Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study

Mosher, Cynthia; Sarkar, Abdullah; Hashem, Alaa AbouBakr; Hamadah, Reem E; Alhoulan, Asma; AlMakadma, Yosra; Khan, Tehreem A.; Al-Hamdani, Abdurahman K; Senok, Abiola

doi:10.1136/bmjopen-2016-012890

Cited by 31 publications

(57 citation statements)

References 16 publications

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“…We also consider that most breastfed infants can recover from a vitamin D deficient state without symptoms if they are weaned at the appropriate time, because the development of rickets is gradual. Breastfeeding is important in promoting attachment between mother and child and in helping children gain immunity (21)(22)(23)(24); however, breastfeeding is also a risk factor for VDD. Therefore, an awareness of the possible development of VDD and rickets, especially in breast-fed infants and their families, is considered necessary.…”

Section: Discussionmentioning

confidence: 99%

Current Vitamin D Status in Healthy Japanese Infants and Young Children

Nakano

Suzuki

Minowa

et al. 2018

J Nutr Sci Vitaminol

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This study aimed to characterize serum 25-hydroxyvitamin D (25OH-D) values among Japanese children aged ≤48 mo. The study included 290 healthy infants and young children aged 0-48 mo (males/females=166/124) living in Shizuoka or Tokyo. The subjects were divided into three groups by age (Low Age: 0-5, Middle Age: 6-15, High Age: 16-48 mo). The vitamin D deficient state was defined as 25OH-D <12 ng/mL, the insufficient state as 12-20 ng/mL, and the sufficient state as >20 ng/mL. The seasonal variation of serum 25OH-D levels was also analyzed. The median serum 25OH-D levels in each group were: Low Age (n=50), 19 ng/mL; Middle Age (n=94), 30 ng/mL; and High Age (n=146), 30 ng/mL. The serum 25OH-D level was significantly lower in the Low Age group than in the other groups (p<0.01). Serum 25OH-D levels in summer and autumn (n=149) were significantly higher than in winter and spring (n=141) (33 vs. 25 ng/mL, p<0.01). In the Low Age group, there was a significant difference in serum 25OH-D levels between breast-fed infants (n=26) and formula-fed or mixed-fed infants (n=19) (12 vs. 32 ng/mL, p<0.01). However, there were no significant differences in 25OH-D levels between the two season classifications in either breast-fed or formula-fed and mixed-fed infants. Although clinical symptoms were not available, more than 75% of the breast-fed infants and 14.6% of infants and young children to whom food had been introduced were defined as having a vitamin D deficient or insufficient state. Breastfeeding seems one of the contributing factor to lower serum 25 OH-D levels among infants ≤5 mo of age.

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Section: Discussionmentioning

confidence: 99%

Current Vitamin D Status in Healthy Japanese Infants and Young Children

Nakano

Suzuki

Minowa

et al. 2018

J Nutr Sci Vitaminol

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“…Our theoretical framework for this study is that, although high rates of EBF are possible by promotion in hospitals at delivery and in the immediate postnatal period by trained personnel, these rates are rapidly eroded due to lack of structured support in the community [22,23]. We hypothesize that facility based trained personnel can continue to provide outreach breastfeeding counseling services in the community by mobile phone and sustain EBF effectively ( Fig.…”

Section: Introductionmentioning

confidence: 99%

Mobile phone support to sustain exclusive breastfeeding in the community after hospital delivery and counseling: a quasi-experimental study

Jerin¹,

Akter²,

Talukder³

et al. 2020

Int Breastfeed J

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Background: Rapid increases in hospital and cesarean deliveries threaten an already falling exclusive breastfeeding rate (EBR) in Bangladesh. There is neither a sustained Baby-Friendly Hospital Initiative (BFHI) nor any community support for breastfeeding mothers. Our aim was to find out whether breastfeeding support after hospital delivery and subsequently by mobile phone at home is effective in improving EBR in infants under six-months of age. Methods: A quasi-experimental study was carried out in 2010 at the Centre for Woman and Child Health (CWCH), Savar, Bangladesh. A total of 129 mothers delivered at CWCH were recruited in pre-intervention phase and their infants followed up between 0 and 5 months of age in the community for exclusive breastfeeding (EBF), anthropometry and illness. An intervention package was then implemented with postpartum support for first hour breastfeeding initiation, correction of position and attachment and face-to-face counseling in hospital followed by mobile phone support by two trained Research Assistants once every 15 days after discharge up to six months of age. During the intervention phase, 164 pregnant women delivered at CWCH were recruited and followed up as in the pre-intervention phase. Results: In the pre-intervention phase among 114 infants, 66 (58%) were found to be exclusively breastfed. In the intervention phase among 151 infants, 118 (78%) were exclusively breastfed (p = 0.000). In the pre-intervention phase EBR at less than one month and five months were 85 and 42% as in the intervention phase these EBR were 89 and 71% respectively. Wasting (weight-for-height Z-score < − 2.00), stunting (height-for-age Z-score < − 2.00), and underweight (weight-for-age Z-score < − 2.00) was 17 (15%), 7 (6%), and 14 (13%) respectively in the preintervention phase. In the intervention phase wasting, stunting, and underweight was 16 (11%), 16 (11%), and 15 (10%) respectively. Therefore, there was no statistically significant differences in nutritional status of the infants in the two phases. There was also no significant differences in child morbidity (pneumonia and diarrhea) between the two phases. Conclusion: A combination of hospital support and mobile phone counseling in the community sustained higher rates of EBF in the community after hospital delivery.

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“…Although our study and others show that BFHI can be successful in increasing EBF in early infancy, maintaining EBF through the recommended six months of age remains a challenge (7,30). For example, in their BFHI trial in Saudi Arabia, Mosher et al showed a signi cant decrease in EBF rates at six months among both the intervention (BFHI hospital) and control (non-BFHI hospital) groups (21). Systematic reviews have shown the importance of ongoing postpartum support to mothers for EBF continuation (18,31), corresponding to…”

Section: Discussionmentioning

confidence: 54%

“…Recent critical re-evaluations of BFHI have suggested that focusing on speci c evidence-based interventions for breastfeeding may be more important than adherence to the overall package or the BFHI certi cation itself (20). In the Middle East region in particular, studies have documented the effectiveness of BFHI implementation in hospitals in Saudi Arabia (21) and the United Arab Emirates (22,23).…”

Section: Problem Description and Available Knowledgementioning

confidence: 99%

“…Interrupted time series is a strong quasi-randomized study design when the use of a control group is not feasible (33,34). In addition, this study's use of patient data allowed for an objective measure (as recorded by healthcare providers) of EBF practice, compared to mothers' self-report in post-discharge surveys used in other studies (21). The EBF data have been strictly audited as a part of CMC's partnership with JHI and validated by the quality department at CMC.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Effects of a ‘Baby-Friendly Hospital Initiative’ on exclusive breastfeeding rates at a private hospital in Lebanon: an interrupted time series analysis

Clermont

Gemayel

Hammoud

et al. 2020

Preprint

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Background: 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 WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is one approach to improve EBF rates. Methods: This 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.Results: The 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 percentage 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. Conclusions: Meeting 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.TRIAL REGISTRATION: Data collection procedures and protocols were reviewed bythe Johns Hopkins Medicine Office of Human Subjects Research Institutional Review Board (application#IRB00155989), and determined to not constitute human subjects research under DHHS or FDAregulations.

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Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study

Cited by 31 publications

References 16 publications

Current Vitamin D Status in Healthy Japanese Infants and Young Children

Current Vitamin D Status in Healthy Japanese Infants and Young Children

Mobile phone support to sustain exclusive breastfeeding in the community after hospital delivery and counseling: a quasi-experimental study

Effects of a ‘Baby-Friendly Hospital Initiative’ on exclusive breastfeeding rates at a private hospital in Lebanon: an interrupted time series analysis

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