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

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Prasad, B. and A. M. Costello (1995). "Impact and sustainability of a "baby friendly" health education intervention at a district hospital in Bihar, India." BMJ 310(6980): 621-623.

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.