@article {8354, title = {Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study.}, journal = {BMJ Open}, volume = {6}, year = {2016}, month = {2016}, pages = {e010232}, abstract = {

OBJECTIVE: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

DESIGN: Controlled, non-randomised trial.

SETTING: 18 Local Health Authorities in 9 regions of Italy.

PARTICIPANTS: 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.

INTERVENTION: Implementation of the 7 steps of the BFCI.

MAIN OUTCOME MEASURES: The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured.

RESULTS: 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.

CONCLUSIONS: 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.

}, issn = {2044-6055}, doi = {10.1136/bmjopen-2015-010232}, author = {Cattaneo, Adriano and Bettinelli, Maria Enrica and Chapin, Elise and Macaluso, Anna and C{\'o}rdova do Esp{\'\i}rito Santo, L{\'\i}lian and Murante, Anna Maria and Montico, Marcella} } @article {1968, title = {Establishing the Baby-Friendly Community Initiative in Italy: development, strategy, and implementation.}, journal = {J Hum Lact}, volume = {28}, year = {2012}, month = {2012 Aug}, pages = {297-303}, abstract = {

BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization and the United Nations Children{\textquoteright}s Fund (UNICEF) to promote breastfeeding in maternity facilities worldwide, has had a global impact on breastfeeding outcomes, but other interventions are needed both before and after hospital discharge to meet the recommended targets at 6 months. The Baby-Friendly Community Initiative (BFCI), a multifaceted program for community-based breastfeeding promotion that is complementary to the BFHI, addresses this challenge.

OBJECTIVE: To describe the development, strategy, and implementation of the BFCI in Italy.

METHODS: In 2006, UNICEF Italy created a working group to develop the BFCI for the Italian health system. A review of the different BFCI models worldwide was conducted. A preliminary adaptation of tools to Italian community health care settings was developed in 2007, when the Italian BFCI Seven Steps were published. Two years later, UNICEF Italy launched the Standards for Best Practice for both hospitals and communities, based on 2009 BFHI and UNICEF UK BFCI materials.

OUTCOMES: The main outcome was to promote this process in Italian regional health systems and develop tools to assess compliance with the BFCI criteria. There is now one fully accredited Baby-Friendly Community in Italy, and 17 other communities are working on the various stages.

CONCLUSIONS: The BFCI, a complex program that involves participation, training, audits, a continuous flow of feedback, and provision of resources for health workers and families, is now a reality in Italy.

}, keywords = {Breast Feeding, Continuity of Patient Care, Delivery Rooms, Female, Health Policy, Humans, Infant, Infant Care, Infant Welfare, Infant, Newborn, Italy, Maternal Health Services, Organizational Policy, Outcome and Process Assessment (Health Care), Practice Guidelines as Topic, Pregnancy, Program Development, Program Evaluation, United Nations, World Health Organization}, issn = {1552-5732}, doi = {10.1177/0890334412447994}, author = {Bettinelli, Maria Enrica and Chapin, Elise M and Cattaneo, Adriano} }