Mother’s Touch, Baby’s Lifeline: Improving Neonatal Outcomes through Kangaroo Mother Care Down-Referral and Integrated Health Services in Gauteng, South Africa
1
Public Health Medicine, University of Pretoria, Pretoria, South Africa
2
Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Overcrowding in tertiary neonatal units is a persistent health system challenge in low- and middle-income countries, leading to reduced nurse-to-patient ratios, increased hospital-acquired infections, and preventable neonatal mortality. Tembisa Provincial Tertiary Hospital (TPTH) in Gauteng, South Africa, routinely operates beyond its approved neonatal bed capacity. In August 2024, a structured Kangaroo Mother Care (KMC) down-referral intervention was implemented to optimise patient flow by transferring clinically stable mother–infant pairs to under-utilised district-level KMC units. This study evaluated the impact of the intervention on overcrowding and key neonatal outcomes at TPTH.
METHODS:
A retrospective comparative study was conducted using routinely collected hospital data. Neonatal indicators were compared across two six-month periods: pre-intervention (February–July 2024) and post-intervention (September 2024–February 2025) . Outcomes included mean monthly neonatal headcount, bed utilisation rate, neonatal mortality rate, absolute number of neonatal deaths, and hospital-acquired infections. August 2024 was treated as a pilot month and excluded from the analysis. Descriptive statistics and independent t-tests were used to assess differences between periods.
RESULTS:
Between August 2024 and February 2025, 236 neonates were down-referred to district KMC units. Following implementation, the mean monthly neonatal headcount decreased significantly from 160.3 to 122.5 (p=0.029), while bed utilisation declined from 159.8% to 141.2% (p=0.009), indicating a substantial reduction in overcrowding. Neonatal mortality rates, absolute neonatal deaths, and hospital-acquired infection rates demonstrated downward trends in the post-intervention period; however these reductions were not statistically significant.
CONCLUSIONS:
The implementation of a structured KMC down-referral model significantly reduced overcrowding in a high-volume tertiary neonatal unit and demonstrated clinically favourable trends in mortality and infection outcomes. Strengthening district-level KMC capacity including human resource support and formalising integrated referral pathways represent feasible, low-cost health system strategies to improve neonatal care and optimise the use of scarce tertiary resources in resource-constrained settings.
Overcrowding in tertiary neonatal units is a persistent health system challenge in low- and middle-income countries, leading to reduced nurse-to-patient ratios, increased hospital-acquired infections, and preventable neonatal mortality. Tembisa Provincial Tertiary Hospital (TPTH) in Gauteng, South Africa, routinely operates beyond its approved neonatal bed capacity. In August 2024, a structured Kangaroo Mother Care (KMC) down-referral intervention was implemented to optimise patient flow by transferring clinically stable mother–infant pairs to under-utilised district-level KMC units. This study evaluated the impact of the intervention on overcrowding and key neonatal outcomes at TPTH.
METHODS:
A retrospective comparative study was conducted using routinely collected hospital data. Neonatal indicators were compared across two six-month periods: pre-intervention (February–July 2024) and post-intervention (September 2024–February 2025) . Outcomes included mean monthly neonatal headcount, bed utilisation rate, neonatal mortality rate, absolute number of neonatal deaths, and hospital-acquired infections. August 2024 was treated as a pilot month and excluded from the analysis. Descriptive statistics and independent t-tests were used to assess differences between periods.
RESULTS:
Between August 2024 and February 2025, 236 neonates were down-referred to district KMC units. Following implementation, the mean monthly neonatal headcount decreased significantly from 160.3 to 122.5 (p=0.029), while bed utilisation declined from 159.8% to 141.2% (p=0.009), indicating a substantial reduction in overcrowding. Neonatal mortality rates, absolute neonatal deaths, and hospital-acquired infection rates demonstrated downward trends in the post-intervention period; however these reductions were not statistically significant.
CONCLUSIONS:
The implementation of a structured KMC down-referral model significantly reduced overcrowding in a high-volume tertiary neonatal unit and demonstrated clinically favourable trends in mortality and infection outcomes. Strengthening district-level KMC capacity including human resource support and formalising integrated referral pathways represent feasible, low-cost health system strategies to improve neonatal care and optimise the use of scarce tertiary resources in resource-constrained settings.
| eISSN: | 2654-1459 |
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