THE MINISTRY OF HEALTH | THE SOCIALIST REPUBLIC OF VIETNAM |
No. 5913/QD-BYT | Hanoi, December 29, 2021 |
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:
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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
DEPUTY MINISTER
Nguyen Truong Son
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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:
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- 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.
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- 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.
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.
2.1 Composition of evaluation team:
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- 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).
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- 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).
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- 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:
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- 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
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Phone number of mother
Discharge date
Vaginal delivery/C-sections
- 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:
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- 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 botherobstetrics 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.
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- 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.
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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.
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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
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1
Benefits of breastfeeding
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
5
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Able to list 3 benefits of breastfeeding
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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)
Able to know continued breastfeeding
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Right (continued breastfeeding until 24 months and beyond)
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
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Delivery #3
I. PRE-BIRTH PREPARATIONS:
1. Checked room temperature, turned off fans
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3. Placed dry cloth on mother’s abdomen
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
6. Checked the vacuum extractor, suction cup and vacuum pressure
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8. Put on two pairs of clean gloves (if there is only 1 midwife)
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
II. ASSISTING THE BIRTH:
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11. Used 1 hand to keep the perineum by 1 swab (or sterile cloth)
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
14. The other hand still kept the perineum from tearing
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Birth of shoulders
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
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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20. The other hand still kept the perineum from tearing when the shoulders were delivered
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
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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23. Called out time of birth (hour__minute__), sex
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
26. Removed the wet cloth
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28. Covered baby’s body with cloth and the head with a hat
29. Checked for a second baby
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30. Gave Oxytocin to mother within 1 minute of delivery
31. Removed outer pair of gloves
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33. Placed the first clamp at 2 cm from umbilical base, push the blood in the cord towards the mother.
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.
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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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
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
Total score
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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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2. Nurse/midwife washed hands
3. Prepared the newborn resuscitation area, turned on heated bed
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)
6. Prepared cord clamp/ties
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
8. Called out time of birth (hour__minute__), sex
9. Placed dry cloth on mother’s thigh
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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
12. Removed the wet cloth, covered baby’s body with cloth and the head with a hat
13. Checked for a second baby
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14. Gave Oxytocin to mother within 1 minute of delivery
15. Checked cord pulsations before clamping, clamped after cord pulsations stopped (usually 1-3 min)
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.
18. Gave baby to the waiting midwife/nurse
19. Put baby prone on the mother’s breast in direct skin-to-skin contact
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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
Total score
“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
Question
Mother with vaginal delivery
Mother with caesarean section
#1
#2
#3
#4
#5
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#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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
7. Since delivery, was the baby fed anything other than breast-milk? (Yes = 1 point, No = 0 point)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Total score
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
2.
The mother supports the baby’s whole body, not just the neck and shoulders
3.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
4.
Ensure that the baby’s face looks forwards breast, with nose opposite nipple
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Attachment to the breast
5.
Touch baby’s lips with her nipples
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
6.
Wait for baby’s mouth to open wide
7.
Move the baby onto the mother’s breast, aiming the lower lip well below the nipple
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Signs of good attachment to the breast
8.
Baby’s chin is touching the breast
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
9.
Baby’s mouth is wide open, puffed cheeks
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Baby’s lower lip is curled out/downwards
11.
More areola is visible above the baby’s mouth than below
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Signs of good breastfeeding
12.
Baby feeds with slow deep sucks
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
13.
Occasional short pauses in sucking are normal; no sucking sounds should be heard
Total score
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
#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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
2.
Support the baby’s whole body, not just neck and shoulders
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Ensure the baby’s ears, shoulders and hips are in a straight line
4.
Ensure that the baby’s face looks forwards breast, with nose opposite nipple
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows the mother how to help baby attach to the breast
5.
Touch baby’s lips with her nipples
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...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
6.
Wait for baby’s mouth to open wide
7.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows the mother how to help baby attach to the breast
8.
Baby’s chin is touching the breast
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
9.
Baby’s mouth is wide open, puffed cheeks
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...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
10.
Baby’s lower lip is curled out/downwards
11.
More areola is visible above the baby’s mouth than below
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...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Discusses with the mother signs of good breastfeeding
12.
Baby feeds with slow deep sucks
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
13.
Occasional short pauses in sucking are normal; no sucking sounds should be heard
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
The mother feels empty after feeding (feed on both sides one after one)
Total score
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Pass
1. Is there a board of breastfeeding regulations: with adequate regulations of WHO on ten steps to successful breastfeeding?
Yes
2. Does the hospital prohibit using infant formula and other linkages with milk formula publicly?
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
3. Are there any pictures encouraging breastfeeding?
Yes
4. Are breastfeeding materials accessible to mothers and her relatives?
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
3
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
7
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
8
Feeding cues
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
9
Proper positioning for breastfeeding
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
10
Attachment to the breast
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
11
Signs of good attachment to the breast
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
12
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
...
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Total score
...
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Health worker #4
Health worker #5
Discuss KMC with the mother
1. Three basic components of KMC
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
2. At least three benefits of continuous KMC
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Show mother on how to prepare for KMC
3. Wash hands before baby care
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
4. Prepare shirt and KMC binder for the mother; caps, diapers for the baby
5. Put shirt and KMC binder on the mother that can be opened at front
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
6. Remove clothes from the baby, and ensure that the baby is wearing cap; change diaper if needed
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
7. Repeat handwashing after touching diaper
Show mother how to position the baby correctly for KMC
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
9. Ensure the baby’s head is slightly extended, with head turned to one side and arms flexed
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
11. Adjust the binder to hold the baby securely so when the mother moves around, the baby will not fall
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
13. Button clothes over the baby and cover with a blanket; ensure that the mother is comfortable
14. Wash hands after baby care
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Total score
...
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Discusses with the mother on how to express breast milk and preparation
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
2. Breast milk is made deep in the breast and flows to the nipple. No milk will come if only the nipple is squeezed
3. Express on average 8–12 times in 24 hours
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
Shows mother breast massage before expressing breast milk
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
6. Wash hands with baby in KMC position
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
8. Use fingers to stroke from the edge of the breast to the nipple
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
9. Use both knuckles to massage from the edge of the breast to the nipple
10. Use thumbs in a circular motion to massage from the edge of the breast to the nipple.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
11. Use the thumb to spin around the areola.
12. Use the thumb and the index finger to roll the nipple.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
13. Continue massage for 3–5 minutes
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows how to express breast milk
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
15. Press back towards the chest wall and compress the breast rhythmically between the thumb and fingers until milk expresses
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
17. Repeat on the second side until both breasts feel empty
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
Shows how to feed using expressed breast milk
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
19. Feed small volumes with cup and spoon
20. Return baby to KMC position
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
21. Wash hands after baby care
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Total score
“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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
1. Recognize feeding cues that indicate the baby is ready to feed
2. Breastfeed 8–12 times in 24 hours
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows the mother how to position the baby
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
3. Wash hands before baby care
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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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
5. Hold baby close with as much STS contact as possible
6. Support the baby’s whole body, not just neck and shoulders
...
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
7. Ensure the baby’s ears, shoulders and hips are in a straight line to midline of body
...
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
8. Ensure that baby’s face looks towards breast, nose opposite nipple
Shows the mother how to help baby attach to the breast
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
9. Touch baby’s lips with her nipples
10. Wait for baby’s mouth to open wide
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
11. Move the baby onto the mother’s breast, aiming the lower lip well below the nipple
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows the mother how to help baby attach to the breast
12. Baby’s chin is touching the breast
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
13. Baby’s mouth is wide open
14. Baby’s lower lip is curled out/downwards
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
15. More areola is visible above the baby’s mouth than below
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Discusses with the mother signs of good breastfeeding
16. Baby feeds with slow deep sucks
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
17. Occasional short pauses in sucking are normal; no sucking sounds should be heard
18. The mother feels empty after feeding (feed on both sides one after one)
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Shows the mother how to return the baby to KMC
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
19. Move the baby back into the KMC position, adjust the binder
20. Wash hands after baby care
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Total score
“PASS” if 4 out of 5 health workers have a total score of ≥ 36/40 points
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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: …………………………………..
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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: …………………
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
(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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)?
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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): ………………………………
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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): ………………………………
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
………………………………………………….
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.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
6) The baby passed away (Stop interview)
00
General information of mother
Full name: ………………………
Phone number: ……………………
Ethnicity: …………………………
Month of discharge from hospital: ………………
1
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
(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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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)
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
(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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
(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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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.
……………………………………………………………
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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.
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
- Children with metabolic diseases cannot tolerate breast milk.
EVALUATION SUMMARY OF CHECKLISTS
I. Evaluation summary of Criterion 2
No.
Description
Pass
Evaluation result
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Checklist 5
Observation/interview of mothers in breastfeeding practices
“PASS” if 4 out of 5 mothers have a total score of ≥ 20/26 points
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Checklist 7
Review of hospital criteria for breastfeeding
Meet the given criteria
Checklist 8
Evaluation of breastfeeding friendly environment
Meet the given criteria
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Conclusion
“Pass” if all Checklists are “Pass”
*Notes: The number of checklist are subject to each hospital
II. Evaluation summary of Criterion 3
For hospitals with pediatrics services and no obstetrics services:
No.
Question
Pass
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
5
During the hospital stay after birth, did you let the baby drink or eat infant formula?
...
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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).
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Conclusion:
The hospital passes the interview via phone if “Pass” all items.
For hospitals with pediatrics services and no obstetrics services:
No.
Question
Pass
Quarter…/20…
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
4
How did the baby eat breast milk?
“Pass” if less than 20% of babies eat breastmilk by bottles
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
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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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”
Conclusion:
The hospital passes the interview via phone if “Pass” all items.
For hospitals with both obstetrics services and pediatrics services:
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Question
Pass
Quarter…/20…
Pass/Fail
A
Criteria for obstetrics services
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
2
...
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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
“Pass” if more than 80% of mothers with vaginal deliveries and 50% of mothers with caesarean sections answer “more than 90 minutes”.
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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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
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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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
B
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”
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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...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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
10
How did the baby eat breast milk?
“Pass” if less than 20% of babies eat breastmilk by bottles
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”.
C
General criteria
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Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
Postpartum mother
Mother/caregiver
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).
...
...
...
Mọi chi tiết xin liên hệ: ĐT:(028) 3930 3279DĐ:0906 22 99 66
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”
Conclusion:
The hospital passes the interview via phone if “Pass” all items.