Can Re-training in Baby Friendly Hospital Initiative (BFHI) Improve Breast Feeding Indicators?

Abstract

To the Editor: Exclusive breast feeding (EBF) for the first 6 mo is crucial for survival, optimal growth and development of infants and young children. According to National Family Health Survey 2005–06 by IIPS (NFHS-3) in India, less than half of children under 6 mo of age are EBF. EBF drops to only 28 % for children aged 4–5 mo; largely due to inadequate counselling, support and rampant use of infant milk substitutes [1]. Through this prospective cohort study conducted in Nagpur at a tertiary care hospital, we studied efficacy of lactation consultation and support following BFHI training in improving the rates ofWHO defined EBF at 6 mo, timely initiation of breast feeding (TIBF) and timely initiation of liquid, semisolid and soft feeds. The approval for the study was obtained from the Institutional Ethical Committee of our institute. In pre-intervention study group, 25 pregnant or lactating women aged 19–45 y were recruited fromOctober 2009 through April 2010. In post-intervention study group, 125 pregnant women were recruited from August 2010 through May 2011. The doctors and nurses were trained in April–May 2010 as per BFHI guidelines by UNICEF and Breast feeding Network of India for Lactation consultation and support. Structured questionnaire on infant feeding indicators was filled in both groups. In the post-intervention group, data was collected at 8 follow-up visits. Table 1 shows that at 6 mo, 65.8 % infants were EBF in the post-intervention group vs. 28 % in the pre-intervention group and that was highly significant (p=0.00). Significantly higher proportion of infants (81.2 %) received liquid, semi-solid and soft feeds at 6th mo + 1 wk in post-intervention group. Aidam et al. [2] and Barros et al. [3] reported rate of EBF at 6 mo of age of 39.5 and 15 % respectively, after lactational counselling which is lower as compared to 65.8 % in our study. Alvarado et al. [4] reported 42 % EBF rate subsequent to frequent postnatal visits by peer educators. The study done by Bavdekar et al. [5] showed that timely initiation of complementary feeding was only 48 %, while in our study 81.2 % showed improved complementary feeding between 6 mo + 1 wk. Counselling of pregnant and lactating women as per BFHI principles can improve infant feeding practices.