Westphal et al. 1616 Westphal MF, Taddei JA, Venancio SI, Bogus CM. Breast-feeding training for health professionals and resultant institutional changes. Bull World Health Organ. 1995;73:461-468. (1995) Santos/SP/Brazil 1992-1993 |
Fair (13/20) |
• 8 public and philanthropic hospitals: intervention group - 4; control group - 4 • 12 professionals trained: 3 per hospital intervention |
• Randomized clinical trial (hospital randomization) |
• Theoretical and practical training: Course (Wellstart-SLC) lasting 14 days, 133 h, with 1/3 practical training |
• Adherence to BFHI Steps 1-10: interviews with managers, health professionals, pregnant women, and mothers before and six months after training |
• Differences in institutional scores by hospital pairs (experimental or control): Pair 1: 0.6 vs. 0.9; Pair 2: 1.6 vs. -0.7 Pair 3: 1.9 vs. 0.2; Pair 4: 0.5 vs. 0.2 • Institutional changes: significant advance in Steps 1, 2, 10 (p -value not stated) |
Prasad & Costello 2525 Prasad B, Costello AM. Impact and sustainability of a baby-friendly health education intervention at a district hospital in Bihar, India. BMY. 1995;310:621-3. (1995) India 1992-1993 |
Fair (13/20) |
• 1 public hospital in the countryside • Hospital Administrators, 8 physicians, 1 ward sister, 9 nurses • Mother-child binomials with normal delivery and healthy babies (172 at baseline, 195 soon after the intervention, and 101 six months later) |
• Before and after type (with comparison between exposed and non-exposed six months post-intervention) |
• ≥ 5 individual or group sessions with health education doctors on Steps 4 and 6 |
• Changes in hospital practices related to Steps 4 and 6: Mothers interviewed at home two weeks after delivery (at baseline, soon after the intervention and six months post-intervention) |
Baseline → soon after the intervention → 6 months post-intervention Mothers exposed to health education: 0% → 100% → 36% - Step 4: BF within the 1st hour of life: 3% → 60% → 14% - Step 6: use of supplements: 96% → 43% → 77% (both significant advances, but p -value is not mentioned) Six months post-intervention: - Step 6: use of supplements: 42% (of exposed, n = 36) vs. 97% (of non-exposed, n = 65)
|
Taddei et al. 2626 Taddei JA, Westphal MF, Venancio S, Bogus C, Souza S. Breastfeeding training for health professionals and resultant changes in breastfeeding duration. Sao Paulo Med J. 2000;118:185-91. (2000) Santos/SP 1992-1993 |
Fair (14/20) |
• 8 public or philanthropic hospitals: intervention group - 4; control group - 4 • 12 trained professionals: 3 per intervention hospital • Mother-child binomials: 494 of 609 eligible (pre-training) and 469 of 555 eligible (post-training) |
• Randomized clinical trial (hospital randomization) |
• Theoretical and practical training: 14-day, 133-h course (Wellstart-SLC course), with 1/3 practice |
• Changes in hospital practices regarding Steps 4, 5, and 7: interview to mothers during home visits (one and six months after delivery) |
• Before/after, exposed
vs.
non-exposed: - Step 4: BF in the delivery room: 2% → 23% × 2% → 8%
- BF within the first 6 h: 41% → 53% × 48% → 50% - Step 5: BF support at the hospital: 48% → 64% vs. 58% → 61% - Step 5: BF support at the hospital: 29% → 49% vs. 35% → 36% - Step 7: rooming in: 8% → 6% vs. 20% →13%
|
Cattaneo & Buzzetti 1919 Cattaneo A, Buzzetti R. Effect on rates of breast-feeding of training for the Baby Friendly Initiative. BMJ. 2001;323:1358-62. (2001) Italy 1996-1998 |
Good (16/20) |
• 8 eligible hospitals Group 1: 4 hospitals with 377 trained professionals (of 536 eligible) from 10/1996 to 02/1997 Group 2: 3 hospitals (1 loss) with 194 trained professionals (of 237 eligible) from 10/1997 to 02/1998 • 2669 Mother-child binomials with BW > 2000 g, without ICU admission |
• Quasi-experimental (with before and after component) |
• Multiplier training in 24-h courses (18 h + 2 h counseling + 4 clinical practice) that trained groups 1 and 2 using the BFHI 18-h course |
• Adherence BFHI Ten Steps: Self-administered questionnaire by professionals (steps 1 and 2), interview to mothers pre and post-evaluation (Steps 4-10) Baseline → post-training |
• Before/after - overall result: - Mean adherence to the Steps: 2.4 → 7.7 steps (p -value not mentioned) • Before/after - group 1 and group 2: - EBF at discharge: 41% → 77% and 23% → 72% (p -value not mentioned) - Step 4: BF within the 1st hour: 12% → 22% and 37% → 60%
- Step 5: latching/positioning: 67% → 88% and 77% → 93%
- Step 5: expression by hand: 60% → 75% and 43% → 72%
- Step 6: use of supplements: 35% → 17% and 8% → 8% - Step 7: rooming in: 72% → 89% and 36% → 77%
- Step 8: BF on demand: 83% → 97% and 97% → 99% - Step 9: use of bottle: 58% → 14% and 70% → 26%
- Step 9: use of pacifier: 56% → 19% and 63% → 52%
• Less advancement in Steps 1, 2, and 10 (p -value not mentioned) |
Durand et al. 2727 Durand M, Labarere J, Brunet E, Pons J-C. Evaluation of a training program for healthcare professionals about breast-feeding. Eur J Obst Gynecol Reprod Biol. 2003;106:134-8. (2003) France 1997-2000 |
Fair (11/20) |
• 1 tertiary maternity hospital • All 73 professionals from the staff • Mother-child binomials without ICU admission: 50 before the training program and 50 after (with 71.4% of response rate) |
• Before and after type |
• Three-day theoretical and practical training on the benefits and management of breastfeeding (10 professionals per class) from 1998 to 2000 |
• Changes in hospital practices related to Steps 4-7, 9, 10: assessment of newborns’ records and self-administered questionnaire, given to mothers at the time of hospital discharge |
• According to medical record: - Step 4: BF within the 1st hour: 7.9% → 21% - Step 6: use of supplements: 82% → 63% - Step 7: mother-child separation > 4 h: 52% → 13%
- Step 9: formula only in cup: 0% → 13.1%
- Step 9: use of bottle: 82% → 26%
- EBF at discharge: 14% → 28% • According to the questionnaire: - Step 5: teach positioning for breastfeeding: 41.7% → 69.2%
- Step 10: post-discharge support resources: 8.3% → 57.7%
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Labarere et al. 2828 Labarere J, Castell M, Fourny M, Durand M, Pons JC. A training program on exclusive breastfeeding in maternity wards. Int J Gynecol Obstet. 2003;83:77-84. (2003) France 1997-2000 |
Fair (14/20) |
• 1 tertiary maternity • All 73 professionals of the staff • Mother-child binomials without ICU admission: 323 (pre-training) and 324 (post-training) |
• Before and after type |
• Three-day theoretical and practical training on benefits and management of breastfeeding (10 professionals per class) from 1998 to 2000 |
• Changes in hospital practices regarding Steps 4-7, and 9: assessment of maternal medical records before and after training retrospectively by nurse not involved in assistance |
EBF at discharge: 15.8% → 35.2%
- Step 4: BF within the 1st hour of life: 9.2% → 16.9%
- Step 6: use of supplements: 77.6% → 54.0%
- Step 7: rooming in: 56.6% → 72.6%
- Step 9: formula in the cup: 0.4% → 23.8%
use of bottle: 77.2% → 14.1%
|
Martens 99 Martens PJ. Does breastfeeding education affect nursing staff beliefs, exclusive breastfeeding rates, and Baby-Friendly Hospital Initiative compliance? The experience of a small, rural Canadian hospital. J Hum Lact. 2000;16:309-18. (2000) Canada 1998 |
Fair (13/20) |
2 small hospitals in rural areas • Intervention Group: 1 hospital, 15 of 24 eligible nursing professionals • Control Group: 1 hospital, 16 of 19 eligible nursing professionals • Breastfed babies: 26 in the intervention hospital and 23 in the control |
• Quasi-experimental |
• 1.5-h training with nurses during working hours + optional tutorial • Focus on knowledge of BF management and BFHI policy |
• Adherence to BFHI and Steps 1, 2, 6, 7, 9, and 10 by the hospital: Self-administered questionnaire by professionals before the intervention and 8 months after. • EBF during hospital stay: assessment of newborn's medical record (intervention: 13 pre and 13 post; control: 14 pre and 9 post) |
• According to the questionnaire: Intervention hospital: - Step 1: written norm: 40% → 87%
- Step 2: skills in BF management: 35% → 60% - Step 6: non-use of supplement: 45% → 87%
- Step 7: rooming in: 90% → 100% - Step 9: non-use of bottle: 30% → 67%
- Step 9: non-use of pacifier: 50% → 67% - Step 10: encourage support groups: 5% → 47%
• According to medical records: experimental vs. control-Adherence to BFHI: 24.4% → 31.9% × 20.2% → 22.5% - EBF during hospital stay: 31% → 54% × 43% → 0%
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Coutinho et al. 2929 Coutinho SB, Lima MC, Ashworth A, Lira PI. Impacto de treinamento baseado na Iniciativa Hospital Amigo da Criança sobre práticas relacionadas à amamentação no interior do Nordeste. J Pediatr (Rio J). 2005;81:471-7. (2005) Pernambuco 1998 (previous cohort) and 2001 |
Fair (13/20) |
• 2 hospitals from SUS • 42 professionals trained (90% of midwives and nurse aids) • 334 mother-child binomials of 364 eligible ones (2001) compared to 364 (1998). Urban area, single birth, with BW ≥2500 g, healthy |
• Before and after type (historical control) |
• Theoretical and practical training:18-h WHO/UNICEF-BFHI course + 2 h of breastfeeding counseling and educational material |
• Adherence to Steps 4 to 9 of BFHI: interview with mothers in the first 48 h and 10 days after delivery. |
historical control → experimental group - Step 4: Skin-to-skin contact: 25.8% → 37.2%
Help with BF at birth: 5.8% → 6.0% - Step 5: latching/positioning: 9.6%→21.0%
- Step 6: EBF within the 1st 48 h: 21.2% → 70.0%
- Step 9: use of pacifier: 47.2% → 24.3%
(other steps - results not shown) |
Zakarija-Grković et al. 3030 Zakarija-Grkovic I, Segvic O, Bozinovic T, Cuze A, Lozancic T, Vockovic A, et al. Hospital practices and breastfeeding rates before and after the UNICEF/WHO 20-hour course for maternity staff. J Hum Lact. 2012;28:389-99. (2012) Croatia 2008 - 2010 |
Good (16/20) |
• 1 tertiary hospital • Trained 80% of the 271 staff professionals • Mother-child binomials (388 pre-training and 385 post) with BW > 2500 g, without ICU admission, single births (interviewed 94.2% of eligible) |
• Before and after type |
• Theoretical and practical training: 20-h WHO/UNICEF-BFHI course: one class in May 2008 and another in February 2009 |
• Adherence to Steps 3 to 9 of BFHI: assessment of newborn's medical record; interview with mothers pre and post-training |
• According to the medical record: - EBF within 48 h: 6.0% → 11.7%
• According to the interviews: - Step 3: recommendations on child feeding: 10.8% → 9.9% - Step 4: held the baby at the 1st contact for > 60 min: 0.8% → 3.2%
- Step 4: baby sucked at the 1st contact: 8.6% → 4.2% - Step 5: help with latching/positioning: 70.3% → 69.0% - Step 5: was shown expression by hand: 44.1% → 44.8% - Step 6: use of supplements: 81.1% → 79.4% - Step 7: rooming in: 0.3% → 5.1%
- Step 8: BF on demand: 21.1 → 29.3%
- Step 8: duration on demand: 17.5% → 28.6%
- Step 9: use of bottle: 79.0% → 77.8% - Step 9: use of pacifier: 0.3% → 0% |