http://bmj.com/cgi/content/abstract/323/7325/1358
BMJ 2001;323:1358-1362 ( 8 December )
Quality improvement report
Adriano Cattaneo
a Unit for Health Services Research and International Cooperation,
Istituto per l'Infanzia, Via dell'Istria 65/1, 34137 Trieste, Italy, b Centre
for the Evaluation of Effectiveness and Appropriateness of Health Care
(CEVEAS), Modena, Italy
Correspondence to: A Cattaneo cattaneo@burlo.trieste.it
Problem: Breastfeeding rates and related hospital practices need
improvement in Italy and elsewhere. Training of staff is necessary,
but its effectiveness needs assessment.
Context: Eight hospitals in different regions of Italy.
Design: Controlled, non-randomised study. Data collected in
three phases. Training after the first phase in group 1 hospitals and
after the second phase in group 2.
Strategies for change: Training of trainers and subsequent training
of health workers with a slightly adapted version of the 18 hour
Unicef course on breastfeeding management and promotion.
Key measures for improvement: Hospital practices, knowledge of
571 health workers, and breastfeeding rates at discharge,
three, and six months in 2669 mother and baby pairs.
Effects of change: After training hospitals improved their compliance
with the "ten steps to successful breast feeding," from an
average of 2.4 steps at phase one to 7.7 at phase three.
Knowledge scores of health professionals increased from 0.41 to
0.72 in group 1 (training after phase one) and from
0.53 to 0.75 in group 2 (after phase two). The rate
of exclusive breast feeding at discharge increased significantly
after training: 41% to 77% in group 1 and 23% to 73% in group
2, as did the rates of full (exclusive plus predominant) breast
feeding at three months (37% to 50% in group 1 v 40% to
59% in group 2) and any breast feeding at six months (43% to 62% in
group 1 v 41% to 64% in group 2).
Lessons learnt: Training for at least three days with a course including
practical sessions and counselling skills is effective in changing
hospital practices, knowledge of health workers, and breastfeeding
rates.
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