Irena Zakarija-Grković

Name dr. sc. ZAKARIJA-GRKOVIĆ IRENA dr. med.


Mentor: prof. dr. sc. RUMBOLDT MIRJANA

Qualifying research publications:
Zakarija-Grković I, Burmaz T. Effectiveness of the UNICEF/WHO 20-hour Course
in Improving Health Professionals’ Knowledge, Practices, and Attitudes to Breastfeeding: Before/After Study of 5 Maternity Facilities in Croatia. Croat Med J 2010; 51:396-405.
IF (JCR 2010) 1.455

Zakarija-Grković I. Exclusive Breastfeeding in the Hospital: How Accurate are the Data? J Hum Lact 2012;28:139-144.
IF (JCR 2012) 1.638

Zakarija-Grković I, Šegvić O, Božinović T, Ćuže A, Lozančić T, Vučković A, Burmaz T. Hospital Practices and Breastfeeding Rates before and after the UNICEF/WHO
20-Hour Course for Maternity Staff. J Hum Lact. 2012;28:389-399.
IF (JCR 2012) 1.638

Objectives: To evaluate knowledge, practices, and attitudes to breastfeeding among Croatian health profesionals before and after completing the revised and expanded UNICEF/WHO 20-hour course. To assess the accuracy of hospital infant feeding data. To evaluate the impact of the UNICEF/WHO 20-hour course on hospital practices and breastfeeding rates during the first 12 months of life.
Methods: A questionnaire testing knowledge, practices, and attitudes toward breastfeeding was distributed to 424 health professionals in Southern Croatia before and 308 after training. Seven hundred and seventy three mothers (388 in the pre-training group and 385 in the post-training group) were included in a birth cohort and interviewed at discharge, 3, 6 and 12 months postpartum to evaluate hospital practices and infant feeding. WHO definitions were used to determine breastfeeding rates.
Results: Knowledge, attitudes and case-scenario based practices improved significantly posttraining. Management of mastitis remained the case scenario with the highest frequency of incorrenct responses. The number of staff with positive attitudes toward breastfeeding increased from 65% to 79%, whereas the number of staff with neutral attitudes dropped from 26.6% to 9.9% (P<0,001) Only 3% of infants were exclusively breastfed throughout the hospital stay. Most formula supplements are not recorded in the standard charts. Only 1 (Step 8) out of 7 Baby-Friendly practices assessed improved significantly 3 months following training. The proportion of newborns exclusively breastfed during the first 48 hours increased from 6.0 to 11.7% (P <0,005). There was no difference in breastfeeding rates at discharge, 3, 6 or 12 months between the pre- and posttraining groups.
Conclusion: The UNICEF/WHO 20-hour course is an effective tool for improving health
professionals' breastfeeding knowledge, attitudes and individual practices. Every feed a newborn receives in hospital should be recorded if we are to obtain reliable and accurate breastfeeding rates.
Significant changes in hospital practices are unlikely to occur with training alone, especially for practices that require a change in hospital policy. However, training is still a key component to drive changes that need to occur.
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