title: Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study.
abstract: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.
  
  
  
  Controlled, non-randomised trial.
  
  
  
  18 Local Health Authorities in 9 regions of Italy.
  
  
  
  5094 mother/infant dyads in 3 cohorts were followed up to 12 months after birth in 3 rounds of data collection: at baseline, after implementation of the intervention in the early intervention group and after implementation in the late intervention group. 689 (14%) dyads did not complete the study.
  
  
  
  Implementation of the 7 steps of the BFCI.
  
  
  
  The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured.
  
  
  
  The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.
  
  
  
  The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.
authors.affiliation: Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Cattaneo
authors.affiliation: Maternal and Child Health Unit, Department of Primary Care, Local Health Authority, Milan, Italy.
authors.forename: Maria Enrica
authors.initials: ME
authors.lastname: Bettinelli
authors.affiliation: Baby Friendly Initiatives, Italian Committee for UNICEF, Rome, Italy.
authors.forename: Elise
authors.initials: E
authors.lastname: Chapin
authors.affiliation: Health Services Research and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Macaluso
authors.affiliation: National Council for Technological and Scientific Development, Porto Alegre, Brazil.
authors.forename: Lílian
authors.initials: L
authors.lastname: Córdova do Espírito Santo
authors.affiliation: Management and Health Laboratory, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Murante
authors.affiliation: Department of Epidemiology and Biostatistics, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Montico
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends; D003256:Community Participation; D005260:Female; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007224:Infant Care; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D008427:Maternal Health Services / Q000458:organization & administration*; D009035:Mothers / Q000193:education / Q000523:psychology; D016134:Organizational Policy; D016730:Program Development; D015397:Program Evaluation; D012944:Social Support
keywords: Baby-Friendly Initiatives; Breastfeeding; Italy