Osman Rukhsar, Katigula Idda, Charles Richard, Ayubu Agnes, Mkakilwa Paula, Abdallah Yaser, Noorani Mariam
Paediatrics, Aga Khan Hospital, Dar es Salaam, Tanzania, United Republic of
The Aga Khan University, Dar es Salaam, Tanzania, United Republic of.
BMJ Open Qual. 2024 Dec 15;13(4):e002893. doi: 10.1136/bmjoq-2024-002893.
Optimal breastfeeding can save the lives of over 800 000 children annually. WHO recommends that all babies initiate breastfeeding within first hour of life, exclusively breastfeed for the first 6 months and continue breastfeeding up to 2 years and beyond. In Tanzania, 70% of babies initiate breastfeeding within first hour and only 64% of infants under 6 months are exclusively breastfed.
Improve rate of early initiation and exclusive breastfeeding from birth to hospital discharge, with the aim of achieving 80% as per Baby Friendly Hospital Initiative standard through implementing quality improvement project.
A quality improvement project was conducted using a Plan-Do-Study-Act (PDSA) framework. Baseline rates of early initiation and exclusive breastfeeding were determined. Sequential strategies were implemented including drafting and implementing hospital policy on breastfeeding and use of formula milk, staff training on lactation management and antenatal education of pregnant women using breastfeeding videos. These were followed by immediate skin-to-skin contact after caesarean birth and modification of newborn feeding charts. Subsequently, daily lactation rounds were implemented, and monthly antenatal classes were conducted for women identified as high risk for breastfeeding challenges. Progress was monitored through monthly audits.
After three PDSA cycles, early breastfeeding initiation improved from 22% to 84% and exclusive breastfeeding rate increased from 45% to 90%.
Early and exclusive breastfeeding rates in hospital can be improved by multidimensional approach including policies, staff training, antenatal education, interdepartmental involvement and having dedicated staff to support lactation.
最佳母乳喂养每年可挽救超过80万名儿童的生命。世界卫生组织建议所有婴儿在出生后一小时内开始母乳喂养，在出生后的前6个月进行纯母乳喂养，并持续母乳喂养至2岁及以上。在坦桑尼亚，70%的婴儿在出生后一小时内开始母乳喂养，而6个月以下婴儿中只有64%进行纯母乳喂养。
提高从出生到出院的早期开始母乳喂养和纯母乳喂养率，目标是通过实施质量改进项目，按照爱婴医院倡议标准达到80%。
使用计划-执行-研究-行动（PDSA）框架开展质量改进项目。确定早期开始母乳喂养和纯母乳喂养的基线率。实施了一系列策略，包括起草和实施关于母乳喂养和配方奶使用的医院政策、对工作人员进行泌乳管理培训以及使用母乳喂养视频对孕妇进行产前教育。剖宫产术后立即进行母婴皮肤接触，并修改新生儿喂养图表。随后，开展每日泌乳查房，并为被确定为母乳喂养有困难的高危孕妇每月举办产前课程。通过每月审核监测进展情况。
经过三个PDSA循环，早期母乳喂养开始率从22%提高到84%，纯母乳喂养率从45%提高到90%。
通过包括政策、工作人员培训、产前教育、部门间参与以及配备专门工作人员支持泌乳在内的多维度方法，可以提高医院的早期和纯母乳喂养率。
