ASSOCIATION BETWEEN FACILITY STATUS – BABY FRIENDLY AND NON-BABY FRIENDLY HOSPITALS AND INFANT FEEDING PRACTICES

ABSTRACT

Introduction: To protect, promote and support breastfeeding, WHO/UNICEF introduced the Baby Friendly Hospital Initiative (BFHI) to eliminate negative hospital practices that interfere with successful lactation. BFHI has been associated with increased EBF. However in Ghana, no study has been done to assess the impact of the Baby Friendly Hospital Initiative on breastfeeding. This study was done to determine the effect of hospital status – Baby Friendly and Non-Baby Friendly on infant feeding practices and infant growth.

Methodology: The study was in two parts – the first was to assess breastfeeding policies of Baby Friendly Hospitals (BFH) and private Non-baby Friendly Hospitals (Non-BFH) to confirm their status. Three BFH and three private Non-BFH were assessed. In all, 165 interviews were conducted (health staff (n=49); pregnant women (n=60); newly delivered mothers (n=56)) using the UNICEF/WHO External Assessment Tool. Data were analyzed with a WHO/UNICEF web analysis tool, designed for this purpose. The second part of the study was to assess the effect of hospital status on BF practices and infant growth at 4 months. A total of 100 mother-baby pairs were recruited from the 6 hospitals (50 mother-infant pairs from BFH and 50 mother-infant pairs from Non-BFH). A semi-structured questionnaire was used to obtain information on maternal and infant characteristics and infant feeding practices in hospital and at home. Anthropometric data (weight and length) were collected during home visits at months 2 and 4. All data were analyzed using SPSS Version 16.0. WHO Anthro (10.4) was used to convert weight, length and age to weight-for-age (WAZ) and length-for-age (LAZ) z-scores. Bi-variate analyses were done to find significant differences in maternal characteristics and hospital practices and infant WAZ and LAZ at 2 months and 4 months. Logistic regression was done to find the determinants of exclusive breastfeeding (EBF) at 4 months.

Results: None of the hospitals passed all the ten steps to successful breastfeeding and code compliance (10+1 steps – the 11th step was added during the review of BFHI Materials in 2009), not even the hospitals previously designated as BFHs. Step 4 (early initiation of breastfeeding) and step 5 (show mothers how to breastfeed and maintain lactation) were not met by all the hospitals assessed. There were no significant differences in infant birth characteristics and breastfeeding education given in the two categories of hospitals (BFH vs. Non-BFH). However the BFH had less caesarean section than Non-BFH (12% vs. 40%) and more babies were delivered onto abdomen in spontaneous vaginal delivery (38.6% in BFH vs. 6.7% in Non-BFH). At discharge, significantly more infants delivered in BFH were EBF than those from the Non-BFH (100% vs. 88%, p=0.011). However, the significant difference in EBF rates disappeared by 2 months. There were no significant differences in the growth of the infants born in the two categories of hospitals at birth, 2 and 4 months. However, at 4 months, infants born in BFH presented less cold/runny nose (5.1% vs. 23.1%; p=0.047).

Conclusion: Due to the fact that none of the study hospitals met the Baby Friendly 10+1 Step criteria, this study did not find significant effect on infant growth at 2 and 4 months. Efforts should be made to regularly train hospitals to maintain the Baby Friendly status to realize the full benefits of EBF on infant growth and development.