Improving kangaroo mother care in a rural Kenyan hospital: a multi-component implementation strategy to strengthen neonatal care delivery

Background Neonatal mortality remains a leading contributor to under-five mortality globally, particularly in low- and middle-income countries (LMICs). Kangaroo mother care (KMC) is an effective, low-cost intervention for improving outcomes among preterm and low birth weight infants; however, implementation remains inconsistent in resource-limited settings. Methods We conducted a quality improvement study at a rural Kenyan hospital using three sequential six-week cycles. Interventions addressed key barriers to KMC, including provider knowledge, caregiver engagement, and environmental constraints. Primary outcomes were initiation of KMC within 24 h of delivery and mean daily duration of KMC. Secondary outcomes included the proportion of eligible hospital days during which neonates received ≥ 1 h of KMC and the proportion of eligible hospital days during which neonates received ≥ 8 h of KMC. Results A total of 45 neonates were enrolled. KMC initiation within 24 h increased from 8.3% at baseline to 83.3% after initial interventions ( P < 0.001) and was sustained thereafter. Mean daily duration increased from 0.2 to 2.0 h/day between Cycle 1 and Cycle 2 ( P < 0.001), and further to 4.1 h/day in Cycle 3 ( P = 0.02). The proportion of days with ≥ 1 h of KMC increased from 7.7% to over 80%. Prolonged KMC (≥ 8 h/day) was achieved only after environmental and infrastructure modifications. Conclusions A structured, multi-component implementation strategy substantially improved KMC initiation and duration in a rural, resource-limited setting. These findings suggest that low-cost, system-level interventions can strengthen neonatal care delivery and provide a scalable model for improving KMC uptake in similar LMIC contexts. Trial registration PACTR202601794718541 (retrospectively registered on 20 December 2025). Clinical trial number Not applicable; this was a quality improvement study. The project was retrospectively registered with the Pan African Clinical Trials Registry (PACTR; PACTR202601794718541) on 20 December 2025.