Study, year
Country
Design
Mother's Age (yr)
Baby's GA (wk)
Outcome DefinitionResultsApplicQuality
Experimental studies
Cattaneo 2001
Italy

Non-randomized, before-after study
Group 1
Age: 29
GA/BW: ≥ 2000 g

Group 2
Age: 30
GA/BW: ≥ 2000 g
Exclusive BF: no other foods or fluid

Full BF: exclusive and predominant BF (non-nutritive fluids allowed)
Exclusive BF at dischargeExclusive BF at 3 moExclusive BF at 6 moWidePoor
BeforeAfterBeforeAfterBeforeAfter
Group 1n518510506510485366
41%77%20%25%1%1%
Group 2n464271471280454233
23%72%15%45%1%13%
BF rates adjusted with direct standardization by parity, type of delivery, and birth weight did not differ significantly.
In both group, differences before and after training in exclusive BF at discharge, full BF at 3 mo, ever BF at 6 mo were significant (P<0.05)
Gau 2004
Taiwan

Non-randomized, before-after study
Age: 31
GA/BW: 38.8
Exclusive BF: only breast milk from the mother or a wet nurse, or expressed breast milk, and no other liquids or solids 200020012002WidePoor
BFHIControlBFHIControlBFHIControl
n13393801144568869313
Exclusive BF rates in hospital34%22%46%23%50%23%
Exclusive BF 2 mo rate6%5%8%3%12%0%
Exclusive breastfeeding rate of the BFHI group was higher than that of the control group in hospital, at 2 weeks, 1 and 2 months postpartum (p<0.001).
BF rates increased year by year (P<0.001) from 2000 to 2002.
Observational studies
Dulon 2003
Germany

Prospective cohort
Age: 91% ≥ 25
GA/BW: ≥ 37
Full BF: exclusive and predominant BF (non-nutritive fluids allowed) Prevalence of Full BFNarrowPoor
At birthAt discharge (5 day)2 mo4 mo6 mo
Low BF promotion index (≤5) n=81491.3%79.7%59.2%42.1%10.8%
High BF promotion index (>5) n=67390.0%76.8%60.9%49.5%15.7%
Increased risk of short-term BF in a hospital with low BF promotion index (adjusted OR: 1.24; 95%CI 0.99, 1.55) after controlling for age, education, area of upbringing, hospital size, and geographic location of hospital.
Associations of short-term BF with maternal age < 25, low education level, and upbringing in East Germany, were stronger
Schniedrova 2003
Czech Republic

Prospective cohort
M: 91% ≥ 25
B: Term, ≥ 2500 g
Ever BFDuration of exclusive BF in both groups were comparable:
BFHI hospitals: 3.9 mo ± 1.92 SD
Other hospitals: 3.90 mo ± 1.84 SD
93.5% of infants were BF exclusively at discharge; 23.1% of infants were BF exclusively at 6 mo. No difference in feeding modes between BFHI and other hospitals.
NarrowPoor
Bosnjak 2004
Croatia

Retro- & Prospective cohort
ndEver BF: at least one meal of BF per day Prevalence of any BFNarrowPoor
1 mo3 mo6 mo9 mo11 or 12 mo
No intervention (1990-93)n28182818281828182818
68%30%11%6%2%
BFHI (1994-98)n22572257225722571179
87%54%28%15%3%
BFHI + postnatal support (1999-2000)n2133206418051214921
87%66%49%35%23%
P between groupsNS<0.05<0.05<0.05<0.05
Not full BFHI because mothers received Happy Baby discharge packs.
Broadfoot 2005
Scotland

Prospective cohort
ndnd UK standard awardNo accreditationNarrowPoor
n39,340289,453
BF at 7 days49.4%42.0%
After controlling for deprivation category, maternal age, number of births at hospital, and year of birth, the adjusted odds ratio of BF at 7 day was 1.28 (95%CI 1.24 to 1.31), compared babies born in hospitals with a UK BFHI standard award to those born in hospitals with no Baby Friendly accreditation.

From: Appendix J. Before-and-After Experimental Studies and Prospective Observational Studies with Concurrent or Historical Controls on Baby Friendly Hospital Initiative

Cover of Interventions in Primary Care to Promote Breastfeeding
Interventions in Primary Care to Promote Breastfeeding: A Systematic Review [Internet].
Evidence Syntheses, No. 66.
Chung M, Ip S, Yu W, et al.

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