Nội dung toàn văn Decision 5913/QD-BYT 2021 criteria recognition of hospitals for excellence in breastfeeding support
THE MINISTRY OF HEALTH | THE SOCIALIST REPUBLIC OF VIETNAM |
No. 5913/QD-BYT | Hanoi, December 29, 2021 |
DECISION
ON APPROVAL FOR “CRITERIA AND GUIDELINES FOR EVALUATION OF RECOGNITION OF HOSPITALS FOR EXCELLENCE IN BREASTFEEDING SUPPORT”
MINISTER OF HEALTH
Pursuant to Government's Decree No. 75/2017/ND-CP dated June 20, 2017 defining the functions, tasks, entitlements and organizational structure of the Ministry of Health;
Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers;
Circular No. 38/2016/TT-BYT dated October 31, 2016 of the Minister of Health on certain measures to promote breastfeeding at health facilities;
At the request of Director of Department of Pediatric and Maternal Health affiliated to the Ministry of Health,
HEREBY DECIDES:
Article 1. Approve “Criteria and guidelines for evaluation of recognition of hospitals for excellence in breastfeeding support” issued herewith.
Article 2. “Criteria and guidelines for evaluation of recognition of hospitals for excellence in breastfeeding support” is the basis for health facilities specialized in obstetrics and gynecology to carry out the evaluation and recognition under guidance of the Ministry of Health.
Article 3. This Decision shall enter into force upon signing and promulgation.
Decision No. 3451/QD-BYT dated August 6, 2019 of the Minister of Health on approval for “Criteria and guidelines for evaluation of recognition of hospitals for excellence in breastfeeding support” shall cease to be effective since the issue date of this Decision.
Article 4. The Chief of the Ministry Office, Director of Department of Pediatric and Maternal Health, Director of Department of Medical Examination and Treatment Management; Heads of affiliates of the Ministry of Health; Directors of Department of Health of provinces and central-affiliated cities; Heads of relevant units shall implement this Decision./.
| PP. MINISTER |
CRITERIA AND GUIDELINES
EVALUATION OF RECOGNITION OF “HOSPITALS FOR EXCELLENCE IN BREASTFEEDING SUPPORT”
(Issued together with Decision No. 5913/QD-BYT dated December 29, 2021)
I. Bases for developing criteria:
- Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers.
- Circular No. 38/2016/TT-BYT dated October 31, 2016 of the Minister of Health on certain measures to promote breastfeeding at health facilities.
- Decision No. 4673/QD-BYT dated November 10, 2014 of the Minister of Health on approval for guidance documents on early essential newborn care.
- Decision No. 4128/QD-BYT dated July 29, 2016 of the Minister of Health on approval for national guidelines for reproductive healthcare services.
- Decision No. 6743/QD-BYT dated November 15, 2016 of the Minister of Health on approval for guidance documents on early essential newborn care in and right after caesarean sections.
- Decision No. 6858/QD-BYT dated November 18, 2016 of the Minister of Health on promulgation of the set of criteria for Vietnamese hospital quality assessment.
II. Criteria for recognition of “Hospital for excellence in breastfeeding support”:
1. For hospitals with obstetrics services and no pediatrics services:
- Criterion 1: The hospital at least achieves level 4 (at least 1 year prior to the evaluation) of criterion E1.3 concerning breastfeeding under the set of criteria for Vietnamese hospital quality assessment.
- Criterion 2: The hospital qualifies for the checklists.
- Criterion 3: The hospital qualifies for interviews of postpartum mothers via cell phones.
2. For hospitals with pediatrics services and no obstetrics services:
- Criterion 1: The hospital self evaluates and keeps records proving that they have performed the following:
• 80% of preterm infants < 37 weeks, low birth weight < 2.000g with stable respiratory status receive Kangaroo mother care (KMC) continuously (≥ 20 hours/day, intermittent ≤ 30 minutes).
• 90% of mothers are able to visit their babies at least once a day in the neonatal intensive care unit (NICU).
• 80% of mothers receive counseling on breastfeeding.
• 80% of babies receive exclusive breastfeeding during their hospital stay.
• There is no violation against Decree 100/2014/ND-CP in the hospital.
- Criterion 2: The hospital qualifies for the checklists.
- Criterion 3: The hospital qualifies for interviews of postpartum mothers/caregivers of infants less than 1 month old receiving treatment at the hospital via cell phones.
3. For hospitals with both obstetrics services and pediatrics services: meet all criteria mentioned in Section 1 and 2.
III. Guidelines for evaluation of recognition:
1. Requests for evaluation of recognition:
After hospitals self-evaluate that they satisfy Criterion 1 (each category of hospitals is specialized in Section II):
- For hospitals affiliated to the Ministry of Health: send a written request to the Ministry of Health (via Department of Maternal and Child Health).
- For hospitals affiliated to the Department of Health: send a written request to the Department of Health.
2. Evaluation:
2.1 Composition of evaluation team:
a) Evaluation team of the Ministry of Health:
- Leading role: Department of Maternal and Child Health.
- Composition: Department of Maternal and Child Health, experts of breastfeeding/EENC/KMC
b) Evaluation team of the Department of Health:
- Leading role: Department of Health
- Composition: Department of Health, Center for Disease Control (Department of Reproductive Healthcare) or equivalent units, staff with expertise in breastfeeding and EENC/KMC.
2.2 Evaluation of Criterion 2 (through checklists in Appendix 1):
a) Evaluation:
For hospitals with obstetrics services and no pediatrics services:
- Evaluation of counseling on breastfeeding for pregnant woman: Interview 5 women who are 7 months pregnant or more at prenatal care rooms (Checklist 1).
- Evaluation of implementation of EENC in vaginal delivery (for breathing babies): Observation of at least 3 vaginal deliveries. Observation of model-based practices in case of absence of vaginal delivery at the evaluation time (Checklist 2).
- Evaluation of implementation of EENC in delivery by caesarean section (for breathing babies): Observation of at least 2 caesarean sections. Observation of model-based practices in case of absence of caesarean section at the evaluation time (Checklist 3).
- Evaluation of breastfeeding practices of mothers: Interview 10 postpartum mothers of full-term infants (or all present mothers if less than 10 mothers) (Checklist 4). Observe 5 breastfeeding mothers at the postpartum and neonatal ward (Checklist 5).
- Evaluation of practices of health workers giving counseling on breastfeeding: Observe practices of 5 health workers giving counseling on breastfeeding at the postpartum and neonatal ward (Checklist 6).
- Review hospital criteria for breastfeeding (Checklist 7).
- Evaluation of breastfeeding friendly environment (Checklist 8).
For hospitals with pediatrics services and no obstetrics services: Evaluation at pediatrics department/ward.
- Evaluation of breastfeeding practices of mothers: Interview 10 mothers of preterm infants <37 weeks and <2.000 gram staying with the babies after treatment in the NICU (Checklist 9).
- Evaluation of health workers' practices in guiding mothers/caregivers to put their babies in the KMC position:
- Observation of 5 health workers in KMC room (Checklist 10).
- Evaluation of the practice of health workers in instructing mothers how to express milk and feed the baby with a spoon or cup when the baby is in the KMC position: Observation of 5 health workers in KMC room (Checklist 11).
- Evaluation of health workers' practices in guiding mothers to breastfeed their babies in the KMC position: Observation of 5 health workers in KMC room (Checklist 12).
- Evaluation of breastfeeding friendly environment (Checklist 8).
For hospitals with both obstetrics services and pediatrics services:
- Evaluate from Checklists 1 to 12.
b) Evaluation results:
- “PASS” item of each checklist (see the bottom of each checklist, Appendix 1).
- The hospital satisfies Criterion 2 if meeting all requirements of the checklist corresponding to each category of hospitals.
- Evaluation summary of the Checklists: Appendix 4
2.3 Evaluation of Criterion 3 through interviews via cell phones:
a) Units in charge of interviews:
- Department of Maternal and Child Health: Conduct interviews at hospital affiliated to the Ministry of Health.
- Department of Health or Center for Disease Control of province (if assigned): Conduct interviews at hospital affiliated to the Department of Health.
- The interview team is composed of staff with expertise in EENC, breastfeeding and KMC.
- The unit shall assign a staff member in charge of general affairs (not engaging in the interview) to: re-interview 5% random mothers who were interviewed before to check the quality of the interview via cell phones.
b) Implementation:
For hospitals with obstetrics services and no pediatrics services:
- Do the survey using the Checklist in Appendix 2.
- According to the time of application for title consideration, the hospital compiles a list of all postpartum mothers discharged from hospital in the preceding quarter and sends it to the unit in charge of interview according to the table below:
Table 1: List of postpartum mothers discharged from hospital in the quarter
Name of mother | Phone number of mother | Discharge date | Vaginal delivery/C-sections |
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- The unit will conduct interviews of 100 random mothers/quarter (50 mothers with caesarean sections) in case of central hospitals or hospitals of provinces/cities and 50 mothers/quarter (25 mothers with caesarean sections) in case of hospitals of districts.
For hospitals with pediatrics services and no obstetrics services:
- Do the survey using the Checklist in Appendix 3.
- According to the time of application for title consideration, the hospital compiles a list of all mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in the preceding quarter and sends it to the unit in charge of interview according to the table below:
Table 2: List of mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in each quarter
Name of mother/caregiver | Name of baby | Phone number of mother/caregiver | Date of birth | Discharge date | Preterm birth (< 37 weeks)/ Full-term birth (≥ 37 weeks) |
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- The unit will conduct interviews of 100 random mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in the quarter in case of central hospitals or hospitals of provinces/cities (50 infants with preterm birth < 37 weeks) and 50 mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in the quarter (25 infants with preterm birth < 37 weeks).
For hospitals with bother obstetrics services and pediatrics services:
- Do the survey using the Checklist in Appendix 2 and Appendix 3: Interview both categories of interviewees.
+ Postpartum mothers discharged from the hospital: do the survey using the Checklist in Appendix 2.
+ Mothers/caregivers of infants less than 1 month old receiving treatment at the hospital: do the survey using the Checklist in Appendix 3.
- According to the time of application for title consideration, the hospital compiles a list of postpartum mothers discharged from the hospital (using Table 1) and a list of all mothers/caregivers of infants less than 1 month old receiving treatment at the hospital (using Table 2) in the preceding quarter and sends it to the unit in charge of interview.
- The unit in charge of interview shall conduct random interviews:
+ For each central hospital or hospital of province/city: interview 100 mothers/quarter in which 80 mothers/quarter of Table 1 (at least 40 mothers with C-sections or all mothers with C-sections in the quarter if less than 40 mothers with C-sections) and 20 mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in Table 2 (with 10 infants with preterm birth < 37 weeks).
+ For each hospital of district: interview 50 mothers/quarter in which 40 mothers/quarter of Table 1 (at least 20 mothers with C-sections or all mothers with C-sections in the quarter if less than 20 mothers with C-sections) and 10 mothers/caregivers of infants less than 1 month old receiving treatment at the hospital in Table 2 (with 5 infants with preterm birth < 37 weeks).
c) Request to select survey sample:
- From the hospital's list of postpartum mothers, after removing invalid phone numbers (missing digits/extra digits), the person in charge randomly selects the mothers’ phone numbers to interview according to the sample interval k, where: k = total number of mothers in the list/corresponding sample size required by each hospital to conduct the survey.
- This sample selection will rotate until the required number is reached (in the case of unsuccessful surveys).
d) Evaluation results:
- The questionnaire form in Appendix 2 and Appendix 3 depends on each hospital.
- Specific evaluation criteria are mentioned in the evaluation summary in Appendix 4.
IV. Maintain the title “Hospital for excellence in breastfeeding support”
After being awarded the title of “Hospital for excellence in breastfeeding support”, the hospital will conduct annual self-evaluation according to the respective checklists.
Quarterly, the hospital conducts its own survey via phone, in specific:
- For hospitals with obstetrics services and no pediatrics services: 20 postpartum mothers discharged from the hospital.
- For hospitals with pediatrics services and no obstetrics services: 20 mothers/caregivers.
- For hospitals with bother obstetrics services and pediatrics services: 15 postpartum mothers discharged from the hospital and 5 mothers/caregivers of infants less than 1 month old receiving treatment at the hospital:
The hospital shall send annual reports to the Ministry of Health (for hospitals affiliated to the Ministry of Health) or the Department of Health (for hospitals affiliated to the Department of Health).
The validity period of the document awarding title of “Hospital for excellence in breastfeeding support” is 5 years, the hospital should seek a renewal 3 months before the expiration from the Ministry of Health/Department of Health. The Ministry of Health/Department of Health will conduct a re-evaluation and grant a renewal to the hospital.
APPENDIX 1.
CHECKLIST
Checklist 1. INTERVIEW OF WOMEN’S 7 MONTHS PREGNANT OR MORE
Answer Yes/Right: 1 point
Answer No/Wrong: 0 point
Description | Pregnant woman #1 | Pregnant woman #2 | Pregnant woman #3 | Pregnant woman #4 | Pregnant woman #5 | |
Be counseled on breastfeeding during prenatal check-ups by health workers | ||||||
1 | Benefits of breastfeeding |
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2 | Harmful effects of baby bottles and infant formula |
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3 | The baby’s stomach size in the first 3 days of life |
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4 | Exclusive breastfeeding duration |
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5 | Continued breastfeeding duration |
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Able to list 3 benefits of breastfeeding | ||||||
6 | Able to list correctly 3 benefits of breastfeeding |
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Able to define exclusive breastfeeding | ||||||
7 | Right (no other food or drink, except for vitamins and medicines prescribed by doctors) |
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8 | Right (exclusive breastfeeding for the first six months of life) |
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Able to know continued breastfeeding | ||||||
9 | Right (continued breastfeeding until 24 months and beyond) |
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| Total score |
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“PASS” if 4 out of 5 pregnant women have a total score of ≥ 7/9 points
Checklist 2. OBSERVATION OF IMPLEMENTATION OF EENC IN VAGINAL DELIVERIES (BREATHING BABIES)
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Observational checklists | Delivery #1 | Delivery #2 | Delivery #3 |
I. PRE-BIRTH PREPARATIONS: |
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1. Checked room temperature, turned off fans |
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2. Washed hands (first of two hand washings) |
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3. Placed dry cloth on mother’s abdomen |
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4. Prepared the resuscitation area, turned on heated bed (dry, clean and warm resuscitation bed) |
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5. Checked that bag and mask in newborn resuscitation area and oxygen are functional |
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6. Checked the vacuum extractor, suction cup and vacuum pressure |
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7. Washed hands (second of two hand washings) |
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8. Put on two pairs of clean gloves (if there is only 1 midwife) |
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9. Put forceps, cord clamp/ties, scissors in easy-to-use order |
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10. Checked if all conditions are met (the perineum is ballooning, the fetal head emerges) before initiating the delivery |
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II. ASSISTING THE BIRTH: |
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Birth of the head |
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11. Used 1 hand to keep the perineum by 1 swab (or sterile cloth) |
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12. Used the fingers 2 and 3 of the other hand to pull down the occiput for the head down |
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13. When the occiput has come out of the vulva, a hand embraces the occiput upwards so that the forehead, eyes, nose, mouth and chin may come out. Told the mother to stop pushing when doing these actions |
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14. The other hand still kept the perineum from tearing |
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15. When the head completely came out, waited for the fetal head rotate itself, the midwife would help the head rotate so that the occiput rotate to one side (left transverse or right transverse) |
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Birth of shoulders |
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16. Check if the cord wraps around the neck. yes, loosed it further. If the cord was tight around the neck, clamped the cord with two forceps, and cut the cord between the two clamps before the shoulder is delivered |
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17. Applied 2 hands to the temples of the fetus |
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18. Gently pulled the fetus downwards to the foot of the midwife and instructed the mother push gently until the anterior shoulder is delivered. |
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19. To assist the birth of posterior shoulder, one hand embraced the fetal head for the nape of the neck between fingers 1 and 2 to pull the head up. |
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20. The other hand still kept the perineum from tearing when the shoulders were delivered |
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Birth of buttocks and limbs |
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21. Kept holding the nape of the neck when delivering the posterior shoulder, moved the hand keeping perineum along the abdomen, buttocks and lower limbs of the fetus |
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22. When reaching the feet of the fetus, quickly caught it so that the foot is between fingers 2, 3, 4 supporting the buttocks. The baby was held in a transverse position. |
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III. IMMEDIATE POSTPARTUM/NEWBORN CARE |
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23. Called out time of birth (hour__minute__), sex |
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24. Drying started within 5 seconds of birth |
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25. Dried the baby thoroughly (wiped the eyes, face, head, chest, abdomen, arms, legs, back, buttocks, and genitals) in 30 seconds |
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26. Removed the wet cloth |
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27. Put baby in direct skin-to-skin contact with mother |
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28. Covered baby’s body with cloth and the head with a hat |
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29. Checked for a second baby |
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30. Gave Oxytocin to mother within 1 minute of delivery |
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31. Removed outer pair of gloves |
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32. Checked cord pulsations before clamping, clamped after cord pulsations stopped (usually 1-3 min) |
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33. Placed the first clamp at 2 cm from umbilical base, push the blood in the cord towards the mother. |
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34. Placed the second clamp at 3 cm from the first clamp (or at 5 cm from umbilical base). Cut the cord near the first clamp using a sterile scissors. |
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35. Delivered placenta: One hand held the clamp. One hand placed on the suprapublic abdomen, waited for the uterus to tighten and held and pushed the uterus towards the sternum. |
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36. Pulled the umbilical cord with control, gently in the direction of the delivery while the hand on the mother’s abdomen pushed the uterus conversely |
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37. When the placenta reached the vulva, lowered the umbilical cord so that the weight of the placenta pulls the membranes. If the membranes did not slip out, lifted the placenta with both hands and twisted in one direction to allow the placenta to separate completely. |
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38. Rubbed the bottom of the uterus through the mother’s abdominal wall until the uterus contracts well every 15 minutes in the first 2 hours after delivery |
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39. Examined placenta: when the uterus was well contracted and no sign of bleeding was found, examined the placenta |
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40. Counseled mother on feeding cues (drooling, mouth opening, tonguing/licking, biting hand, crawling). Explained that the baby will be placed skin-to-skin with the mother continuously in at least 90 minutes and complete the first breast-feeding before being separated to weigh and receive other care |
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Total score |
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“PASS” if 3 out of 3 vaginal deliveries have a total score of ≥ 72/80 points
Checklist 3. OBSERVATION OF IMPLEMENTATION OF EENC IN CAESAREAN SECTIONS (BREATHING BABIES)
Adequate/proper performance (2 points); inadequate performance (1 point); none (0 point)
Activity | C-section #1 | C-section #2 |
I. PRE-BIRTH PREPARATIONS: |
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1. Checked room temperature, turned off fans |
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2. Nurse/midwife washed hands |
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3. Prepared the newborn resuscitation area, turned on heated bed |
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4. Checked that bag, mask, vacuum extractor, suction cup and oxygen are functional |
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5. Washed hands before surgery, wore sterile clothes, wore gloves (surgeons and midwife picking up the baby) |
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6. Prepared cord clamp/ties |
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7. Placed a sterile cloth over the woman's thighs below the incision at the time of caesarean section |
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II. IMMEDIATE POSTPARTUM/NEWBORN CARE |
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8. Called out time of birth (hour__minute__), sex |
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9. Placed dry cloth on mother’s thigh |
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10. Drying started within 5 seconds of birth |
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11. Dried the baby thoroughly in order (wiped the eyes, face, head, chest, abdomen, arms, legs, back, buttocks, and genitals) in 30 seconds |
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12. Removed the wet cloth, covered baby’s body with cloth and the head with a hat |
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13. Checked for a second baby |
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14. Gave Oxytocin to mother within 1 minute of delivery |
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15. Checked cord pulsations before clamping, clamped after cord pulsations stopped (usually 1-3 min) |
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16. Placed the first clamp at 2 cm from umbilical base, push the blook in the cord towards the mother. |
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17. Placed the second clamp at 3 cm from the first clamp (or at 5 cm from umbilical base). Cut the cord near the first clamp using a sterile scissors. |
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18. Gave baby to the waiting midwife/nurse |
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19. Put baby prone on the mother’s breast in direct skin-to-skin contact |
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20. Covered baby’s back with dry cloth |
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21. Counseled mother on feeding cues (drooling, mouth opening, tonguing/licking, biting hand, crawling) and support the baby to attach well to the breast. Explained that the baby will be placed skin-to-skin with the mother continuously in at least 90 minutes and complete the first breast-feeding before being separated to weigh and receive other care |
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Total score |
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“PASS” if 2 out of 2 caesarean sections have a total score of ≥ 38/42 points
Checklist 4. INTERVIEWS OF POSTPARTUM MOTHERS WITH FULL-TERM BIRTH
Question | Mother with vaginal delivery | Mother with caesarean section | ||||||||
#1 | #2 | #3 | #4 | #5 | #1 | #2 | #3 | #4 | #5 | |
1. Did anyone push down on the mother’s belly? (Yes = 1 point, No = 0 point) |
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2. Was the baby placed in direct skin-to-skin contact with mother right after birth? (Yes = 1 point, No = 0 point) |
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3. How long did the baby remain in uninterrupted skin-to-skin contact? (≥ 90 min = 1 point; < 90 min = 0 point) |
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4. How long after birth did the baby first breastfeed? (15-90 min = 1 point; other = 0 point) |
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5. How long after birth was the baby bathed? (≥ 24 h = 1 point; < 24 h = 0 point) |
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6. Did the baby stay with the mother during the entire hospital stay (rooming in)? (Yes = 1 point, No = 0 point) |
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7. Since delivery, was the baby fed anything other than breast-milk? (Yes = 1 point, No = 0 point) |
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8. Did the baby use baby bottles and pacifiers? (Yes = 1 point, No = 0 point) |
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9. Was anything applied to the cord stump and was the umbilical cord tape placed? (Both no = 1 point; yes in one or both cases = 0 point) |
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10. Did the mother have infant formula, baby bottles, gifts with images of milk for infants under 24 months/baby bottles/pacifiers sponsored by baby food companies with her? (Yes = 1 point, No = 0 point) |
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11. Did the mother get medical advice from health workers at the hospital about the benefits of breastfeeding? (Yes = 1 point, No = 0 point) |
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12. Was mother counseled on feeding cues by health workers at the hospital? (Yes = 1 point, No = 0 point) |
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13. Was mother counseled on how to place the baby in the breast by health workers at the hospital? (Yes = 1 point, No = 0 point) |
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14. Was mother counseled on how to help the baby to attach to the breast by health workers at the hospital? (Yes = 1 point, No = 0 point) |
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15. Was mother counseled on signs of baby’s proper attachment to the breast by health workers at the hospital? (Yes = 1 point, No = 0 point) |
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16. Did mother tell exactly that the baby has breastfed 8-12 times in 24 hours or on demand? (Yes = 1 point, No = 0 point) |
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17. Did mother tell correctly size of the baby’s stomach in the first 3 days of life? (Yes = 1 point, No = 0 point) |
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18. Was the baby given Vitamin K1 after 90 minutes of first breastfeeding and skin-to-skin contract? (Yes = 1 point, No = 0 point) |
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Total score |
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“PASS” if 8 out of 10 mothers have a total score of ≥ 14/18 points
Checklist 5. OBSERVATION OF MOTHERS IN BREASTFEEDING PRACTICES
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Activity | Mother #1 | Mother #2 | Mother #3 | Mother #4 | Mother #5 | |
Feeding position | ||||||
1. | The mother holds the baby so that the baby’s belly is close to the mother’s belly |
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2. | The mother supports the baby’s whole body, not just the neck and shoulders |
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3. | Ensure the baby’s ears, shoulders and hips are in a straight line |
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4. | Ensure that the baby’s face looks forwards breast, with nose opposite nipple |
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Attachment to the breast | ||||||
5. | Touch baby’s lips with her nipples |
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6. | Wait for baby’s mouth to open wide |
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7. | Move the baby onto the mother’s breast, aiming the lower lip well below the nipple |
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Signs of good attachment to the breast | ||||||
8. | Baby’s chin is touching the breast |
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9. | Baby’s mouth is wide open, puffed cheeks |
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10. | Baby’s lower lip is curled out/downwards |
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11. | More areola is visible above the baby’s mouth than below |
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Signs of good breastfeeding | ||||||
12. | Baby feeds with slow deep sucks |
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13. | Occasional short pauses in sucking are normal; no sucking sounds should be heard |
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Total score |
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“PASS” if 4 out of 5 mothers have a total score of ≥ 20/26 points
Checklist 6. OBSERVATION OF HEALTH WORKERS GIVING COUNSELLING FOR BREASTFEEDING
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Activity | #1 | #2 | #3 | #4 | #5 | |
Shows the mother how to position the baby | ||||||
1. | Hold baby so that the baby’s belly is close to the mother’s belly |
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2. | Support the baby’s whole body, not just neck and shoulders |
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3. | Ensure the baby’s ears, shoulders and hips are in a straight line |
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4. | Ensure that the baby’s face looks forwards breast, with nose opposite nipple |
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Shows the mother how to help baby attach to the breast | ||||||
5. | Touch baby’s lips with her nipples |
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6. | Wait for baby’s mouth to open wide |
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7. | Move the baby onto the mother’s breast, aiming the lower lip well below the nipple |
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Shows the mother how to help baby attach to the breast | ||||||
8. | Baby’s chin is touching the breast |
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9. | Baby’s mouth is wide open, puffed cheeks |
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10. | Baby’s lower lip is curled out/downwards |
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11. | More areola is visible above the baby’s mouth than below |
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Discusses with the mother signs of good breastfeeding | ||||||
12. | Baby feeds with slow deep sucks |
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13. | Occasional short pauses in sucking are normal; no sucking sounds should be heard |
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14. | The mother feels empty after feeding (feed on both sides one after one) |
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Total score |
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“PASS” if 4 out of 5 health workers have a total score of ≥ 25/28 points
* Notes: Health workers should avoid touching the baby but showing the mother how to breastfeed herself.
Checklist 7. REVIEW OF HOSPITAL CRITERIA
Criteria | Source of information authentication | Standard achieved |
1- At least 95% of obstetrics and neonatal staff are trained on counseling and support for mothers to breastfeed. | Certification/certificate of training for breastfeeding: Issued by training institution (B-C code) with training course in breastfeeding. | At least 95% |
2- % of breastfeeding counselor staff participating in training course in breastfeeding and obtaining certifications/certificates | Hospital’s decision to assign staff to undertake counseling of breastfeeding. Certification | At least 95% |
3- Availability of a regular group to support breastfeeding mothers (including doctors, nurses, midwives, etc.), having knowledge and skills of counseling, guidance and support for breastfeeding mothers, relieve plugged milk ducts, proper feeding, how to maintain breast-milk production. | Decision to establish the group “Breastfeeding support” (list of members, action plan) | Yes |
4- At least 80% of vaginal deliveries are fully performed with EENC | EENC data of the hospital | At least 80% There is a system of birth register and software |
5- At least 50% of caesarean sections are fully performed with EENC out of eligible cases | EENC data of the hospital | At least 50% There is a system of birth register and software |
6- No violation of marketing of substitutes for breast-milk in hospital as prescribed in Government's Decree No. 100/2014/ND-CP dated November 6, 2014 on business and use of dietary products for infants, baby bottles and pacifiers, including: • No case in which a health worker prescribes a breast-milk substitute for babies in unnecessary cases • No display and sale of breast-milk substitutes in hospital canteens. • No breast-milk substitutes, baby bottles, pacifiers in recovery rooms (in case of vaginal deliveries). | Observation at hospital | No violation |
“PASS” when all specified criteria are met
Checklist 8. EVALUATION OF BREASTFEEDING FRIENDLY ENVIRONMENT
Question | Prenatal care room(s) | Delivery room(s) | Recovery room(s) | Neonatal care unit | Pass |
1. Is there a board of breastfeeding regulations: with adequate regulations of WHO on ten steps to successful breastfeeding? |
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| Yes |
2. Does the hospital prohibit using infant formula and other linkages with milk formula publicly? |
| Yes | |||
3. Are there any pictures encouraging breastfeeding? |
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| Yes |
4. Are breastfeeding materials accessible to mothers and her relatives? |
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| Yes |
5. Does the hospital encourage the use of cups and spoons instead of using baby bottles when babies are not breastfed directly? |
| Yes | |||
6. Are posters, video, pictures, etc. of milk formula companies visible in the hospital? (including infant formula companies which advertise pregnant woman formula). |
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| No |
7. Is there a breastfeeding counseling program for mothers at the hospital? |
| Yes | |||
8. Is there a breast-milk storage refrigerator? |
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| Available at neonatal care unit |
9. Is there a separate and clean area with full of supporting materials for mothers: nutrition when breastfeeding, proper feeding position, breast massage, milking by hand of by machine. |
| Yes | |||
10. Are there equipment to help mothers express milk when the baby is not yet breastfed (preterm babies, babies with facial deformities…) available at the hospital? |
| Yes | |||
11. Are there breast milk substitutes, feeding bottles, and pacifiers for sale at the hospital canteen? |
| No | |||
“PASS” when all specified criteria are met
Checklist 9. INTERVIEW OF MOTHERS WITH PRETERM AND LIGHT-BIRTHWEIGHT BABIES DISCHARGED FROM THE NICU (n=10)
* Choose mothers of infants <37 weeks and <2000 gram at birth
Description | Mother #1 | Mother #2 | Mother #3 | Mother #4 | Mother #5 | Mother #6 | Mother #7 | Mother #8 | Mother #9 | Mother #10 | |
1 | During the isolation period, is the mother encouraged to visit the child at least once a day? (Yes = 1 point, No = 0 point) |
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2 | During the mother-child isolation period, did the hospital health workers advise and guide the mother to express milk for the baby? (Yes = 1 point, No = 0 point) |
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3 | During the hospital stay, was the child given anything other than breast milk? (excluding fluids, drugs, special milk according to medical requirements) (Yes = 0 point, No = 1 point) |
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4 | During the hospital stay, did the child completely not eat breast milk from a bottle (the child was directly breastfed or fed breast milk through a cup, spoon, syringe, feeding tube)? (Yes = 1 point, No = 0 point) |
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5 | In the past 24 hours, has the child received Kangaroo mother care ≥ 20 hours? (Yes = 1 point, No = 0 point) |
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6 | Is the child separated from the mother (who provides the Kangaroo mother care) for more than 30 minutes? (Yes = 0 point, No = 1 point) |
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| Did the mother receive advice and practical guidance from the health workers at the hospital on the following breastfeeding-related contents? (Yes = 1 point, No = 0 point) |
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7 | Benefits of breastfeeding |
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8 | Feeding cues |
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9 | Proper positioning for breastfeeding |
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10 | Attachment to the breast |
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11 | Signs of good attachment to the breast |
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12 | Ways to express and store breast milk |
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| Total score |
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“PASS” if 8 out of 10 mothers have a total score of ≥ 9/12 points
Checklist 10. OBSERVATIONS OF HEALTH WORKERS HELPING MOTHERS/CAREGIVERS POSITION THE BABIES CORRECTLY FOR KMC
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Step | Health worker #1 | Health worker #2 | Health worker #3 | Health worker #4 | Health worker #5 |
Discuss KMC with the mother |
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1. Three basic components of KMC |
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2. At least three benefits of continuous KMC |
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Show mother on how to prepare for KMC |
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3. Wash hands before baby care |
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4. Prepare shirt and KMC binder for the mother; caps, diapers for the baby |
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5. Put shirt and KMC binder on the mother that can be opened at front |
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6. Remove clothes from the baby, and ensure that the baby is wearing cap; change diaper if needed |
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7. Repeat handwashing after touching diaper |
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Show mother how to position the baby correctly for KMC |
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8. Hold the baby – one hand on head, one hand on bottom, and place between the breasts, chest to chest vertically with legs and arms flexed |
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9. Ensure the baby’s head is slightly extended, with head turned to one side and arms flexed |
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10. Pull the binder over the baby’s feet, upper edge of wrap placed at the level of the baby’s ears and then the lower edge pulled under baby’s buttocks with the feet inside the binder in the frog position |
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11. Adjust the binder to hold the baby securely so when the mother moves around, the baby will not fall |
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12. Check that the baby can breathe easily and that the tight edge of the binder is not over the baby’s chest |
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13. Button clothes over the baby and cover with a blanket; ensure that the mother is comfortable |
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14. Wash hands after baby care |
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Total score |
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“PASS” if 4 out of 5 health workers have a total score of ≥ 25/28 points
Checklist 11. OBSERVING HEALTH WORKER SHOWING MOTHER HOW TO DO BREAST MASSAGE AND EXPRESS BREAST MILK HERSELF WHILE PRACTISING KMC SKILLS
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Step | Health worker #1 | Health worker #2 | Health worker #3 | Health worker #4 | Health worker #5 |
Discusses with the mother on how to express breast milk and preparation |
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1. Expressed breast milk is given to preterm babies who cannot suck or swallow or who tire easily. It can also be used for term babies so the baby can be fed breast milk when the mother is away |
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2. Breast milk is made deep in the breast and flows to the nipple. No milk will come if only the nipple is squeezed |
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3. Express on average 8–12 times in 24 hours |
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4. Hand expressing should not hurt but if you get sore, there is a problem with technique that needs to be corrected |
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5. Clean cup with lid in soap and water, then fill with boiling water, wait until cool and empty to be ready for the expressed milk |
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Shows mother breast massage before expressing breast milk |
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6. Wash hands with baby in KMC position |
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7. Pull the upper edge of wrap placed at the level of the baby’s armpit, and then the lower edge pulled at the level of the baby’s hip, hold the baby – one hand on head, one hand on bottom, turn the baby toward the unexpressed breast, and expose the breast to be expressed. |
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8. Use fingers to stroke from the edge of the breast to the nipple |
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9. Use both knuckles to massage from the edge of the breast to the nipple |
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10. Use thumbs in a circular motion to massage from the edge of the breast to the nipple. |
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11. Use the thumb to spin around the areola. |
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12. Use the thumb and the index finger to roll the nipple. |
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13. Continue massage for 3–5 minutes |
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Shows how to express breast milk |
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14. Form the hand into a “C” on the area behind the areola, about 2–4 cm from the center of the nipple |
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15. Press back towards the chest wall and compress the breast rhythmically between the thumb and fingers until milk expresses |
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16. When the flow slows, move the fingers and thumb to a new position gradually moving all around the areola; continue until the milk flow stops |
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17. Repeat on the second side until both breasts feel empty |
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18. Put a lid on the container and store in a cool place or fridge until ready to feed to baby; explain how long milk can be stored (room, fridge, freezer) |
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Shows how to feed using expressed breast milk |
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19. Feed small volumes with cup and spoon |
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20. Return baby to KMC position |
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21. Wash hands after baby care |
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Total score |
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“PASS” if 4 out of 5 health workers have a total score of ≥ 38/42 points
Checklist 12. OBSERVING HEALTH WORKER HELPING MOTHER BREASTFEED IN KMC
Adequate/accurate (2 points); inadequate (1 point); none (0 point)
Step | Health worker #1 | Health worker #2 | Health worker #3 | Health worker #4 | Health worker #5 |
Discusses how to breastfeed with the mother |
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1. Recognize feeding cues that indicate the baby is ready to feed |
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2. Breastfeed 8–12 times in 24 hours |
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Shows the mother how to position the baby |
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3. Wash hands before baby care |
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4. Pull the upper edge of wrap placed at the level of the baby’s armpit, and then the lower edge pulled at the level of the baby’s hip, hold the baby – one hand on head, one hand on bottom, turn the baby toward the unexpressed breast |
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5. Hold baby close with as much STS contact as possible |
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6. Support the baby’s whole body, not just neck and shoulders |
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7. Ensure the baby’s ears, shoulders and hips are in a straight line to midline of body |
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8. Ensure that baby’s face looks towards breast, nose opposite nipple |
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Shows the mother how to help baby attach to the breast |
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9. Touch baby’s lips with her nipples |
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10. Wait for baby’s mouth to open wide |
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11. Move the baby onto the mother’s breast, aiming the lower lip well below the nipple |
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Shows the mother how to help baby attach to the breast |
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12. Baby’s chin is touching the breast |
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13. Baby’s mouth is wide open |
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14. Baby’s lower lip is curled out/downwards |
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15. More areola is visible above the baby’s mouth than below |
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Discusses with the mother signs of good breastfeeding |
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16. Baby feeds with slow deep sucks |
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17. Occasional short pauses in sucking are normal; no sucking sounds should be heard |
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18. The mother feels empty after feeding (feed on both sides one after one) |
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Shows the mother how to return the baby to KMC |
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19. Move the baby back into the KMC position, adjust the binder |
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20. Wash hands after baby care |
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Total score |
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“PASS” if 4 out of 5 health workers have a total score of ≥ 36/40 points
APPENDIX 2.
EXIT INTERVIEWS OF POSTPARTUM MOTHERS VIA CELL PHONES (FOR HOSPITAL WITH OBSTETRICS SERVICES)
Introduction: Hello Ms. My name is…I am working for the Department of Health/the Ministry of Health/Center for Disease Control. We are trying to find out some information about your stay at the hospital, particularly the nursing of your baby(ies) and the support of the health workers given to you. We only interview you within 5-10 minutes. Everything you say here and your name will be kept confidential. Any information you provide may help improve the hospital’s care for mothers and infants.
No. | Question | Answer |
0 | Confirmation of participating in the interview | 1) The mother agrees to answer the phone 2) The caregiver agrees to answer the phone 3) The mother refuses to answer the phone after a thorough explanation (Stop interview) 4) The mother is busy and makes an appointment for another day (Stop interview) 5) Wrong or unavailable phone number (Stop interview) 6) The baby passed away (Stop interview) |
00 | General information of mother Full name: ………………………………... Phone number: ……………………………. Ethnicity: ………………………………….. Month of discharge from hospital: ………………………… |
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1 | How many months old is your youngest child? | (Note the number of months) (≤ 6 months): |
1a | Is the baby a boy or a girl? | 1) Boy 2) Girl 9) Other: ………………… |
2 | From yesterday until now (last 24 hours), has he/she been breastfed? | 1) Yes (Go to question 2a) 2) No (Go to question 3) 3) Receive other mother’s breastmilk (Skip to question 2a) |
2a | In addition to breastfeeding, do you let him/her eat or drink anything else? | 1) Yes (Go to question 2b) 2) No - Exclusive breastfeeding |
2b | In addition to breastfeeding, do you let him/her eat or drink anything else? (Multiple choice question) | 1) Water 2) Formula 9) Others (Specify): ……………………………… |
3 | Did you experience vaginal delivery or caesarean section? | 1) Vaginal delivery 2) Caesarean section |
3a | How much weeks of gestation at birth? | 1) < 37 weeks (less than 259 days) 2) ≥ 37 weeks (from 259 days or more) |
Now, I will ask about the time you gave birth at the hospital | ||
4 | Was the baby placed in skin-to-skin contact with you right after birth? | 1) Yes (Go to question 4a) 2) No (Go to question 5) 8) No answer (Go to question 5) 9) Do not know/Do not remember (Go to question 5) |
4a | How long did the baby remain in uninterrupted skin-to-skin contact with you? <0} | 1) Under 90 minutes 2) Over 90 minutes 9) Do not know/Do not remember (All → go to question 5) |
5 | How long after birth did the baby lie with you? | 1) Right after birth (less than 1 hour) 2) From 1 to 6 hours 3) After 6 hours 9) Do not know/Do not remember |
6 | Had the baby completed the first breastfeed (attached, deep sucking) before separation from the mother? | 1) Yes 2) No 8) No answer 9) Do not know/Do not remember |
7 | During the postpartum period at the hospital, besides breastfeeding, did you give your baby anything else (except taking medicine prescribed by the doctor)? | 1) Yes (Go to question 7a) 2) No (Go to question 8) 8) No answer (Go to question 8) 9) Do not know/Do not remember (Go to question 8) |
7a | During the postpartum period at the hospital, in addition to breastfeeding, do you let him/her eat or drink anything else? (Multiple choice question) | 1) Drinking water 2) Formula 9) Others (Specify): ……………………………… |
8 | Did the mother receive advice and practical guidance on breastfeeding from the health workers at the hospital? | 1) Yes 2) No 8) No answer 9) Do not know/Do not remember |
9 | Did doctors and nurses counsel on using infant formula for babies under 24 months old (except for prescribed cases)(*)? | 1) Yes (Go to question 9a) 2) No (Go to question 10) 8) No answer (Go to question 10) 9) Do not know/Do not remember (Go to question 10) |
9a | Why was you given counseling for using infant formula from doctors or nurses? | 1) Less milk, no milk 2) Caesarean section 3) The mother is unable to breastfeed because of maternal illness 4) The baby is unable to be breastfed because of illness or preterm birth 5) The mother wants to feed the baby infant formula 6) Others (Specify): ……………………………… 8) No answer 9) Do not know/Do not remember |
10 | Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital? | 1) Are there any poster, pictures or promotional materials of infant formula for babies under 24 months old 2) Are there any marketing staff of infant formula for babies under 24 months old in the area of hospital 3) Did the hospital display or health workers market or sell infant formula for babies under 24 months old 4) Someone called the mother (when she was at the hospital and after leaving the hospital) and advised on formula for babies under 24 months old, baby bottles, pacifiers 5) There are advertisements of pregnant woman formula, formula for postpartum mothers and/or giving promotional gifts 6) There are advertisements and display of baby bottles, pacifiers 9) Other forms of advertisement and marketing of infant formula for babies under 24 months old (Go to question 10a) 0) None of the above. |
10a | Describe other forms of advertising and marketing of infant formula? | ………………………………………………….. |
11 | Do you have any suggestions for the hospital to improve or help with breastfeeding? | 1) Yes (Go to question 11a) 2) No (Stop interview) |
11a | Suggestions for the hospital to improve or help with breastfeeding? | …………………………………………………. |
Notes: If the mothers have more time and are interested, more time should be spent on advising on breastfeeding. If not, say thanks and end the interview.
(*) Cases prescribed by a doctor such as:
- Children whose mothers are seriously ill and cannot breastfeed or express milk.
- Children whose mothers are being irradiated or must take drugs that are contraindicated for breastfeeding such as anti-thyroid drugs, anti-cancer drugs, etc.
- Children with metabolic diseases cannot tolerate breast milk.
APPENDIX 3.
EXIT INTERVIEWS OF POSTPARTUM MOTHERS/CAREGIVERS VIA CELL PHONES (FOR HOSPITAL WITH PAEDIATRICS SERVICES AND NO OBSTETRICS SERVICES)
Introduction: Hello Ms. My name is…I am working for the Department of Health/the Ministry of Health/Center for Disease Control. We are trying to find out some information about your stay at the hospital, particularly the nursing of your baby(ies) and the support of the health workers given to you. We only interview you within 5-10 minutes. Everything you say here and your name will be kept confidential. Any information you provide may help improve the hospital’s care for mothers and infants.
No. | Question | Answer |
0 | Confirmation of participating in the interview | 1) The mother agrees to answer the phone 2) The caregiver agrees to answer the phone 3) The mother refuses to answer the phone after a thorough explanation (Interview stops) 4) The mother is busy and makes an appointment for another day (Interview stops) 5) Wrong or unavailable phone number (Interview stops) 6) The baby passed away (Stop interview) |
00 | General information of mother Full name: ……………………… Phone number: …………………… Ethnicity: ………………………… Month of discharge from hospital: ……………… |
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1 | How many months old is your youngest child? | (Record the number of months): |
1a | Is the baby a boy or a girl? | 1) Boy 2) Girl 9) Other: ………………………………………… |
2 | From yesterday until now (last 24 hours), has he/she been breastfed? | 1) Yes (Go to question 2a) 2) No (Go to question 3) 3) Receive other mother’s breastmilk (Skip to question 2a) |
2a | In addition to breastfeeding, do you let him/her eat or drink anything else? | 1) Yes (Go to question 2b) 2) No - Exclusive breastfeeding (Go to question 3) |
2b | In addition to breastfeeding, do you let him/her eat or drink anything else? (Multiple choice question) | 1) Drinking water 2) Formula 9) Others (Specify): ……………………………… |
Now, I will ask about the time when the baby received treatment at the hospital: | ||
3 | Does the baby weigh <2000g upon admission to the hospital? | 1) Yes (Go to question 4) 2) No (Go to question 5) |
4 | Was the baby kept in KMC position? | 1) Yes (Go to question 4a and 4b) 2) No (Go to question 5) |
4a | How long was KMC applied? | 1) < 20 hours/day 2) ≥ 20 hours/day |
4b | How long was the longest separation? | 1) ≤ 30 minutes/time 2) > 30 minutes/time |
5 | During the isolation period, is the mother allowed to stay with the child or encouraged to visit the child at the NICU at least once a day? | 1) Yes 2) No |
6 | During the hospital stay after birth, did you let the baby drink or eat infant formula? | 1) Yes (Go to question 6a) 2) No - Exclusive breastfeeding (Go to question 6b) 8) No answer (Go to question 6b) 9) Do not know/Do not remember (Go to question 6b) |
6a | During the postpartum period at the hospital, in addition to breastfeeding, do you let him/her eat or drink anything else? (Multiple choice question) | 1) Drinking water 2) Formula 9) Others (Specify): ……………………………… (All - go to question 7) |
6b | During the hospital stay, what origin source of breastmilk did the baby use? | 1) Mother’s own milk 2) Donor milk from breastmilk bank 3) Other mother’s milk (All - go to question 7) |
7 | How did the baby eat breast milk? | 1) Direct breastfeeding (Skip to question 8) 2) Cup 3) Spoon 4) Syringe 5) Feeding tube 6) Baby bottle (From 2-6 - Go to question 7a) |
7a | Did you feed your baby directly before feeding with breast milk using a spoon, syringe, feeding tube or feeding bottle? | 1) Yes 2) No |
8 | During the hospital stay, did you receive advice and practical guidance on breastfeeding from the health workers at the hospital? | 1) Yes 2) No 8) No answer 9) Do not know/Do not remember |
9 | Did doctors and nurses counsel on using infant formula for babies under 24 months old (except for prescribed cases)(*)? | 1) Yes (Go to question 9a) 2) No (Go to question 10) 8) No answer (Go to question 10) 9) Do not know/Do not remember (Go to question 10) |
9a | Why was you given counseling for using infant formula from doctors or nurses? | 1) Less milk, no milk 2) The mother is unable to breastfeed because of maternal illness 3) The baby is unable to be breastfed because of illness or preterm birth 4) The mother wants to feed the baby infant formula 7) Others (Specify): ……………………………………… 8) No answer 9) Do not know/Do not remember |
10 | Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital? (Multiple choice question) | 1) Are there any poster, pictures or promotional materials of infant formula for babies under 24 months old 2) Are there any marketing staff of infant formula for babies under 24 months old in the area of hospital 3) Did the hospital display or health workers market or sell infant formula for babies under 24 months old 4) Someone called the mother (when she was at the hospital and after leaving the hospital) and advised on formula for babies under 24 months old, baby bottles, pacifiers 5) There are advertisements of pregnant woman formula, formula for postpartum mothers and/or giving promotional gifts 6) There are advertisements and display of baby bottles, pacifiers 9) Other forms of advertisement and marketing of infant formula for babies under 24 months old? (Go to question 10a) 0) None of the above. |
10a | Describe other forms of advertising and marketing of infant formula. | …………………………………………………………… |
11 | Do you have any suggestions for the hospital to improve or help with breastfeeding? | 1) Yes 2) No (Stop interview) |
11a | Suggestions for the hospital to improve or help with breastfeeding? | …………………………………………………. |
Notes: If the mothers have more time and are interested, more time should be spent on advising on breastfeeding. If not, say thanks and end the interview.
(*) Cases prescribed by a doctor such as:
- Children whose mothers are seriously ill and cannot breastfeed or express milk.
- Children whose mothers are being irradiated or must take drugs that are contraindicated for breastfeeding such as anti-thyroid drugs, anti-cancer drugs, etc.
- Children with metabolic diseases cannot tolerate breast milk.
APPENDIX 4.
EVALUATION SUMMARY OF CHECKLISTS
I. Evaluation summary of Criterion 2
No. | Description | Pass | Evaluation result | Pass/Fail |
Checklist 1 | Interview of women’s 7 months pregnant or more | “PASS” if 4 out of 5 pregnant women have a total score of ≥ 7/9 points |
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Checklist 2 | Observation of implementation of EENC in vaginal deliveries (breathing babies) | “PASS” if 3 out of 3 vaginal deliveries have a total score of ≥ 72/80 points |
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Checklist 3 | Observation of implementation of EENC in Caesarean sections (breathing babies) | “PASS” if 2 out of 2 caesarean sections have a total score of ≥ 38/42 points |
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Checklist 4 | Interviews of postpartum mothers with full-term birth | “PASS” if 8 out of 10 mothers have a total score of ≥ 15/18 points |
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Checklist 5 | Observation/interview of mothers in breastfeeding practices | “PASS” if 4 out of 5 mothers have a total score of ≥ 20/26 points |
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Checklist 6 | Observation of health workers giving counseling for breastfeeding | “PASS” if 4 out of 5 health workers have a total score of ≥ 25/28 points |
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Checklist 7 | Review of hospital criteria for breastfeeding | Meet the given criteria |
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Checklist 8 | Evaluation of breastfeeding friendly environment | Meet the given criteria |
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Checklist 9 | Interview of mothers with preterm and ligh-birthweight babies discharged from the NICU | “PASS” if 8 out of 10 mothers have a total score of ≥ 9/12 points |
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Checklist 10 | Observations of health workers helping mothers/caregivers position the babies correctly for KMC | “PASS” if 4 out of 5 health workers have a total score of 25/28 points |
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Checklist 11 | Observing health worker showing mother how to do breast massage and express breast milk herself while practicing KMC skills | “PASS” if 4 out of 5 health workers have a total score of 38/42 points |
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Checklist 12 | Observing health worker helping mother breastfeed in KMC | “PASS” if 4 out of 5 health workers have a total score of 36/40 points |
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Conclusion | “Pass” if all Checklists are “Pass” *Notes: The number of checklist are subject to each hospital |
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II. Evaluation summary of Criterion 3
For hospitals with pediatrics services and no obstetrics services:
No. | Question | Pass | Quarter…/20… | Pass/Fail | |
Vaginal delivery | Caesarean section | ||||
1 | Was the baby placed in skin-to-skin contact with you right after birth? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”. |
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2 | How long did the baby remain in skin-to-skin contact with you? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “more than 90 minutes”. |
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3 | How long after birth did the baby lie with you? | “Pass” if more than 95% of mothers with vaginal deliveries answer that her baby lied with her. |
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4 | Had the baby completed the first breastfeed (attached, deep sucking) before separation from the mother? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”. |
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5 | During the hospital stay after birth, did you let the baby drink or eat infant formula? | “Pass” if more than 90% of mothers with vaginal deliveries and caesarean sections answer “No”. |
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6 | During the hospital stay, did you receive advice and practical guidance on breastfeeding from the health workers at the hospital? | “Pass” if more than 80% of mothers with vaginal deliveries and caesarean sections answer “Yes”. |
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7 | Did the health workers counsel on using infant formula (except for prescribed cases)(*)? | “Pass” if 100% of mothers with vaginal deliveries and caesarean sections answer “No” (except for prescribed cases). |
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8 | Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital? | “Pass” if more than 100% of mothers with vaginal deliveries and caesarean sections answer “No”. |
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Conclusion: | The hospital passes the interview via phone if “Pass” all items. |
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For hospitals with pediatrics services and no obstetrics services:
No. | Question | Pass | Quarter…/20… | Pass/Fail |
1 | Was the baby kept in KMC position (≥ 20 hours/day, intermittent ≤ 30 minutes/time)? | “Pass” if more than 80% of mothers of preterm infants < 37 weeks, low birth weight < 2.000g answer “Yes” |
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2 | During the isolation period, was you allowed to stay with the child or encouraged to visit the child at the NICU at least once a day? | “Pass” if more than 90% of mothers were not isolated or were allowed to visit the child at the NICU at least once a day |
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3 | What did the baby eat during hospital stay? | “Pass” if more than 80% of babies received exclusive breastfeeding or breastmilk in other forms (expressed breastmilk, breastmilk bank, etc) during the hospital stay |
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4 | How did the baby eat breast milk? | “Pass” if less than 20% of babies eat breastmilk by bottles |
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5 | During the hospital stay, did you receive advice and practical guidance on breastfeeding from the health workers at the hospital? | “Pass” if more than 80% of mothers answer “Yes”. |
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6 | Did the health workers counsel on using infant formula (except for prescribed cases)(*)? | “Pass” if 100% of mothers/caregivers answer “No” (except for prescribed cases). |
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7 | Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital? | “Pass” if 100% of mothers/caregivers answer “No” |
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Conclusion: | The hospital passes the interview via phone if “Pass” all items. |
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For hospitals with both obstetrics services and pediatrics services:
No. | Question | Pass | Quarter…/20… | Pass/Fail | |
A | Criteria for obstetrics services | ||||
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| Vaginal delivery | Caesarean section |
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1 | Was the baby placed in skin-to-skin contact with you right after birth? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”. |
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2 | How long did the baby remain in skin-to-skin contact with you? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “more than 90 minutes”. |
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3 | How long after birth did the baby lie with you? | “Pass” if more than 95% of mothers with vaginal deliveries answer that her baby lied with her. |
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4 | Had the baby completed the first breastfeed (attached, deep sucking) before separation from the mother? | “Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “Yes”. |
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5 | During the hospital stay after birth, did you let the baby drink or eat infant formula? | “Pass” if more than 90% of mothers with vaginal deliveries and caesarean sections answer “No”. |
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6 | During the hospital stay, did you receive advice and practical guidance on breastfeeding from the health workers at the hospital? | “Pass” if more than 80% of mothers with vaginal deliveries and caesarean sections answer “Yes”. |
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B | Criteria for pediatrics services | ||||
7 | Was the baby kept in KMC position (≥ 20 hours/day, intermittent ≤ 30 minutes/time)? | “Pass” if more than 80% of mothers of preterm infants < 37 weeks, low birth weight < 2.000g answer “Yes” |
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8 | During the isolation period, was you allowed to stay with the child or encouraged to visit the child at the NICU at least once a day? | “Pass” if more than 90% of mothers were not isolated or were allowed to visit the child at the NICU at least once a day |
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9 | What did the baby eat during hospital stay? | “Pass” if more than 80% of babies received exclusive breastfeeding or breastmilk in other forms (expressed breastmilk, breastmilk bank, etc) during the hospital stay |
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10 | How did the baby eat breast milk? | “Pass” if less than 20% of babies eat breastmilk by bottles |
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11 | During the hospital stay, did you receive advice and practical guidance on breastfeeding from the health workers at the hospital? | “Pass” if more than 80% of mothers answer “Yes”. |
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C | General criteria | ||||
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| Postpartum mother | Mother/caregiver |
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12 | Did the health workers counsel on using infant formula (except for prescribed cases)(*)? | “Pass” if 100% of mothers/caregivers answer “No” (except for prescribed cases). |
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13 | Did you see any advertisement or marketing of infant formula for babies under 24 months, baby bottles, pacifiers in the hospital? | “Pass” if 100% of mothers/caregivers answer “No” |
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Conclusion: | The hospital passes the interview via phone if “Pass” all items. |
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