Globally, preterm birth and low birth weight (LBW) pose significant health challenges, leading to elevated rates of neonatal death and illness.1 According to the World Health Organization, roughly 15% of all babies born alive are classified as LBW, amounting to approximately 20 million infants each year worldwide.2 In resource-limited settings, the prevalence of LBW can be even higher, reflecting disparities in maternal health and access to adequate prenatal care. 3

Infants born with a weight under 2,500 grams, irrespective of their gestational age (LBW), or those delivered prior to 37 weeks of gestation (preterm), face an increased likelihood of both immediate and long-term health issues. 4 These babies are more susceptible to various complications, including respiratory problems, susceptibility to infections, and difficulties in maintaining body temperature and feeding issues. 5

The effective management of newborns, especially those who are low birth weight (LBW) and preterm, requires comprehensive care strategies. 6 One such strategy is Kangaroo Mother Care (KMC), which involves skin-to-skin contact and exclusive breastfeeding. KMC is essential for improving health outcomes in LBW and preterm infants by stabilizing their physiological conditions and strengthening maternal-infant bonding. 7 This method helps meet the infant's biological needs by providing warmth, affection, and nutrition while also reducing the risks of hypothermia and hypoglycemia.8 KMC can prevent prolonged hospitalization and is a cost-effective approach to reducing infant mortality and morbidity rates. 9 Additionally, it supports cognitive development, enhances mother-child bonding, boosts maternal confidence in infant care, and decreases stress for both mother and baby. 10 KMC is more practical and affordable than incubators, offering benefits such as reduced infection rates, improved weight gain, and better overall development. 11

The early postnatal period is crucial for LBW infants, significantly influencing their developmental trajectory and overall health outcomes. 12 One critical aspect of postnatal care is the establishment of effective mother-infant bonding, which plays a pivotal role in promoting the infant's emotional and physical development. 13 The strong postnatal attachment is also associated with improved feeding behaviors, better weight gain, and a decreased incidence of neonatal complications for mothers of LBW and preterm infants, establishing a robust attachment can be particularly challenging due to the stress and medical complications associated with their infants' conditions. 14, 15 Kangaroo Mother Care can alleviate maternal anxiety and stress, thereby fostering this important bond.

Despite significant progress over the past decade, challenges remain in ensuring the survival, health, growth, and neurological development of preterm and LBW infants in many countries. 16 Research from various income-level countries shows that KMC effectively promotes weight gain and improves health outcomes in LBW infants. 17 However, data on LBW infants in underdeveloped regions is often scarce, as many deliveries occur in homes or small health facilities, leading to frequent underreporting of LBW cases. 18

The benefits of KMC are well-documented, but its implementation remains inconsistent, especially in areas with limited maternal knowledge and awareness. 19 Educational modules designed to inform mothers about KMC can address this gap, offering crucial knowledge and encouraging the practice of KMC.

This study aims to evaluate the impact of an information module on postnatal attachment and KMC knowledge among mothers of LBW infants. The findings may contribute to providing valuable insights for refining educational strategies and developing more effective interventions, ultimately improving health outcomes for LBW and preterm infants.

Table 1 depicts that the majority of post-natal mothers have completed 10th-class education. All in the experimental group were married, while 83.9% in the control group were married. Most participants were housemakers, with 100% in the control group. The majority had a monthly income of ₹17,001-35,000 and lived in nuclear families in rural areas. Most were Hindu, and many of the preterm infants weighed 1.6-2 kg. The majority were primigravida, with most deliveries being normal vaginal with episiotomy. None had heard of kangaroo mother care.

Table 2 describes that in the control group, the majority had inadequate knowledge both in the pre-test (90.3%) and post-test (87.1%). Only a small increase in moderate knowledge was observed from 9.7% to 12.9%. No participants had adequate knowledge in either test. In the experimental group, 80.6% had inadequate knowledge in the pre-test, but this dropped to 0% in the post-test. Conversely, the percentage with adequate knowledge increased significantly from 0% in the pre-test to 83.9% in the post-test, while those with moderate knowledge slightly decreased from 19.4% to 16.1%.

Table 3 revealed that in the pre-test, both the control and experimental groups had similar scores acrossthe quality of attachment, absence of hostility, and pleasure in interaction. However, in the post-test, the experimental group showed significant improvements in quality of attachment increased to 20.96 ± 0.091, absence of hostility to 35.48 ± 1.38, and pleasure in interaction to 18.48 ± 0.56. In contrast, the control group showed minimal changes, indicating a substantial positive effect in the experimental group.

Table 4 describes that in control group exhibited a slight increase in knowledge from pre-test (5.35 ± 1.68) to post-test (5.83 ±1.71), with a t-value of 2.70 and a p-value of 0.011, indicating statistically significant improvement. In contrast, the experimental group demonstrated a substantial gain in knowledge, with pre-test scores of (5.90 ±1.75) rising to (12.00 ± 1.50) post-test, yielding a t-value of 16.388 and a p-value of 0.000, reflecting a highly significant effect. This demonstrates that the information module significantly improved knowledge of kangaroo mother care in the experimental group relative to the control group.

Table 5 shows that the control group exhibited minimal changes inthe quality of attachment, absence of hostility, and pleasure in interaction from pre-test to post-test, with p-values indicating no significant improvement. In contrast, the experimental group demonstrated significant gains across all measures. Quality of attachment increased from a pre-test mean of (8.29 ±1.34) to a post-test mean of (20.96 ± 0.91); absence of hostility rose from (16.74 ± 1.87) to (35.48 ± 1.38); and pleasure in interaction improved from (8.61 ± 1.11) to (18.48 ± 0.56). All changes in the experimental group were statistically significant (p-values < 0.001), confirming the effectiveness of the module in enhancing maternal attachment.

Table 6 shows the relationship between knowledge regarding mother care and maternal attachment. The correlation between knowledge and maternal attachment is +0.06 which indicates a Positive low correlation in the pre-test, similarly, the post-test score is -0.124 which indicates a negative low correlation in the control group. The correlation between knowledge and maternal attachment is -0.134 which indicates a negative low correlation in the pre-test but after the intervention, the post-test score is +0.05 which indicates a positive low correlation in the experimental group.

Table 7 shows the association between knowledge score with selectedsocio-demographic variables. The obtained P-value for Age (in Years), literacy, Marital Status, occupation, monthly income, type of family, Locality, religion, the weight of the preterm, Gravida, and type of delivery, have you heard about kangaroo mother care is more than the level of significance i.e. 0.05, which indicates that there is no significant association between knowledge score with selected socio-demographic variables.

The study findings suggest that postnatal mothers in the experimental group showed significant improvements in knowledge and attachment compared to the control group after receiving an informational module. The results of the current study indicate that in the pre-test 90.3% of the participants in the control group and 80.6% of the participants in the experimental group had insufficient knowledge about Kangaroo Mother Care (KMC). In the control group, a maximum of 87.1% of the participants had inadequate knowledge. In contrast, in the experimental group, 83.9% of the participants had adequate knowledge about KMC after the implementation of the information module. The results aligned with a study conducted by Lawal et al., which showed that mothers who underwent KMC training retained better knowledge and were more likely to practice it while caring for their low-birth-weight infants.21 This improved neonatal outcomes, such as weight gain, successful breastfeeding, and reduced hospital stays. Mothers of premature or low birth weight (LBW) infants often encounter difficulties in forming early attachment due to extended hospital stays, anxiety, and stress. 22 Premature births and low birth weight (LBW) often require extended stays in the neonatal intensive care unit (NICU), which can physically separate the mother and infant during critical bonding periods. 23 This separation, along with the medical complexities and uncertainties surrounding the infant’s health, often leads to increased maternal anxiety and stress, further complicating the attachment process. 24

The study results show that the experimental group had a significantly improved postnatal maternal attachment compared to the control group. The experimental group had a lower absence of hostility, with a mean score of 16.74 ± 1.87, compared to the control group's mean score of 17.12 ± 1.40. In the posttest, the experimental group's mean score further decreased to 35.48 ± 1.38, indicating even less absence of hostility compared to the control group's mean score of 17.19 ± 1.32. The findings align with a study by Mehrpisheh et al., indicating that kangaroo mother care (KMC) not only enhances infants' physical health but also fosters emotional bonding between mother and baby. 25 The close physical contact involved in kangaroo mother care (KMC) has been shown to have a positive impact on maternal sensitivity and attachment behaviors, helping to alleviate the emotional distress often experienced by mothers of preterm infants. 26 The skin-to-skin contact and emotional connection encouraged by kangaroo mother care (KMC) have been proven to strengthen the bond between mother and infant, decrease maternal anxiety, and improve the mother's capacity to meet the infant's needs. 27 These results align with a study by Conde-Agudelo et al., which showed that kangaroo mother care (KMC) led to a significant decrease in neonatal mortality rates, particularly in low-resource environments. 28

The study found a strong positive correlation (+0.051) between knowledge and maternal attachment, highlighting the link between knowledge and emotional bonding. When mothers have a better understanding of how to care for their preterm infants, they are more likely to form a secure attachment, which is crucial for the infant's emotional and physical development.

The lack of significant associations between socio-demographic variables (such as age, literacy, income, and family structure) and knowledge scores suggests that the educational module was effective across diverse demographic backgrounds. This finding aligns with a study by Maleki et al., showing the universal applicability of educational interventions in improving maternal care practices, irrespective of socio-demographic factors. 29 This is particularly important in settings where maternal literacy levels and healthcare access may vary significantly, indicating that even brief, targeted interventions can have a meaningful impact on maternal behaviors and outcomes.

Preterm births and low birth weight (LBW) infants are significant factors in neonatal health, especially in areas with limited resources. 30 Kangaroo Mother Care (KMC) is known to improve neonatal outcomes but faces challenges in implementation due to mothers' lack of knowledge and awareness. Additionally, mothers of LBW infants may experience compromised maternal-infant attachment due to heightened anxiety and stress. This study aims to assess how structured educational interventions, such as information modules on KMC, can enhance maternal knowledge and improve postnatal attachment, ultimately leading to better neonatal outcomes.

The study shows that introducing an information module on KMC can significantly increase maternal knowledge and postnatal attachment among mothers of LBW infants. These results emphasize the important role of educational interventions in empowering mothers to follow best practices in neonatal care and improving the bond between mother and infant. Policymakers and healthcare providers should consider incorporating structured educational programs like the KMC module into standard postnatal care protocols, especially in resource-limited settings, to enhance outcomes for both mothers and infants.