An assessment of adherence to the ten steps of the baby friendly hospital initiative guidelines by the Kenyatta national hospital maternity unit

Abstract

Background Breastfeeding is known to be beneficial for maternal health and infants‘ optimal growth, development and health. The Baby Friendly Hospital Initiative (BFHI) is one of the most effective methods of improving exclusive breastfeeding and breastfeeding overall. Despite the promotional efforts the rates of exclusive breastfeeding are still low worldwide. This could be due to inadequate maternal support both antenatally and postnatally as defined by the Ten Steps of Successful Breastfeeding in the Baby Friendly Hospital Initiative (BFHI) guidelines, hence the need to assess the implementation of these Ten Steps. Kenyatta National Hospital is a certified Baby Friendly hospital with a busy maternity that had an average of 750 deliveries per month in the year 2012. Objectives of the study This study was carried out mainly to assess the status of adherence to the Ten Steps of the BFHI by Kenyatta National Hospital. Secondary objectives were to quantify the proportion of newborns breastfed within first hour of birth, to correlate day 7 clinical outcomes of the infants to timing of breastfeeding initiation and the presence of information on breastfeeding support and to compare the mothers who initiated breastfeeding within the first hour of delivery to those having delayed initiation. Methodology: This was a: - 1. Short longitudinal survey of the mothers involving observation of care from the time of delivery, an interview within 12-24 hours and a follow up interview at day 7. 2. Cross-sectional survey of the health care workers and 3. An institutional observation to ascertain adherence to step 1 of the Ten Steps. Study materials were adapted from the WHO/UNICEF‘s IYCF assessment tool and the BFHI hospital self-appraisal and monitoring xi Results We enrolled 103 mothers who had come to deliver at the KNH, with a mean age of 27 years (SD 5.5), range of 15 years to 40 years and 72 health care workers in the Maternity Unit, mean age of 37 years (SD 10.2). KNH was fully compliant with steps 6, 7, 8 and 9 giving an overall 40% compliance rate. The hospital did not achieve the threshold required to be classified as fully compliant with steps 1, 2, 3, 4, 5 and 10. The babies initiated to the breast within the first hour of birth were 68%. The median time to breastfeeding initiation was longer for those who experienced morbidity in the first 7 days of life compared to those who did not have any morbidity, 57.5 minutes versus 40 minutes respectively (p value = 0.713. In addition, 78% of mothers whose infants had morbidity had not received information on post partum breastfeeding support compared to 54% whose infants had no morbidity (p value = 0.292). Demographic characteristics of age, parity, marital status and level of education were comparable for mothers who had early initiation versus those with delayed breastfeeding initiation (p values of 0.797, 0.142, 0.838 and 0.707 respectively). Conclusion This study found that Kenyatta National Hospital was not compliant with the Ten Steps of the BFHI. The proportion of newborns that had early initiation of breastfeeding (within 1 hour of birth) was 68%. There was a difference in neonatal mortality between the mothers who had early initiation of breastfeeding to those with delayed initiation but statistically it was not significant. There was also a difference in neonatal mortality between the mothers who received antenatal information on breastfeeding to those who did not but the difference was not statistically significant. There was no significant difference between the mothers who had early initiation of breastfeeding to those who initiated breastfeeding late as pertains to their age, parity, marital status and level of education. Recommendations Kenyatta National Hospital should intensify implementation of the BFHI. Larger studies on mothers and their infants to ascertain the long term effect of timing of initiation of breastfeeding to infant morbidity and mortality should be conducted