title: Monitoring compliance with the International Code of Marketing of Breastmilk Substitutes in west Africa: multisite cross sectional survey in Togo and Burkina Faso.
abstract: OBJECTIVE
  To monitor compliance with the International Code of Marketing of Breastmilk Substitutes in health systems, sales outlets, distribution points, and the news media in Togo and Burkina Faso, west Africa.
  
  
  METHODS
  Multisite cross sectional survey.
  
  
  METHODS
  Staff at 43 health facilities and 66 sales outlets and distribution points, 186 health providers, and 105 mothers of infants aged < or =5 months in 16 cities.
  
  
  RESULTS
  Six (14%) health facilities had received donations of breast milk substitutes. All donations were being given to mothers free of charge. Health providers in five (12%) health facilities had received free samples of breast milk substitutes for purposes other than professional research or evaluation. Health professionals in five (12%) health facilities had received promotional gifts from manufacturers. Promotional materials of commercial breast milk substitutes were found in seven (16%) health facilities. Special displays to market commercial breast milk substitutes were found in 29 (44%) sales and distribution points. Forty commercial breast milk substitutes violated the labelling standards of the code: 21 were manufactured by Danone, 11 by Nestlé, and eight by other national and international manufacturers. Most (148, 90%) health providers had never heard of the code, and 66 mothers (63%) had never received any counselling on breast feeding by their health providers.
  
  
  CONCLUSIONS
  In west Africa manufacturers are violating the code of marketing of breast milk substitutes. Comparable levels of code violations are observed with (Burkina Faso) or without (Togo) regulating legislation. Legislation must be accompanied by effective information, training, and monitoring systems to ensure that healthcare providers and manufacturers comply with evidence based practice and the code.
authors.affiliation: Helen Keller International, Regional Office for Africa, New York, NY 10010, USA. vaguayo@hkimali.org
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aguayo
authors.forename: Jay S
authors.initials: JS
authors.lastname: Ross
authors.forename: Souleyman
authors.initials: S
authors.lastname: Kanon
authors.forename: Andre N
authors.initials: AN
authors.lastname: Ouedraogo
mesh_terms: D000329:Advertising / Q000941:ethics / Q000592:standards; D000818:Animals; D001903:Bottle Feeding; D002050:Burkina Faso; D003376:Counseling; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards; D006266:Health Education; D006268:Health Facilities / Q000941:ethics / Q000592:standards*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D040541:Marketing / Q000941:ethics / Q000592:standards*; D008402:Mass Media; D008892:Milk / Q000600:supply & distribution*; D017410:Practice Guidelines as Topic / Q000592:standards; D011356:Product Labeling / Q000592:standards; D011361:Professional Competence; D014037:Togo