Initiation of breast feeding and duration of any breast feeding are known to differ by ethnic group, but there are limited data on differences in exclusive breast feeding. This study aimed to determine if there are ethnic differences in the initiation and duration of any and exclusive breast feeding. METHODS: Breast-feeding data were obtained from a subsample of 1365 women recruited to a multi-ethnic cohort study (Born in Bradford) between August 2008 and March 2009. Poisson regression was used to investigate the impact of socio-economic, life style and birth factors on ethnic differences in the prevalence of breast feeding. RESULTS: Compared with white British mothers, initiation of breast feeding was significantly higher in all ethnic groups and this persisted after adjustment for socio-economic, life style and birth factors [Pakistani: prevalence rate ratio (PRR) = 1.19 (95% confidence interval 1.10, 1.29); Other South Asian: PRR = 1.29 (1.18, 1.42); Other ethnicities: PRR = 1.33 (1.21, 1.46)]. There were no differences in exclusive breast feeding at 4 months [Pakistani: PRR = 0.77 (0.54, 1.09); Other South Asian: PRR = 1.55 (0.99, 2.43); Other ethnicities: PRR = 1.50 (0.88, 2.56)]. Any breast feeding at 4 months was significantly higher in mothers of all non-white British ethnicities [Pakistani: PRR = 1.27 (1.02, 1.58); Other South Asian: PRR = 1.99 (1.52, 2.62); Other ethnicities: 2.45 (1.86, 3.21)]. CONCLUSIONS: Whilst women of ethnic minority groups were significantly more likely to initiate breast feeding and continue any breast feeding for 4 months compared with white British women, the rates of exclusive breast feeding at 4 months were not significantly different once socio-economic, life style and birth factors were accounted for.

Die Akkumulation von lipophilen und biologisch persistenten Chlorkohlenwasserstoffen in der Nahrungskette und die infolgedessen auftretende relativ hohe Belastung gestillter Säuglinge hat zu Besorgnissen hinsichtlich möglicher negativer Folgen für die Gesundheit dieser Kinder geführt. Ein Fokus der Arbeit ist Frage, ob der Kontamination von Humanmilch mit polychlorierten Dibenzo-p-dioxinen (PCDDs, 'Dioxine'), Dibenzofuranen (PCDFs, 'Furanen') und Biphenylen (PCBs) in Deutschland zu messbaren Veränderungen sensibler biologischer Parametern führt. Blut wurde im Alter von 11 Monaten von gestillten (für mindestens 4 Monate, n=80) und nicht gestillten Kindern (n=21) entnommen zur umfangreichen Untersuchung des Immunsystems, von biologischen Parametern im Plasma und von Parametern der Schilddrüsenfunktion. Die direkte Messung von PCDDs, PCDFs und PCBs im Plasma bei den Kindern und deren Müttern konnte die erwartete Akkumulation dieser Verbindungen bestätigen, die etwa 4-fach höheren Werten beim Kind (im Vergleich zu mütterlichen Werten) nach einer langen Stillperiode vom 40 Wochen entspricht. Es konnte keine signifikante Korrelation von den untersuchten biologischen Parametern mit den Fremdstoff-Konzentrationen gefunden werden. Somit konnten keine biologischen Effekte dieser in der Muttermilch ungewünschten Verbindungen nachgewiesen werden, und die bestehende Stillempfehlung konnte bekräftigt werden. Der zweite Fokus der Arbeit beschäftigt sich mit der Frage von biologischen Wirkungen bei zwei Frauen, die gegenüber der am meisten toxischen Dioxin-Verbindung exponiert wurden: 2,3,7,8-Tetrachlordibenzo-p-dioxin (TCDD). Diese Frauen hatten die höchsten je beim Menschen gemessenen Konzentrationen, eine der beiden leidet unter einer schweren Chlorakne. Es wurde ein breites Spektrum immunologischer Parameter untersucht sowie die Aktivität der Cytochrome P450 1A2 (CYP1A2) Aktivität in der Leber, die mit dem Koffein-Test gemessen wurde. Zum Vergleich wurden zwei Kontrollgruppen bestehend aus 30 Nichtrauchern bzw. 20 starken Rauchern untersucht unter Verwendung der gleichen Methoden. Die Ergebnisse des Koffein-Tests zeigen eine ca. 10-fach höhere CYP1A2-Aktivität bei den hoch TCDD-exponierten Frauen, während Tabakrauch (durchschnittlich 28 Zigaretten pro Tag) zu einem maximal 1,8-fachem Anstieg führte. Die immunologischen Untersuchungen zeigten keine Hinweise auf einen starken Einfluss von TCDD bei den hochexponierten Frauen. Es bestätigte sich, dass der Mensch relativ wenig sensibel ist in Hinblick auf die toxischen Effekte von TCDD. / The accumulation of lipophilic and biologically persistent chlorinated hydrocarbons in the food chain and the following relatively high exposure of breast-fed infants has caused concern about possible negative health effects in these children. One focus of the document is the question whether the contamination of human milk with polychlorinated dibenzo-p-dioxins (PCDDs, 'dioxins'), dibenzofurans (PCDFs, 'furans') and biphenyls (PCBs) in Germany leads to measurable changes of sensitive biological parameters. Blood was taken from breast-fed (for at least four months, n=80) and formula-fed infants (n=21) at the age of 11 months for extensive investigations regarding the immune system and biological parameters in plasma including those of the thyroid function. From direct measurements of PCDDs, PCDFs and PCBs in plasma of the children and their mothers, the expected accumulation of the compounds was confirmed, corresponding to about 4-times higher values in the infant (compared to maternal values) following a long duration of breast-feeding of 40 weeks. For the different biological parameters investigated, no significant correlation with concentrations of the xenobiotics was found. Therefore, biological effects of these unwanted compounds in human milk. could not be detected, and the existing recommendation for breast-feeding was emphasized. The second focus of the document is the investigation of biological changes in two women exposed to the most toxic dioxin: 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). These women had the highest concentrations of this compound ever measured in adults, one of them suffering from severe chloracne. A broad panel of immunological parameters was measured as well as hepatic cytochrome P450 1A2 (CYP1A2) activity using the caffeine test. For comparison, two age-matched control groups of 30 non-smokers and 20 heavy smokers were studied using the same methods. Results of caffeine tests showed an about 10-fold increase of CYP1A2 activity in the highly TCDD-exposed women, whereas tobacco smoke (28 cigarettes per day on average) was found to increase the activity 1.8-times maximally. Immunological investigations did not reveal a strong impact of TCDD in these highly exposed women. These results confirm that humans are relatively insensitive to the toxic effects of dioxins.

Made available in DSpace on 2016-01-26T12:51:12Z (GMT). No. of bitstreams: 1 rosicleryagi_dissert.pdf: 414700 bytes, checksum: 16f9a0fd1dd26383f4b843678eec9dd6 (MD5) Previous issue date: 2005-07-14 / Brazilian government policy of public health aims to promote and support breastfeeding; consequently reducing the infant mortality as well as improving the children´s quality of life. The objectives of this study were: a) to observe the diet of premature and full-term babies aged under two years, assessing the breastfeeding indicators of the World Health Organization (WHO): exclusive breastfeeding, predominant breastfeeding, complementary proper foods, continued breastfeeding and milk bottle feeding; b) to compare standardized diets among premature and full-term newborns. Casuistics: Two hundred of mothers of newborns and infants participated the study. They were divided into four groups (50 each): Group I (< 4 months); Group II ( between 6 and <10 months); Group III ( between 12 and < 16 months); Group IV ( between 20 and <24 months). Method: At first the project was approved by the Ethics Committee of Research. Afterwards, before the routinely consulting, the mothers answered a questionnaire based on a methodology standardized by WHO about information of diet during the last 24 hours. Results: The majority of mothers was adult (lesser than 20% of adolescents), able to read and write (97%; IC:93 to 99%), living with a partner (estimative of 79.5%; IC:73 to 85%), minority worked outside (27%; IC:21 to 34%). Average of 70.5% (IC:64 to 77%) of cesarean labor and 50.5% (IC:43 to 57%) of premature labor. The minority performed the first breastfeeding in the labor room (estimative of 18%; IC:13 to 25%). In Group I, the rate of exclusive breastfeeding was 40% (IC:26 to 55%), and predominant breastfeeding 28% (IC:16 to 42%). In Group II, the rate of breastfeeding with complementary proper foods was 46% (IC:32 to 61%). In Group III, the rate of continued breastfeeding up to one year was 30% (IC:18 to 45%); and in Group IV, the rate of continued breastfeeding up to two years was 32% (IC:20 to 47%). The rate of milk bottle feeding for babies under one year was 57% (IC:47 to 67%). Conclusions: The characteristics of the groups of mothers and babies were almost homogeneous, both have been following partially the facilitator routines of breastfeeding. As the age of babies increased, breastfeeding diminished, with the early introduction of liquids and complementary diet. The standardized diet of full-term and premature babies was similar. / O Brasil adota uma política de saúde voltada para a promoção, proteção e apoio ao aleitamento materno, como forma de reduzir a mortalidade infantil e melhorar a qualidade de vida das crianças. Os objetivos deste estudo foram; a) caracterizar a amostra e verificar a alimentação de bebês com idade inferior a dois anos, prematuros e a termo, avaliando os indicadores de aleitamento materno propostos pela Organização Mundial de Saúde (OMS): amamentação exclusiva, amamentação predominante, alimentação complementar oportuna, amamentação continuada e alimentação por mamadeira; b) comparar padrões alimentares entre bebês prematuros e a termo. Casuística: participaram do estudo 200 mães de recém-nascidos e lactentes divididas em quatro grupos de 50 mães; Grupo 1 (<4 meses); Grupo II (entre 6 e <10 meses); Grupo III (entre 12 e <16 meses); Grupo IV (entre 20 e <24 meses). Método; O projeto foi aprovado pelo Comitê de Ética em Pesquisa. Antes da consulta rotineira, as mães responderam a um questionário, fundamentado em metodologia padronizada pela OMS, sobre informações alimentares relativas as últimas 24 horas. Resultados: A maioria das mães encontrava-se na fase adulta (menos de 20% de adolescentes), alfabetizadas (97%; lC:93 a 99%), com parceiros (estimativa de 79,5%; 10:73 a 85%), minoria trabalhava fora (27%; 10:21 a 34%). Estimativa de 70,5% (lC:64 a 77%) de parto cesárea e 50,5% (lC:43 a 57%) de prematuridade. A minoria realizou a primeira mamada na sala de parto (estimativa de 18%; lC:13 a 25%). No Grupo 1 a taxa de aleitamento materno exclusivo foi 40% (lC:26 a 55%) e de aleitamento materno predominante 28% (10:16 a 42%). No Grupo II a taxa de aleitamento materno com alimentação complementar oportuna de 46% (10:32 a 61%). Para o Grupo III, a taxa de aleitamento materno continuado até um ano foi de 30% (10:18 a 45%) e para o Grupo IV a taxa de aleitamento materno continuado até dois anos foi de 32% (10:20 a 47%). Nota de Resumo A taxa de alimentação por mamadeira para menores de um ano foi de 57% (10:47 a 67%). Conclusões: As características dos grupos de mães e crianças foram quase homogêneas; ambos seguiam parcialmente rotinas facilitadoras da amamentação. O aleitamento materno diminui com o aumento da idade, havendo a introdução precoce de líquidos e alimentação complementar. O padrão alimentar dos bebês a termo e prematuros foi semelhante.

MCur / Department of Advanced Nursing Science / Background: The Mother-Baby Friendly Initiative (MBFI) promotes and supports breastfeeding in environments such as clinics, community health centres and hospitals that have fully-functioning maternity units. The implementation of the Mother-Baby Friendly Initiative in hospitals is associated with significant increases in the initiation and duration of exclusive breastfeeding (EBF). The Mother-Baby Friendly Initiative also leads to improved healthcare for infants, children and provides improved maternal health to all mothers. The main aim of this study was to assess the knowledge, attitudes and practices (KAP) of nurses regarding the Mother-Baby Friendly Initiative in non-accredited primary healthcare (PHC) facilities of Makhuduthamaga Sub-district. Method: Descriptive, cross-sectional and correlational study designs were used with the quantitative method. All the 18 non-accredited primary healthcare facilities were purposively selected and a total sampling method was used to select all the nurses working in these non-accredited primary healthcare facilities. Permission to conduct the study was sought from the University of Venda Research Ethics Committee and the Limpopo Department of Health Research Committee. Data was collected using a structured self-administered questionnaire. Content and face validity were enhanced before the actual data collection process. One hundred and ninety questionnaires were distributed and 164 responded, giving a response rate of 86.3%. Cronbach’s alpha test determined the reliability and reflected 0.981, indicating high reliability. Data was analysed using the Statistical Package for Social Sciences (SPSS) 23.0 and the Pearson coefficient of correlation established the relationship between variables. The study followed ethical considerations such as privacy, autonomy, confidentiality, fair treatment and right to self-determination. Results: In this study, 50.6% were professional nurses (PNs), 6.7% were nursing managers (NMs), 15.2% were enrolled nurses (ENs) and 27.4% were enrolled nursing assistants (ENAs). This study found that 100% of NMs, 65.1% of PNs, 54.2% of ENs and 26.7% of ENAs had received formal training on lactation management. Seventy-two percent (72%) of NMs, 90.4% of PNs, 72% of ENs vii and 66.7% of ENAs were knowledgeable about the duration of exclusive breastfeeding. This analysis found that the majority of nurses agreed that MBFI increases breastfeeding rates. Results showed that 63.6% of NMs, 69.6% of PNs, 56% of ENs and 46.7% of ENAs teach and demonstrate hand-milk expression to breastfeeding mothers. Furthermore, this research revealed that there was a significant relationship between the knowledge, attitudes and practices of nurses with a p-value of (p-00.01). Recommendations and Conclusion: This study recommends that all nurses should receive formal training on MBFI implementation and this should be conducted to improve ENs and ENAs’ awareness about MBFI. MBFI should be integrated into the training curriculum for all nursing categories. This study further recommends that a support model for implementation of MBFI be developed and implemented.