Abstract
Globally, suboptimal breastfeeding contributes to more than 800,000 child deaths annually. In South Sudan, few women breastfeed early. We assessed the effect of a Baby-Friendly Hospital Initiative training on early initiation of breastfeeding at Juba Teaching Hospital in South Sudan. We carried out the training for health workers after a baseline survey. We recruited 806 mothers both before and four to six months after training. We used a modified Poisson model to assess the effect of training. The prevalence of early initiation of breastfeeding increased from 48% (388/806) before to 91% (732/806) after training. Similarly, early initiation of breastfeeding increased from 3% (3/97) before to 60% (12/20) after training among women who delivered by caesarean section. About 8% (67/806) of mothers discarded colostrum before compared to 3% (24/806) after training. Further, 17% (134/806) of mothers used pre-lacteal feeds before compared to only 2% (15/806) after training. Regardless of the mode of birth, the intervention was effective in increasing early initiation of breastfeeding [adjusted prevalence ratio (APR) 1.69, 95% confidence interval CI (1.57-1.82)]. These findings suggest an urgent need to roll out the training to other hospitals in South Sudan. This will result in improved breastfeeding practices, maternal, and infant health.
Highlights
Optimal breastfeeding includes early initiation of breastfeeding, exclusive breastfeeding (EBF) from birth up to six months and continued breastfeeding for at least two years [1]
Less than half the mothers lived in rural areas, the majority were married, less than half had attended primary schools, most were not formally employed, and half had low socioeconomic status
This result showed that Baby-Friendly Hospital Initiative (BFHI) is still, even if it has been 25 years since its launch, an important programme to be implemented in places where it has not yet been implemented
Summary
Optimal breastfeeding includes early initiation of breastfeeding (within one hour of birth), exclusive breastfeeding (EBF) from birth up to six months and continued breastfeeding for at least two years [1]. According to the 2016 Lancet Breastfeeding Series, attaining high rates of EBF could prevent as much as 800,000 child deaths per year globally [2,3]. Results from the Neovita study in Ghana, India and Tanzania reported that early initiation of breastfeeding independently reduces neonatal mortality and facilitates EBF [4]. A meta-analysis of Demographic and Health Surveys (DHS) from 29 sub-Saharan African countries showed that 50% of women practiced early initiation of breastfeeding [5]. Findings from South Sudan showed that the prevalence of early initiation of breastfeeding ranged between 35% and 48% in both. Res. Public Health 2019, 16, 3917; doi:10.3390/ijerph16203917 www.mdpi.com/journal/ijerph
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