Impact of Baby-friedly Hospital Initiative (BFHI) Training Program on Breastfeeding Practices (BFHI)
Impact of Baby Friendly Hospital Initiative Training Program on Nurses' and Mothers' Breastfeeding Practices and Experiences
This study aims to evaluate the impact of Baby Friendly Hospital Initiative training program on nurses' and mothers' breastfeeding practices and experiences.
Research Hypotheses
- Maternity nurses who participate in the Baby Friendly Hospital Initiative training program exhibit improvement in breastfeeding practice scores and more positive breastfeeding experiences after the training program than before.
- Breastfeeding mothers who receive Baby Friendly Hospital Initiative support have good breastfeeding practices and more positive breastfeeding experiences.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Breastfeeding is a long-time investment in women's and babies' lives, not just a personal decision. World Health Organization (WHO) recommends breast milk as the most appropriate food for infants under six months of age. Breast milk contains all the nutrients that babies need in the first six months of life, so it is an ideal food for infants . Children who were breastfed had a lower risk of obesity and chest problems. Furthermore, breastfeeding mothers also benefited from breastfeeding, with lower rates of breast cancer, ovarian cancer, type II diabetes, and postnatal depression.
Exclusive breastfeeding (EBF) has been identified as the single most effective intervention for child survival, with the potential to prevent 13% of under-five deaths annually in low- and middle-income settings . WHO and United Nations Children's Fund (UNICEF) recommend optimal infant and young child feeding as immediate and early initiation of breastfeeding within the first hour of birth, EBF for the first 6 months of life, and with complementary feeding up to 2 years of age.
Early cessation of breastfeeding is a public health concern, especially in high-income countries, where only 25% of children were breastfeeding at 12 months of age, far below the global average of 74%. Women often cited difficulties, including low milk supply, painful nipples, and latching problems, as reasons for breastfeeding cessation. In addition, other factors, including lack of support or feeding advice, formula use, and returning to work, also contributed to breastfeeding cessation.
Evidence-based breastfeeding support is important for achieving breastfeeding recommendations, preventing morbidity and mortality, and promoting sustainable development goals. Thus, WHO and UNICEF have set a goal to increase breastfeeding rates to 75% in early infancy, 50% at six months, and 25% at one year of age.The Baby Friendly Hospital Initiative (BFHI) is a global program launched in 1991 by UNICEF and WHO to protect, promote and support breastfeeding in all maternity services. It requires all facilities that apply for the status of "Baby-Friendly Hospital" to provide maternity care to follow the "Ten Steps for the Successful Promotion of Breastfeeding" .
One of the 10 steps in this initiative is to have a written infant feeding policy that is routinely communicated to staff and parents. Step 2 requires the training of all healthcare staff in skills that are necessary to implement the policy. Healthcare providers play a key role in the beginning and continuity of the correct applications in breastfeeding and "Baby Friendly Hospital" criteria in society.In controlled studies, it was seen that training the nurses about BFHI principles increases their breastfeeding knowledge and practice scores and exclusive breastfeeding rates.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Abeer Sa Ali, Ass.lecturer
- Phone Number: +201097536907
- Email: dr_abeer_salah@mans.edu.eg
Study Contact Backup
- Name: Samia Othman, professor
- Phone Number: +201008375791
Study Locations
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Dakahlia
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Mansoura, Dakahlia, Egypt, 35516
- Faculty of Nursing, Mansoura University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
For nurses: all nurses who were working at inpatient postpartum wards and the delivery unit in Mansoura University Hospital with at least one year of work experience and who were providing direct care to the mothers and their newborns
For mothers:
- Who had the intention to breastfeed.
- Primiparous women
- Age between 18 and 35 years.
- Who had given birth to a singleton baby.
- Free from serious medical or obstetrical complications.
Exclusion Criteria:
Breastfeeding mothers will be excluded from the study if their baby had:
- Born before 37 weeks of gestation.
- An Apgar score of less than 8 at 5 minutes.
- A birthweight of less than 2,500 g.
- Born with severe medical conditions or congenital malformations.
- Admitted to the neonatal intensive care unit.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: training program for nurses
The Baby Friendly Hospital Initiative training program will be conducted for maternity nurses at the inpatient postpartum wards (9, 10, 15 and 18) and the delivery unit in Mansoura University Hospital (MCH), Dakahlia governorate, Egypt.
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The Baby-Friendly Hospital Training Program is a critical intervention to improve maternal and infant health outcomes by promoting and supporting breastfeeding worldwide. It empowers the maternity nurses in this study to create an environment that prioritizes the needs of mothers and babies, ensuring the best possible start to life. It will be conducted for eight sessions (theoretical and practical), each session for about 20-30 minutes. It will include the importance of early initiation of breastfeeding, skin-to-skin contact immediately after birth, the importance of exclusive and continued breastfeeding, positions of breastfeeding, the importance of avoiding pre-lacteal feeds and unnecessary supplementation, advantages of rooming-in, and how to manage common breast and nipple conditions. The researcher will design an Arabic booklet and distribute it to the nurses at the first session as a guide to reinforce the teaching |
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No Intervention: evaluating the outcome of the training program on breastfeeding mothers' practices
Before the training program, the first group of mothers (47 mothers) will be interviewed at the postpartum wards after delivery and the researcher will evaluate their self-reported breastfeeding practices during their hospital stay. After the training program, the second group (homogeneous) of mothers (47 mothers) will be interviewed at the postpartum wards after delivery and the researcher will evaluate their self-reported breastfeeding practices during their hospital stay. |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Evaluating the nurses' experiences regarding baby-friendly hospital initiative training program
Time Frame: 3 months
|
Interview questionnaire sheet will be adapted from (Gerhardsson, Oras, Mattsson, Blomqvist & Funkquist, 2022) and will be translated into Arabic by the researcher.
It will consist of two parts: Part (1): Demographic and professional characteristics of the nurses.
Part (2): Nurses' experiences regarding BFHI training program questionnaire: Before the training program, the nurses will be asked two questions: (Do you think breastfeeding is an interesting part of your job? / Do you think your role is important in improving breastfeeding support in the healthcare continuum).
After the training program, the nurses will be asked whether their interest in breastfeeding increased during the training and whether they had received new tools that they could use when providing breastfeeding support.
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3 months
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Evaluating the nurses' practices regarding BFHI principles
Time Frame: 3 months
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Observational checklist to observe the nurses' practices regarding BFHI principles will be adapted from (Timalsina, 2020) and will consist of 10 items such as a demonstration of proper positioning, attachment, and rooming in….etc. Scoring system: The total practice score equals 10 and the nurses will be given a score (2) for done correctly, a score (1) for done incorrectly and a score (0) for not done. It will be classified into: poor for <50%, satisfactory 50-70%, and good practice >70%. |
3 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Evaluating the secondary outcome of the training program for nurses on breastfeeding mothers' self- reported practices regarding the baby-friendly hospital initiative principles before and after the program.
Time Frame: 6 months
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Evaluating the impact of the training program on mothers' practices regarding the baby-friendly hospital initiative principles for one group of mothers before the training and another homogenous group after conducting the program and compare between the two groups. It will measure by: Structured Interview questionnaire will consist of two parts: Part (1): Demographic characteristics of the mothers Part (2): Self-reported BFHI practices questionnaire: This tool will be adapted from (WHO/UNICEF, 2009) to assess the self-reported breastfeeding practices that mothers experienced during the hospital stay such as time of initiation of breastfeeding, staff assistance with positioning and attaching the baby, expression of breast milk and skin to skin contact. |
6 months
|
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Evaluating the impact of the training program on mothers' experiences regarding breastfeeding
Time Frame: 6 months
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Evaluating the impact of the training program on mothers' experiences regarding breastfeeding for one group of mothers before the training and another homogenous group after conducting the program and compare between the two groups. It will measure by: Mothers' breastfeeding experiences questionnaire: This tool will be adapted from (Giannì et al., 2020). It will cover four areas: breastfeeding experience, breastfeeding difficulties, breastfeeding support, and intention to breastfeed again in the following pregnancy. |
6 months
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Abeer Ali, Ass.lecturer, Faculty of Nursing, Mansoura University, Egypt
Publications and helpful links
General Publications
- Hawkins SS, Stern AD, Baum CF, Gillman MW. Compliance with the Baby-Friendly Hospital Initiative and impact on breastfeeding rates. Arch Dis Child Fetal Neonatal Ed. 2014 Mar;99(2):F138-43. doi: 10.1136/archdischild-2013-304842. Epub 2013 Nov 25.
- Ducharme-Smith K, Gross SM, Resnik A, Rosenblum N, Dillaway C, Orta Aleman D, Augustyn M, Silbert-Flagg J, Caulfield LE. Exposure to Baby-Friendly Hospital Practices and Breastfeeding Outcomes of WIC Participants in Maryland. J Hum Lact. 2022 Feb;38(1):78-88. doi: 10.1177/0890334421993771. Epub 2021 Feb 16.
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- Breastfeeding
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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