Cost-effectiveness analysis of the Baby Friendly Hospital Initiative in promoting exclusive breastfeeding and reducing infant mortality.

• Grant number: 16/11688-1
• Support Opportunities: Regular Research Grants
• Start date: October 01, 2016
• End date: December 31, 2018
• Field of knowledge: Health Sciences - Collective Health - Public Health
• Principal Investigator: Marina Ferreira Rea
• Grantee: Marina Ferreira Rea
• Host Institution: Faculdade de Saúde Pública (FSP). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Osvaldinete Lopes de Oliveira Silva

Abstract

Breastfeeding (BF) is the most important practice with impact in preventing infant morbidity / mortality, and reduce the risk of maternal and child diseases. Despite advances, BF rates in Brazil are still below the WHO recommendations, requiring effective and feasible interventions economically to promote breastfeeding. Among the strategies deployed, the Baby-Friendly Hospital Initiative (BFHI) has a strong impact on the promotion of breastfeeding and can be cost effective for the health system. OBJECTIVES: To evaluate the cost effectivity of BFHI in promoting exclusive breastfeeding and reducing child mortality in São Paulo. METHODOLOGY: This is a full economic evaluation study to be conducted in public hospitals in São Paulo / SP. It will be evaluated three baby-friendly hospitals, (BFH) compared to three hospitals not BFHI (NBFH), in relation to costs and effectiveness in promoting breastfeeding. Considering the BFHI intervention in health course in BFH and therefore, children born there are exposed to this intervention, the BFH will make up the intervention group and NBFH - the comparison group. The study will be conducted in four stages. At first, the effectiveness of BFHI will be evaluated by the increase in the prevalence of exclusive breastfeeding (EBF) in the first six months of life for children born in the intervention group compared to the comparison group. It will be three structured interviews with selected sample of mothers: the first in the maternity ward, and the other at 60 and 180 days, by phone. In the second phase, the costs relating to hospital procedures with the mother-child diad in both groups of hospitals will be analyzed. In the third stage, it will be identified as final outcomes the number of prevented cases of acute respiratory infection (ARI) and the number of deaths averted, estimated from the increasing prevalence of EBF in the intervention group, based on current scientific evidence. In the fourth stage, finally, it will be calculated as cost-effectiveness ratio measures the cost / effectiveness ratio and cost / effectiveness Incremental. To evaluate the effectiveness of BFHI will be used techniques for survival analysis by constructing Kaplan-Meie curve ( univariate analysis using the log-rank and multivariate testing the Cox regression model). To compare the breastfeeding proportions in both groups the chi-square test with 95% significance level will be used. In evaluating cost effectiveness sensitivity analysis will be performed. (AU)

Scientific publications

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

SILVA, OSVALDINETE LOPES DE OLIVEIRA; REA, MARINA FERREIRA; SARTI, FLAVIA MORI; BUCCINI, GABRIELA. Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil. PUBLIC HEALTH NUTRITION, v. 24, n. 8, p. 2365-2375, JUN 2021. (16/11688-1)