Knowledge, attitudes and practices of nursing staff regarding the Baby-Friendly Hospital Initiative in non-accredited obstetric units in Cape Town

Objectives: The objectives of this study were to assess nursing staff knowledge, attitudes and practices regarding the Baby-Friendly HospitalInitiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHIimplementation; and to describe the barriers and constraints to the implementation of BFHI principles.Study design: Cross-sectional descriptive survey.Setting: The study was done in eight non-BFHI-accredited primary care maternity obstetric units in Cape Town.Subjects: The subjects were eight MOU managers and a random sample of 45 nursing staff.Outcomes measures: Knowledge, attitude and practices regarding BFHI and barriers to BFHI implementation were assessed by an intervieweradministered questionnaire.Results: The study demonstrated acceptable awareness and knowledge of the recommended BFHI principles. A total of 56.6% of the staffcould define rooming-in, 47.2% could define the components of the BFHI, and 52.8% could name three baby-friendly care practices androutines. Eighty-nine per cent of the nursing staff were able to demonstrate correct positioning of the baby for breastfeeding, and 91.1% could demonstrate the correct attachment of the baby to the breast. Only 8.9% of the nursing staff were able to adequately demonstrate the correcthand milk-expressing technique, 35.6% knew about the correct management of painful nipples and 22.2% knew how to manage engorgement. Only 40% could adequately describe the safe preparation of infant formula. The enrolled nursing assistants (ENA) were significantly lessknowledgeable than the other cadres of nurses. The majority of the nurses had a positive attitude toward BFHI principles and practices