c-KMC) in urban slum settings is limited. This quality improvement exploratory study explored the feasibility, safety, and adherence of implementing c-KMC in the urban slums of Kolkata, India. Methods A preliminary qualitative assessment explored barriers to c-KMC through in-depth interviews with mothers of LBW infants ( n = 3) who received facility-initiated KMC, and two focus group discussions with frontline health workers ( n = 6). From September 1, 2023 to July 31, 2024, KMC was implemented on stable LBW newborns (≤2,200 g; n = 218) in community settings. Mothers received counselling, training, and KMC kits. Home visits were conducted on days 7, 14, and 28 after birth or discharge to reinforce KMC and breastfeeding. Results Mothers had limited KMC knowledge and received minimal counselling, or follow-up post-discharge. Frontline health workers cited workload, population density, migration, and space constraints as major barriers to c-KMC. Among 218 infants enrolled, only 23.4% received facility-initiated KMC. Average KMC duration was 3.4 h/day at homes across follow-up visits. By day 28, 95% of mothers continued KMC, no KMC related adverse event was noted and 84% practiced exclusive breastfeeding. Conclusion c-KMC implementation was feasible and safe in slum settings when supported through structured counselling, home visits, and trained workers. The findings support the operational feasibility of integrating c-KMC within existing home-based newborn care platforms.