Improving early initiation and exclusive breastfeeding practice through PDSA framework: the experience at a private hospital in Tanzania.

Introduction: Optimal breastfeeding can save the lives of over 800 000 children annually. WHO recommends that all babies initiate breastfeeding within first hour of life, exclusively breastfeed for the first 6 months and continue breastfeeding up to 2 years and beyond. In Tanzania, 70% of babies initiate breastfeeding within first hour and only 64% of infants under 6 months are exclusively breastfed.

Objective: Improve rate of early initiation and exclusive breastfeeding from birth to hospital discharge, with the aim of achieving 80% as per Baby Friendly Hospital Initiative standard through implementing quality improvement project.

Methods: A quality improvement project was conducted using a Plan-Do-Study-Act (PDSA) framework. Baseline rates of early initiation and exclusive breastfeeding were determined. Sequential strategies were implemented including drafting and implementing hospital policy on breastfeeding and use of formula milk, staff training on lactation management and antenatal education of pregnant women using breastfeeding videos. These were followed by immediate skin-to-skin contact after caesarean birth and modification of newborn feeding charts. Subsequently, daily lactation rounds were implemented, and monthly antenatal classes were conducted for women identified as high risk for breastfeeding challenges. Progress was monitored through monthly audits.

Results: After three PDSA cycles, early breastfeeding initiation improved from 22% to 84% and exclusive breastfeeding rate increased from 45% to 90%.

Conclusion: Early and exclusive breastfeeding rates in hospital can be improved by multidimensional approach including policies, staff training, antenatal education, interdepartmental involvement and having dedicated staff to support lactation.