External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil
External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil
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DOI：
10.1186/s13006-018-0195-4
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发表时间：
2019-01-05
影响因子：
3.5
通讯作者：
Ramos, Eloane Goncalves
中科院分区：
文献类型：
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作者：
Araujo, Renara Guedes;Fonseca, Vania de Matos;Ramos, Eloane Goncalves
背景在巴西，爱婴医院倡议建议遵循以下标准：成功母乳喂养的十个步骤、《母乳代用品国际销售守则》和良好的生育和分娩做法。巴西爱婴医院每三年由外部评估人员重新评估一次，每年由自我监测重新评估一次。本研究旨在验证自我监测系统是否能够发挥其作用，使认证医院能够评估和改善其对BFHI标准的遵守情况。从这个意义上讲，我们将分析自我监测评估结果，并将其与外部再评估结果进行比较。方法本描述性评估研究由巴西爱婴医院的自我监测评估员在2010年至2015年期间和外部评估员在2015年期间对BFHI标准的遵守情况进行。从2010年到2015年，143家BFHI认证的医院进行了监测。根据自我监测评价，在评估期间，遵守爱婴基金会标准的程度趋势稳定。大多数标准的依从性超过70%，除了第4步（出生后第一个小时内的皮肤接触和母乳喂养），平均依从性为67%。步骤1（书面政策），7（同房）和9（不提供人工乳头）显示平均依从性超过90%。关于2015年进行的外部评估，遵守率最低的标准是第4步和对妇女友好的护理，两者都低于50%。步骤9和10（将母亲介绍给母乳喂养支持小组）的遵守率达到90%以上。2015年，自我监测在大多数标准中提供的依从性水平显著高于外部评估，除了步骤3（母乳喂养的产前信息）和步骤10。步骤1（书面政策），2（培训），5（显示母亲如何母乳喂养），妇女友好的护理和父亲或母亲留在他们的newbors.ConclusionsThe自我监测系统的评价之间的差异超过30%点部分履行其作用，允许认可的医院自我评估和提高遵守BFHI标准的比率。今后对医院管理人员的培训需要解决困难，并确定解决办法，以改善步骤4和6的执行情况。
BackgroundIn Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment.MethodsThis descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015.ResultsSelf-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn.ConclusionsThe self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.