Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia

Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia Beyene Roba Ireso, Abiy Seifu Estifanos, Damen Haile Mariam, Grace J. Chan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5230470/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Dec, 2025 Read the published version in Discover Public Health → Version 1 posted 12 You are reading this latest preprint version Abstract Background: Each year, 2.3 million neonates die, with over one million of these deaths occurring within the first 24 hours of birth. Preterm birth is contributing to over 50% of all neonatal deaths. Initiating Kangaroo Mother Care (KMC) immediately after birth, rather than waiting for stabilization, can reduce neonatal mortality by 25%. However, in Ethiopia, as of 2021, only 5%-10% of eligible premature newborns received any form of KMC. If the utilization of effective KMC remains low, mortality rates among preterm and low birth weight (LBW) infants are likely to remain higher than optimal. Methods: A cross-sectional study design was conducted using existing data to determine effective early KMC (eKMC) coverage. A total of 599 eligible low-birth-weight newborns were included in the data analysis. Bivariate and multivariate logistic regression analyses were applied, with a significance level set at p < 0.05. Result: The study included 599 of 705 neonates with birth weight <2,000g born or referred to selected hospitals between March 2017 and March 2019, all alive and not referred out within 24 hours. Among these eligible neonates, only 8.9% received effective eKMC, 20.5% received early any skin-to-skin (STS) care, and 64.6% were exclusively breastfed. Caesarean section delivery was associated with lower odds of effective eKMC compared to vaginal delivery (AOR ‘adjusted odd ratio’ = 0.2; 95% CI: 0.05-0.89), with birth order, multiple births, gestational age at time of delivery, birth weight, delivery mode, household income, and religion adjusted. Infants with very low birth weight (VLBW) (<1,500g) had significantly lower odds of receiving effective eKMC compared to those with LBW (1,500-2,000 grams) (AOR=0.099 ;95% CI: 0.022-0.44), while infants born at nine months or later and single births were more likely to receive effective eKMC compared to premature and multiple births (twins or triplets), with (AOR = 3.35; 95% CI: 1.17-9.6) and (AOR = 4.4; 95% CI: 1.8-11.1), respectively. Conclusion: Our study found a low coverage of effective eKMC. Household income, mode of delivery, birth weight, gestational age at the time of delivery, and multiple births were significantly associated with uptake of effective eKMC. preterm birth early KMC Ethiopia Figures Figure 1 Background Globally, an estimated 13.4 million newborn babies were born preterm (<37 weeks) in 2020, compared with 13.8 million in 2010. The global annual rate of reduction was estimated at -0.14% from 2010 to 2020. Southern Asia and sub-Saharan Africa accounted for approximately 65% of all preterm births globally in 2020 (1). In Ethiopia, the overall pooled prevalence of preterm birth was 10.48% in 2020 (2) and 13% of babies weighed <2,500g at birth (3). Compared to babies born at term (at least 37 weeks gestation) and with a normal birth weight (at least 2,500g), preterm and LBW babies have a 2- to 10-fold higher risk of death. They are also more susceptible to infections, poor body temperature regulation, impaired respiration, feeding difficulties, and growth failure (4,5). Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 900,000 deaths in 2019 (6). Of the 2.3 million annual neonatal deaths worldwide, over 1 million occur within the first 24 hours of birth, and preterm birth is a risk factor in over 50% of them (6). According to the Ethiopian Mini Demographic Health Survey (EDHS) 2019 report, the neonatal mortality rate was 33 deaths per 1000 live births. In low-income settings, half of the babies born at or below 32 weeks die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive. Currently, the World Health Organization (WHO) recommends different interventions for preterm prevention and care, with KMC being one crucial intervention (7). KMC is the early, prolonged (8-24 hrs), continuous STS contact between the mother (or substitute) and her LBW and/or preterm baby or babies at the hospital, health center, and in the community, with support for correct positioning and exclusive breastfeeding. Studies have demonstrated its efficacy in mitigating morbidity arising from complications in preterm births. Moreover, it has been found to decrease mortality rates among preterm or LBW infants (8,9), foster breastfeeding practices (10), strengthen the bond between mother and infant, and exert a favorable influence on the physical and psychological development of the infant (11). Compared to conventional care, KMC has been shown to reduce mortality of clinically stable LBW infants by approximately 40%, nosocomial infection/ sepsis by 55% and hypothermia by 66% (12). Additionally starting KMC immediately after birth, compared to initiating KMC after the babies are stabilized, reduces neonatal deaths by 25 % (13). However, the global KMC rate has remained low, with coverage being less than 5% in 2021 (14), and efforts to increase implementation have been largely unsuccessful. In Ethiopia, despite the policy emphasis on expanding KMC, the percentage of preterm or LBW neonates introduced to KMC remains low. Studies indicate that prior to 2021, only 5%-10% of eligible newborns received any form of KMC, irrespective of its quality (15,16). The national target, as outlined in the newborn and child survival and development strategy, aims to achieve a KMC coverage rate of 70% for preterm babies by the year 2025 (17). If effective KMC utilization continues to be low, it is reasonable to expect that mortality rates among preterm and LBW infants could persist at higher-than-optimal levels. The landscape of effective eKMC for preterm and LBW neonates is marked by limited empirical studies addressing the coverage and associated factors of effective eKMC. The scarcity of research on this critical aspect of neonatal care hinders a comprehensive understanding of the factors contributing to the low rates of KMC initiation within the crucial first hours of birth. This study aimed to determine the coverage and determinant factors of effective eKMC initiation within 24 hours of birth among LBW neonates in selected hospitals in Oromia, Ethiopia, using a secondary data. Methods Data Source We used a secondary dataset collected from March 2017 to March 2019 across five hospitals—Asella Referral and Teaching Hospital, Kersa Hospital, Bekoji Hospital, Tirunesh Beijing Hospital, and Batu General Hospital—and 39 health centers. The data were originally collected to develop a locally tested and optimized KMC scale-up model aimed at achieving high population-based effective coverage of KMC in the Oromia region (18). Study design A cross-sectional study design was employed. Study population The study population comprised all <2,000g neonates either born in or referred to the specifically chosen hospitals within the Oromia region. Inclusion criteria All live-born neonates born in or referred to the selected hospitals, with a birth weight of <2,000g, were included, irrespective of gestational age, type of delivery, or singleton or twin status. Exclusion criteria Infants who died or were referred outside the study district within 24 hours of birth were excluded. Operational Definition Effective eKMC coverage: The proportion of <2000grams infants who initiated KMC defined as STS contact for at least 8 hours combined with exclusive breastfeeding in the first 24 hours after birth. Data management and analysis The secondary data were examined for outliers, missing values/completeness, timeliness and relevance. The analysis was performed using StataMP 17. Descriptive data were presented using tables and figures. Bivariate analysis was conducted to determine the association between each independent variable and effective eKMC. Variables with a p-value of less than 0.20 were then entered into the multivariate logistic regression model for the final analysis. Odds ratios with 95% CI were used to measure the strength of the association between dependent and independent variables, and the level of significance was declared at a p-value < .05. Results Socio-demographic and obstetric characteristics of the study subjects From a total of 705 neonates weighing less than 2,000 grams who were recruited between March 2017 and March 2019, 599 (85%) were born in or referred to the selected hospitals, were alive, and had not been referred out of the hospital for at least 24 hours of age, and were included in the analysis. The maternal age distribution showed, with a large proportion of them falling between 20-29 years (64.6%). The marital status of the participants revealed that most mothers were married (96.5%). The educational background varied, with 43.9% having completed primary education, 30% secondary education, and 21.4% having no education. Most of the deliveries of the observed neonates took place in a health facility (95.2%) and conducted vaginally (85.6%). The gender distribution of the infants was comparable, with 48.9% females and 51.1% males. Birth weight data revealed that 26.9% infants had VLBW (<1,500g). The number of multiple births included a majority of single births (67.9%) (Table 1). Table 1: Basic Sociodemographic and Obstetric Characteristics of the Study Subjects Among 599 eligible neonates for KMC within 24 hours of birth, effective eKMC coverage was 8.9% (53/599), while the coverage of any STS care within 24 hours was 20.5% (123/599), and early exclusive breastmilk feeding (eEBF) stood at 64.6% (387/599) (Figure 1). Factors associated with Effective eKMC Several factors were significantly associated with effective eKMC. Notably, being Protestant, having a higher household income, delivering vaginally, having a higher birth weight, longer gestational age, and single births were associated with higher odds of effective eKMC. The multivariate logistic regression analysis showed that mothers who identified as Protestant had significantly higher odds of practicing effective eKMC compared to those who were Orthodox (AOR ‘adjusted odd ratio’ = 3.8; 95% CI: 1.2-11.6), with mode of delivery, birth order, multiple births, gestational age at time of delivery, birth weight, delivery mode, and household income adjusted. Mothers with a middle income (20,000–50,000 ETB per year) and high income (>50,000 ETB per year) had higher odds of effective eKMC compared to those with low income, with AORs of 5.6 (95% CI: 2-15.3) and 4.9 (95% CI: 1.7-14.9), respectively. Mothers who had a C/S delivery had significantly lower odds of practicing effective eKMC compared to those who had a vaginal delivery (AOR = 0.2; 95% CI: 0.05-0.89). Infants with VLBW (<1,500g) had significantly lower odds of receiving effective eKMC compared to those with LBW (1,500-2,000g), with an AOR of 0.099 (95% CI: 0.022-0.44). Infants born at nine months or later had significantly higher odds of receiving effective eKMC compared to those born at seven months or earlier (AOR = 3.35; 95% CI: 1.17-9.6). Single births were 4.4 times more likely to receive effective eKMC compared to multiple births (twins or triplets) (AOR = 4.4; 95% CI: 1.8-11.1) (Table 2). Table 2: Crude and Adjusted odds ratios for factors associated with effective eKMC. Discussion This research aims to assess the extent of effective eKMC coverage and identify factors associated with its practice. The coverage of Effective eKMC is 8.9%, while exclusive breastfeeding stands at 64.6%. The utilization of effective eKMC among <2,000g neonates is notably low, at only 8.9%. This outcome underscores a concerning inadequacy in the implementation of KMC, despite well-documented benefits of eKMC for the survival and well-being of LBW neonates. Studies in two regions of Ethiopia reported KMC coverage rates of 14.4% and 10%, respectively, initiated immediately after birth (19,20).These findings closely align with our study, emphasizing the persistent challenges in achieving higher KMC coverage within the critical time frame across different regions of Ethiopia. Furthermore, a hospital-based cross-sectional study conducted at Kenyatta National Hospital on modes of thermoregulation revealed that only 7% of infants received KMC (21). Studies in Malawi demonstrated initiation rates for KMC in hospital deliveries ranging from 0.6% to 17.4%, while in Nigeria, eKMC after birth was reported to be less than 10% (22,23). Despite the World Health Organization's (WHO) recommendation advocating uninterrupted STS contact for healthy mothers and newborns (24), previous research indicates a declining trend in the adoption of this practice. Concerning the durations of KMC, our study identified insufficient duration of skin-to-skin contact. Similarly, a study in Bangalore, India, revealed that some mothers practiced KMC for shorter durations (5-15 minutes) instead of the recommended hour due to perceived fatigue and stress (25). Another study in Ghana reported less time spent on KMC during both the day and night compared to health facility recommendations (26). These findings suggest practical challenges and variations in adhering to recommended KMC durations influenced by factors such as fatigue, perceived difficulty, and contextual differences between health facility settings. Addressing these challenges is crucial for enhancing the effectiveness and widespread adoption of KMC. Our study found that mothers who had a caesarean section delivery had significantly lower odds of practicing Effective eKMC compared to those who had a vaginal delivery. This finding aligns with various studies conducted both in Ethiopia and globally. A study in the Tigray region of northern Ethiopia revealed that mothers who had a current spontaneous vaginal delivery were 5.39 times more likely [(AOR=5.39, 95% CI: (2.3, 12.25)] to practice KMC compared to those delivered by forceps (27). Similar findings were reported in a study conducted at Dessie Referral Hospital in Northeast Ethiopia (28). Additionally, multiple studies have consistently indicated this. (10,16,29). This is likely because of delays resulting from prolonged recovery time and the postoperative pain mothers experience, which restricts their mobility and limits their access to the baby's bed. Our study found that mothers with middle and high incomes had significantly higher odds of practicing effective eKMC compared to those with low incomes, with adjusted odds ratios (AORs) of 5.6 (95% CI: 2–15.3) and 4.9 (95% CI: 1.7–14.9), respectively. This finding aligns with expectations, as lower socioeconomic status often correlates with limited education, information, and access to healthcare services, including prenatal and neonatal care, which may impact a mother's ability to practice KMC. Several studies conducted at different times have also revealed similar associations (13,30,31). This study found that infants with VLBW (<1,500g) and those born preterm had significantly lower odds of receiving effective eKMC compared to infants with LBW (1,500–2,000g) and those born at term. The lower prevalence of effective eKMC among VLBW and preterm infants, as opposed to LBW and term-born infants, is expected due to the greater medical fragility of premature infants, who require specialized care that may delay the initiation and practice of KMC in the early postnatal period. Numerous studies support these findings. (32–34). This study indicates that single births were 4.4 times more likely to receive effective early KMC compared to multiple births (twins or triplets). Notably, one study documented that 9.8% of participants faced challenges in delivering effective KMC, with the presence of twins being a significant contributing factor (35). The analysis of early eEBF coverage within the context of KMC has yielded coverage rate of 64.6%. This particular finding underscores the fundamental role of eEBF within the context of KMC. A review of the extant literature shows a notable consistency in the reported eEBF coverage across diverse studies. For instance, an investigation conducted in Tanzania reported that less than 20% of participants initiated breastfeeding within the initial hour following delivery, yet over half of the neonates had received breast milk within six hours post-delivery, with more than 80% being breastfed within the first 24 hours (36). Similarly, a study carried out in China noted that a substantial portion of mothers practicing KMC exclusively breastfed their infants during the 24 hours preceding their hospital discharge, registering a rate of 54.6% (37). Furthermore, an inquiry conducted in Ghana documented an incidence of EBF at 54.8% (38). These collective findings indicate a shared thread of understanding among these diverse studies regarding the significance of eEBF within the KMC context. The consistent trend in the reported eEBF coverage rates from various global contexts underlines the paramount importance of promoting eEBF as an essential component of KMC. Nevertheless, it is imperative to recognize that disparities in coverage rates may emanate from regional and contextual variables. Additionally, it is noteworthy that a systematic review has reported a higher prevalence of eEBF (62%) in infants weighing less than 2,500g (39), signifying potential variations in eEBF practices among distinct neonatal subgroups. Our study has both strengths and limitations. One strength is the use of secondary data, which provides a wealth of variables, offering flexibility for alternative analyses, merging, and exploration. However, a limitation is the time gap between the collection of this secondary data, which was gathered between April 2018 and March 2019, and the present year. This gap may limit our results’ representation of the current eKMC practices in the study areas. Therefore, we recommend further research to address these limitations. Conclusion Our study found low coverage of effective eKMC. Household income, mode of delivery, birth weight, gestational age at the time of delivery, and multiple births were significantly associated with Effective eKMC. Interventions at the health system and health facility levels are recommended to improve the coverage of effective KMC. Abbreviations CI Confidence interval C/S Caesarean section EBF Exclusive breast feeding eEBF Early Exclusive breast feeding Effective eKMC Effective early KMC LBW Low birth weight VLBW Very low birth weight Declarations Ethics approval and consent to participate We obtained ethical approval from the Research Ethics Committee of the School of Public Health, College of Health Sciences, Addis Ababa University. In addition, permission to access and utilize the secondary data was obtained from the relevant authorities. Consent for publication Not applicable Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding The author received no specific funding for this work. Authors' contributions ASE conceived the study. ASE and BRI designed the study. BRI analysed the data. ASE supervised the data analysis. BRI wrote the original draft. ASE, DHM and GJC have reviewed and substantively edited the draft. All authors have read and approved the final manuscript. Acknowledgment We would like to express our gratitude to the School of Public Health, College of Health Sciences, Addis Ababa University, for their financial support. Special thanks to Addisalem Fikre and Mesfin Kote for their support in utilizing the KMC implementation dataset. 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Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana? PLOS ONE. 2022 May 5;17(5):e0267179. Behzadifar M, Saki M, Behzadifar M, Mardani M, Yari F, Ebrahimzadeh F, et al. Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis. BMC Pediatr. 2019 Oct 27;19(1):384. Tables Table 1: Basic Socio-demographic and Obstetric Characteristics of the Study Subjects Maternal characteristics (N=599) % Age ≤19 36 6 20-29 387 64.6 ≥30 173 9.3 Missing 3 0.6 Marital status Single 16 2.7 Married 578 96.5 Divorced 3 0.5 Widowed 2 0.3 Religion Orthodox 315 52.6 Muslim 246 41.1 Protestant 35 5.8 Others 3 0.5 School attainment No Education 128 21.4 Primary Completed 263 43.9 Secondary Completed 180 30 Post-Secondary 28 4.7 Occupation Professional/technical/managerial 31 5.2 Sales and services 30 5 Skilled manual 33 5.5 Unskilled manual 17 2.8 Agriculture 64 10.7 Others 421 70.3 Missing 3 0.5 Household Income (ETB), per year 50,000 124 20.7 No. Living children 0 10 1.7 1-2 387 64.6 3 or more 202 33.7 Residency In catchment 359 59.9 Out of catchment 240 40.1 Place of delivery Health facility 570 95.2 Home 29 4.8 Delivery mode Vaginal 513 85.6 C/S 86 14.4 New-born characteristics Sex Female 293 48.9 Male 306 51.1 Birth weight LBW 1,500-2,000 grams 438 73.1 VLBW <1,500 grams 161 26.9 Gestational age at time of delivery =9month 103 17.2 Multiple births Single 407 67.9 Twins & Triplets 192 32.1 Basic Socio-demographic and Obstetric Characteristics of the Study Subjects in Selected Hospitals in Oromia, Ethiopia, April 2018 to March 2019. Table 2: Crude and Adjusted odds ratios with 95% confidence intervals for factors associated with Effective eKMC Variable Effective KMC within 24 hours of birth COR ( 95%CI) AOR ( 95%CI) Yes, (%) No, (%) Religion Orthodox 36(11.43%) 279(88.57%) 1 1 Muslim 11(4.47%) 235(95.53%) 0.36(0.18-0.73)* 0.48(0.23-1.02) Protestant 6(17.14%) 29(82.86%) 1.6(0.6-4.1) 3.8(1.2-11.6)* Household Income (ETB), per year "Low Income" 50,000 15(12.1%) 109(87.9%) 5.83(2.06-16.48)* 4.9(1.7-14.9)* No. Living children 0 2(20%) 8(80%) 1 1 1-2 39(10.08%) 348(89.92%) 0.45(0.09-2.18) 0.37(0.06-2.5) 3 or more 12(5.94%) 190(94.06%) 0.25(0.04-1.3) 0.6(0.07-4.5) Delivery mode Vaginal 51(9.94%) 462(90.06%) 1 1 C/S 2(2.33%) 84(97.67%) 0.2(0.05-0.9)* 0.2(0.05-0.89)* Birth weight LBW 1,500-2,000 grams 51(11.64%) 387(88.36%) 1 1 VLBW <1,500 grams 2(1.24%) 159(98.76%) 0.09(0.02-0.39)* 0.099(0.022-0.44)* Gestational age at time of delivery =9month 13(12.62%) 90(87.38%) 3.4(1.3-8.7)* 3.35(1.17-9.6)* Multiple births Single 46(11.3%) 361(88.7%) 3.37(1.5-7.6)* 4.4(1.8-11.1)* Twins & Triplets 7(3.65%) 185(96.35%) 1 1 Birth order 1 36(11.25%) 284(88.75%) 1.95(1.1-3.6)* 2.19(0.8-5.6) >1 17(6.09%) 262(93.91%) 1 1 Adjusted for all variables in the model, 1-references COR – Crude odds Ratio, AOR – Adjusted Odds Ratio, CI: confidence interval. * P- Value <0.05, Crude and Adjusted odds ratios with 95% confidence intervals for factors associated with effective eKMC in Selected Hospitals in Oromia, Ethiopia, April 2018 to March 2019. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Dec, 2025 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 20 Feb, 2025 Reviews received at journal 22 Nov, 2024 Reviews received at journal 21 Nov, 2024 Reviews received at journal 18 Nov, 2024 Reviewers agreed at journal 17 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviewers agreed at journal 03 Nov, 2024 Reviewers invited by journal 01 Nov, 2024 Editor assigned by journal 23 Oct, 2024 Submission checks completed at journal 22 Oct, 2024 First submitted to journal 09 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5230470","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369685091,"identity":"2632d070-4aa8-49bf-b3aa-d3308825f9b7","order_by":0,"name":"Beyene Roba Ireso","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYFACHgZmCIP5gMEHIMXGTrwWtoTCGSCKmXgtPAafecC2EdBg3t578HNBxWE5c/a2xM02v7bJ8zEzMH74mINbi8yZc8nSM84cNrbsOXzYOLfvtmEbMwOz5MxtuLVISOQYSPO2HU7ccCMtzTi35zYjUAsbMy9+Lca/ef8drt9w/435b8ue2/bEaDGT5m04nGBwg8fAmOHH7UTCWnjOpVnPOJZuuOFMWoJhb8Pt5DZmxmb8fmHvPXy7oMZa3uD44QMGP/7ctp3f3nzww0c8WqCgGUIxtoHJBoLqgaAOSv8hRvEoGAWjYBSMNAAAfxVR0UVzpoIAAAAASUVORK5CYII=","orcid":"","institution":"Department of Reproductive, Family, and Population Health, School of Public Health, Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Beyene","middleName":"Roba","lastName":"Ireso","suffix":""},{"id":369685092,"identity":"e5e0a262-a98b-43e0-a78c-31ce29411387","order_by":1,"name":"Abiy Seifu Estifanos","email":"","orcid":"","institution":"Department of Reproductive, Family, and Population Health, School of Public Health, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Abiy","middleName":"Seifu","lastName":"Estifanos","suffix":""},{"id":369685093,"identity":"c0a5a23a-24bc-4962-b01b-c935fd5bacdc","order_by":2,"name":"Damen Haile Mariam","email":"","orcid":"","institution":"Department of Health Systems Management and Health Policy, School of Public Health, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Damen","middleName":"Haile","lastName":"Mariam","suffix":""},{"id":369685094,"identity":"b2b34f9e-8668-4450-b8a9-80c9283ff64b","order_by":3,"name":"Grace J. Chan","email":"","orcid":"","institution":"Division of Medical Critical Care, Department of Paediatrics, Boston Children's Hospital, Harvard Medical School","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"J.","lastName":"Chan","suffix":""}],"badges":[],"createdAt":"2024-10-09 08:08:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5230470/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5230470/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-025-01256-4","type":"published","date":"2025-12-16T15:57:28+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67443546,"identity":"80612bf4-d81e-4f12-8883-3caf4b10c1d1","added_by":"auto","created_at":"2024-10-25 06:19:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20343,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eEffective eKMC coverage in Selected Hospitals in Oromia, Ethiopia, April 2018 to March 2019.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5230470/v1/c5ab8aeda003fed3e25db14f.png"},{"id":98814138,"identity":"4704e032-2e17-4397-8464-7b956fde6d24","added_by":"auto","created_at":"2025-12-22 16:11:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1192512,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5230470/v1/5b4a96a7-0797-44d9-8640-fddf543f24e7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, an estimated 13.4 million newborn babies were born preterm (\u0026lt;37 weeks) in 2020, compared with 13.8 million in 2010. The global annual rate of reduction was estimated at -0.14% from 2010 to 2020. Southern Asia and sub-Saharan Africa accounted for approximately 65% of all preterm births globally in 2020\u0026nbsp;(1). In Ethiopia, the overall pooled prevalence of preterm birth was 10.48% in 2020\u0026nbsp;(2)\u0026nbsp;and 13% of babies weighed \u0026lt;2,500g at birth\u0026nbsp;(3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompared to babies born at term (at least 37 weeks gestation) and with a normal birth weight (at least 2,500g), preterm and LBW babies have a 2- to 10-fold higher risk of death. They are also more susceptible to infections, poor body temperature regulation, impaired respiration, feeding difficulties, and growth failure\u0026nbsp;(4,5). Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 900,000 deaths in 2019\u0026nbsp;(6). Of the 2.3 million annual neonatal deaths worldwide, over 1 million occur within the first 24 hours of birth, and preterm birth is a risk factor in over 50% of them\u0026nbsp;(6). According to the Ethiopian Mini Demographic Health Survey (EDHS) 2019 report, the neonatal mortality rate was 33 deaths per 1000 live births.\u003c/p\u003e\n\u003cp\u003eIn low-income settings, half of the babies born at or below 32 weeks die due to a lack of feasible, cost-effective care such as warmth, breastfeeding support, and basic care for infections and breathing difficulties. In high-income countries, almost all of these babies survive.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCurrently, the World Health Organization (WHO) recommends different interventions for preterm prevention and care, with KMC being one crucial intervention\u0026nbsp;(7). KMC is the early, prolonged (8-24 hrs), continuous STS contact between the mother (or substitute) and her LBW and/or preterm baby or babies at the hospital, health center, and in the community, with support for correct positioning and exclusive breastfeeding. Studies have demonstrated its efficacy in mitigating morbidity arising from complications in preterm births. Moreover, it has been found to decrease mortality rates among preterm or LBW infants\u0026nbsp;(8,9), foster breastfeeding practices\u0026nbsp;(10), strengthen the bond between mother and infant, and exert a favorable influence on the physical and psychological development of the infant\u0026nbsp;(11). \u0026nbsp; Compared to conventional care, KMC has been shown to reduce mortality of clinically stable LBW infants by approximately 40%, nosocomial infection/ sepsis by 55% and hypothermia by 66%\u0026nbsp;(12). \u0026nbsp; Additionally starting KMC immediately after birth, compared to initiating KMC after the babies are stabilized, reduces neonatal deaths by 25 %\u0026nbsp;(13).\u003c/p\u003e\n\u003cp\u003eHowever, the global KMC rate has remained low, with coverage being less than 5% in 2021 (14), and efforts to increase implementation have been largely unsuccessful. In Ethiopia, despite the policy emphasis on expanding KMC, the percentage of preterm or LBW neonates introduced to KMC remains low. Studies indicate that prior to 2021, only 5%-10% of eligible newborns received any form of KMC, irrespective of its quality (15,16). The national target, as outlined in the newborn and child survival and development strategy, aims to achieve a KMC coverage rate of 70% for preterm babies by the year 2025 (17). If effective KMC utilization continues to be low, it is reasonable to expect that mortality rates among preterm and LBW infants could persist at higher-than-optimal levels. The landscape of effective eKMC for preterm and LBW neonates is marked by limited empirical studies addressing the coverage and associated factors of effective eKMC. The scarcity of research on this critical aspect of neonatal care hinders a comprehensive understanding of the factors contributing to the low rates of KMC initiation within the crucial first hours of birth. This study aimed to determine the coverage and determinant factors of effective eKMC initiation within 24 hours of birth among LBW neonates in selected hospitals in Oromia, Ethiopia, using a secondary data.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eData Source\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used a secondary dataset collected from March 2017 to March 2019 across five hospitals\u0026mdash;Asella Referral and Teaching Hospital, Kersa Hospital, Bekoji Hospital, Tirunesh Beijing Hospital, and Batu General Hospital\u0026mdash;and 39 health centers. The data were originally collected to develop a locally tested and optimized KMC scale-up model aimed at achieving high population-based effective coverage of KMC in the Oromia region\u0026nbsp;(18).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study design was employed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised all \u0026lt;2,000g neonates either born in or referred to the specifically chosen hospitals within the Oromia region.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll live-born neonates born in or referred to the selected hospitals, with a birth weight of \u0026lt;2,000g, were included, irrespective of gestational age, type of delivery, or singleton or twin status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInfants who died or were referred outside the study district within 24 hours of birth were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational Definition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective eKMC coverage: The proportion of \u0026lt;2000grams infants who initiated KMC defined as STS contact for at least 8 hours combined with exclusive breastfeeding in the first 24 hours after birth.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe secondary data were examined for outliers, missing values/completeness, timeliness and relevance. The analysis was performed using StataMP 17. Descriptive data were presented using tables and figures. Bivariate analysis was conducted to determine the association between each independent variable and effective eKMC. Variables with a p-value of less than 0.20 were then entered into the multivariate logistic regression model for the final analysis. Odds ratios with 95% CI were used to measure the strength of the association between dependent and independent variables, and the level of significance was declared at a p-value \u0026lt; .05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic and obstetric characteristics of the study subjects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom a total of 705 neonates weighing less than 2,000 grams who were recruited between March 2017 and March 2019, 599 (85%) were born in or referred to the selected hospitals, were alive, and had not been referred out of the hospital for at least 24 hours of age, and were included in the analysis.\u003c/p\u003e\n\u003cp\u003eThe maternal age distribution showed, with a large proportion of them falling between 20-29 years (64.6%). The marital status of the participants revealed that most mothers were married (96.5%). The educational background varied, with 43.9% having completed primary education, 30% secondary education, and 21.4% having no education. Most of the deliveries of the observed neonates took place in a health facility (95.2%) and conducted vaginally (85.6%).\u003c/p\u003e\n\u003cp\u003eThe gender distribution of the infants was comparable, with 48.9% females and 51.1% males. Birth weight data revealed that 26.9% infants had VLBW (\u0026lt;1,500g). The number of multiple births included a majority of single births (67.9%) (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1: \u0026nbsp;Basic Sociodemographic and Obstetric Characteristics of the Study Subjects\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAmong 599 eligible neonates for KMC within 24 hours of birth, effective eKMC coverage was 8.9% (53/599), while the coverage of any STS care within 24 hours was 20.5% (123/599), and early exclusive breastmilk feeding (eEBF) stood at 64.6% (387/599) (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with Effective eKMC\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral factors were significantly associated with effective eKMC. Notably, being Protestant, having a higher household income, delivering vaginally, having a higher birth weight, longer gestational age, and single births were associated with higher odds of effective eKMC.\u003c/p\u003e\n\u003cp\u003eThe multivariate logistic regression analysis showed that mothers who identified as Protestant had significantly higher odds of practicing effective eKMC compared to those who were Orthodox\u0026nbsp;(AOR \u0026lsquo;adjusted odd ratio\u0026rsquo; =\u0026nbsp;3.8; 95% CI: 1.2-11.6), with mode of delivery, birth order, multiple births, gestational age at time of delivery, birth weight, delivery mode, and household income adjusted.\u0026nbsp;Mothers with a middle income (20,000\u0026ndash;50,000 ETB per year) and high income (\u0026gt;50,000 ETB per year) had higher odds of effective eKMC compared to those with low income, with AORs of 5.6 (95% CI: 2-15.3) and 4.9 (95% CI: 1.7-14.9), respectively. Mothers who had a C/S delivery had significantly lower odds of practicing effective eKMC compared to those who had a vaginal delivery (AOR = 0.2; 95% CI: 0.05-0.89). Infants with VLBW (\u0026lt;1,500g) had significantly lower odds of receiving effective eKMC compared to those with LBW (1,500-2,000g), with an AOR of 0.099 (95% CI: 0.022-0.44). Infants born at nine months or later had significantly higher odds of receiving effective eKMC compared to those born at seven months or earlier (AOR = 3.35; 95% CI: 1.17-9.6). Single births were 4.4 times more likely to receive effective eKMC compared to multiple births (twins or triplets) (AOR = 4.4; 95% CI: 1.8-11.1) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 2: Crude and Adjusted odds ratios for factors associated with effective eKMC.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research aims to assess the extent of effective eKMC coverage and identify factors associated with its practice. The coverage of Effective eKMC is 8.9%, while exclusive breastfeeding stands at 64.6%.\u003c/p\u003e\n\u003cp\u003eThe utilization of effective eKMC among \u0026lt;2,000g neonates is notably low, at only 8.9%. This outcome underscores a concerning inadequacy in the implementation of KMC, despite well-documented benefits of eKMC for the survival and well-being of LBW neonates. Studies in two regions of Ethiopia reported KMC coverage rates of 14.4% and 10%, respectively, initiated immediately after birth\u0026nbsp;(19,20).These findings closely align with our study, emphasizing the persistent challenges in achieving higher KMC coverage within the critical time frame across different regions of Ethiopia.\u003c/p\u003e\n\u003cp\u003eFurthermore, a hospital-based cross-sectional study conducted at Kenyatta National Hospital on modes of thermoregulation revealed that only 7% of infants received KMC\u0026nbsp;(21). Studies in Malawi demonstrated initiation rates for KMC in hospital deliveries ranging from 0.6% to 17.4%, while in Nigeria, eKMC after birth was reported to be less than 10%\u0026nbsp;(22,23). Despite the World Health Organization\u0026apos;s (WHO) recommendation advocating uninterrupted STS contact for healthy mothers and newborns\u0026nbsp;(24), previous research indicates a declining trend in the adoption of this practice.\u003c/p\u003e\n\u003cp\u003eConcerning the durations of KMC, our study identified insufficient duration of skin-to-skin contact. Similarly, a study in Bangalore, India, revealed that some mothers practiced KMC for shorter durations (5-15 minutes) instead of the recommended hour due to perceived fatigue and stress\u0026nbsp;(25). Another study in Ghana reported less time spent on KMC during both the day and night compared to health facility recommendations\u0026nbsp;(26). These findings suggest practical challenges and variations in adhering to recommended KMC durations influenced by factors such as fatigue, perceived difficulty, and contextual differences between health facility settings. Addressing these challenges is crucial for enhancing the effectiveness and widespread adoption of KMC.\u003c/p\u003e\n\u003cp\u003eOur study found that mothers who had a caesarean section delivery had significantly lower odds of practicing Effective eKMC compared to those who had a vaginal delivery.\u0026nbsp;This finding aligns with various studies conducted both in Ethiopia and globally. A study in the Tigray region of northern Ethiopia revealed that mothers who had a current spontaneous vaginal delivery were 5.39 times more likely [(AOR=5.39, 95% CI: (2.3, 12.25)] to practice KMC compared to those delivered by forceps\u0026nbsp;(27). Similar findings were reported in a study conducted at Dessie Referral Hospital in Northeast Ethiopia\u0026nbsp;(28).\u0026nbsp;Additionally, multiple studies have consistently indicated this.\u0026nbsp;(10,16,29). This is likely because of delays resulting from prolonged recovery time and the postoperative pain mothers experience, which restricts their mobility and limits their access to the baby\u0026apos;s bed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study found that mothers with middle and high incomes had significantly higher odds of practicing effective eKMC compared to those with low incomes, with adjusted odds ratios (AORs) of 5.6 (95% CI: 2\u0026ndash;15.3) and 4.9 (95% CI: 1.7\u0026ndash;14.9), respectively. This finding aligns with expectations, as lower socioeconomic status often correlates with limited education, information, and access to healthcare services, including prenatal and neonatal care, which may impact a mother\u0026apos;s ability to practice KMC. Several studies conducted at different times have also revealed similar associations\u0026nbsp;(13,30,31).\u003c/p\u003e\n\u003cp\u003eThis study found that infants with VLBW (\u0026lt;1,500g) and those born preterm had significantly lower odds of receiving effective eKMC compared to infants with LBW (1,500\u0026ndash;2,000g) and those born at term. The lower prevalence of effective eKMC among VLBW and preterm infants, as opposed to LBW and term-born infants, is expected due to the greater medical fragility of premature infants, who require specialized care that may delay the initiation and practice of KMC in the early postnatal period. Numerous studies support these findings.\u0026nbsp;(32\u0026ndash;34).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study indicates that single births were 4.4 times more likely to receive effective early KMC compared to multiple births (twins or triplets). Notably, one study documented that 9.8% of participants faced challenges in delivering effective KMC, with the presence of twins being a significant contributing factor\u0026nbsp;(35).\u003c/p\u003e\n\u003cp\u003eThe analysis of early eEBF coverage within the context of KMC has yielded coverage rate of 64.6%. This particular finding underscores the fundamental role of eEBF within the context of KMC. A review of the extant literature shows a notable consistency in the reported eEBF coverage across diverse studies. For instance, an investigation conducted in Tanzania reported that less than 20% of participants initiated breastfeeding within the initial hour following delivery, yet over half of the neonates had received breast milk within six hours post-delivery, with more than 80% being breastfed within the first 24 hours\u0026nbsp;(36). Similarly, a study carried out in China noted that a substantial portion of mothers practicing KMC exclusively breastfed their infants during the 24 hours preceding their hospital discharge, registering a rate of 54.6%\u0026nbsp;(37). Furthermore, an inquiry conducted in Ghana documented an incidence of EBF at 54.8%\u0026nbsp;(38). These collective findings indicate a shared thread of understanding among these diverse studies regarding the significance of eEBF within the KMC context. The consistent trend in the reported eEBF coverage rates from various global contexts underlines the paramount importance of promoting eEBF as an essential component of KMC. Nevertheless, it is imperative to recognize that disparities in coverage rates may emanate from regional and contextual variables. Additionally, it is noteworthy that a systematic review has reported a higher prevalence of eEBF (62%) in infants weighing less than 2,500g\u0026nbsp;(39), signifying potential variations in eEBF practices among distinct neonatal subgroups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study has both strengths and limitations. One strength is the use of secondary data, which provides a wealth of variables, offering flexibility for alternative analyses, merging, and exploration. However, a limitation is the time gap between the collection of this secondary data, which was gathered between April 2018 and March 2019, and the present year. This gap may limit our results\u0026rsquo; representation of the current eKMC practices in the study areas. Therefore, we recommend further research to address these limitations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study found low coverage of effective eKMC. Household income, mode of delivery, birth weight, gestational age at the time of delivery, and multiple births were significantly associated with Effective eKMC. Interventions at the health system and health facility levels are recommended to improve the coverage of effective KMC.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"margin-right: calc(40%); width: 60%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eConfidence interval\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eC/S\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eCaesarean section\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eEBF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eExclusive breast feeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eeEBF \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eEarly Exclusive breast feeding\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eEffective eKMC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eEffective early KMC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eLBW \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eLow birth weight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4286%;\"\u003e\n \u003cp\u003eVLBW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68.5714%;\"\u003e\n \u003cp\u003eVery low birth weight\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eWe obtained ethical approval from the Research Ethics Committee of the School of Public Health, College of Health Sciences, Addis Ababa University. In addition, permission\u0026nbsp;to access and utilize the secondary data was obtained from the relevant authorities.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe author received no specific funding for this work.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eASE conceived the study. ASE and BRI designed the study. BRI analysed the data. ASE supervised the data analysis. BRI wrote the original draft. ASE, DHM and GJC have reviewed and substantively edited the draft. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgment\u003c/h2\u003e\n\u003cp\u003eWe would like to express our gratitude to the School of Public Health, College of Health Sciences, Addis Ababa University, for their financial support. Special thanks to Addisalem Fikre and Mesfin Kote for their support in utilizing the KMC implementation dataset.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOhuma EO, Moller AB, Bradley E, Chakwera S, Hussain-Alkhateeb L, Lewin A, et al. National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis. The Lancet. 2023 Oct 7;402(10409):1261\u0026ndash;71. \u003c/li\u003e\n\u003cli\u003eMuchie KF, Lakew AM, Teshome DF, Yenit MK, Sisay MM, Mekonnen FA, et al. Epidemiology of preterm birth in Ethiopia: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020 Sep 29;20(1):574. \u003c/li\u003e\n\u003cli\u003eCentral Statistical Agency (CSA) [Ethiopia] and ICF. 2016. Ethiopia Demographic and Health Survey 2016. \u003c/li\u003e\n\u003cli\u003eEscobar GJ, McCormick MC, Zupancic JAF, Coleman‐Phox K, Armstrong MA, Greene JD, et al. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006 Jul;91(4):F238\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eWang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatrics. 2004 Aug;114(2):372\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eLiu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. The Lancet. 2012 Jun 9;379(9832):2151\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. WHO recommendations on interventions to improve preterm birth outcomes [Internet]. Geneva: World Health Organization; 2015 [cited 2022 Oct 25]. 98 p. Available from: https://apps.who.int/iris/handle/10665/183037\u003c/li\u003e\n\u003cli\u003eBoundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, et al. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016 Jan;137(1):e20152238. \u003c/li\u003e\n\u003cli\u003eLawn JE, Mwansa-Kambafwile J, Horta BL, Barros FC, Cousens S. \u0026ldquo;Kangaroo mother care\u0026rdquo; to prevent neonatal deaths due to preterm birth complications. Int J Epidemiol. 2010 Apr;39 Suppl 1:i144-154. \u003c/li\u003e\n\u003cli\u003eMekonnen AG, Yehualashet SS, Bayleyegn AD. The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and LBW infants: a meta-analysis of published studies. Int Breastfeed J. 2019 Feb 19;14(1):12. \u003c/li\u003e\n\u003cli\u003eTessier R, Cristo M, Velez S, Giron M, de Calume ZF, Ruiz-Palaez JG, et al. Kangaroo mother care and the bonding hypothesis. Pediatrics. 1998 Aug;102(2):e17. \u003c/li\u003e\n\u003cli\u003eConde-Agudelo A, D\u0026iacute;az-Rossello JL. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database Syst Rev. 2014 Apr 22;(4):CD002771. \u003c/li\u003e\n\u003cli\u003eWHO Immediate KMC Study Group, Arya S, Naburi H, Kawaza K, Newton S, Anyabolu CH, et al. Immediate \u0026ldquo;Kangaroo Mother Care\u0026rdquo; and Survival of Infants with Low Birth Weight. N Engl J Med. 2021 May 27;384(21):2028\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eWHO. (2023). Kangaroo mother care A transformative innovation in health care [Internet]. Available from: https://iris.who.int/bitstream/handle/10665/367626/9789240072657-eng.pdf?sequence=1\u003c/li\u003e\n\u003cli\u003eSave the Children; Rapid Health Facility Assessment on Service Availability and Delivery of Care to Premature and/or Low Birth Weight Babies. 2015. \u003c/li\u003e\n\u003cli\u003eMony PK, Tadele H, Gobezayehu AG, Chan GJ, Kumar A, Mazumder S, et al. Scaling up Kangaroo Mother Care in Ethiopia and India: a multi-site implementation research study. BMJ Glob Health. 2021 Sep;6(9):e005905. \u003c/li\u003e\n\u003cli\u003eEthiopia Minister of Health. Health Sector Transformation Plan II HSTP II 2020/21-2024/25 (2013 EFY - 2017 EFY). 2021. \u003c/li\u003e\n\u003cli\u003eEstifanos AS, Haile Mariam D, Fikre A, Kote M, Tariku A, Chan GJ. Implementation science to design, test and scale up effective Kangaroo Mother Care in Oromia region, Ethiopia. Acta Paediatr. 2023 Aug;112 Suppl 473:56-64. doi: 10.1111/apa.16413. Epub 2022 Jun 12. PMID: 35691617. \u003c/li\u003e\n\u003cli\u003eYusuf E, Fiseha F, Dulla D, Kassahun G. Utilization of Kangaroo Mother Care (KMC) and Influencing Factors Among Mothers and Care Takers of Preterm/Low Birth Weight Babies in Yirgalem Town, Southern, Ethiopia. Divers Equal Health Care. 15(2):0\u0026ndash;0. \u003c/li\u003e\n\u003cli\u003eGidey S, Gebremariam DS, Hadush MY, Berhe A, Abay TH, Medhanyie AA, et al. Practice of Kangaroo Mother Care Among Low-Birth-Weight Infants Discharged from Health Facilities and Its Outcome in Mekelle City, Tigray, Northern Ethiopia. Int J Gen Med. 2023 Feb 28;16:757\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eAmolo L, Irimu G, Njai D. Knowledge of postnatal mothers on essential newborn care practices at the Kenyatta National Hospital: a cross sectional study. Pan Afr Med J. 2017;28:97. \u003c/li\u003e\n\u003cli\u003eSave the Children. (2017). KANGAROO MOTHER CARE IN MALAWI [Internet]. Available from: https://www.healthynewbornnetwork.org/hnn-content/uploads/Malawi-KAP-Summary-Sheet.pdf\u003c/li\u003e\n\u003cli\u003eSave the Children. (2017). KANGAROO MOTHER CARE IN NIGERIA [Internet]. Available from: https://www.healthynewbornnetwork.org/hnn-content/uploads/Nigeria-KAP-Summary-Sheet.pdf\u003c/li\u003e\n\u003cli\u003eWHO, Research WHORH and, Organization WH. Kangaroo Mother Care: A Practical Guide. World Health Organization; 2003. 55 p. \u003c/li\u003e\n\u003cli\u003eAlenchery AJ, Thoppil J, Britto CD, de Onis JV, Fernandez L, Suman Rao PN. Barriers and enablers to skin-to-skin contact at birth in healthy neonates - a qualitative study. BMC Pediatr. 2018 Feb 9;18(1):48. \u003c/li\u003e\n\u003cli\u003eNguah SB, Wobil PN, Obeng R, Yakubu A, Kerber KJ, Lawn JE, et al. Perception and practice of Kangaroo Mother Care after discharge from hospital in Kumasi, Ghana: A longitudinal study. BMC Pregnancy Childbirth. 2011 Dec 1;11(1):99. \u003c/li\u003e\n\u003cli\u003eAyele E, Tasew H, Mariye T, Gebreayezgi G, Bahrey D, Gereziher K, Engdashet S, Gidey T, Gebreyesus A. Magnitude of kangaroo mother care practice and its associated factors in Tigray region, northern Ethiopia, 2019: cross-sectional study design. Pan Afr Med J. 2023 Jan 4;44:5. doi: 10.11604/pamj.2023.44.5.29894. PMID: 36818028; PMCID: PMC9935649. \u003c/li\u003e\n\u003cli\u003eSemanew Y, Etaye M, Tizazu A, Abebaw D, Gebremedhin T. Newborn care practices and its determinants among postnatal mothers in Dessie Referral Hospital, Northeast Ethiopia. BMC Res Notes. 2019 Feb 21;12(1):96. \u003c/li\u003e\n\u003cli\u003eGebreslassie H, Degefa H, Gidey B, Mehari M, Mengesha M, Tilahun M, et al. Kangaroo mother care practice and its associated factors among postnatal mothers who gave birth in public general hospitals of Eastern and Central zone, Tigray, North Ethiopia. 2020. \u003c/li\u003e\n\u003cli\u003eBoundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016 Jan;137(1):e20152238. doi: 10.1542/peds.2015-2238. Epub 2015 Dec 23. PMID: 26702029; PMCID: PMC4702019. \u003c/li\u003e\n\u003cli\u003eChan GJ, Valsangkar B, Kajeepeta S, Boundy EO, Wall S. What is kangaroo mother care? Systematic review of the literature. J Glob Health. 2016 Jun;6(1):010701. doi: 10.7189/jogh.06.010701. PMID: 27231546; PMCID: PMC4871067. \u003c/li\u003e\n\u003cli\u003eLawal TV, Lawal DI, Adeleye OJ. Determinants of Kangaroo Mother Care among low-birth-weight infants in low resource settings. PLOS Glob Public Health. 2023 Sep 12;3(9):e0002015. doi: 10.1371/journal.pgph.0002015. PMID: 37699007; PMCID: PMC10497168. \u003c/li\u003e\n\u003cli\u003eKoreti M, Muntode Gharde P. A Narrative Review of Kangaroo Mother Care (KMC) and Its Effects on and Benefits for Low Birth Weight (LBW) Babies. Cureus. 14(11):e31948. \u003c/li\u003e\n\u003cli\u003eKostandy RR, Ludington-Hoe SM. The evolution of the science of kangaroo (mother) care (skin-to-skin contact). Birth Defects Res. 2019;111(15):1032\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eMekle DD, Patil DR, Jha P. Implementation of Kangaroo Mother care for low birth weight babies: supportive factors and barriers perceived by mothers. Pediatr Rev Int J Pediatr Res. 2018 Feb 28;5(2):87\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003ePenfold S, Hill Z, Mrisho M, Manzi F, Tanner M, Mshinda H, et al. A large cross-sectional community-based study of newborn care practices in southern Tanzania. PloS One. 2010 Dec 21;5(12):e15593. \u003c/li\u003e\n\u003cli\u003eZhang B, Duan Z, Zhao Y, Williams S, Wall S, Huang L, et al. Intermittent kangaroo mother care and the practice of breastfeeding late preterm infants: results from four hospitals in different provinces of China. Int Breastfeed J. 2020 Jul 17;15(1):64. \u003c/li\u003e\n\u003cli\u003eAgyekum MW, Codjoe SNA, Dake FAA, Abu M. Is Infant birth weight and mothers perceived birth size associated with the practice of exclusive breastfeeding in Ghana? PLOS ONE. 2022 May 5;17(5):e0267179. \u003c/li\u003e\n\u003cli\u003eBehzadifar M, Saki M, Behzadifar M, Mardani M, Yari F, Ebrahimzadeh F, et al. Prevalence of exclusive breastfeeding practice in the first six months of life and its determinants in Iran: a systematic review and meta-analysis. BMC Pediatr. 2019 Oct 27;19(1):384. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Basic Socio-demographic and Obstetric Characteristics of the Study Subjects\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(N=599)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026le;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e20-29 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eMissing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eOrthodox \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSchool attainment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eNo Education \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003ePrimary Completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e43.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eSecondary Completed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003ePost-Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e4.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eProfessional/technical/managerial \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eSales and services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eSkilled manual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eUnskilled manual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eAgriculture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eMissing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income (ETB), per year\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026lt; 20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e20,000 \u0026ndash; 50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026gt;50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. Living children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e3 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e33.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidency \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eIn catchment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e59.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eOut of catchment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e40.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eHealth facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e570\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e95.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eHome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelivery mode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e85.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNew-born characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e48.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e51.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eLBW 1,500-2,000 grams\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e73.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eVLBW \u0026lt;1,500 grams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e26.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age at time of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026lt;=7month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e7-9month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e54.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u0026gt;=9month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple births\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66.0617%;\"\u003e\n \u003cp\u003eTwins \u0026amp; Triplets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14.882%;\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 19.0563%;\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBasic Socio-demographic and Obstetric Characteristics of the Study Subjects in Selected Hospitals in Oromia, Ethiopia, April 2018 to March 2019.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Crude and Adjusted odds ratios with 95% confidence intervals for factors associated with Effective eKMC\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"840\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 31.6159%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffective KMC within 24 hours of birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (\u003c/strong\u003e95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (\u003c/strong\u003e95%CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003eYes, (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003eNo, (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eOrthodox \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e36(11.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e279(88.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e11(4.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e235(95.53%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e0.36(0.18-0.73)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e0.48(0.23-1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e6(17.14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e29(82.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1.6(0.6-4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e3.8(1.2-11.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Income (ETB), per year\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026quot;Low Income\u0026quot;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt; 20,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e5(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e212(97.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026ldquo;Middle Income\u0026rdquo; 20,000 \u0026ndash; 50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e33(12.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e225(87.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e6.22(2.38-16.23)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e5.6(2-3.15)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026ldquo;High Income\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e15(12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e109(87.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e5.83(2.06-16.48)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e4.9(1.7-14.9)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. Living children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e2(20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e8(80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e1-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e39(10.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e348(89.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e0.45(0.09-2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e0.37(0.06-2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e3 or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e12(5.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e190(94.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e0.25(0.04-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e0.6(0.07-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelivery mode\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e51(9.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e462(90.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eC/S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e2(2.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e84(97.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e0.2(0.05-0.9)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e0.2(0.05-0.89)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eLBW 1,500-2,000 grams\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e51(11.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e387(88.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eVLBW \u0026lt;1,500 grams\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e2(1.24%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e159(98.76%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e0.09(0.02-0.39)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e0.099(0.022-0.44)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age at time of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026lt;=7month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e7(4.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e163(95.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e7-9month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e33(10.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e293(89.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e2.6(1.1-6.1)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e2.5(0.98-6.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026gt;=9month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e13(12.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e90(87.38%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e3.4(1.3-8.7)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e3.35(1.17-9.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple births\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e46(11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e361(88.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e3.37(1.5-7.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e4.4(1.8-11.1)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003eTwins \u0026amp; Triplets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e7(3.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e185(96.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth order\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e36(11.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e284(88.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1.95(1.1-3.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e2.19(0.8-5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.4208%;\"\u003e\n \u003cp\u003e\u0026gt;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0273%;\"\u003e\n \u003cp\u003e17(6.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.5886%;\"\u003e\n \u003cp\u003e262(93.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.3692%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.5402%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAdjusted for all variables in the model, 1-references\u003c/p\u003e\n\u003cp\u003eCOR \u0026ndash; Crude odds Ratio, AOR \u0026ndash; Adjusted Odds Ratio, CI: confidence interval. * P- Value \u0026lt;0.05,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCrude and Adjusted odds ratios with 95% confidence intervals for factors associated with effective eKMC in Selected Hospitals in Oromia, Ethiopia, April 2018 to March 2019.\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"preterm birth, early KMC, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-5230470/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5230470/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEach year, 2.3 million neonates die, with over one million of these deaths occurring within the first 24 hours of birth. Preterm birth is contributing to over 50% of all neonatal deaths. Initiating Kangaroo Mother Care (KMC) immediately after birth, rather than waiting for stabilization, can reduce neonatal mortality by 25%. However, in Ethiopia, as of 2021, only 5%-10% of eligible premature newborns received any form of KMC. If the utilization of effective KMC remains low, mortality rates among preterm and low birth weight (LBW) infants are likely to remain higher than optimal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA cross-sectional study design was conducted using existing data to determine effective early KMC (eKMC) coverage. A total of 599 eligible low-birth-weight newborns were included in the data analysis. Bivariate and multivariate logistic regression analyses were applied, with a significance level set at p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult: \u003c/strong\u003eThe study included 599 of 705 neonates with birth weight \u0026lt;2,000g born or referred to selected hospitals between March 2017 and March 2019, all alive and not referred out within 24 hours. Among these eligible neonates, only 8.9% received effective eKMC, 20.5% received early any skin-to-skin (STS) care, and 64.6% were exclusively breastfed. Caesarean section delivery was associated with lower odds of effective eKMC compared to vaginal delivery (AOR ‘adjusted odd ratio’ = 0.2; 95% CI: 0.05-0.89), with birth order, multiple births, gestational age at time of delivery, birth weight, delivery mode, household income, and religion adjusted. Infants with very low birth weight (VLBW) (\u0026lt;1,500g) had significantly lower odds of receiving effective eKMC compared to those with LBW (1,500-2,000 grams) (AOR=0.099 ;95% CI: 0.022-0.44), while infants born at nine months or later and single births were more likely to receive effective eKMC compared to premature and multiple births (twins or triplets), with (AOR = 3.35; 95% CI: 1.17-9.6) and (AOR = 4.4; 95% CI: 1.8-11.1), respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eOur study found a low coverage of effective eKMC. Household income, mode of delivery, birth weight, gestational age at the time of delivery, and multiple births were significantly associated with uptake of effective eKMC.\u003c/p\u003e","manuscriptTitle":"Effective Early Kangaroo Mother Care Coverage and Associated Factors Among Low- Birth-Weight Neonates in Selected Hospitals in Oromia Region, Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-25 06:19:50","doi":"10.21203/rs.3.rs-5230470/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-20T08:02:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-22T17:43:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-21T20:29:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-18T14:41:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311379073605712258144936160992689859810","date":"2024-11-17T15:29:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320614023493288846745960727195706779467","date":"2024-11-15T01:05:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"63867961752905613840030543057070127168","date":"2024-11-14T13:51:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282498259267471508561589217262517849711","date":"2024-11-03T16:43:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-01T16:02:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-23T19:07:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-22T10:03:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-10-09T08:01:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a8dbe751-e84b-48e2-84d4-13e5ea2868fe","owner":[],"postedDate":"October 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T16:06:48+00:00","versionOfRecord":{"articleIdentity":"rs-5230470","link":"https://doi.org/10.1186/s12982-025-01256-4","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2025-12-16 15:57:28","publishedOnDateReadable":"December 16th, 2025"},"versionCreatedAt":"2024-10-25 06:19:50","video":"","vorDoi":"10.1186/s12982-025-01256-4","vorDoiUrl":"https://doi.org/10.1186/s12982-025-01256-4","workflowStages":[]},"version":"v1","identity":"rs-5230470","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5230470","identity":"rs-5230470","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}