Orientador: Rosana de Fátima Possobon / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-23T17:31:41Z (GMT). No. of bitstreams: 1 Raven_FernandaGabrieledaCosta_M.pdf: 550713 bytes, checksum: 54c00f6eb994af5aaa305ecab1d7e8bc (MD5) Previous issue date: 2013 / Resumo: A prática do aleitamento materno é essencial para a proteção e a promoção da saúde da criança e é fundamental nos primeiros meses de vida. A amamentação contribui nutricional e imunologicamente para o desenvolvimento do lactente, prevenindo e controlando morbidades futuras. Além disso, auxilia no correto desenvolvimento facial e respiratório, além de estimular o vínculo entre mãe e filho. O aleitamento materno exclusivo é definido pela Organização Mundial de Saúde (OMS) como a oferta somente de leite, sem mesmo água ou chá, permitindo-se apenas gotas de vitaminas ou medicamentos, e deve ocorrer até o sexto mês de vida. A OMS recomenda, ainda, que o aleitamento deve ser mantido, de forma complementada, até 2 anos de idade ou mais. Entretanto, diversos fatores podem interferir na instalação e na manutenção do aleitamento, devendo ser investigados, a fim de prevenir sua influência, evitando o desmame precoce. Este estudo investigou a associação entre aleitamento materno exclusivo, nos seis primeiros meses de vida da criança, e condições socioeconômicas da mãe (escolaridade, renda, paridade, presença do companheiro, etc.), variáveis do período gestacional (início e número de consultas do pré-natal, problemas de saúde durante a gestação, tempo gestacional, etc.) e do período pós-parto (peso do bebê ao nascer, início da amamentação, permanência em alojamento conjunto, problemas de mama, se fez uso de chupeta, etc.). A amostra foi constituída por 305 crianças e suas respectivas mães, participantes do Programa de Atenção Precoce à Saúde oferecido pelo Centro de Pesquisa e Atendimento Odontológico para Pacientes Especiais (Cepae-FOP-Unicamp), no município de Piracicaba, Estado de São Paulo, Brasil. A prevalência de aleitamento materno exclusivo ao 6º mês foi de 23,9% e de desmame, 8,9%. Não foram detectadas diferenças estatisticamente significantes entre as variáveis socioeconômicas, demográficas e relacionados ao pré e pós-parto. Houve associação significativa entre abandono do aleitamento materno exclusivo e uso de chupeta (p = 0,0085; OR= 0,45; IC 95%: 0,25-0,80). Conclui-se que, para esta amostra, o uso da chupeta foi fator de risco para a manutenção do aleitamento materno exclusivo / Abstract: The practice of breastfeeding is essential for the protection and promotion of child health and is essential in the first months of life. Breastfeeding contributes to nutritional and immune development in infants, preventing and controlling morbidity future. Additionally, it assists in the correct breathing and facial development, and stimulate the connection between mother and child. Exclusive breastfeeding is defined by the World Health Organization (WHO) as the offer only milk, not even water or tea, allowing only vitamin drops or medications, and should occur until the sixth month of life. WHO also recommends that breastfeeding should be maintained as supplemented, up to 2 years of age or older. However, several factors may interfere with the installation and maintenance of breastfeeding, these factors should be investigated in order to prevent their influence, avoiding premature weaning. This study investigated the association between exclusive breastfeeding for the first six months of a child's life, and socioeconomic status of the mother (education, income, parity, presence of a partner, etc.). Variables of the gestational period (beginning and number of queries prenatal health problems during pregnancy, gestational age, etc..) and postpartum (baby's weight at birth, breastfeeding initiation, stay in rooming-in unity, breast problems, if made use of pacifiers, etc.). The sample consisted of 305 children and their mothers who participated in a Research and Dental Treatment Center for Special Patients (Cepae-FOP-Unicamp), in Piracicaba, State of São Paulo, Brazil. The prevalence of exclusive breastfeeding at 6 months was 23.9% and weaning, 8.9%. There were no statistically significant differences between the socioeconomic, demographic, and related to pre-and postpartum. There was a significant association between interruption of exclusive breastfeeding and pacifier use (p = 0.0085 OR = 0.45 95% CI: 0.25 to 0.80). We conclude that, for this sample, pacifier use was a risk factor for the maintenance of exclusive breastfeeding / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

Magister Curationis - MCur / Women, who are HIV-positive, may transmit the virus to their babis during labour and through breast milk. HIV-positive mothers have to be counselled and encouraged to make informed decisions about the feeding of their babies to avoid this transmission. The feeding choices are exclusive breast-feeding , exclusive formula feeeding or modified feeding. this study focused on the perceptions, knowledge and experiences of breastfeeding women living with HIV/AIDS in the Oshakati district, Northern Namibia. A qualitative descriptive research design was used to conduct the study. The sresaerch was conducted at the Prevention of Mother-to-Child Transmission (PMTCT) Clinic, in the intermediate Hospital, Oshakati. The Medical Superitendant of the Hospital gave the researcher permission to conduct the study at the PMTCT clinic. A purposive sample was used consisting of 14 breastfeeding women who are HIV-positive and aged between 15-49 years. the ages of their babies were between one day and six months. The data collected through individual face-face-interviews. The interviews were tape-recorded with the permission of the respondents. The interviews were transcribed verbatim and data were analysed by thematic content analysis. The Health Belief Model guided the description and interpretation of the data. Th study revealed that some women had inadequate knowledge about the transmission of HIV through breastfeeding. Their breastfeeding choices were influennced by their knowledge and perceptions while their experiences were shaped by their relationships with their partners and family. / South Africa

Orientador: Elaine Pereira da Silva Tagliaferro / Resumo: O trabalho está dividido em duas publicações cujos objetivos foram: a) realizar uma revisão integrativa da literatura, identificando e descrevendo a intenção de amamentar em gestantes e fatores associados (Publicação 1); b) investigar o nível da intenção de amamentar e variáveis associadas entre gestantes que estão no terceiro trimestre de gravidez (Publicação 2). Para a Publicação 1, foram consultadas as bases de dados Medical Literature Analysis and Retrieval System Online (PubMed/Medline), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Scopus, através dos descritores intenção/intention and aleitamento materno/breastfeeding or breast feeding por três revisores independentes. A Publicação 2 é um estudo observacional transversal, realizado mediante a coleta de dados em entrevista e questionário semi-estruturado e autoadministrado. A pesquisa foi realizada com 653 gestantes no terceiro trimestre de gestação. Para a variável resposta intenção de amamentar foi utilizada a escala Infant Feeding Intentions (IFI), traduzida e adaptada para o português do Brasil. As variáveis independentes incluíram características demográficas e socioeconômicas, da gestação, do aleitamento materno, da família, de assistência à saúde, biológicas e hábitos. A revisão integrativa realizada na Publicação 1 incluiu 17 estudos transversais quantitativos/mistos desfecho para intenção de amamentar de forma exclusiva em gestantes. Observou-se variação da prevalência da intenção de a... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T16:55:22Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_BrunaPivettaPrevedello.pdf: 4240323 bytes, checksum: 23699e78f61721ae7b36e5cc194fdcc8 (MD5) / Made available in DSpace on 2018-08-22T16:55:22Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_BrunaPivettaPrevedello.pdf: 4240323 bytes, checksum: 23699e78f61721ae7b36e5cc194fdcc8 (MD5) Previous issue date: 2017-12-15 / The aim of the present study was to verify the intention to breastfeed of pregnant women attending the Basic Health Units and Family Health Strategy in the city of Santa Maria, Rio Grande do Sul, as well as to alert them to the importance of breastfeeding (BF) , by creating a short animated video. The research design was a transversal type. Information about the intention to breastfeed the pregnant women were collected through semi-structured interviews conducted by trained researchers. There was also collected data related to biological, socioeconomic, and behavioral aspects relative to medical history and social support. The data were analyzed in the program Stata 13 (Stata Corp LP, College Station, USA). Initially, a descriptive analysis of the explanatory variables was performed, after which a Logistic Regression Analysis was performed to evaluate the association of the predictor variables with the intention to have exclusive breastfeeding (EB) for 6 months. Among the 100 pregnant women interviewed, 6 were excluded due to lack of information in the questionnaire. Among the 94 women included, the mean gestation time was 16.92 weeks (sd:11,35), most of them were in the third trimester of gestation and had only one child. Regarding the BF, 93 pregnant women presented intention to breastfeed. The planned time ranged from 3 to 72 weeks, with an average of 17.41 (sd:11,64). Regarding EB, 89 pregnant women had the intention to perform it, and the intended time for this ranged from 1 to 72 weeks, and 62 (70.45%) of them intended to perform it for 6 months. In this study, most of the pregnant women did not participate in a group of pregnant women (62.76%) and had not received guidance on the importance of the BF (50%), and only 15 were expected to perform it for more than 6 months. Although no positive association was found, it was possible to verify, through the data distribution, a higher proportion of pregnant women belonging to the age categories between 20-40 year old, white, with no intention to perform EB for 6 months. The schooling and marital status also had no influence on this outcome, as well as health problems, medication use, gestational trimester, number of pregnancies and social support did not influence the intention to perform the EB for 6 months. About the product generated from this master's dissertation, the short video, in the format of animation, brings timely information respecting the current trends of search for clarifications in the information channels, mainly internet. It is concluded that although the intention to breastfeed does not correspond to breastfeeding, it is an important predictor and, in this study, although most of the pregnant women presented an intention to perform BF, many intend to perform it for a short time. Thus, the information on the importance of BF to the health of the mother and the baby is fundamental and must be carried out from different means, including through videos that can be disseminated on television and the web. / A finalidade do presente estudo foi verificar a intenção de amamentar de gestantes atendidas em Unidades Básicas de Saúde e Estratégia Saúde da Família, do município de Santa Maria, Rio Grande do Sul, bem como alertá-las sobre a importância do aleitamento materno (AM), por meio da criação de um vídeo animado de curta duração. O delineamento da pesquisa foi do tipo transversal. Informações a respeito da intenção de amamentar das gestantes foram coletadas através de entrevistas semi-estruturadas. Também, foram coletados dados relacionados aos aspectos biológicos, socioeconômicos e comportamentais, referentes à história médica e ao apoio social. Os dados foram analisados no programa Stata 13 (Stata Corp LP, College Station, USA). Inicialmente, foi realizada uma análise descritiva das variáveis explicativas, posteriormente a Análise de Regressão Logística para avaliar a associação das variáveis preditoras com o desfecho ter intenção de aleitamento materno exclusivo (AME) por 6 meses. Entre as 100 gestantes entrevistas, 6 foram excluídas devido à falta de informações no questionário. Entre as 94 mulheres incluídas, a média de tempo de gestação foi 16,92 semanas (dp:11,35), sendo que a maior parte delas estavam no terceiro trimestre de gestação e possuíam um filho. Quanto ao AM, 93 gestantes apresentaram intenção de amamentar. O tempo planejado variou entre 3 e 72 semanas, com média de 17,41 (dp:11,64). Já em relação ao AME, 89 gestantes tinham intenção de realizá-lo, sendo que o tempo pretendido para este variou de 1 a 72 semanas, e 62 (70,45%) delas pretendiam realizá-lo por 6 meses. Nesta pesquisa, destaca-se que a maioria das grávidas não participavam de grupo de gestantes (79,78%) e não haviam recebido orientação sobre a importância do AM (64,89%), sendo que apenas 15 pretendiam realizá-lo por mais de 6 meses. Embora não tenha sido encontrada associação positiva, foi possível verificar através da distribuição dos dados, uma proporção maior de gestantes que pertenciam às categorias de idade entre 20 e 40 anos, da raça branca, sem intenção de realizar o AME por 6 meses. A escolaridade e o estado civil também não tiveram influência sobre este desfecho, bem como problemas de saúde, uso de medicamentos, trimestre gestacional, número de gestações e apoio social não influenciaram a intenção de realizar o AME por 6 meses. Sobre o produto gerado a partir desta dissertação de mestrado, o vídeo curto, no formato de animação, traz informações pontuais respeitando as tendências atuais de busca por esclarecimentos nos canais de informação, principalmente internet. Conclui-se que apesar da intenção de amamentar não corresponder a realização do aleitamento, ela é um importante preditor e, neste estudo, embora a maioria das gestantes tenha apresentado intenção de realizar o AM, muitas pretendem realizá-lo por pouco tempo. Assim, a informação sobre a importância do AM para a saúde da mãe e do bebê é fundamental e deve ser realizada a partir de diferentes meios, inclusive por vídeos que podem ser divulgados na televisão e web.

To determine the relationship between infant-feeding practices and diarrhoeal infections, a descriptive survey was conducted to infants between six to 12 months of age. A guided interview was conducted to 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results show that breast-feeding is routinely practiced by the majority of mothers and exclusive breast-feeding is very low, but supplementary feed in the form of formula or solids are introduced by the majority of respondents within the first three months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast-feeding should be promoted as an important intervention in the control of diarrhoea / Health Studies / M.A. (Nursing Science)

OBJETIVOS: Descrever as taxas de início de aleitamento materno em gêmeos; investigar o efeito do aconselhamento pré-natal nas taxas de aleitamento materno total e exclusivo em gêmeos e identificar os fatores associados ao desmame e os fatores citados por mães de gêmeos como motivo para a interrupção da amamentação, durante os primeiros seis meses de vida dos lactentes. MÉTODOS: Estudo prospectivo em que cento e setenta e uma grávidas de gêmeos foram randomizadas para grupo aconselhamento pré-natal ou grupo controle. Dados de aleitamento materno foram coletados por entrevistas pessoais presenciais em três diferentes momentos após o parto: 30 a 40 dias (Período 1), 90 dias (Período 2) e 180 dias (Período 3). RESULTADOS: A análise foi composta por 68 grávidas de gêmeos no grupo aconselhamento pré-natal e 60, no grupo controle. Cento e vinte e três mães de gêmeos iniciaram amamentação (96,1%). Não houve diferença significativa nas taxas de aleitamento materno total entre o grupo aconselhamento pré-natal e grupo controle nos tempos analisados: Período 1 [razão de chances (RC) 1,87, intervalo de confiança (IC) de 95% 0,71 - 4,95], Período 2 [RC 1,50, IC 95% (0,72 - 3,10)], Período 3 [RC 1,06, IC 95% (0,51 - 2,19)]. Não foi observada também diferença nas taxas de aleitamento materno exclusivo entre os grupos: Período 1 [razão de chances (RC) 0,76, intervalo de confiança (IC) de 95% 0,28 - 2,11], Período 2 [RC 1,59, IC 95% (0,36 - 6,87)], Período 3 [RC 0,83, (IC 95% 0,10 - 6,45)]. Ao considerar-se a correlação entre gêmeos de mesma mãe, também não houve diferença entre as razões dos riscos (RR) para desmame no grupo aconselhamento pré-natal e GC até 180 dias de vida dos lactentes, RR 2,091 (IC 95% 0,27 - 15,77). A análise da associação dos fatores (maternos, obstétricos, neonatais e relacionados ao processo de amamentação) com o desmame em gêmeos durante os primeiros 180 dias de vida, avaliados pela metodologia das análises de sobrevivência, evidenciou maior risco de parada da amamentação nas participantes com: modo de amamentação não-exclusivo (p = 0,004, modelo de regressão de riscos proporcionais de Cox); ausência de ajuda durante o período de lactação (p = 0,001); dificuldade para amamentar (p = 0,003); duração da amamentação prévia menor do que 12 meses (p = 0,001); e peso do nascimento do recémnascido inferior a 2.300g (p < 0,001). Os fatores mais citados por mães de gêmeos como motivo para desmame, nos três períodos analisados, foram oferta inadequada de leite materno, comportamento dos lactentes e retorno ao emprego/ trabalho. CONCLUSÕES: Em gêmeos, o aconselhamento pré-natal não aumentou significativamente as taxas de aleitamento materno. Foram identificados os principais fatores associados ao desmame em lactentes gêmeos nos primeiros 180 dias de vida. Esse conhecimento pode ajudar a melhorar as estratégias para aumentar as taxas de aleitamento materno em gêmeos / OBJECTIVES: To describe the rates of initiation of breastfeeding in twins; to evaluate the effect of antenatal counseling on the rates of any and exclusive breastfeeding in twins; and to identify the factors associated with weaning and the factors cited by mothers of twins as a reason for breastfeeding cessation during the first six months of twin infants\' age. METHODS: A prospective trial in which one hundred and seventy-one women pregnant with twins were randomized into the prenatal counseling group or control group. Breastfeeding data were collected through personal interviews at three different times after birth: 30-40 days (Time 1), 90 days (Time 2) and 180 days (Time 3). RESULTS: The analysis comprised 68 women pregnant with twins in the prenatal counseling group and 60 in the control group. One hundred and twenty-three mothers of twins initiated breastfeeding (96.1%). There was no significant difference in the any breastfeeding rates between prenatal counseling group and control group in the analyzed times: Time 1 [odds ratio (OR) 1.87, 95% confidence intervals (CI) 0.71 - 4.95], Time 2 [OR 1.50, 95% CI (0.72 - 3.10)], Time 3 [OR 1.06, 95% CI (0.51 - 2.19)]. There was also no difference in the exclusive breastfeeding rates among the groups: Time 1 [OR 0.76, 95% CI (0.28 - 2.11)], Time 2 [OR 1.59, 95% CI (0.36 - 6.87)], Time 3 [OR 0.83, 95% CI (0.10 - 6.45)]. When considering the correlation between twins of the same mother, no difference was found between prenatal counseling group and control group, once the hazard ratio (HR) for weaning was 2,091 [95% CI (0.27 - 15.77)]. The analysis of the association of factors (maternal, obstetric, neonatal and related to the breastfeeding process) with weaning in twins during the first 180 days of life, evaluated by survival analysis methodologies, demonstrated a higher risk of breastfeeding cessation in the participants with: non-exclusive breastfeeding mode (p = 0.004, Cox proportional hazards regression model); absence of help during the lactation period (p = 0.001); difficulty in breastfeeding (p = 0.003); duration of previous breastfeeding less than 12 months (p = 0.001); and birth weight of the newborn of less than 2300g (p < 0.001). The main reasons for weaning cited by mothers of twins were insufficient breast milk supply, infant\'s behavior and returning to work. CONCLUSIONS: In twins, prenatal counseling did not significantly increase breastfeeding rates. The main factors associated with weaning in twin infants during the first 180 days of life were identified. This knowledge can help improve strategies to increase breastfeeding rates in twins

Wong Hing-yan, Esther. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 264-278 (2nd gp.)). / Abstracts in English and Chinese. / Acknowledgements --- p.I / Contents --- p.III / List of Tables --- p.VIII / List of Figures --- p.X / List of abbreviations --- p.XI / Abstract --- p.XII / Chapter 1 --- Introduction and Study Hypothesis --- p.1 / Chapter 1.1 --- Introduction and Overview --- p.1 / Chapter 1.2 --- Study Aim and Hypothesis --- p.2 / Chapter 2 --- Literature Review --- p.4 / Chapter 2.1 --- Definition of Breastfeeding --- p.4 / Chapter 2.2 --- Definition of the Exclusive Breastfeeding --- p.5 / Chapter 2.3 --- Benefits of Breastfeeding --- p.6 / Chapter 2.4 --- Current Status of Breastfeeding Globally and in Hong Kong --- p.10 / Chapter 2.4.1 --- Breastfeeding Globally --- p.10 / Chapter 2.4.2 --- Statistics on Global BF Practice --- p.11 / Chapter 2.4.3 --- Breastfeeding in Hong Kong --- p.15 / Chapter 2.4.4 --- Summary and Conclusions --- p.21 / Chapter 2.5 --- Factors Infuencing Breastfeeding --- p.22 / Chapter 2.5.1 --- Social Demographic Factors --- p.22 / Chapter 2.5.2 --- Psychosocial Factors --- p.31 / Chapter 2.5.3 --- Health Services Related Factors --- p.45 / Chapter 2.5.4 --- Cultural Practices --- p.51 / Chapter 2.5.5 --- Summary and Conclusions --- p.62 / Chapter 2.6 --- Strategies to Promote Breastfeeding --- p.62 / Chapter 2.6.1 --- Breastfeeding Policy Recommendations --- p.63 / Chapter 2.6.2 --- Baby Friendly Hospital Initiative --- p.66 / Chapter 2.6.3 --- International Code of Marketing of Breast Milk Substitutes --- p.69 / Chapter 2.6.4 --- Breastfeeding Consultant Programmes --- p.72 / Chapter 2.6.5 --- Breastfeeding Peer Counsellor Programmes --- p.73 / Chapter 2.7 --- Peer Counsellor Programmes --- p.75 / Chapter 2.7.1 --- Adult Learning Model --- p.76 / Chapter 2.7.2 --- Learning Breastfeeding --- p.77 / Chapter 2.7.3 --- Peer Counselling on Learning Breastfeeding --- p.79 / Chapter 2.7.4 --- Historical Review of Peer Counselling Programmes --- p.81 / Chapter 2.7.5 --- Peer Counselling Programmes in Other Countries --- p.82 / Chapter 2.7.6 --- Peer Counselling Programme in Hong Kong --- p.91 / Chapter 3 --- Methodology --- p.95 / Chapter 3.1 --- Sampling --- p.95 / Chapter 3.1.1 --- Study Population --- p.95 / Chapter 3.1.2 --- Sample Sources --- p.95 / Chapter 3.1.3 --- Inclusion / Exclusion Criteria --- p.95 / Chapter 3.1.4 --- Sample Size Determination --- p.96 / Chapter 3.2 --- Study Design --- p.97 / Chapter 3.2.1 --- Ward Allocation --- p.97 / Chapter 3.2.2 --- Peer Counsellor --- p.97 / Chapter 3.2.3 --- Sampling Method --- p.100 / Chapter 3.3 --- Subject Recruitment --- p.101 / Chapter 3.3.1 --- Pilot Study --- p.101 / Chapter 3.3.2 --- Recruitment --- p.103 / Chapter 3.3.3 --- Recruitment Interview --- p.107 / Chapter 3.3.4 --- Follow-up Interviews --- p.107 / Chapter 3.4 --- Data Collection --- p.108 / Chapter 3.4.1 --- Recruitment Data Collection --- p.109 / Chapter 3.4.2 --- Follow-up Data Collection --- p.109 / Chapter 3.4.3 --- Final Evaluation --- p.112 / Chapter 3.4.4 --- Data Collection on Termination of Breastfeeding --- p.112 / Chapter 3.4.5 --- Evaluation from Peer Counsellors --- p.114 / Chapter 3.4.6 --- Tools / Questionnaire Design and Its Validity --- p.115 / Chapter 3.4.7 --- Content of the Study Booklet --- p.116 / Chapter 3.4.8 --- Data Validity --- p.123 / Chapter 3.5 --- Data Entry & Analyses --- p.123 / Chapter 3.5.1 --- Data Entry --- p.123 / Chapter 3.5.2 --- Data Analyses --- p.123 / Chapter 4 --- Results --- p.127 / Chapter 4.1 --- Overview --- p.127 / Chapter 4.2 --- Sample Characteristics and Demographic Background --- p.127 / Chapter 4.2.1 --- Subject Profile --- p.127 / Chapter 4.2.2 --- Sample Characteristics --- p.131 / Chapter 4.2.3 --- Sample Characteristics Compared with HK Census Information --- p.137 / Chapter 4.3 --- Main study Findings --- p.138 / Chapter 4.3.1 --- Infant Feeding Categories at Follow-Ups --- p.138 / Chapter 4.3.2 --- BF duration --- p.140 / Chapter 4.3.3 --- BF exclusivity --- p.144 / Chapter 4.3.4 --- Relationship between BF Duration and BF Exclusivity --- p.155 / Chapter 4.3.5 --- Reasons for Giving Formula Supplement to BF Infants --- p.158 / Chapter 4.3.6 --- Termination of BF --- p.162 / Chapter 4.4 --- Subsidiary Results --- p.169 / Chapter 4.4.1 --- Overview --- p.169 / Chapter 4.4.2 --- Rationale for Regrouping Study Mothers --- p.169 / Chapter 4.4.3 --- "Characteristics Differences of Mothers from the ""Short-term Breastfeeders"" Group and Mothers from the ""Long-term Breastfeeders"" Group""" --- p.171 / Chapter 4.4.4 --- "Characteristics Differences between ""Short-term Breastfeeders"" and ""Prolonged Breastfeeders""" --- p.176 / Chapter 4.4.5 --- Cox Proportional Hazard Regression Analysis and BF Duration --- p.181 / Chapter 4.4.6 --- BF Duration and Working Mothers --- p.184 / Chapter 4.4.7 --- Formula Advertisement and BF --- p.187 / Chapter 4.4.8 --- Knowledge of BF --- p.189 / Chapter 4.5 --- Evaluation of Breastfeeding Experience --- p.193 / Chapter 4.5.1 --- Mothers' Evaluation of the Overall BF Experience --- p.194 / Chapter 4.5.2 --- Mothers' Evaluation of PC Support Intervention --- p.196 / Chapter 4.5.3 --- Peer Counsellors' Consultation Log Sheets --- p.198 / Chapter 4.5.4 --- Peer Counselors' Evaluation --- p.199 / Chapter 5 --- Discussion --- p.204 / Chapter 5. 1 --- Main Result Interpretation --- p.204 / Chapter 5.1.1 --- BF Duration --- p.204 / Chapter 5.1.2 --- BF Exclusivity --- p.205 / Chapter 5.1.3 --- BF Duration and BF Exclusivity --- p.210 / Chapter 5.1.4 --- Possible Explanations of the Study Results --- p.210 / Chapter 5.1.5 --- Similarities between Mclnnes' Peer Counseling Study and the Present Study --- p.213 / Chapter 5.2 --- Study Limitations --- p.216 / Chapter 5.2.1 --- Study Sample --- p.216 / Chapter 5.2.2 --- Data Validity and Recall Bias --- p.219 / Chapter 5.3 --- Common Reasons for Termination --- p.220 / Chapter 5.4 --- Implications of the Study Result and Future Direction --- p.221 / Chapter 5.5 --- Subsidiary Result Interpretation --- p.227 / Chapter 5.5.1 --- Factors that Have Positive Influences on BF --- p.228 / Chapter 5.5.2 --- Factors that Have No Particular Influences on BF --- p.243 / Chapter 5.5.3 --- Factors that Have Negative Influences on BF --- p.246 / Chapter 5.5.4 --- Future Directions --- p.261 / Conclusion --- p.262 / References --- p.264 / Appendices --- p.279

OBJETIVOS: Descrever as taxas de início de aleitamento materno em gêmeos; investigar o efeito do aconselhamento pré-natal nas taxas de aleitamento materno total e exclusivo em gêmeos e identificar os fatores associados ao desmame e os fatores citados por mães de gêmeos como motivo para a interrupção da amamentação, durante os primeiros seis meses de vida dos lactentes. MÉTODOS: Estudo prospectivo em que cento e setenta e uma grávidas de gêmeos foram randomizadas para grupo aconselhamento pré-natal ou grupo controle. Dados de aleitamento materno foram coletados por entrevistas pessoais presenciais em três diferentes momentos após o parto: 30 a 40 dias (Período 1), 90 dias (Período 2) e 180 dias (Período 3). RESULTADOS: A análise foi composta por 68 grávidas de gêmeos no grupo aconselhamento pré-natal e 60, no grupo controle. Cento e vinte e três mães de gêmeos iniciaram amamentação (96,1%). Não houve diferença significativa nas taxas de aleitamento materno total entre o grupo aconselhamento pré-natal e grupo controle nos tempos analisados: Período 1 [razão de chances (RC) 1,87, intervalo de confiança (IC) de 95% 0,71 - 4,95], Período 2 [RC 1,50, IC 95% (0,72 - 3,10)], Período 3 [RC 1,06, IC 95% (0,51 - 2,19)]. Não foi observada também diferença nas taxas de aleitamento materno exclusivo entre os grupos: Período 1 [razão de chances (RC) 0,76, intervalo de confiança (IC) de 95% 0,28 - 2,11], Período 2 [RC 1,59, IC 95% (0,36 - 6,87)], Período 3 [RC 0,83, (IC 95% 0,10 - 6,45)]. Ao considerar-se a correlação entre gêmeos de mesma mãe, também não houve diferença entre as razões dos riscos (RR) para desmame no grupo aconselhamento pré-natal e GC até 180 dias de vida dos lactentes, RR 2,091 (IC 95% 0,27 - 15,77). A análise da associação dos fatores (maternos, obstétricos, neonatais e relacionados ao processo de amamentação) com o desmame em gêmeos durante os primeiros 180 dias de vida, avaliados pela metodologia das análises de sobrevivência, evidenciou maior risco de parada da amamentação nas participantes com: modo de amamentação não-exclusivo (p = 0,004, modelo de regressão de riscos proporcionais de Cox); ausência de ajuda durante o período de lactação (p = 0,001); dificuldade para amamentar (p = 0,003); duração da amamentação prévia menor do que 12 meses (p = 0,001); e peso do nascimento do recémnascido inferior a 2.300g (p < 0,001). Os fatores mais citados por mães de gêmeos como motivo para desmame, nos três períodos analisados, foram oferta inadequada de leite materno, comportamento dos lactentes e retorno ao emprego/ trabalho. CONCLUSÕES: Em gêmeos, o aconselhamento pré-natal não aumentou significativamente as taxas de aleitamento materno. Foram identificados os principais fatores associados ao desmame em lactentes gêmeos nos primeiros 180 dias de vida. Esse conhecimento pode ajudar a melhorar as estratégias para aumentar as taxas de aleitamento materno em gêmeos / OBJECTIVES: To describe the rates of initiation of breastfeeding in twins; to evaluate the effect of antenatal counseling on the rates of any and exclusive breastfeeding in twins; and to identify the factors associated with weaning and the factors cited by mothers of twins as a reason for breastfeeding cessation during the first six months of twin infants\' age. METHODS: A prospective trial in which one hundred and seventy-one women pregnant with twins were randomized into the prenatal counseling group or control group. Breastfeeding data were collected through personal interviews at three different times after birth: 30-40 days (Time 1), 90 days (Time 2) and 180 days (Time 3). RESULTS: The analysis comprised 68 women pregnant with twins in the prenatal counseling group and 60 in the control group. One hundred and twenty-three mothers of twins initiated breastfeeding (96.1%). There was no significant difference in the any breastfeeding rates between prenatal counseling group and control group in the analyzed times: Time 1 [odds ratio (OR) 1.87, 95% confidence intervals (CI) 0.71 - 4.95], Time 2 [OR 1.50, 95% CI (0.72 - 3.10)], Time 3 [OR 1.06, 95% CI (0.51 - 2.19)]. There was also no difference in the exclusive breastfeeding rates among the groups: Time 1 [OR 0.76, 95% CI (0.28 - 2.11)], Time 2 [OR 1.59, 95% CI (0.36 - 6.87)], Time 3 [OR 0.83, 95% CI (0.10 - 6.45)]. When considering the correlation between twins of the same mother, no difference was found between prenatal counseling group and control group, once the hazard ratio (HR) for weaning was 2,091 [95% CI (0.27 - 15.77)]. The analysis of the association of factors (maternal, obstetric, neonatal and related to the breastfeeding process) with weaning in twins during the first 180 days of life, evaluated by survival analysis methodologies, demonstrated a higher risk of breastfeeding cessation in the participants with: non-exclusive breastfeeding mode (p = 0.004, Cox proportional hazards regression model); absence of help during the lactation period (p = 0.001); difficulty in breastfeeding (p = 0.003); duration of previous breastfeeding less than 12 months (p = 0.001); and birth weight of the newborn of less than 2300g (p < 0.001). The main reasons for weaning cited by mothers of twins were insufficient breast milk supply, infant\'s behavior and returning to work. CONCLUSIONS: In twins, prenatal counseling did not significantly increase breastfeeding rates. The main factors associated with weaning in twin infants during the first 180 days of life were identified. This knowledge can help improve strategies to increase breastfeeding rates in twins

To determine the relationship between infant-feeding practices and diarrhoeal infections, a descriptive survey was conducted to infants between six to 12 months of age. A guided interview was conducted to 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results show that breast-feeding is routinely practiced by the majority of mothers and exclusive breast-feeding is very low, but supplementary feed in the form of formula or solids are introduced by the majority of respondents within the first three months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast-feeding should be promoted as an important intervention in the control of diarrhoea / Health Studies / M.A. (Nursing Science)

PhDPH / Department of Public Health / The benefits of breastfeeding, particularly exclusive breastfeeding, are well recognized. It can reduce the risk of mortality related to malnutrition, otitis media and respiratory infection. Breastfeeding may also decrease the risk of obesity in later life for infants who have been breastfed for more than six months. Besides, breastfeeding improves cognition, and children who have been breastfed show higher intelligence quotient test scores and improved school performance. In addition, long-period breastfeeding is associated with a reduced risk of breast cancer and ovarian cancer for mothers. The World Health Organization and United Nations International Children’s Emergency Fund recommended exclusive breastfeeding for six months and breastfeeding to two years and beyond. However, this study showed that only 27% of children under six months have had been exclusively breastfed. In this situation, an intervention programme was required. The aim of this study was to develop an intervention programme to promote exclusive breastfeeding strategies in Limpopo Province. Intervention mapping was used to guide the development of a programme. A convergent, parallel mixed-method was used wherein qualitative and quantitative data were collected and analysed concurrently. A qualitative approach was used to assess the implementation of exclusive breastfeeding and to explore challenges experienced by health care workers in the implementation of exclusive breastfeeding in Limpopo Province. This was carried out by means of in-depth interviews with 30 professional nurses. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. A quantitative approach was used to determine the factors that influence exclusive breastfeeding. Reliability and validity of the instrument was ensured through extensive literature review and test-retest methodology. Questionnaires were distributed to 400 respondents. Tesch’s eight steps of data analysis was used to analyse qualitative data. The Statistical Package for the Social Sciences, version 26, was used to analyse the quantitative data. The results were merged, and the interpretation discussed. Five higher-order themes emerged from quantitative data analysis. The themes emerged from qualitative data were confirmed by the findings from statistical data, thus merging both qualitative and quantitative data. Findings were presented to the stakeholders, managers and dieticians and their inputs further confirmed and supported the findings. The findings informed the development of an intervention programme. The intervention comprises of the three components, training of community health workers, healths talks focusing on lactating mothers and health talks focusing on families and community. The developed intervention was validated by the stakeholders and the results were analysed through simple descriptive statistics where the data were summarized using frequency distributions and graphic representations. The results revealed that the programme was feasible, compatible and applicable to current practice. Recommendations were made and topics for further research were also suggested. / NRF