Investigating socioeconomic disparities of Kangaroo mother care on preterm infant health outcomes

Figures & data

Table 1. Structure chart.

Stage-A	Pakistan
Stage-B	Province (South-Punjab)
Stage-C	Region (Muzaffargarh, Bahawalpur and DG Khan)
Stage-D	Hospitals (Private & Public)
Stage-E	KMC Units in Obstetrics and gynecology department (respondents)

Table 2. SEM of socio-ecological factors influencing preterm infant health outcomes.

Factors/variables	Illustration
Demographic	Gender, gestational age at birth, multiple births, birth weight
Kangaroo mother care and awareness	Information about KMC, awareness of KMC in area, KMC information/training, familiarity with KMC, past KMC practice, and typical KMC session length
Urban–rural and socioeconomic factors	Urban or rural residence, primary household breadwinner, receiving government subsidies/aid, highest education level, partner’s education level, proximity to healthcare facility and health insurance coverage
Health outcomes	Overall preterm infant health and infant health complications since birth
Maternal health during pregnancy	Pregnancies, including current, receiving prenatal care, pregnancy complications, iron or folic acid supplements, experience of anemia, smoking or alcohol during pregnancy, exposure to toxins/hazards and stressors during pregnancy
Urban–rural disparities and access to healthcare	Availability of nearby healthcare facilities and quality of local healthcare services

Table 3. Interrelated aspects of neonatal and maternal health: an in-depth examination.

Characteristics	Total (%)	Characteristics	Total (%)
Infant information		Kangaroo mother care and awareness
Gender		How did you first learn about kangaroo mother care
Male	232 (32.26)	Healthcare provider	270 (37.55)
Female	487 (67.73)	Family/friends	416 (57.85)
Gestational age at birth (in weeks)		Online resources	33 (4.58)
Extremely preterm (≤28 weeks)	41 (5.70)
Very preterm (29–32 weeks)	106 (14.74)	Do you feel that there is enough awareness about kangaroo mother care in your community
Moderate preterm (33–34 weeks)	211 (29.34)	Yes	0 (0)
Late preterm (35–37 weeks)	361 (50.20)	No	501 (69.68)
Multiple births (e.g. twins, triplets)		Not sure	218 (30.31)
Yes	9 (0.01)	Would you be interested in receiving more information or training on kangaroo mother care
No	710 (98.74)	Yes	701 (97.49)
Birth weight (g)		No	0 (0)
		Not sure	18 (2.50)
Less than 1000	41 (5.70)	Are you familiar with Kangaroo Mother Care (KMC)
1000–1600	106 (14.74)	Yes	518 (72.04)
1600–2300	492 (68.42)	No	95 (13.21)
2300–2900	80 (11.12)	Somewhat	106 (14.74)
Urban–rural and socioeconomic factors		Have you practiced Kangaroo mother care with the preterm infant
Do you reside in an urban or rural area		Yes	671 (93.32)
Urban	547 (76.07)	No	48 (6.67)
Rural	172 (23.92)	How frequently have you practiced Kangaroo Mother Care
Are you the primary breadwinner of your household		Daily	470 (65.36)
Yes	241 (33.51)	Several times a week	155 (21.55)
No	478 (66.48)	Once a week	86 (11.96)
Does your family receive any government subsidies or financial aid programs		Rarely	8 (1.11)
Yes	510 (70.93)	What is the typical duration of Kangaroo mother-care sessions
No	209 (29.06)	Less than an hour	370 (51.46)
What is the highest level of education you have completed		1–2 h	338 (47.00)
Less than high school	293 (40.75)	2–4 h	6 (0.83)
High school graduate	324 (45.06)	More than 4 h	5 (0.69)
Some college or technical school	55 (7.64)	Health outcomes
Bachelor’s degree	45 (6.25)	How would you rate the overall health of your preterm infant
Postgraduate degree	2 (0.27)	Excellent	16 (2.22)
What is the highest level of education completed by your partner (if applicable)		Very good	19 (2.64)
Less than high school	147 (20.44)	Good	177 (24.61)
High school graduate	262 (36.43)	Fair	265 (36.85)
Some college or technical school	276 (38.38)	Poor	242 (33.65)
Bachelor’s degree	28 (3.89)	Has your preterm infant experienced any health complications since birth
Postgraduate degree	6 (0.83)	Yes	554 (77.05)
N/A (if no partner)	0 (0)	No	165 (22.94)
Do you have health insurance for yourself and your baby		Urban–rural disparities and access to healthcare
Yes	206 (28.65)	Are there healthcare facilities or hospitals in your vicinity
No	513 (71.34)	Yes	550 (76.49)
Maternal health during pregnancy		No	169 (23.50)
How many pregnancies have you had, including the current one
1	13 (1.80)	How would you rate the quality of healthcare services available in your area
2	75 (10.43)	Excellent	39 (5.42)
3 or more	631 (87.76)	Good	37 (5.14)
Did you receive prenatal care during your pregnancy		Average	120 (16.68)
Yes	684 (95.13)	Poor	523 (72.73)
No	35 (4.86)	How far is the nearest healthcare facility from your residence (specify distance in kilometers or miles)
Did you experience any complications during your pregnancy (e.g. gestational diabetes, preeclampsia)		1–20 km	103 (14.32)
Yes	538 (74.82)	21–40 km	411 (57.16)
No	135 (18.77)	Above 40 km	205 (28.51)
Not sure	46 (6.39)	–	–
Did you take iron or folic acid supplements during your pregnancy
Yes	595 (82.75)	–	–
No	124 (17.24)	–	–
Did you experience anemia during your pregnancy			–
Yes	662 (92.07)	–	–
No	57 (7.92)	–	–
Not sure	0 (0)	–	–
Did you smoke or consume alcohol during your pregnancy
Yes	0 (0)	–	–
No	719 (100)	–	–
Were you exposed to any environmental toxins or hazards during your pregnancy (e.g. pollution, chemicals)
Yes	57 (7.92)	–	–
No	662 (92.07)	–	–
Did you experience any significant stressors or emotional challenges during your pregnancy
Yes	684 (95.13)		–
No	35 (4.86)	–	–

Table 4. Model fitting information.

Model	Model fitting criteria		Likelihood ratio tests
	−2 log likelihood		Chi-square		Df	p Value
Intercept only	1096.430		–		–	.001
Final	21966.326		–		28	.001
Goodness-of-fit
Pearson	–		1.705		24	.001
Deviance	–		21942.66		24	.001
Pseudo R-square
Cox and Snell		Nagelkerke		McFadden
0.535		0.723		0.401

Table 5. Multinomial logistic regression of maternal health during pregnancy and preterm infant health outcome.

Factors/covariates	Coefficient (SE)	OR (95% CI)	p Value
Very good health outcome of preterm infant
Intercept	108.934 (30.51)	–	.001
Complications during your pregnancy (e.g. gestational diabetes, preeclampsia)	−3.593 (3.01)	36.35 (0.09–133.02)	.233
Number of pregnancy	−0.775 (0.82)	1.46 (0.09–2.30)	.346
Parental care	54.448 (19.49)	3.54 (0.00–4.39)	.001
Environmental toxins or hazards	−5.568 (2.21)	0.90 (0.32–2.29)	.012
Use folic acid	41.478 (9.26)	1.44 (0.87–3.12)	.001
Experience anemia	36.627 (9.06)	8.82 (1.69–14.59)	.001
Consume alcohol	0a	–	–
Stressors or emotional challenges	−44.448 (19.49)	3.54 (2.10–6.37)	.001
Good health outcome of preterm infant
Intercept	177.694 (11.45)	–	.001
Complications during your pregnancy (e.g. gestational diabetes, preeclampsia)	−0.021 (3.00)	0.97 (0.00–3.47)	.994
Number of pregnancy	−7.041 (1.65)	29.80 (11.47–56.28)	.001
Parental care	34.448 (6.41)	2.64 (1.22–10.23)	.001
Environmental toxins or hazards	−3.510 (1.57)	0.03 (0.00–1.65)	.026
Use folic acid	53.198 (3.41)	2.00 (1.47–6.32)	.001
Experience anemia	38.547 (3.44)	1.29 (0.50–3.11)	.001
Consume alcohol	0a	–	–
Stressors or emotional challenges	−54.448 (6.39)	4.61 (1.26–9.90)	.001
Fair health outcome of preterm infant
Intercept	180.265 (8.86)	–	.001
Complications during your pregnancy (e.g. gestational diabetes, preeclampsia)	−2.322 (2.93)	10.20 (2.03–32.61)	.429
Number of Pregnancy	−4.795 (0.85)	12.89 (6.59–46.72)	.001
Parental Care	36.448 (5.20)	5.52 (1.19–10.05)	.001
Environmental toxins or hazards	2.581 (1.43)	0.07 (0.00–1.26)	.072
Use folic acid	56.558 (2.90)	1.05 (0.54–3.15)	.001
Experience anemia	53.896 (2.76)	6.74 (2.96–11.53)	.001
Consume alcohol	0a	–	–
Stressors or emotional challenges	50.448 (5.23)	3.54 (1.29–8.012)	.001
Poor health outcome of preterm infant
Intercept	177.821 (3.22)	–	–
Complications during your pregnancy (e.g. gestational diabetes, preeclampsia)	15.906 (2.94)	3.67 (1.14–11.72)	.001
Number of pregnancy	6.214 (0.75)	3.36 (0.76–14.76)	.045
Parental care	−53.403 (0.65)	1.00 (0.012–3.60)	.108
Environmental toxins or hazards	36.606 (1.43)	0.02 (0.00–0.45)	.001
Use folic acid	39.494 (1.66)	2.95 (1.13–7.70)	.012
Experience anemia	48.929 (1.31)	8.82 (6.72–11.59)	.001
Consume alcohol	0b	–	–
Stressors or emotional challenges	43.40	1.00 (0.11–2.23)	–

CI: confidence interval; OR: odds ratio; SE: standard error.

^a This parameter is set to zero because it is redundant.

Data availability statement

The corresponding author can provide access to the data, models and code that support the findings of this study.