The Baby-Friendly Hospital Initiative: increasing breastfeeding and decreasing infant mortality in Brazil

Abstract

Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.

Determinants of the offer of breast milk complements for newborns

“…In this study, we found a high prevalence of complement offer, which corroborates the ndings of studies conducted in other countries and in Brazilian cities [2,14,15,19]. Although the WHO recommends skin-toskin contact at birth, breastfeeding in the rst hour of life and "Do not give the newborn baby any food or drink other than breast milk, unless such procedure has a medical indication", most NB received the complement in the rst hours and days after birth.…”

“…Exclusive Breastfeeding (EB) -which should be offered from birth to the rst 6 months of life -is among the World Health Organization recommendations for reducing child mortality [1][2][3]. Studies show that the chances of remaining in breastfeeding (BF) in the rst month and in the following months are greater when the newborn (NB) is placed in immediate contact with the genitor, skin-to-skin, and even more when it is possible to accomplish the "Golden Hour".…”

Factors and survival of exclusive breastfeeding in preterm infants upon discharge at six months of age

“…The BF in the first 6 months of life of children born in BFHI hospital, had the effect of reducing deaths from any cause and infection. [3] In a neonatal network of 18 neonatal units in the United Kingdom with the "Getting It Right From the Start Programme" intervention, the rate of EBF and motherchild skin-to-skin method was increased and this associated with the decrease in costs due to gastroenteritis (GE) and necrotizing enterocolitis (NEC) in more than half a million pounds sterling, as demonstrated by a cost-benefit study. [4] The establishment of EBF is favorably influenced thanks to BFHI or related practices, even so, difficulties are seen in the application of some of its components, such is the case of prenatal education about EBF (step 3) and in support for postnatal EBF (step 10) associated with a shorter duration of EBF.…”

Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil

“…In Brazil, the BFHI was adopted as a public policy within the health system since 1992; yet the current coverage is only 23•4 % of births in BFHI facilities nationwide (7,11) , indicating the relevance of addressing the programme implementation challenges. A recent analysis conducted in Brazil indicated that BFHI is effective in reducing infant mortality by promoting breast-feeding (12) ; nevertheless, there is still a gap in the literature regarding the costs associated with adoption of BFHI (i.e., whether effects outweigh financial resources applied in its implementation and maintenance).…”