Literature review for - Flourish Paediatrics

Baby Friendly Hospital Initiative and Breastfeeding Performance
Search results
The initial search of the databases included 110 references on the BFHI and breastfeeding outcomes
were identified. Data were extracted from 14 references, and 6 publications were used to form the
final body of evidence statements. Sufficient evidence was found to make a statement on the
implementation of the BFHI and breastfeeding outcomes. Details of the BFHI program components
are found in the WHO/UNICEF documents (Saadeh and Casanovas 2009; WHO/UNICEF 2009)
Is the implementation of the BFHI associated with breastfeeding performance and duration?
Draft Evidence statement
Draft Grade
Component Rating Notes
Implementation of the BFHI improves breastfeeding
outcomes
B
Evidence Base Good 1 systematic review (of 2 RCT and 4 cohort 1P), 2
invention studies (2P).
Consistency Good All studies found a positive effect of the BFHI.
Clinical impact Good Direct effect
Generalisability Excellent Developed and developing countries
Applicability Excellent Directly applicable.
Conclusions
The systematic review included two good quality RCTs, two poor quality experimental studies and
four poor quality observational studies. We identified an additional cohort study and two additional
observational studies. The BFHI intervention was based on hospital accreditation based on the BFHI
principles. The two randomised trials in the table (Kramer and Coutinho) were both included in the
SLR by Chung and were both of high quality, one in Belarus and the other in Brazil. All studies
were consistent with the implementation of BFHI in a hospital being associated with higher rates of
exclusive breastfeeding.
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