1. By: Dr. Amani Abdelrahman Sidahmed MD, IBCLC
Effect of Health Care Providers Training on Exclusive Breastfeeding Trend at a Maternity Hospital in Sudan, 2014
By:
Dr. Amani Abdelrahman Sidahmed
MD, IBCLC

2. Contents of the presentation
Background
Aim of the study
Methods
Results & Discussion
Conclusion
Recommendations
References

3. Background
Under-5 mortality rate is a leading indicator of the level of child health and overall development in countries (Hosseinpoor AR et al, 2010)
UNICEF reported that globally, under-five mortality was reported to be 51 deaths per 1000 live births in 2011.
According to Sudan Household Survey, 2010, under-five mortality rate was 78 per 1000 live birth.

4. According to WHO exclusive breastfeeding (EBF) reduces child mortality due to illnesses.
It has the potential to prevent 13% of all annual deaths among children aged less than 5 years in developing countries (Jones G, 2003).

5. In Sudan, repeated household surveys showed that the rate of exclusive breastfeeding was 34% in 2006, and showed little improvement in 2010 by reaching 41%.

6. In 2010 a study showed that breastfeeding counseling of the mothers increases the rates of exclusive breastfeeding in Khartoum state (Sudan). Further research to evaluate the effect of training of the health care providers on exclusive breastfeeding was suggested by that study.

7. Aim of this study
To assess the effect of training of the healthcare providers on the trend of exclusive breastfeeding in a Maternity hospital in Omdurman(Sudan) 2014.

8. Methods
A quasi-experimental study in which the Military Maternity Hospital was assigned as a case and Alribat Hospital was assigned as a control
In both hospitals no breastfeeding training was carried out before.

9. Two Study populations
the health care providers of the obstetric and nursery units.
2. mothers who delivered in the two hospitals and gave birth normally to a single infant with a gestational age of at least 37 completed weeks.

10. Sample size and sampling techniques
All eligible health care providers were included in the study: 107 in the study and 61 in control hospital.
For the mothers, a formula was used assuming two equal sample sizes for the study and comparison groups, that is n1=n2=108

11. Data collection tools and techniques
pretest and posttest for the health care providers
The same done once for the control
structured questionnaire was used to interview mothers immediately after delivery to assess the method of feeding.

12. A checklist which was used to assess the midwives' skills with regards to breastfeeding.
The mothers were followed up through phone interviews.

13. The intervention
The intervention comprised two modalities: training workshops and bed side training.
All the training materials were adapted from the WHO Breastfeeding Training Manual , and Infant and Young Child Feeding Counseling Integrated Course.

14. Data analysis
The comparability of the respondents from the study and control hospitals was checked.
The responses to the knowledge and attitude questions were given grades of good, fair, or poor before entry.

15. Chi-squire test was performed and P-value <0
Chi-squire test was performed and P-value <0.05 was considered significant.
The proportions of exclusive breastfeeding at discharge, at one, two, three, and six month were compared using the Z-test.
The data was analyzed using the software statistical package for social science (SPSS) and Epitools.

16. Ethical approval
The study was approved by the ethical committee of the Sudanese medical specialization board. Permission from state ministry of health and the concerned hospitals was also obtained. Verbal consent from all the participants was also ascertained.

17. Results & Discussion
168 health care providers, 38 midwives, and 218 mothers were included in this study. The two groups of participants (2hospitals) were comparable regarding age, marital status and having children or not and the working experience

18. Most of the participants were young
This composition may reflect the turnover rate; this issue was highlighted in a study conducted in New Zealand and was affecting the proper implementation of the breastfeeding policy (Moore T, 2007).

19. 5-10

21. Knowledge
No statistically significant difference in baseline knowledge of the health care providers P>0.05 the difference in knowledge before and after training however was statistically significant P-value <0.0001
These findings were supported by a study conducted in Italy (Cattaneo A, 2001) and a study conducted in Pennsylvania (Spatz D, 2005).

24. Attitude
Attitude showed just significant difference(P=0.049), This situation is similar to what happened in a Canadian hospital, training did not affect the attitude significantly(P=0.80) (Martens P, 2000)

26. The Skills
Before training there was no documented breastfeeding support by anyone of the observed cadre.
After training however all the midwives were counseling the mothers, and also helped them to initiate breastfeeding correctly within an hour after birth. An interventional study conducted in Denmark supports these findings (Kronborg H et al, 2007).

27. Regarding the effect of training on the proportions of exclusive breastfeeding, the percentages at initiation, as well as the trend over time were remarkably higher in the study compared to the control hospital. Many studies support this in India (Prasad B,1995), Scotland (Broadfoot M, 2005) and Switzerland (Merten S et al, 2005).

28. The trend
There was an observable difference between the trends in the study and control hospitals. These observed differences were statistically significant as was shown by Z-test. The P values were < The same was noticed in a study from developing countries (Sheryl W 2009).

30. Z-Statistical test of proportions of exclusive breastfeeding at discharge, one, two, three, and 6 months

31. Conclusion
Breastfeeding training resulted in significant improvement in health care providers’ knowledge, attitude and skills of breastfeeding support. This was reflected positively in the
exclusive breastfeeding trend.

32. Recommendations
Breastfeeding courses as part of under and post graduate
curricula.
Raising the awareness of the health care providers about
the importance of breastfeeding; through continuous training.
More research is suggested; to know the influence of
household, community and cultural practices/beliefs on EBF.

33. References
Broadfoot M (2005) The Baby Friendly Hospital Initiative and breast feeding rates in Scotland. BMJ 90: 114.
Cattaneo A (2001) Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. BMJ 323: 1358.
Hosseinpoor AR, Harper S, Lee JH, Lynch J, Mathers C (2015) International shortfall inequality in life expectancy in women and in men, 1950–2010. Bulletin of the World Health Organization 90:

34. References Cont.
Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS (2003) How many child deaths can we prevent this year? The Lancet 362:
Kronborg H, Vaeth M, Olsen J, Harder I (2007) Health visitors and breastfeeding support: influence of knowledge and self efficacy. Eur J Pub Health 18:
Martens P (2000) Does Breastfeeding Education affect Exclusive Breastfeeding Rates. J Human Lacta 16:
Merten S, Dratva J, Ackermann-Liebrich U (2005) Do Baby-Friendly Hospitals Influence Breastfeeding Duration on a National level. Pediatrics 116:

35. References Cont.
Moore T (2007) Implementing Baby Friendly Hospital Initiative policy: the case of New Zealand public hospitals. Int Breastfeed J 2: 8.
Prasad B (1995) Impact and sustainability of a "baby friendly “health education intervention at a district hospital in Bihar, India. BMJ 310:
Sheryl W (2009) Exploring the impact of the Baby-Friendly Hospital Initiative on trends in exclusive breastfeeding. Int Breastfeed J 4: 11.
Spatz D (2005) Advocacy for Breastfeeding: Making a Difference One Community at a Time. J Human Lacta 21: