title: Effect on rates of breast feeding of training for the baby friendly hospital initiative.
abstract: OBJECTIVE
  Breastfeeding rates and related hospital practices need improvement in Italy and elsewhere. Training of staff is necessary, but its effectiveness needs assessment.
  
  
  BACKGROUND
  Eight hospitals in different regions of Italy.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Hospital practices, knowledge of 571 health workers, and breastfeeding rates at discharge, three, and six months in 2669 mother and baby pairs.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Unit for Health Services Research and International Cooperation, Istituto per l'Infanzia, Via dell'Lstria 65/1 34137 Trieste, Italy. cattaneo@burlo.trieste.it
authors.forename: A
authors.initials: A
authors.lastname: Cattaneo
authors.forename: R
authors.initials: R
authors.lastname: Buzzetti
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D004502:Education, Medical, Continuing / Q000379:methods*; D004509:Education, Nursing, Continuing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000193:education; D009741:Nursing Staff, Hospital / Q000193:education; D009774:Obstetrics / Q000193:education; D010564:Personnel, Hospital / Q000193:education*