Thesis (MPH.) -- University of Limpopo, 2022 / Background: The Mother baby friendly initiative (MBFI) is an initiative that was launched in 1991 as a global programme to create an environment that enables and supports women to breastfeed their infants, providing advice to mothers and practical assistance to promote breastfeeding. This initiative plays an important role in improving infant’s nutritional status, growth, development and health for both mother and infant and supports exclusive breastfeeding. MBFI aims at increasing breastfeeding rate by supporting, protecting and promoting breastfeeding in health facilities. Aim: of the study is to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at Standerton hospital. Method: A qualitative descriptive design was used to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at selected hospital. Purposive sampling of the healthcare providers were the target population for the study as they are responsible for the implementation of MBFI in the hospital. In this research, data collected were in a form of interviews, audiotapes and written notes from interviews. Tesch’s eight steps in data analysis was used to analyse data. Results: The studies key theme and sub theme give the study’s findings and perspective of the issues found. The studies key theme were: 1. Knowledge of participants on MBFI at Standerton hospital, 2. Views about current practices of MBFI at Standerton –hospital and 3. Challenges regarding MBFI implementation at Standerton. MBFI was considered significant in the facility, however, due to inconsistences and challenges faced by the nurses the initiative was not fully implemented to improve breastfeeding rates. Conclusion: the study conclude that nurse’s had some knowledge on the MBFI initiative as they understood their role in breastfeeding advocacy and enhancing maternal and child health. There were significant challenges in MBFI implementation such as shortage of staff, lack of resources and training that hindered MBFI compliance and mothers not receiving the full benefits of the initiative, which contribute to decreased breastfeeding rates within the facility.

INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Introduction: Exclusive breastfeeding (EBF) contributes towards reducing infant and young child mortality however global EBF rates are sub-optimal. One of the factors that influences a mothers‟ choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa has adopted the ICMBS, the Code was only legislated in December 2012 to ensure compliance. Aim: To do a baseline assessment of the extent of ICMBS violations in the South African advertising media including magazines, newspapers, television (TV) and radio. Methods: In this cross-sectional study data were collected on multiple occasions. Data were collected by means of recording and/or screening daily broadcasts from four TV channels (SABC 1, 2, 3 and e.tv), nine commercial radio stations, 116 different magazines and 10 different newspapers for ICMBS violations. This study was done within a period of four months between November 2012 and January 2014. Violations pertaining to advertising media include advertising or promoting infant formula, other milk products marketed for children up to 36 months of age (e.g. growing-up milk or follow-on milk), foods for infants younger than six months, any other food or beverages marketed or represented to be suitable for the use as partial or total replacements of breast milk, and feeding bottles and teats to the general public (article 5.1 of the ICMBS). Results: A total number of 30 violations were identified from 117 baby product advertisements that were published in eight of the 169 screened magazines. No violations were found from advertisements on TV, radio or in newspapers. The majority of advertisements that violated article 5.1 of the ICMBS, were advertisements of feeding bottles (60%), followed by advertisements of growing-up milk (20%) and feeding teats (16.7%). Only one violation (3.3%) was an advertisement of infant food for infants younger than six months. Advertisements with violations were advertising baby products from 11 different companies. More than half of the violations (56.7%) were published in two editions from the same magazine, or inserts within that magazine, who‟s target group was pregnant women. Eight advertisements with violations (26.6%) were published in family magazines, three (10%) were published in baby magazines, and two (6.7%) were published in lifestyle magazines. Conclusion: According to the present baseline study, ICMBS violations were only found in a small percentage (4.7%) of magazines targeted mainly at pregnant women. However, although the present study included the majority of available South African magazines distributed in South Africa, not all the available newspapers, TV channels and radio stations were included in the sample size. The true extent of ICMBS violations in the South African advertising media may therefore be higher. It can also not be concluded that BMS companies use only magazines to advertise products pertaining to the scope of the ICMBS. A follow-up study need to determine the impact of legislating the Code on ICMBS violations in advertising media. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Introduction: Exclusive breastfeeding (EBF) contributes towards reducing infant and young child mortality however global EBF rates are sub-optimal. One of the factors that influences a mothers‟ choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa has adopted the ICMBS, the Code was only legislated in December 2012 to ensure compliance. Aim: To do a baseline assessment of the extent of ICMBS violations in the South African advertising media including magazines, newspapers, television (TV) and radio. Methods: In this cross-sectional study data were collected on multiple occasions. Data were collected by means of recording and/or screening daily broadcasts from four TV channels (SABC 1, 2, 3 and e.tv), nine commercial radio stations, 116 different magazines and 10 different newspapers for ICMBS violations. This study was done within a period of four months between November 2012 and January 2014. Violations pertaining to advertising media include advertising or promoting infant formula, other milk products marketed for children up to 36 months of age (e.g. growing-up milk or follow-on milk), foods for infants younger than six months, any other food or beverages marketed or represented to be suitable for the use as partial or total replacements of breast milk, and feeding bottles and teats to the general public (article 5.1 of the ICMBS). Results: A total number of 30 violations were identified from 117 baby product advertisements that were published in eight of the 169 screened magazines. No violations were found from advertisements on TV, radio or in newspapers. The majority of advertisements that violated article 5.1 of the ICMBS, were advertisements of feeding bottles (60%), followed by advertisements of growing-up milk (20%) and feeding teats (16.7%). Only one violation (3.3%) was an advertisement of infant food for infants younger than six months. Advertisements with violations were advertising baby products from 11 different companies. More than half of the violations (56.7%) were published in two editions from the same magazine, or inserts within that magazine, who‟s target group was pregnant women. Eight advertisements with violations (26.6%) were published in family magazines, three (10%) were published in baby magazines, and two (6.7%) were published in lifestyle magazines. Conclusion: According to the present baseline study, ICMBS violations were only found in a small percentage (4.7%) of magazines targeted mainly at pregnant women. However, although the present study included the majority of available South African magazines distributed in South Africa, not all the available newspapers, TV channels and radio stations were included in the sample size. The true extent of ICMBS violations in the South African advertising media may therefore be higher. It can also not be concluded that BMS companies use only magazines to advertise products pertaining to the scope of the ICMBS. A follow-up study need to determine the impact of legislating the Code on ICMBS violations in advertising media. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Although it is well-established that the fatty acid profile of breast milk will reflect the dietary fatty acids, the response time with which this occurs is not known. We hypothesized that fatty acids from a given meal would be transferred acutely from chylomicrons into breast milk. To test this hypothesis, the following experiment was performed. Fourteen lactating women drank 700 Calorie breakfast formulas containing six different test fats: 40 grams of cocoa butter, coconut, safflower or canola oil, 20 grams of menhaden oil or 7 grams of herring oil. Each fat contained a specific fatty acid whose appearance was tracked in the milk. After consuming the breakfast formula, subjects collected mid-feeding milk samples at 0, 6, 10, 14 and 24 hours, and one morning sample on days two through seven. Fatty acids specifically tracked in milk samples were: C12:0 (coconut oil), C18:0 (cocoa butter), C18:2n-6 (safflower oil), C18:3n-3 (canola oil), C22:ln-ll (herring oil), and C20:5n-3 and C22:6n-3 (menhaden oil). There was a significant increase in each of these fatty acids in human milk (p<0.001). Elevation of these fatty acids was first observed at 6 hours. Maximum increases of these fatty acids occurred 10 h after safflower oil (177% of baseline), 14 hours after cocoa butter (154%), coconut oil (216%), canola oil (206%) and menhaden oil (C20:5n-3 [1157%]), and 24 hours after the herring oil (2621%) and menhaden oil (C22:6n-3 [506%]). Compared to baseline, these fatty acids were significantly elevated (p<0.05) from 10 to 24 hours. However, after menhaden oil, C20:5n-3 was significantly elevated for 3 days and C22:6n-3 for 2 days. These data support the hypothesis that there is an acute transfer of dietary fatty acids from chylomicrons into human milk. / Graduation date: 1996

Breastfeeding trends in the United States have varied considerably since the early 1900s. Medical and federal surveys representing comprehensive data on breastfeeding rates of American women show an inconsistency in breastfeeding trends over the course of the past 110 years. Some decades report a growth in breastfeeding rates of infants newborn to 6 months, whereas other decades report a decline. This report examines breastfeeding trends from the early 1900s to present day to suggest which factors have played a role in the decline and rise of breastfeeding in the United States. / text

published_or_final_version / abstract / toc / Zoology / Master / Master of Philosophy

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