Assessing compliance with the Neo-BFHI recommendations in neonatal wards in South African hospitals
This study formed part of a larger study where a multi-country comparison was conducted to assess the level of implementation of the Neo-Baby-friendly Hospital Initiative (Neo-BFHI) in various neonatal wards in 36 countries. This study however focused on the South African data. Introduction and problem statement: In 2009, the World Health Organisation (WHO) and United Nations International Children’s Emergency Fund (UNICEF) published an update of the Baby-friendly Hospital Initiative (BFHI) package and encouraged all concerned sectors of the health care system and other relevant settings to support the recommendation of encouraging exclusive breastfeeding (EBF). That same year, the Nordic and Quebec Working Group was formed to address BFHI for the special context of preterm and sick infants and their families. The working group has developed a unified expansion of the BFHI to neonatal wards ("Neo-BFHI"). The adaptation takes into consideration that neonatal wards provide various levels of neonatal care, ranging from care for extremely preterm infants and infants with serious medical/surgical conditions, to care for premature, late preterm, low birth weight, early term and full-term infants, who may require episodic or short-term monitoring or medical interventions. The Nordic and Quebec Working Group developed a self-assessment tool to assist units in expanding BFHI to the neonatal ward environment. However, this self-assessment tool had not been tested and contextualised for the South African situation, and the level of compliance with the Neo-BFHI recommendations, in South African neonatal wards, was unknown. Research aim and objective: This study aimed to measure the level of compliance with the recommendations for the Baby-Friendly Hospital Initiative for Neonatal wards (known as Neo-BFHI) in a set of neonatal units across South Africa. The objective of this study was to provide baseline data regarding the level of compliance with Neo-BFHI in South African neonatal wards. Research design: This study used a quantitative cross-sectional survey design. Research method: Data were collected by using the questionnaire developed by the international working group. The respondents completed questionnaires, using EasyTrial online software. Respondents were instructed to ensure that each questionnaire was completed by the person/s with the best knowledge about current breastfeeding practices in the ward. Respondents were reminded, during completion of the questionnaire, that the intention was to measure compliance with practices implemented in their neonatal wards at that time, rather than what they might be working towards. In order to participate, wards were not required to be working towards improving implementation of breastfeeding practices, hold BFHI-certified accreditation, or even be aware of the Baby-friendly Program. For most countries, the survey aimed to provide initial, baseline data about Neo-BFHI compliance and this was also the case for South Africa. Results: A total of 48 completed questionnaires were received. South-Africa scored 76.5% compliance overall for neonatal wards complying with the Neo-BFHI recommendations. The public hospital groups that participated, scored an average of 85.1%, while the participating private hospital groups scored 73.2%. The level 1 hospitals that participated scored an average of 89%. Furthermore, hospitals that are authorised to provide level 3 care, scored an average of 75%, whereas level 2 hospitals scored 92%. Conclusion: South-African hospitals managed to score an overall compliance rate of 76.5% with the recommendations. The public hospital group scored higher than the private hospital groups. Level 2 hospitals scored the highest, followed by level 1 hospitals; and level 3 hospitals had the lowest compliance scores.
- Health Sciences