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. 1995 Mar 11;310(6980):621-3.
doi: 10.1136/bmj.310.6980.621.

Impact and sustainability of a "baby friendly" health education intervention at a district hospital in Bihar, India

B Prasad  1 , A M Costello
Affiliations

Impact and sustainability of a "baby friendly" health education intervention at a district hospital in Bihar, India

B Prasad et al. BMJ. .

Abstract

Objectives: To evaluate the impact and sustainability of a baby friendly training intervention for staff at an Indian district hospital on initiation of breast feeding and use of prelacteal feeds by mothers.

Design: Intervention study with assessment by interviewing mothers.

Subjects: 172 mothers recruited before the intervention, 195 recruited immediately after the intervention, and 101 recruited six months later.

Setting: District hospital in a small town in Bihar, India.

Main outcome measures: Age of infant when breast feeding started, use of prelacteal feeds, and colostrum feeding.

Intervention: 10 day training programme for doctors, nurses, and midwives, explaining the benefits and feasibility of early breast feeding and dangers of prelacteal feeds together with instruction on explaining this information to mothers.

Results: Breast feeding was started within 24 hours of birth by 53 (29%) of control mothers, 164 (84%) in the early follow up group, and 60 (59%) in the late follow up group. Prelacteal feeds were used by 165 (96%), 84 (43%), and 78 (77%) respectively. Only 36 mothers in the late follow up group reported receiving education on feeding. Mothers in this group who had received the education were significantly more likely than mothers who received no education to breast feed early (28 (78%) v 11 (17%), P < 0.001) and not use prelacteal feeds (21 (58%) v 2 (3%), P < 0.001).

Conclusions: Training doctors and midwives greatly improves the feeding practices of mothers. However, the impact of the training fell off quickly and refresher training is needed to sustain the improvement.

PIP: A health education intervention implemented at a district hospital in Bihar, India, sought to encourage new mothers to abandon harmful traditional practices such as delayed breast feeding initiation, disposal of colostrum, and prelacteal feeds. Hospital physicians, nurses, and midwives were exposed to a 10-day training program focused on "baby friendly" practices. In the 20 days following the staff intervention, 195 mothers were enrolled in the study and interviewed at home two weeks after delivery; also interviewed at home were 172 controls who delivered before the staff training. An additional 101 mothers were enrolled and interviewed six months after the staff training. Most mothers were illiterate Hindus from rural areas. Breast feeding was initiated within 24 hours by 164 mothers (84%) in the early group, 60 (59%) in the late group, and 53 (29%) mothers in the control group. The percentages of mothers giving prelacteal feeds were 43%, 77%, and 96%, respectively. Of note was the finding that only 36 mothers (36%) in the second intervention group reported having received guidance from staff on infant feeding. Overall, these findings suggest that training hospital staff in infant feeding practices has a beneficial effect on maternal behaviors, but this effect declines quickly over time as a result of staff turnover and loss of interest. Refresher training every six months is recommended for program sustainability.

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