Al-Jawaldeh Ayoub, Abul-Fadl Azza
Department of Nutrition Sciencies, University of Vienna, Viena A-1090, Austria.
Pediatric Department, Banha Faculty of Medicine, Benha University, Benha 13511, Egypt.
Children (Basel). 2018 Mar 11;5(3):41. doi: 10.3390/children5030041.
The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity ( < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.
爱婴医院倡议（BFHI）是一项促进母乳喂养支持与保护的全球计划。然而，其对营养不良的影响，尤其是在面临冲突和紧急情况动荡的东地中海区域（EMR）国家，值得进一步研究。话虽如此，本文旨在探讨EMR国家实施BFHI的现状和挑战。通过结构化问卷、个人访谈和数据库从各国收集了关于BFHI实施、母乳喂养做法和营养状况的数据。EMR的22个国家分类如下：8个处于营养转型高级阶段的国家（第一组），5个处于营养转型早期阶段的国家（第二组），4个存在严重营养不良的国家（第三组），以及5个处于复杂紧急情况的国家（第四组）。结合营养不良讨论了实施BFHI面临的挑战。22.7%的EMR国家未实施BFHI。指定的爱婴医院共有829家（第一组：78.4%，第二组：9.05%；第三组：7.36%；第四组：5.19%）。营养转型高级阶段的国家BFHI实施率最高，但母乳喂养持续率最低。另一方面，营养状况不佳和紧急状态与BFHI低实施率和低纯母乳喂养率相关，但持续率高。母乳喂养的早期开始和较长持续时间与超重和肥胖呈负相关（<0.001）。在处于紧急状态的国家，母乳喂养仍然是主要的营养来源。然而，由于BFHI实施不力，次优母乳喂养做法普遍存在，从而导致营养不良。需要政治意愿和基于社区的倡议来促进该地区的母乳喂养并加强BFHI。
