The purpose of this project was to highlight an intervention to increase breastfeeding initiation and exclusive breastfeeding during the birth hospitalization in a coastal mid-Atlantic inner city hospital. Although researchers and national standards promote early initiation and exclusive breastfeeding, there continues to be a significant number of women who do not breastfeed and/or supplement with formula. The advantages of breastfeeding for mother and infant are substantial and include protecting babies from allergens to reducing maternal breast and ovarian cancer. Breastfeeding rates of initiation and exclusivity at the project hospital were below benchmarks set by international, national, and state agencies. The project intervention utilized bedside RNs who were educated and trained by the Perinatal Unit Clinical Nurse Specialist and the unit lactation counselors on bedside lactation support. The educational intervention capitalized on Dennis's theory of breast-feeding self-efficacy, which emphasizes maternal confidence in breastfeeding success. A convenience sample of breastfeeding rates of initiation and exclusivity from one month's delivered mothers pre-intervention (n = 203) compared to one month's breastfeeding rates of delivered mothers post-intervention (n = 220) was derived from electronic medical record nursing documentation and formed the data points for analysis. Outcome measures demonstrated an institutional increase in rates of breastfeeding initiation and in breastfeeding exclusivity. Chi-square analysis of both outcomes was not statistically significant; however progression towards the benchmarks was made, demonstrating clinical significance. Future social change from the project's success will be evident in reduction of sequelae from the above named maternal and infant acute and chronic illnesses.

The United States Department of Health and Human Services wrote Healthy People 2000 National Health Promotion and Disease Prevention Objectives. One major goal is to reduce the mortality rate for infants by reducing low birthweight. The disparities have been great when goals and objectives are applied to poor and minority populations. Objectives have been set to reduce risk factors associated with low infant birthweight. These include addressing inappropriate health practices, and appropriate nutrition for mother and infant. Forty-eight Asian and 50 Caucasian participants were compared for maternal diet, health practices, breastfeeding initiation and duration, and infant growth parameters. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Results showed 39 (81.3%) of the Asians and 43 (86.0%) of the Caucasians were breastfeeding at least once a day. There was no significant difference in the reasons for cessation of breastfeeding between ethnicities. Diets were compared for kilocalories, protein, iron, calcium, vitamins A and C, and folate. Asian mothers had greater iron (13.13 mg) and vitamin A (2606.18 µg) intakes, along with a more nutrient dense diet overall. Caucasian mothers reported a greater calcium intake (1087.08 mg). ANOVA (one-way analysis of variance) revealed no significant differences in nutrient intakes. However, Multiple Range Test Analysis identified calcium intake of Asian breastfeeding women (767.40 mg) as significantly lower than that of Caucasian nonbreastfeeding women (1094.89 mg). Vitamin A intake was higher in nonbreastfeeding Asian women (2788.46 µg) than in nonbreastfeeding (1740.44 µg) and breastfeeding (845.75 µg) Caucasian women. Bivariate analysis revealed positive correlation between the Asian group and tobacco use during pregnancy. Mean height for age and mean weight for age were significantly greater in breastfed babies. Weight for height was not greater, indicating they are not proportionally different from their nonbreastfed peers.

The aim of these studies was to increase knowledge about hospital feeding routines in high-risk neonates. A retrospective medical chart review procedure was used to study routines at the neonatal units of two Swedish hospitals. In Papers I and II, the sample (Uppsala n=21 and Umeå n=21) comprised of small for gestational age (SGA) infants, in Papers III (Uppsala n=64 and Umeå n=59) and IV (n=127), the samples comprised of appropriate for gestational age (AGA) infants. Paper I indicated large enteral/oral milk volumes rendered i.v. administration of glucose unnecessary, reduced weight loss and helped SGA infants regain birth weight earlier. More rapid postnatal growth did not remain up to 18 months with corrected age in any growth variable (Paper II). In Paper III, effects were compared whether the infants’ volume of breast milk intake in hospital was estimated by “clinical indices” or determined by test-weighing. Infants treated in hospitals where test-weighing was practised attained exclusive breastfeeding at an earlier postmenstrual age (PMA), and they were discharged at an earlier PMA. However, the two study units were similar regarding the proportion of infants attaining exclusive breastfeeding. Paper IV revealed preterm AGA infants with higher standard deviation scores (SDS) at birth had more negative changes from birth to discharge for all growth variables. Conclusions: Papers I and II indicated that early initiation of enteral/oral feeding with proactive increases in milk volume was beneficial short term. No evidence was found for a proactive nutrition regimen with initial large volumes of milk resulting in a different pattern of growth up to the corrected age of 18 months. Test-weighing before and after breastfeeding might help infants to attain exclusive breastfeeding at an earlier PMA (study III). Finally, preterm AGA infants with higher SDS at birth are at higher risk of inadequate growth during their hospital stay (study IV).

There is limited study of the prevalence of childhood obesity and being overweight in 6 to 9 year old children living in Saskatchewan and Canada using the international standards and measured data. Limited data exists of the prevalence of obesity in rural and small urban communities. In 2000, a cross-sectional survey of children was conducted that primarily assessed the respiratory health of children in two southern Saskatchewan communities. Anthropometric measurements (height and weight) as well as child and familial data were available for 1241 children ages 6 to 9 years. Using data from this study and applying international standards for obesity and overweight developed by Cole and colleagues (2000) an analysis was undertaken to describe and compare the prevalence of overweight and obesity between communities and identify associated risk factors. Although the mean body mass index (BMI) differed statistically between communities, no differences in overweight and obesity were identified once the international standards were applied. The overall prevalence was 19.2% for being overweight and 5.2% for obesity. More girls than boys were overweight and obese at age 9. After adjusting for age, sex and community, maternal smoking during pregnancy and current gastrointestinal symptoms of nausea and/or diarrhea were associated with overweight and obesity. Lower physical activity in free time was associated with being overweight as a child. Children who were not consistently participating in physical education and sports in school were more likely to be overweight and obese. This research provides important new information regarding the prevalence and associated risk factors for overweight and obesity in school aged children in Saskatchewan. Although results concur with international prevalence rates of childhood obesity, children in this study were not as overweight or obese as previously reported data has shown for similar Canadian populations. Less physical activity, both in school and at home, may be important for the development and continuation of childhood obesity. Further research is necessary to explore reasons why obese and overweight children are experiencing significant digestive related health concerns.

This thesis attempted to determine whether there was a relationship between an antepartum increase in knowledge of breastfeeding and women's choice to breastfeed after parturition. A group of women of low social class was given instruction about breastfeeding in three forty-five minute sessions during the last four months of pregnancy. Data, concerning the number of women who chose to breastfeed, were collected from the group that was given the information and from the group that was not given information. The data were analyzed statistically. The Chi Square test was applied to the data to determine whether there was any relationship between the giving of instruction about breastfeeding and the mothers' choices to breastfeed. Though more mothers in the experimental group did choose to breastfeed than in the control group, the relationship between the giving of instruction and the choice to breastfeed was not significant, according to statistical analysis.Ball State UniversityMuncie, IN 47306

AbstractThis study compared breast-feeding success rates for nursing mothers from three different population groups: (1) those with no medically supervised education, (2) those with exposure to supportive medical staff and to a patient education handout on breast-feeding, and (3) those with exposure to the handout and to a videotape on breast-feeding shown in the hospital during the first few days postpartum. Success was defined as using breast milk as the primary means of infant nutrition at five to six weeks postpartum. It was found that educating mothers in an organized fashion significantly improves success rates over that seen when organized patient education was not offered (p<.001). The group educated by postpartum videotapes tended to do better than the group educated by only patient education handouts and interested medical staff. This relationship was not significant at the .05 level (.05<p<.10), but was strong enough to warrant further investigation. Lack of correct information was related to all of the reasons for not breast-feeding and for prematurely stopping breast-feeding.Honors CollegeBall State UniversityMuncie, IN 47306

The present study investigated the effect of an educational message on the knowledge and choice of infant feeding practices of expectant mothers. A convenience sample totaling 4.2 women attending prenatal classes from one community hospital completed the pre-test questionnaire designed for the study. A content validity jury was employed to increase the reliability and validity of the instrument. The educational message followed the pre-test and included a videocassette, educational handout, and a question and answer period. A total of 36 women returned to complete the post-test questionnaire. The results revealed a significant difference in knowledge level scores beyond the 0.001 level of mothers receiving the educational message. Also, the data revealed a significant difference beyond the 0.001 level in pre-test/posttest scores of bottle- and breast-feeding mothers. There was no significant improvement in mothers choosing to breast-feed following the educational message. The conclusions drawn from the study are that an educational message improves infant feeding knowledge level and may better prepare mothers for their infant feeding choice. The educational message does not influence the mothers' planned infant feeding method.Ball State UniversityMuncie, IN 47306

With an increasing amount of attention being paid to maternal mental health and the knowledge that maternal depression has the potential to adversely affect the breastfeeding relationship, the demand for appropriate breastfeeding support for mothers struggling with postpartum depression is on the rise. Using a hermeneutic phenomenological approach, the objective of this thesis research was to explore the lived experience of breastfeeding in women with postpartum depression to enhance understanding of what it means for these women to feel supported by registered nurses. After obtaining ethical and operational approval, recruitment began in September 2011 via the Saskatoon Postpartum Depression Support Program, a community wellness program offered by the Saskatoon Health Region. The researcher conducted in-depth, conversation-style interviews with five postpartum mothers. Interviews were transcribed verbatim and were analyzed according to emerging themes. The lived experience of breastfeeding with postpartum depression presented itself across interviews as overarching patterns, which are expressed by the following four themes: making the decision to breastfeed and having great expectations; learning the moves and wanting reassurance (establishing the breastfeeding relationship); breastfeeding in the dark (maintaining the breastfeeding relationship while trying to manage the symptoms of depression); keeping it under wraps and waiting it out (the issue of support). The mothers in this study valued the breastfeeding relationship when it went well; however, breastfeeding difficulties intensified symptoms of depression. Mothers who made the decision to breastfeed their infants needed ongoing support from healthcare professionals and loved ones to continue to breastfeed when faced with the debilitating symptoms of postpartum depression. This research concluded that women need increased anticipatory guidance to be prepared for the demands of motherhood. Women who are at risk for postpartum depression need appropriate treatment throughout the perinatal period and beyond. To these ends nurses must enhance their role as breastfeeding and postpartum depression educators across an extended perinatal period. Nurses should work along with other healthcare providers (midwives, social workers, physicians) to assess the effectiveness and appropriateness of prenatal classes as they are currently offered. Increased emphasis should be focused on newborn feeding and care for mother and baby postnatally in conjunction with prenatal preparation for birth itself. The issue of professional nursing support for breastfeeding must be explored from a sociopolitical context in order to determine if nurses have the cultural and institutional support they need to provide responsive care to mothers and babies. Enhanced support for breastfeeding certification among frontline staff is recommended. It is also recommended that staffing guidelines to decrease nurse-to-client ratios be implemented in order to give nurses the time needed to support mothers as they work through breastfeeding challenges (especially those mothers at risk for postpartum depression). Further, nurses need to enhance efforts to engage mothers and their families in a participatory manner so that knowledge gleaned results in responsive interventions.

AIM: The aim of this study was to a) find out which recommendations are given by nurses regarding breastfeeding to HIV infected mothers, at Muhimbili hospital and the adherence of these, and (b) to find out the nurses’ opinions regarding the WHO recommendations and the parents’ adherence to these. The study will also look into if the nurses are aware of any changes in knowledge among the parents in an HIV context.METHOD: There were eight semi-structured interviews with open ended questions that were performed at Muhimbili Hospital. All the interviews were recorded and transcribed with content analysis.RESULT: The nurses’ recommendations are adapted to the mothers’ socio-economical situation. The benefits of replacement foods are emphasized if conditions are suitable, otherwise exclusive breast feeding is recommended. Some recommendations are difficult to follow due to poor sanitary standards, low economical standard and stigmatization. Cultural norms may affect the mothers’ choice of feeding method as it might raise suspicions in their community if they do not breastfeed. The knowledge of mother-to-child-transmission has increased but to reduce the transmission rates more knowledge is still needed and a change in attitude towards HIV infected mothers.CONCLUSION: The recommendations given by the nurses to HIV-positive mothers are not directly according to the ones by the WHO although the content is similar. The recommendations are adjusted in accordance to the Tanzanian women’s individual situation. Adherence problems to the recommendations are due to lack of economic recourses and stigmatization from the community. In order to improve the adherence of the given recommendations a reduction in stigmatization is needed, through increased knowledge and changes in attitudes.

There is limited study of the prevalence of childhood obesity and being overweight in 6 to 9 year old children living in Saskatchewan and Canada using the international standards and measured data. Limited data exists of the prevalence of obesity in rural and small urban communities. In 2000, a cross-sectional survey of children was conducted that primarily assessed the respiratory health of children in two southern Saskatchewan communities. Anthropometric measurements (height and weight) as well as child and familial data were available for 1241 children ages 6 to 9 years. Using data from this study and applying international standards for obesity and overweight developed by Cole and colleagues (2000) an analysis was undertaken to describe and compare the prevalence of overweight and obesity between communities and identify associated risk factors. Although the mean body mass index (BMI) differed statistically between communities, no differences in overweight and obesity were identified once the international standards were applied. The overall prevalence was 19.2% for being overweight and 5.2% for obesity. More girls than boys were overweight and obese at age 9. After adjusting for age, sex and community, maternal smoking during pregnancy and current gastrointestinal symptoms of nausea and/or diarrhea were associated with overweight and obesity. Lower physical activity in free time was associated with being overweight as a child. Children who were not consistently participating in physical education and sports in school were more likely to be overweight and obese. This research provides important new information regarding the prevalence and associated risk factors for overweight and obesity in school aged children in Saskatchewan. Although results concur with international prevalence rates of childhood obesity, children in this study were not as overweight or obese as previously reported data has shown for similar Canadian populations. Less physical activity, both in school and at home, may be important for the development and continuation of childhood obesity. Further research is necessary to explore reasons why obese and overweight children are experiencing significant digestive related health concerns.