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Impact and sustainability of a "baby friendly" health education intervention at a district hospital in Bihar, India

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Prasad, B. and A. M. Costello (1995). "Impact and sustainability of a "baby friendly" health education intervention at a district hospital in Bihar, India." BMJ 310(6980): 621-623.

OBJECTIVES: To evaluate the impact and sustainability of a baby friendly training intervention for staff at an Indian district hospital on initiation of breast feeding and use of prelacteal feeds by mothers.

DESIGN: Intervention study with assessment by interviewing mothers.

SUBJECTS: 172 mothers recruited before the intervention, 195 recruited immediately after the intervention, and 101 recruited six months later. SETTING: District hospital in a small town in Bihar, India.

MAIN OUTCOME MEASURES: Age of infant when breast feeding started, use of prelacteal feeds, and colostrum feeding.

INTERVENTION: 10 day training programme for doctors, nurses, and midwives, explaining the benefits and feasibility of early breast feeding and dangers of prelacteal feeds together with instruction on explaining this information to mothers.

RESULTS: Breast feeding was started within 24 hours of birth by 53 (29%) of control mothers, 164 (84%) in the early follow up group, and 60 (59%) in the late follow up group. Prelacteal feeds were used by 165 (96%), 84 (43%), and 78 (77%) respectively. Only 36 mothers in the late follow up group reported receiving education on feeding. Mothers in this group who had received the education were significantly more likely than mothers who received no education to breast feed early (28 (78%) v 11 (17%), P < 0.001) and not use prelacteal feeds (21 (58%) v 2 (3%), P < 0.001).

CONCLUSIONS: Training doctors and midwives greatly improves the feeding practices of mothers. However, the impact of the training fell off quickly and refresher training is needed to sustain the improvement.

Why the focus on direct impact data?

A common challenge from policy makers, funders, community members, people directly experiencing development issues, and governments is: Demonstrate your Impact. Prove that what you are doing works. The high quality, highly credible data presented on the cards below is designed to help you answer that question for your social change, behaviour change, community engagement, communication and media for development, strategy formulation, policy engagement and funding initiatives. At this link filter the research data to your specific interests and priorities

Why a playing cards design?

There is a physical pack of cards with this data (to get a copy please request through the comment form for any card). The card approach allows for easy identification and selection of relevant direct impact data in any context. For example if talking with a donor and you need to identify proof of impact say "take a look at the 7 of Hearts". Quick access can be provided to high-quality data for many areas of your work – funding, planning, policy, advocacy, community dialogue, training, partner engagement, and more. A card deck is also engaging, easy to use and share, a conversation starter, and a resource - and they are fun and different. So we kept that design for the online images as it can serve similar purposes. 

What are the criteria for inclusion?

The impact data presented meets the following high standard for inclusion criteria:

  • Positive change or trend in a priority development issue;
  • Social change or behaviour change strategy or process;
  • Randomized Control Trial or Systematic Review methodology;
  • High quality peer review journal published;
  • Numeric impact data point
  • Published since 2010.