The Role of Social Support for Improving Kangaroo Mother Care

Practice among Low Birth Weight Infants’ Mothers

in North Jakarta

Intan Silviana Mustikawati

Department of Public Health, Universitas Esa Unggul, Jl. Arjuna Utara No. 6A, Jakarta, Indonesia

Keywords: Kangaroo Mother Care, Practice, Social support, Low Birth Weight Infants

Abstract: Kangaroo Mother Care (KMC) is a skin-to-skin contact between mother and newborn, frequent or exclusive

breastfeeding, and early discharge from the hospital. Social support is crucial for improving KMC practice

among Low Birth Weight Infants (LBWI)’s mothers after discharge from hospital. The objective of this study

was to assess the relationship between social support and KMC practice among LBWI’s mothers. This

research was a cross-sectional approach implemented in three village in North Jakarta that are Cilincing, Koja,

and Tanjung Priok. The respondents in this study were 50 LBWI’s mothers post-discharged from Koja

Hospital, North Jakarta. The sample was selected by consecutive sampling. The data were collected by

questionnaire and interview. Mann-Whitney U-test was used to analyzed the data. The average age of

respondents was 31 years old, the average of parity was 2 children, most of the respondents had a low level

of education (64%), all were didn’t work, and 56% of their home was close to health facility. The average

duration of KMC practice was 3 hours per day. This study found that social support consisting of family

support (z=-2,54, p value<0,05, CI 95%) and community health workers support (z=-2.70, p value<0,05, CI

95%) had significant relationship with practice of KMC among LBWI’s mothers. The family support were in

the form of replacing mother to do KMC, helps to tie KMC clothes, assist in carrying out household chores

and the community health workers support were in the form of provide education about KMC, reminding

mothers to practice KMC, and correcting the KMC practice. Information and education to the family and

community members are required continuously in order to support LBWI’s mothers improving KMC practice.

1 INTRODUCTION

The deaths among newborn in developing countries

still very high, that is 40% of all deaths of under five

years age children (Lawn et al., 2005). Low Birth

Weight (LBW) was one of the causes of the death.

About 95% of premature and/or LBW are born each

in the developing countries (Lawn et al., 2010).

Indonesian Demographic and Health Surveys (Badan

Kependudukan dan Keluarga Berencana Nasional,

Statistik, & Kesehatan, 2013) explored that Neonatal

Mortality Rate is still higher than Mortality Rate

among Infant and Mortality Rate among under five

children in Indonesia.

Many health problems occurs among Low Birth

Weight Infants (LBWI) because of the organs of the

body that have not yet developed perfectly. They are

greater risk for hypothermi, infectious problems,

growth and development problems, that affects

survival (Soleimani et al., 2014; Ballot, et al., 2012).

The LBWI are at risk for keeping the temperature

stable. They are easily get cold or hypothermy that

could affect to infection (USAID and MCHIP,

2012)

Kangaroo Mother Care is one method of

improving thermal care and increase survival rate

among LBWI (USAID and MCHIP, 2012). It has

been proven as an effective approach for caring the

LBWI. Kangaroo Mother Care (KMC) is early,

prolonged, and continuous skin-to-skin contact

between mother and infants. The practice of KMC

starts in hospital and continue at home after

discharge. It will improve breastfeeding and

increase survival rate among LBWI (WHO, 2003).

Some research explored that many benefits of

KMC practice, such as increasing breastfeeding,

increase love and affection between mother and

infants, increase weight, body length and head

circumference, lower hospital stay, and improving

204

Mustikawati, I.

The Role of Social Support for Improving Kangaroo Mother Care Practice among Low Birth Weight Infants’ Mothers in North Jakarta.

DOI: 10.5220/0010760100003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 204-209

ISBN: 978-989-758-542-5

survival rate (Sloan et al., 1994; Charpak & Ruiz-

pela, 2000; Charpak et al., 2017).

KMC practice among LBWI’s mothers starts at

hospital and continue at home, with the support from

health workers. But many obstacles that must be

faced by LBWI’s mothers in practicing KMC at

home, both internal and eksternal factors. There are

few barriers of the practice of KMC at home, such as

household chores, looking after the child, and support

from family (Nguah et al., 2011; Quasem et al.,

2003). One of the achievement of KMC practice at

home is determined by support from the social

environment include family, relatives, and

community.

KMC practice can be influenced by various

factors such as individual and social factors. Social

support is very important for improving KMC

practice among LBWI’s mothers after discharge from

hospital. Social support is a crucial factor for the

success of KMC practice (Charpak & Ruiz-pela,

2000). Social support refers to assistance received

from family members, relatives, and community to

perform KMC. Social support including one of the

enablers to KMC adoption (Chan et al., 2017).

Bergh et al., (2018) had conducted research on

LBWI’s mothers perceptions and practices of KMC

in Koja Hospital, North Jakarta. The sustainability of

KMC practice among LBWI’s mothers after

discharged from hospital is very important. The

practice of KMC will influence on the health

conditions and infants growth. Therefore, social

support is needed by LBWI’s mothers in order to

practice KMC properly. The objective of the study

was to assess the relationship between social support

and the practice of KMC among LBWI’s mothers

post-discharged from Koja Hospital, North Jakarta.

2 METHOD

This research was a cross-sectional approach to assess

the relationship between social support consisting of

family support and community health workers

support and the practice of KMC among LBWI’s

mothers. It implemented in three village in North

Jakarta that are Cilincing, Koja, and Tanjung Priok.

The respondents in this study were 50 LBWI’s

mothers post-discharged from Koja Hospital, North

Jakarta. The sample was selected by consecutive

sampling.

The practice of KMC was the dependent variable

in this study, while social support consisting of family

support and community health workers support were

the independent variables. The data were collected by

questionnaire and interview to identify socio-

demographic characteristics and the practice of KMC.

Mann-Whitney U-test was used to analyzed the data.

3 RESULTS

3.1 Socio-demographic Characteristics

In this study, the average age of respondents was 31

years old, the average of parity was 2 children, most

of the respondents had a low level of education

(64%), all were didn’t work, and 56% of their home

was close to health facility.

3.2 The KMC Practice

All of LBWI’s mothers in this study were continue to

practice KMC at home after discharge from Koja

Hospital, North Jakarta. The mothers were practiced

KMC with an average duration of 3 hours per day.

Most of the respondents were practiced KMC in the

morning after they've finished their household works.

Then they were continue practiced KMC at night

assisted by their husband after work. In addition, they

were assisted also by family members such as

grandmothers, auties, and other family members in

practicing KMC.

3.3 Relationship between Social

Support and the Practice of KMC

3.3.1 Relationship between Family Support

and the Practice of KMC

Majority of respondents in this study was supported

by family members in practicing KMC (74%). The

family supports were in the form of replacing mother

to do KMC, helps to tie KMC clothes, and assist in

carrying out household chores.

Mann-Whitney U-test found that family supports

had significant relationship with the practice of KMC

among LBWI’s mothers (z=-2,54, p value<0,05, CI

95%). The mean duration of KMC practice was

higher among LBWI’s mothers who get support from

their families (Mean=3,32 hours, SD=1,03) compared

to LBWI’s mothers who did not get the support from

the families (Mean=2,54 hours, SD=0,52). It can be

seen in the following table.

The Role of Social Support for Improving Kangaroo Mother Care Practice among Low Birth Weight Infants’ Mothers in North Jakarta

205

Table 1: Relationship between Family Support and Practice

of KMC

KMC

Pract

ice

Fami

Supp

ort

Mea

SD SE

valu

No 13 2,54 0,52 0,14

0,01

Yes 37 3,32 1,03 0,17

3.3.2 Relationship between Community

Health Workers Support and the

Practice of KMC

Majority of respondents in this study was supported

by community health workers in practicing KMC

(52%). The community health workers support were

in the form of provide education about KMC,

reminding mothers to practice KMC, and correcting

the KMC practice.

Mann-Whitney U-test found that community

health workers supports had significant relationship

with the practice of KMC among LBWI’s mothers

(z=-2,70, p value<0,05, CI 95%). The mean duration

of KMC practice was higher among LBWI’s mothers

who get the support from community health workers

(Mean=3,50 hours, SD=1,10) compared to LBWI’s

mothers mothers who did not get the support from

community health workers (Mean=2,71 hours,

SD=0,62). It can be seen in the following table.

Table 2: Relationship between Community Health Workers

Support and the Practice of KMCPractice of KMC

Community

Health

Workers

ort

n Mean SD SE p value

No 13 2,71 0,62 0,13 0,007

Yes 37 3,50 1,10 0,22

4 DISCUSSION

Practice is the realization of the knowledge and

attitude of a real deed. Action is a person's response

to stimulus in real or open form (Notoatmodjo, 2007).

According to Notoatmodjo (2012), practice is the

movement or action of the body after getting

stimulation or adaptation from inside or outside the

body of an environment.

In this study, LBWI’s mothers were practiced

KMC with a mean duration of 3,12 hours per day.

Some studies showed different durations of time in

practicing KMC at home. A study in India (Dawar et

al., 2019) showed that KMC is practiced with an

average duration of 3.3 hours per day. While other

study in India found that mothers practice KMC with

an average duration of 1.3 hours per day (Raajashri,

R & Adhisivam, B, 2018); 5 hours per day (Rasaily

et al., 2017). Study in Nigeria (Opara, PI & Okorie,

2017) showed that mothers practiced KMC with an

average of 3.25 hours per day. While other study

(Bazzano et al., 2012) found that mothers practice

KMC for 2 hours per day.

Behavior is a person's response to a stimulus from

the environment. Behavior is influenced by several

factors, consisting of internal and external factors.

Internal factors derived from the person itself, include

social demographic factors and external factors

derived from from outside of the person, include

socio-cultur value, community, social environments,

economic and politic condition, government policy,

etc. (Notoatmodjo, 2003). KMC practice can be

influenced by various factors such as individual and

social factors.

Social support is very important for improving

KMC practice among LBWI’s mothers after

discharge from hospital. Social support include

community support is a crucial factor the success of

KMC practice (Charpak & Ruiz-pela, 2000). Social

support is the kind of help received from other people

to practice KMC. Social support including one of the

enablers to KMC adoption. Chan et al., (2017) found

barriers and enablers to KMC adoption, that are buy-

in (the adoption of KMC and the advantages), social

support and empowerment (support from

environment such as family members and

community), time (time availability to practice

KMC), medical problems (health problems of

mothers or infants), access (the information provided

regarding KMC and the of availability of KMC

resources), and cultural norms cultural belief, family

values of caring the newborn ) (Chan et al., 2017).

Social support in this study consist of family

support and community health workers support. In

this study, family support had significant relationship

with KMC practice among LBWI’s mothers in North

Jakarta. The family supports were in the form of

replacing mother to do KMC, helps to tie KMC

clothes, and assist in carrying out household chores.

Family support is an important component of

KMC practice. Family support referred to the

assistance from other people (family members) to

perform KMC (Mustikawati et al., 2020). Family

support may derived from the LBWI’s fathers,

grandmothers, and relatives in family. The supports

will increase mother’s self evidence to care the

LBWI’s, therefore will increase KMC practice

(Effendi & Ichwan, 2012).

ICSDH 2021 - International Conference on Social Determinants of Health

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Study by Mustikawati et al., (2020) found that

family support was one of the facilitators of KMC

practice at home or KMC in the community. Another

study by Effendi & Ichwan (2012) showed that social

support had relationship with KMC practice. The

social support consit of tangible and emotional

support. Example of tangible support was helping

mothers in practicing KMC or doing house chores.

Mothers need this help to practice KMC routinely

every day.

A study by Bello et al (Morhason-Bello,

Adedokun & Ojengbede, 2009) found that KMC

practice related with the social support given during

childbirth. The early period of breast feeding after

delivery will affect the KMC practice. The success of

KMC influenced by family support, include husband,

grandmother, or other relatives in the family.

The emotional support is very important to

support mothers during delivery. The physiologic

support from the family will give strength to mothers

to care the LBWI’s. She'll be able to take better care

of the LBWI’s and ready in the face of problems in

taking care of the LBWI’s (Effendi & Ichwan, 2012).

LBWI’s mothers will usually face various

problems in taking care of the small baby that can

cause stress. Therefore, the mothers need any help

from outside to dealing with the stress. Social support

received from family or other relatives will help

LBWI’s mothers decrease the stress (Eisengart et al.,

2003).

Caltabiano et al., (1996) said that emotional

support is very important for health status of

individual. Emotional support given for LBWI’s

mothers after delivery will makes mothers feel enjoy,

comfortable, feel loved and cared for that will have

an impact on LBWI’s care and KMC practice. The

mothers will do her role better with the support.

This study showed that community health

workers support had significant relationship with

KMC practice among LBWI’s mothers in North

Jakarta. The community health workers support were

in the form of provide education about KMC,

reminding mothers to practice KMC, and correcting

the KMC practice. Community health workers in this

study play a role in providing information and

education about KMC to LBWI’s mothers.

Study by Effendi & Ichwan (2012) found a

significant relationship between informational

support and KMC practice. Informational support

refers to the information needed to do the activities

and to handle any problems found in doing the

practice. The information will help mothers to take

the actions (M. Robin DiMatteo, 2001). Information

and education of caring the LBWI’s include KMC

practice will be very important to ensure KMC

practice among LBWI’s mothers.

The success of KMC need support from

individual and community. They will contribute to

the continuity of KMC practice after discharge from

hospital (USAID and MCHIP, 2012). Therefore,

mothers and family will practice KMC at home well

without any reluctants or barriers. Problems found in

practicing KMC will faced together by mothers and

families.

Study by Chan et al., (2016) explained that several

things needed to adopt practice KMC, that are the

availability of time, support from relatives include

family and community, and medical condition.

Promotion and education to LBWI’s mothers and

family are required to increase KMC practice, include

home visit by community health workers.

Researches conducted in Bangladesh, India, and

Ghana (Darmstadt et al., 2006; Quasem et al., 2003b;

Sloan et al., 2008) showed that education provided by

community health workers has been shown to

improve KMC practice. LBWI’s mothers want to

practice KMC when the benefits of KMC are

explained to them before (in the antenatal or postnatal

period). In addition, the understanding of KMC

through a cultural approach that suits the community

and the solution provided when facing problems in

practicing KMC will increase KMC practice among

LBWI’s mothers.

5 CONCLUSIONS

This study showed that social support consting of

family support and community health workers

support had significant relationship with KMC

practice among LBWI’s mothers in North Jakarta.

Information and education to family and community

members are required continuously in order to

support LBWI’s mothers improving KMC practice.

ACKNOWLEDGMENTS

We would like to thank the North Jakarta Health

Office, for granting us permission to conduct this

research, and University of Esa Unggul who have

provided support to researchers in conducting

research and publication of research results.

The Role of Social Support for Improving Kangaroo Mother Care Practice among Low Birth Weight Infants’ Mothers in North Jakarta

207

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