Abstract
BackgroundExclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries. The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is one approach to improve EBF rates.MethodsThis study documents the implementation of BFHI at Clemenceau Medical Center (CMC), a private hospital in Lebanon, and analyzes data on EBF practices among CMC’s patients before, during, and after the implementation period. The process of launching the BFHI at CMC is discussed from the perspective of key stakeholders using the SQUIRE guidelines for reporting on quality improvement initiatives. As an objective measure of the program’s impact, 2,002 live births from July 2015 to February 2018 were included in an interrupted time series analysis measuring the rates of EBF at discharge prior to, during, and following the bundle of BFHI interventions.ResultsThe steps necessary to bring CMC in line with the BFHI standards were implemented during the period between November 2015 and February 2016. These steps can be grouped into three phases: updates to hospital policies and infrastructure (Phase 1); changes to healthcare staff practices (Phase 2); and improvements in patient education (Phase 3). The baseline percentage of EBF was 2.4 % of all live births. Following the BFHI intervention, the observed monthly change in EBF in the “Follow-Up” period (i.e., the 24 months following Phases 1–3) was significantly increased relative to the baseline period (+ 2.0 % points per month, p = 0.006). Overall, the observed rate of EBF at hospital discharge increased from 2.4 to 49.0 % of all live births from the first to the final month of recorded data.ConclusionsMeeting the BFHI standards is a complex process for a health facility, requiring changes to policies, practices, and infrastructure. Despite many challenges, the results of the interrupted time series analysis indicate that the BFHI reforms were successful in increasing the EBF rate among CMC’s patients and sustaining that rate over time. These results further support the importance of the hospital environment and health provider practices in breastfeeding promotion, ultimately improving the health, growth, and development of newborns.
Highlights
Exclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries
The results of the interrupted time series analysis indicate that the Baby-Friendly Hospital Initiative (BFHI) reforms were successful in increasing the EBF rate among Clemenceau Medical Center (CMC)’s patients and sustaining that rate over time
Rationale and specific aims This study describes the experience of Clemenceau Medical Center (CMC), located in Beirut, Lebanon, with the implementation of the BFHI program in 2015
Summary
Exclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries. Problem description and available knowledge The practice of exclusive breastfeeding (EBF) of newborn infants through six months of age has been validated as having a wide range of health benefits for both baby and mother [1, 2], as well as broader economic and environmental benefits for society [3]. It is recommended as the standard for infant feeding by the World Health Organization (WHO) [4], the American Academy of Pediatrics [1], the American College of Obstetricians and Gynecologists [5], and the Lebanese Ministry of Health [6]. A number of studies have examined the causes of low EBF rates in Lebanon, and have identified hospital-related factors (such as lack of rooming-in) [7]; maternal employment and related barriers [8,9,10,11]; negative perceptions of breastfeeding (fear of weight gain and breast sagging) and experiences of breastfeeding (insufficient milk, pain, sleep deprivation) [9]; cultural beliefs around “bad milk” and potential harm to the infant [12]; and lack of government policy engagement to promote breastfeeding [9, 13]
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