title: Marketing of breast-milk substitutes in Zambia: evaluation of compliance to the international regulatory code.
abstract: We sought to assess the level of non-compliance with the International Code of Marketing breast-milk substitutes (BMS) and/or Statutory Instrument (SI) Number 48 of 2006 of the Laws of Zambia in two suburbs, Kalingalinga and Chelstone, in Zambia.
  
  
  
  This was a cross sectional survey. Shop owners (80), health workers (8) and mothers (214) were interviewed. BMS labels and advertisements (62) were observed. The primary outcome was mean non-compliance defined as the number of article violations divided by the total 'obtainable' violations. The score ranges from 0 to 1 with 0 representing no violations in all the articles and one representing violations in all the articles.
  
  
  
  A total of 62 BMS were assessed. The mean non-compliance score by manufacturers in terms of violations in labelling of BMS was 0.33 (SD = 0.28; 95% CI: 0.26, 0.40). These violations were mainly due to labels containing pictures or graphics representing an infant. 80 shops were also assessed with mean non-compliance score in respect of violations in tie-in-sales, special display, and contact with mothers at the shop estimated as 0.14 (SD = 0.14; 95% CI: 0.11, 0.18).
  
  
  
  Non-compliance with the Code and/or the local SI is high after 10 years of domesticating the Code.
authors.affiliation: School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia.|Chainama College of Health Sciences, Box 33991, Lusaka, Zambia.
authors.forename: P
authors.initials: P
authors.lastname: Funduluka
authors.affiliation: Centre for Infectious Diseases Research in Zambia, Box 3481, Lusaka, Zambia.|Department of Biostatistics, School of Public Health, University of Ghana, P.O. Box LG 25 Legon, Accra.
authors.forename: S
authors.initials: S
authors.lastname: Bosomprah
authors.affiliation: Centre for Infectious Diseases Research in Zambia, Box 3481, Lusaka, Zambia.
authors.forename: R
authors.initials: R
authors.lastname: Chilengi
authors.affiliation: National Food and Nutrition Commission, Lumumba Road, Box 32669, Lusaka, Zambia.
authors.forename: R H
authors.initials: RH
authors.lastname: Mugode
authors.affiliation: School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia.
authors.forename: P A
authors.initials: PA
authors.lastname: Bwembya
authors.affiliation: School of Public Health, University of Zambia, Box 50110, Lusaka, Zambia.|Immunomedics Inc., 300, American Rd., Morris Plains, NJ, USA.
authors.forename: B
authors.initials: B
authors.lastname: Mudenda
mesh_terms: D001903:Bottle Feeding / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006293:Health Promotion / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D041943:Infant Formula; D007391:International Cooperation / Q000331:legislation & jurisprudence*; D040541:Marketing / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011356:Product Labeling; D015024:Zambia