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Updated: Jul 31, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Baseline status regarding compliance with neo-BFHI recommendations in South African neonatal wards: a cross-sectional
Welma Lubbe1, Lisa Springer1, Ragnhild Maastrup2
1NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa.
Insights
South Africa shows good compliance with the Baby-friendly Hospital Initiative for neonatal wards (Neo-BFHI). However, public hospitals outperform private ones, highlighting a need for targeted strategies to improve Neo-BFHI accreditation and adherence in private facilities.
Area of Science:
- Neonatal care
- Public health initiatives
- Breastfeeding promotion
Background:
- The Baby-friendly Hospital Initiative (BFHI) was revised in 2009 by WHO and UNICEF to promote exclusive breastfeeding.
- The initiative's scope was extended to neonatal units by the Nordic and Quebec Working Group, forming the Neo-BFHI.
Purpose of the Study:
- To assess the level of compliance with the "Baby-friendly Hospital Initiative for neonatal wards" (Neo-BFHI) in South African neonatal units.
- To identify disparities in Neo-BFHI compliance between public and private healthcare facilities.
Main Methods:
- A cross-sectional survey was conducted involving 33 neonatal wards in South African public and private hospitals.
- Data was collected using the Neo-BFHI self-assessment questionnaire via EasyTrial software.
- Statistical analysis was performed using SPSS version 24.
Main Results:
- The median Neo-BFHI compliance score in South Africa was 77, with public hospitals scoring higher (85) than private hospitals (73).
- Accredited Baby-friendly hospitals demonstrated higher compliance than non-accredited ones.
- Highest compliance was observed for Guiding Principle 1 (respect for mothers) and step 5 (breastfeeding support), while steps 4 (kangaroo mother care) and 7 (maternal-infant togetherness) showed lower scores.
Conclusions:
- South Africa has largely implemented Neo-BFHI recommendations, but compliance and accreditation are lower in private hospitals.
- There is a need for targeted strategies to enhance BFHI accreditation and compliance, especially within the private healthcare sector.
- Level 1 and 2 care facilities exhibited significantly higher compliance than level 3 facilities.
Background:
In 2009, the World Health Organization and the United Nations Children's Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group.
Aim:
To determine the level of compliance with the recommendations outlined in the "Baby-friendly Hospital Initiative for neonatal wards" (Neo-BFHI) in the South African neonatal wards.
Method:
In this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24.
Results:
The South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant "togetherness"), respectively. Level 1 and 2 care facilities scored significantly higher than level 3.
Conclusion:
Although South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals.
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