Impact of Baby-friedly Hospital Initiative (BFHI) Training Program on Breastfeeding Practices

NCT ID: NCT06824597

Last Updated: 2025-02-13

Basic Information

• Recruitment Status: NOT_YET_RECRUITING
• Clinical Phase: NA
• Total Enrollment: 142 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-02-28
• Study Completion Date: 2025-12-31

Brief Summary

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.

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.

Conditions

Breastfeeding Outcomes

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

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.

Group Type: EXPERIMENTAL

Baby-friendly hospital initiative training program

Intervention Type: BEHAVIORAL

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

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.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Baby-friendly hospital initiative training program

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

Intervention Type: BEHAVIORAL

Eligibility Criteria

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.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

Mansoura University

OTHER

Sponsor Role: lead

Responsible Party

Abeer Salah Ali Mohamed

Assistant Lecturer

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Abeer Ali, Ass.lecturer

Role: PRINCIPAL_INVESTIGATOR

Faculty of Nursing, Mansoura University, Egypt

Locations

Faculty of Nursing, Mansoura University

Al Mansurah, Dakahlia Governorate, Egypt

Countries

Egypt

Central Contacts

Abeer Sa Ali, Ass.lecturer

Role: CONTACT

dr_abeer_salah@mans.edu.eg

+201097536907

Samia Othman, professor

Role: CONTACT

+201008375791

References

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.

Reference Type: BACKGROUND

PMID: 24277661 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 33591853 (View on PubMed)

Related Links

https://apps.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse_s4/en/index.html

Baby-friendly hospital initiative: revised, updated and expanded for integrated care. Section 4, Hospital self-appraisal and monitoring

Other Identifiers

breastfeeding

Identifier Type: -

Identifier Source: org_study_id