title: [The impact of training based on the Baby-Friendly Hospital Initiative on breastfeeding practices in the Northeast of Brazil].
abstract: OBJECTIVE
  To evaluate the impact of training based on the Baby Friendly Hospital Initiative on breastfeeding practices in maternity wards and during the first 6 months of life.
  
  
  METHODS
  Ninety percent of nursing auxiliaries and midwives were trained at two institutions (A and B) in Palmares, Pernambuco state. Three hundred and thirty-four mothers were interviewed within the first 48 hours and 10 days after childbirth to evaluate breastfeeding practices at the maternities and fulfillment of steps 4 through 10 of the Baby Friendly Hospital Initiative. A subset of 166 mothers received seven home visits to evaluate breastfeeding practices throughout the first 6 months of life and to compare results with those of a cohort study conducted in the area in 1998.
  
  
  RESULTS
  The performance of maternity B was significantly better than that of maternity A, from steps 4 to 10 and also in terms of exclusive breastfeeding and offering less water or tea to infants (p < 0.001). The comparison with a previous cohort study demonstrated an improvement in breastfeeding practices at the maternity wards and an increase of exclusive breastfeeding prevalence (from 21.2 to 70%), during the first 48 hours after delivery and throughout the first six months.
  
  
  CONCLUSIONS
  The training promoted partial change to some practices related to breastfeeding, having a positive effect on total and exclusive breastfeeding at the maternity wards. However, there was no significant change to these practices over the first 6 months of life, suggesting the need for effective interventions to support exclusive breastfeeding in the health sector and in the community.
authors.affiliation: Departamento Materno Infantil, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil. soniabechara@terra.com.br
authors.forename: Sonia B
authors.initials: SB
authors.lastname: Coutinho
authors.forename: Marília de C
authors.initials: Mde C
authors.lastname: Lima
authors.forename: Ann
authors.initials: A
authors.lastname: Ashworth
authors.forename: Pedro I C
authors.initials: PI
authors.lastname: Lira
mesh_terms: D000328:Adult; D001938:Brazil; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000458:organization & administration*; D006771:Hospitals, Maternity; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007318:Inservice Training; D009035:Mothers / Q000523:psychology; D010564:Personnel, Hospital / Q000193:education*; D012959:Socioeconomic Factors; D013997:Time Factors