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Walsh A, Pieterse P, Mishra N, Chirwa E, Chikalipo M, Msowoya C, Keating C, Matthews A. Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review. Int Breastfeed J 2023; 18:22. [PMID: 37061737 PMCID: PMC10105160 DOI: 10.1186/s13006-023-00556-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/26/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. METHODS This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken. RESULTS A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies. CONCLUSION At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.
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Affiliation(s)
- Aisling Walsh
- RCSI, University of Medicine and Health Sciences, Dublin, Ireland.
| | | | | | - Ellen Chirwa
- Kamuzu University of Health Sciences, Blantyre, Malawi
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Sokan-Adeaga MA, Sokan-Adeaga AA, Sokan-Adeaga ED, Osibogun A, Edris H. Predictors of exclusive breastfeeding practice among nursing mothers attending a health care facility in a peri-urban setting in Lagos State, Nigeria. Afr Health Sci 2022; 22:545-559. [PMID: 36407371 PMCID: PMC9652619 DOI: 10.4314/ahs.v22i2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND The Nigerian government initiated various national infant and young child feeding programmes (1992-2005) to improve juveniles well-being. Despite these efforts, under-five children feeding related diseases and mortality still escalate. Investigating the drivers of exclusive breastfeeding (EBF) is exigent in tackling this menace. OBJECTIVE To investigate maternal socio-demographic and index child variables that serve as predictors of EBF practice among nursing mother attending a healthcare facility in Lagos, western Nigeria. METHODS One hundred and twenty (N=120) consenting nursing mothers (15-49 years) with infants between 0-24 months completed a structured, self-administered questionnaire. Scores of current practice level for EBF was computed and adjusted odd ratios (aORs) generated from a logistic regression model. RESULTS Respondents mean age was 28.7 ± 2.3 years. Of 120 respondents, 82(68.3%) and 38(31.7%) had good and poor EBF practice respectively. Having an index child <6months age (aOR=5.02, 95% confidence intervalCI=1.28-15.43), being in monogamy (aOR=3.0, 95% CI=1.80-6.73), having tertiary education (aOR=3.12, 95% CI=1.39-8.96), being married (aOR=2.0, 95% CI=0.1-0.8) and vaginal delivery (aOR=2.96, 95% CI=1.75-7.48) increased the odds of EBF practice. CONCLUSION Age of index child, marriage type, maternal education, marital status and nature of delivery independently predicted EBF practice.
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Affiliation(s)
- Micheal Ayodeji Sokan-Adeaga
- Department of Community Health and Primary Health Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adewale Allen Sokan-Adeaga
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, Lead City University, Ibadan, Nigeria
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Eniola Deborah Sokan-Adeaga
- Department of Physiology, Faculty of Basic Medical Sciences, College of Medicine, LadokeAkintola University of Technology (LAUTECH), Ogbomosho, Oyo State, Nigeria
| | - Akin Osibogun
- Department of Community Health and Primary Health Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Hoseinzadeh Edris
- Incubation and Innovation Center, Saveh University of Medical Sciences, Saveh, Iran
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Nyondo-Mipando AL, Kinshella MLW, Salimu S, Chiwaya B, Chikoti F, Chirambo L, Mwaungulu E, Banda M, Newberry L, Hiwa T, Vidler M, Dube Q, Molyneux E, Mfutso-Bengo J, Goldfarb DM, Kawaza K. Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi. Int Breastfeed J 2021; 16:72. [PMID: 34565391 PMCID: PMC8474749 DOI: 10.1186/s13006-021-00418-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. Methods The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. Results The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Conclusions Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.
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Affiliation(s)
- Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Sangwani Salimu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Brandina Chiwaya
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Felix Chikoti
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lusungu Chirambo
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Ephrida Mwaungulu
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Mwai Banda
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Laura Newberry
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Queen Dube
- Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - Elizabeth Molyneux
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Joseph Mfutso-Bengo
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi.,Center of Bioethics for Eastern & Southern Africa (CEBESA), Blantyre, Malawi
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
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Nkrumah J, Abuosi AA, Nkrumah RB. Towards a comprehensive breastfeeding-friendly workplace environment: insight from selected healthcare facilities in the central region of Ghana. BMC Public Health 2021; 21:1647. [PMID: 34503476 PMCID: PMC8427943 DOI: 10.1186/s12889-021-11652-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background In the last three decades, Ghana has championed the objectives of Baby-Friendly Hospital Initiatives to provide pregnant women and nursing mothers with the skills and support systems necessary for attaining optimal breastfeeding. Yet, little is known in literature on how these intervention regimes practically promote breastfeeding-friendly work environment in healthcare facilities and their level of effectiveness. This study explores the extent to which healthcare facilities in Ghana’s Effutu Municipality provide breastfeeding-friendly workplace environment to breastfeeding frontline health workers. Methods A descriptive mixed-method approach was employed to collect data from fifty-four participants, comprising healthcare facility representatives and breastfeeding frontline health workers. A self-administered questionnaire with structured responses was administered to frontline health workers, followed by interview guides for representatives of hospital management. Thematic analysis was used to analyze interview responses. Responses to questionnaires were processed with SPSS version 23.0 and presented using frequencies and percentages. Results Three main themes emerged, namely, Standpoints on workplace breastfeeding support; Breastfeeding support, and Suggested future directions. Beyond this, six sub-themes emerged, including backings for workplace breastfeeding support; perceived benefits of breastfeeding support; factors of poor breastfeeding workplace support; maternity protection benefits; workplace support gaps, and awareness creation on benefits. Breastfeeding frontline health workers held that their hospitals have no breastfeeding policy (96%), no breastfeeding facility (96%), they do not go to work with baby (96%), but had 12 weeks maternity leave (96%) and worked half-day upon return to work (70%). Conclusion Health facilities in the study do not provide a breastfeeding-friendly work environment except for the privileges provided by the Labor Act and conditions of service. Continuous advocacy on breastfeeding workplace support and stakeholder engagement to build consensus on the mix of strategies suitable to cushion breastfeeding frontline health workers is recommended for optimal breastfeeding and improved productivity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11652-5.
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Affiliation(s)
- Jacqueline Nkrumah
- Faculty of Science Education, Department of Health Administration and Education, University of Education, P.O Box 25, Central Region, Winneba, West African, Ghana.
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, P. O. Box 75, Greater Accra Region, Accra-Legon, West Africa, Ghana
| | - Rodney Buadi Nkrumah
- Center for Research on Children and Families, McGill University
- 3506 University Street, Suite 106, Montreal, QC, H3A 2A7, Canada
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Kinshella MLW, Prasad S, Hiwa T, Vidler M, Nyondo-Mipando AL, Dube Q, Goldfarb D, Kawaza K. Barriers and facilitators for early and exclusive breastfeeding in health facilities in Sub-Saharan Africa: a systematic review. Glob Health Res Policy 2021; 6:21. [PMID: 34229756 PMCID: PMC8259208 DOI: 10.1186/s41256-021-00206-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa carries a disproportionate burden of under-five child deaths in the world and appropriate breastfeeding practices can support efforts to reduce child mortality rates. Health facilities are important in the promotion of early and exclusive breastfeeding. The purpose of this review was to examine facility-based barriers and facilitators to early and exclusive breastfeeding in Sub-Saharan Africa. METHODS A systematic search was conducted on Medline, Web of Science, CINAHL, African Journals Online and African Index Medicus from database inception to April 29, 2021 and primary research studies on breastfeeding practices in health facilities in Sub-Saharan Africa were included in the review. We assessed qualitative studies with the Critical Appraisal Skills Programme Qualitative Checklist and quantitative studies using the National Heart, Lung, and Blood Institute tool. The review protocol was registered to Prospero prior to conducting the review (CRD42020167414). RESULTS Of the 56 included studies, relatively few described health facility infrastructure and supplies-related issues (5, 11%) while caregiver factors were frequently described (35, 74%). Facility-based breastfeeding policies and guidelines were frequently available but challenged by implementation gaps, especially at lower health service levels. Facilitators included positive caregiver and health worker attitudes, knowledge and support during the postpartum period. Current studies have focused on caregiver factors, particularly around their knowledge and attitudes, while health facility infrastructure and supplies factors appear to be growing concerns, such as overcrowding and lack of privacy during breastfeeding counselling that lowers the openness and comfort of mothers especially those HIV-positive. CONCLUSION There has been a dramatic rise in rates of facility births in Sub-Saharan Africa, which must be taken into account when considering the capacities of health facilities to support breastfeeding practices. As the number of facility births rise in Sub-Saharan Africa, so does the responsibility of skilled healthcare workers to provide the necessary breastfeeding support and advice to caregivers. Our review highlighted that health facility infrastructure, supplies and staffing appears to be a neglected area in breastfeeding promotion and a need to strengthen respectful maternity care in the delivery of breastfeeding counselling, particularly in supporting HIV-positive mothers within the context of Sub-Saharan Africa.
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Sarina Prasad
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Tamanda Hiwa
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Alinane Linda Nyondo-Mipando
- School of Public Health and Family Medicine, Department of Health Systems and Policy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Queen Dube
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi.,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi
| | - David Goldfarb
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital and University of British Columbia, Vancouver, Canada
| | - Kondwani Kawaza
- Department of Pediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. .,Queen Elizabeth Central Hospital, Pediatrics, Blantyre, Malawi.
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Zhang Y, Yang J, Li W, Wang N, Ye Y, Yan S, Wang S, Zeng T, Huang Z, Zhang F, Li Y, Yao S, Wang H, Rozelle S, Xu T, Jin X. Effects of baby-friendly practices on breastfeeding duration in China: a case-control study. Int Breastfeed J 2020; 15:92. [PMID: 33143740 PMCID: PMC7640486 DOI: 10.1186/s13006-020-00334-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months. METHODS Participants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses. RESULTS Of mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included "breastfeeding within one hour after birth" (74.29% vs. 59.09%), "breastfeeding on demand" (86.48% vs. 75.00%), and "never use a pacifier" (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563). CONCLUSIONS These data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.
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Affiliation(s)
- Yue Zhang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China.
| | - Jinliuxing Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Wenhao Li
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Nianrong Wang
- Chongqing Health Center for Women and Children, Chongqing, 400000, China
| | - Ya Ye
- Chongqing Health Center for Women and Children, Chongqing, 400000, China
| | - Shuangqin Yan
- Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243011, Anhui, China
| | - Sumei Wang
- Ma'anshan Maternal and Child Health Hospital, Ma'anshan, 243011, Anhui, China
| | - Ting Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, Guangxi, China
| | - Zijuan Huang
- Liuzhou Maternity and Child Healthcare Hospital, Liuzhou, 545001, Guangxi, China
| | - Fenghua Zhang
- Qingdao Maternal and Children Healthcare Center, Qingdao, 26600, Shandong, China
| | - Yin Li
- Qingdao Maternal and Children Healthcare Center, Qingdao, 26600, Shandong, China
| | - Shiyi Yao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, 100191, China
| | - Scott Rozelle
- Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, 94305, USA
| | - Tao Xu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
| | - Xi Jin
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, 100081, China
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Peven K, Bick D, Purssell E, Rotevatn TA, Nielsen JH, Taylor C. Evaluating implementation strategies for essential newborn care interventions in low- and low middle-income countries: a systematic review. Health Policy Plan 2020; 35:ii47-ii65. [PMID: 33156939 PMCID: PMC7646733 DOI: 10.1093/heapol/czaa122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 01/02/2023] Open
Abstract
Neonatal mortality remains a significant health problem in low-income settings. Low-cost essential newborn care (ENC) interventions with proven efficacy and cost-effectiveness exist but have not reached high coverage (≥90%). Little is known about the strategies used to implement these interventions or how they relate to improved coverage. We conducted a systematic review of implementation strategies and implementation outcomes for ENC in low- and low middle-income countries capturing evidence from five medical and global health databases from 1990 to 2018. We included studies of implementation of delayed cord clamping, immediate drying, skin-to-skin contact (SSC) and/or early initiation of breastfeeding implemented in the first hour (facility-based studies) or the 1st day (community-based studies) of life. Implementation strategies and outcomes were categorized according to published frameworks: Expert Recommendations for Implementing Change and Outcomes for Implementation Research. The relationship between implementation strategies and outcomes was evaluated using standardized mean differences and correlation coefficients. Forty-three papers met inclusion criteria. Interventions included community-based care/health promotion and facility-based support and health care provider training. Included studies used 3-31 implementation strategies, though the consistency with which strategies were applied was variable. Conduct educational meetings was the most frequently used strategy. Included studies reported 1-4 implementation outcomes with coverage reported most frequently. Heterogeneity was high and no statistically significant association was found between the number of implementation strategies used and coverage of ENC. This review highlights several challenges in learning from implementation of ENC in low- and low middle-income countries, particularly poor description of interventions and implementation outcomes. We recommend use of UK Medical Research Council guidelines (2015) for process evaluations and checklists for reporting implementation studies. Improved reporting of implementation research in this setting is necessary to learn how to improve service delivery and outcomes and thereby reduce neonatal mortality.
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Affiliation(s)
- Kimberly Peven
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, 57 Waterloo Road, London SE1 8WA, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, UK
| | - Edward Purssell
- School of Health Sciences, City, University of London, London, UK
| | - Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jane Hyldgaard Nielsen
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
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8
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Agbozo F, Ocansey D, Atitto P, Jahn A. Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. J Hum Lact 2020; 36:175-186. [PMID: 31112053 DOI: 10.1177/0890334419848728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. RESEARCH AIM To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. METHODS In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance. RESULTS The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices. CONCLUSIONS Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.
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Affiliation(s)
- Faith Agbozo
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.,Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
| | - Doris Ocansey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Prosper Atitto
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany
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9
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Tampah-Naah AM, Kumi-Kyereme A, Amo-Adjei J. Maternal challenges of exclusive breastfeeding and complementary feeding in Ghana. PLoS One 2019; 14:e0215285. [PMID: 31048865 PMCID: PMC6497241 DOI: 10.1371/journal.pone.0215285] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/30/2019] [Indexed: 11/18/2022] Open
Abstract
Mothers are recommended to exclusively breastfeed their infants for the first six months of their lives. Also, after the sixth month, breastfeeding should continue with added complementary foods to the diets of children. Studies designed to sought the views of mothers on breastfeeding practices are limited. The aim of this study was to explore challenges to breastfeeding practices by considering spatial, societal and maternal characteristics in Ghana. Twenty mothers aged 15–49 years were interviewed purposively in selected communities within two regions of the country. Thematic content analytical procedures were applied to interpret and present findings. Challenges (to both exclusive breastfeeding and complementary feeding) spanned across spatial (home and work places), societal, and maternal characteristics. Key themes identified were in relation to household chores, work schedules, family influence, low breast milk production, swollen breasts or sore nipples, access to food items and preparation or giving foods. Addressing these challenges would require co-creation of supportive environments between couples and significant others as well as tackling institutional barriers that obstruct adequate breastfeeding among mothers. On complementary feeding, there is the need to form community health volunteers help educate mothers more on how to appropriately use local foods to feed their children.
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Affiliation(s)
- Anthony Mwinilanaa Tampah-Naah
- Department of Environment and Resource Studies, Faculty of Integrated Development Studies, Wa Campus, University for Development Studies, Tamale, Ghana
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Akwasi Kumi-Kyereme
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Joshua Amo-Adjei
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
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Zakarija-Grković I, Boban M, Janković S, Ćuže A, Burmaz T. Compliance With WHO/UNICEF BFHI Standards in Croatia After Implementation of the BFHI. J Hum Lact 2018; 34:106-115. [PMID: 28602147 DOI: 10.1177/0890334417703367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The primary goal of the Baby-Friendly Hospital Initiative (BFHI) is to create conditions in maternity facilities that enable women to initiate and sustain the practice of breastfeeding exclusively. Research aim: This study aimed to determine hospital practices and breastfeeding rates before and after BFHI implementation and assess compliance with UNICEF/World Health Organization (WHO) standards for seven of the BFHI's Ten Steps to Successful Breastfeeding ( Ten Steps). METHODS Mothers of healthy, term infants ( N = 1,115) were recruited from the postnatal ward of the University Hospital of Split, Croatia, between February 2008 and July 2011 and followed for 12 months in a repeated-measures, prospective, longitudinal, three-group, nonequivalent, cohort study. Breastfeeding rates, hospital practices-including seven of the Ten Steps-and maternal sociodemographic data were collected. RESULTS Parts of all seven Ten Steps that were assessed improved significantly post-BFHI. Step 3 ("antenatal education") showed the least improvement, whereas Step 7 ("rooming-in"; 2.6% pre-BFHI vs. 98.5% post-BFHI) and Step 9 ("no pacifiers/teats"; 21.8% pre-BFHI vs. 99.4% post-BFHI) showed the greatest improvement. Six months after Baby-Friendly designation, only Steps 7 and 9 were in full compliance with UNICEF/WHO standards. In-hospital, exclusive-breastfeeding rates rose markedly ( p < .001), but no change occurred in breastfeeding rates at 3, 6, or 12 months. CONCLUSION Full implementation of the BFHI was associated with significant improvement in hospital practices and in-hospital, exclusive-breastfeeding rates, but it did not affect breastfeeding rates postdischarge, emphasizing the vital role of community support. Baby-Friendly Hospital Initiative standards declined rapidly post-hospital designation, indicating the need for regular monitoring and reassessment as well as ongoing, effective training for hospital staff.
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Affiliation(s)
- Irena Zakarija-Grković
- 1 Departments of Family Medicine and Clinical Skills, University of Split School of Medicine, Split, Croatia
| | - Marija Boban
- 2 Health Centre of Split and Dalmatia County, Split, Croatia
| | - Sunčana Janković
- 3 Department of Paediatrics, University Hospital Zagreb, Zagreb, Croatia
| | - Anamarija Ćuže
- 2 Health Centre of Split and Dalmatia County, Split, Croatia
| | - Tea Burmaz
- 4 Department of Prevention, Local Health Unit of Venice, Hygiene and Public Health Service, Venezia-Mestre, Italy
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Diji AKA, Bam V, Asante E, Lomotey AY, Yeboah S, Owusu HA. Challenges and predictors of exclusive breastfeeding among mothers attending the child welfare clinic at a regional hospital in Ghana: a descriptive cross-sectional study. Int Breastfeed J 2017; 12:13. [PMID: 28286540 PMCID: PMC5343322 DOI: 10.1186/s13006-017-0104-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 02/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The challenges and predictors of exclusive breastfeeding (EBF) have been examined in many parts of the world. Considering the socio-cultural dynamics and the few research studies in Ghana, the factors that hinder and predict EBF practice in other countries may be different in the Ghanaian setting. The study therefore sought to assess the challenges and predictors of EBF among mothers attending a child welfare clinic at a regional hospital in Ghana. METHODS A descriptive cross-sectional study was carried out between January and March, 2015 to elicit information from 240 mothers who were sampled using simple random sampling technique. A validated structured questionnaire was used in collecting data on participants' socio-demographic characteristics and reported breastfeeding practices. Participants' breastfeeding challenges were rated on a Likert scale from 1 (not at all), 2 (mild), 3 (moderate), 4 (severe) to 5 (unbearable). In this study, EBF refers to birth of the infants up to six months. RESULTS The top three breastfeeding challenges of mothers were: belief that breast milk alone was not sufficient in meeting their babies' nutritional needs [mean 3.43 (standard deviation {SD} 1.35)], short maternity leave period [mean 3.41 (SD 1.29)], and socio-cultural pressure to introduce water and artificial feeds [mean 3.39 (SD 1.28)]. Independent predictors of EBF were: infant's age [Adjusted Odds Ratio (AOR) 0.82 (95% Confidence Interval [CI] 0.71, 0.95)], and self-employment [AOR 2.67 (95% CI 1.11, 6.41)]. CONCLUSION Mothers are confronted with numerous EBF challenges both at the individual and societal levels, and stakeholders need to consider these in order to support breastfeeding mothers to maximize outcomes. Reviewing the labour laws on Ghana's maternity leave to accommodate an extended maternity leave in addition to the employee's annual leave could further improve EBF practice rates.
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Affiliation(s)
| | - Victoria Bam
- Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana
| | - Ernest Asante
- Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana
| | | | - Samuel Yeboah
- Department of Nursing, P. M. B., U. P. O., KNUST, Kumasi, Ghana
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Mogre V, Dery M, Gaa PK. Knowledge, attitudes and determinants of exclusive breastfeeding practice among Ghanaian rural lactating mothers. Int Breastfeed J 2016; 11:12. [PMID: 27190546 PMCID: PMC4869336 DOI: 10.1186/s13006-016-0071-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/09/2016] [Indexed: 11/17/2022] Open
Abstract
Background The practice of exclusive breastfeeding (EBF) is influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors. This study assessed knowledge, attitudes and practice of EBF among rural lactating mothers with infants aged 0–6 months. Factors associated to the practice of EBF were also investigated. Methods This cross-sectional study was conducted among 190 rural lactating mothers with infants aged 0–6 months seeking postnatal care at a health centre in Ghana. All data was collected using a questionnaire that contained both closed and open ended questions. Results About 26 % (n = 50) of the mothers were unable to correctly define EBF. The majority (92.6 %, n = 176) of the mothers said they felt good to EBF for 6 months, to breastfed on demand (99.5 %, n = 189) and did not have difficulties EBF (90 %, n = 171). Despite the generally positive attitude towards EBF, 42 % (n = 79) of the mothers did not EBF their babies. These mothers did not practice EBF because they misunderstood certain signs of the child to mean wanting to eat food or drink water, regarded breastmilk to be inadequate to meet the nutritional needs of the child and misunderstood healthcare professionals’ EBF advice. Higher maternal education was associated with higher likelihood of EBF (OR 3.5; 95 % CI 1.6, 7.7; p = 0.002). Mothers whose babies were younger than 3 months were more likely to EBF (OR 12.0; 95 % CI 4.4, 32.5; p < 0.001) than those having babies aged ≥ 3 months. Furthermore, higher knowledge of EBF was associated with the likelihood of EBF (OR 5.9; 95 % CI 2.6, 13.3; p < 0.001). Conclusion Mothers’ knowledge and attitudes towards EBF were favourable but practice of EBF was suboptimal. This study adds additional evidence that knowledge of EBF, child’s age and maternal level of education are important determinants of the practice of EBF. Beyond dissemination of health messages, healthcare professionals should pay more counselling attention to less educated mothers, and also older children’s caregivers.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Box TL 1883, Tamale, Ghana
| | - Michael Dery
- Department of Community Nutrition, School of Allied Health Sciences, University for Development Studies, Box TL 1883, Tamale, Ghana
| | - Patience K Gaa
- Nutrition Unit, Lawra District Hospital, Box 19, Upper West Region, Lawra Ghana
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Ogunlesi TA, Ogunfowora OB. The Influence of Method, Timing of Onset and Duration of Enteral Feeding on the Duration of Hospitalization of Newborn Infants in a Nigerian Special Care Baby Unit. Ann Med Health Sci Res 2015; 5:397-402. [PMID: 27057377 PMCID: PMC4804650 DOI: 10.4103/2141-9248.177991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Feeding practices among high-risk newborn babies have not been extensively studied in the resource-constrained parts of the world. Aim: To describe the pattern of milk use among infants in a resource-poor special care baby unit (SCBU) and relate these to the outcome of hospitalization. Subjects and Methods: Setting – SCBU of Olabisi Onabanjo University Teaching Hospital, Sagamu. Design – Prospective study of consecutively admitted inborn babies within the first 24 h of life. The data analyzed included the weight and estimated gestational age (EGA) of the babies, the age at the onset of and duration of feeds (breast milk and artificial milk [AM]). Results: Out of the 118 infants studied, (78.8%) 93/118 received breast milk and 16.1% (19/118) received AM. The mean age at the commencement of enteral feeding was 3.9 days. The age at the onset of suckling was negatively correlated with the EGA and body weight. The age at the onset and duration of enteral feeding were directly related to the duration of admission. Conclusion: More than three-quarter of the infants hospitalized in the unit received breast milk, but commencement was mostly delayed beyond the 3rd day of life. The duration of admission may be related to the timing of onset and duration of milk use.
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Affiliation(s)
- T A Ogunlesi
- Department of Paediatrics, Olabisi Onabanjo University, Sagamu, Nigeria
| | - O B Ogunfowora
- Department of Paediatrics, Olabisi Onabanjo University, Sagamu, Nigeria
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Shrivastava SR, Shrivastava PS, Ramasamy J. The Baby-Friendly Hospital Initiative: foundation stone in ensuring exclusive breastfeeding. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.953892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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