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Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices.

Abstract

BACKGROUND

Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation.

RESEARCH AIM

To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria.

METHODS

In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance.

RESULTS

The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices.

CONCLUSIONS

Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.

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  • Authors+Show Affiliations

    ,

    1 Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana. 2 Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany.

    ,

    1 Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.

    ,

    1 Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.

    2 Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Germany.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31112053

    Citation

    Agbozo, Faith, et al. "Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices." Journal of Human Lactation : Official Journal of International Lactation Consultant Association, 2019, p. 890334419848728.
    Agbozo F, Ocansey D, Atitto P, et al. Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. J Hum Lact. 2019.
    Agbozo, F., Ocansey, D., Atitto, P., & Jahn, A. (2019). Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. Journal of Human Lactation : Official Journal of International Lactation Consultant Association, p. 890334419848728. doi:10.1177/0890334419848728.
    Agbozo F, et al. Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. J Hum Lact. 2019 May 21;890334419848728. PubMed PMID: 31112053.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. AU - Agbozo,Faith, AU - Ocansey,Doris, AU - Atitto,Prosper, AU - Jahn,Albrecht, Y1 - 2019/05/21/ PY - 2019/5/22/entrez SP - 890334419848728 EP - 890334419848728 JF - Journal of human lactation : official journal of International Lactation Consultant Association JO - J Hum Lact N2 - BACKGROUND: Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. RESEARCH AIM: To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. METHODS: In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance. RESULTS: The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices. CONCLUSIONS: Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation. SN - 1552-5732 UR - https://www.unboundmedicine.com/medline/citation/31112053/Compliance_of_a_Baby-Friendly_Designated_Hospital_in_Ghana_With_the_WHO/UNICEF_Baby_and_Mother-Friendly_Care_Practices L2 - http://journals.sagepub.com/doi/full/10.1177/0890334419848728?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -