Infant and young child feeding (IYCF) has a lifelong influence on health and is critically important during emergencies. Policies and guidance are designed to support IYCF in emergencies (IYCF-E), but are seldom fully implemented. Lebanon has a long history of national emergencies and is currently hosting 1.2 million Syrian refugees. Lebanese infant feeding practices are sub-optimal overall. To respond adequately in emergencies, there is a need to understand how best to address the nutritional needs of vulnerable infants and young children. This single-case study with three-level embedded units of analysis examines policies and programmes on IYCF-E in Lebanon. The study utilised a desk review comprising existing policies and guidance at all levels; a survey questionnaire targeting non-governmental organisations (n=54) (organisational level); semi-structured interviews with 12 stakeholders (central level), and focus groups with health care providers (n=8) and mothers (n=8) (service provision level). Descriptive analyses were used for survey data and thematic analysis for qualitative data. Existing policies were based on international guidance. However, despite notable efforts, these have not been fully implemented, disseminated or enforced at all levels. Policies were not part of a national strategy and IYCF-E was not integrated within national emergency preparedness plans. Programmes at each level lacked the necessary services to support mothers, notably an absence of counselling and support and a reliance on support from international organisations. Barriers include the lack of awareness and prioritisation of recommended IYCF practices and policies, gaps in human and financial resources, operational challenges and the influence of the infant formula industry which have combined to hinder the advancement of adequate IYCF policies and practices. Opportunities include the need to establish, organise, prioritise, and implement IYCF plans that are integrated within health and emergency plans, and disseminated. Any initiative needs to be evaluated and documented through rigorous implementation research.

<p>Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria (&ldquo / Ten Steps to successful Breastfeeding&rdquo / ). South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent&nbsp / to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing&nbsp / nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy.</p>

<p>Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria (&ldquo / Ten Steps to successful Breastfeeding&rdquo / ). South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent&nbsp / to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing&nbsp / nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy.</p>

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2006. / LICL has E-Thesis 0016 ; please contact computer services.

The initiation and duration of exclusive chest/breastfeeding are important health determinants and a key focus of existing public health policy and programs. Despite the demonstrated benefits of chest/breastfeeding and focus on interventions, overall rates of initiation and exclusivity in Ontario remain low. The purpose of this study was to describe how midwifery clients in Ontario - a population credited with high rates of exclusive chest/breastfeeding - access information to support infant feeding decisions. A descriptive, cross-sectional online electronic survey was conducted using the Midwifery Infant Feeding Information Survey questionnaire which was locally developed for this study. A total of 235 midwifery clients who were either in or recently discharged from midwifery care at the time of the survey completed the questionnaire. Data analysis was completed using descriptive statistics with total counts and content analysis for open-ended questions. This research contributes new knowledge about infant feeding information access including the reported usefulness and preferences of various information sources across the continuum of care; the importance of the midwife-client relationship and the online information environment; potential communication gaps in the delivery of comprehensive prenatal infant feeding information; and self-reported infant feeding patterns suggesting midwifery exclusive chest/breastfeeding rates may not be as high as previously thought. Further research to improve information access is needed in order to identify barriers midwives face in discussing infant feeding with clients; explore the effect of health literacy in an online information environment to support the potential development of evidence-based, midwifery-specific online/digital tools. The study findings are relevant for both the academic and clinical midwifery community in developing effective strategies to further support midwifery clients in meeting their infant feeding goals. This study will further inform researchers, public health practitioners, policy makers, and other stakeholders representing all childbearing families in Ontario. / Thesis / Master of Public Health (MPH) / The goal of this study was to examine how midwifery clients in Ontario access information about infant feeding throughout the pregnancy and postpartum period. An online survey of 235 current and former midwifery clients identified why some information sources were more useful than others, and how infant feeding information could become more accessible. The midwife-client relationship and use of online/digital media were identified as important information sources. However, a number of information gaps were identified that suggest not all clients benefit from comprehensive discussions with their midwife in preparation for infant feeding. Further research is needed to understand barriers midwives may face in discussing infant feeding with their clients, and the use of online/digital tools to support midwifery clients to meet their infant feeding goals. The results of this study may benefit all childbearing families in Ontario.

Submitted by IVANA REGINA GONÇALVES null (nanaenf82@hotmail.com) on 2016-12-13T18:58:31Z No. of bitstreams: 1 Tese Ivana Goncalves.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-12-15T14:52:37Z (GMT) No. of bitstreams: 1 goncalves_ir_dr_bot.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5) / Made available in DSpace on 2016-12-15T14:52:37Z (GMT). No. of bitstreams: 1 goncalves_ir_dr_bot.pdf: 2035441 bytes, checksum: e2a1f49f031767147cf4e472de95ceea (MD5) Previous issue date: 2016-11-18 / O programa de uso da imunoglobulina palivizumabe teve início em 2007 no Estado de São Paulo e em 2013 estendeu-se nacionalmente, sendo destinado a crianças com maior risco para a infecção pelo Virus Sincicial Respiratório (VSR). Desde seu início, o programa permanece sem avaliação sistemática. O objetivo dessa pesquisa foi avaliar o programa de uso da imunoglobulina palivizumabe no Estado de São Paulo. Foram avaliados os 16 locais de aplicação: cinco Centros de Referência para Imunobiológicos Especiais (CRIE) e 11 postos de aplicação existentes no Estado de São Paulo, seguindo o referencial de avaliação proposto por Donabedian. Dados de estrutura e processo foram obtidos por entrevista com os responsáveis pela aplicação da imunoglobulina; para avaliação de resultado foram entrevistadas as mães das crianças do programa, visando identificar a associação entre falha na tomada do palivizumabe e a necessidade de hospitalização em Unidade de Terapia Intensiva por doença ou sintomatologia respiratória no período de sazonalidade do VSR. Participaram desta pesquisa 693 crianças/responsáveis (85,1% da população elegível), que ingressaram no programa entre março e agosto de 2014, sendo a coleta de dados realizada entre março e setembro do mesmo ano. Para análise de resultado foi utilizado o odds ratio pontual e intervalar com intervalo de confiança de 95%, considerando-se associações estatisticamente significativas se p < 0,05. Para avaliação de estrutura foram consideradas 30 variáveis relacionadas a condições preconizadas pelas políticas públicas de saúde e para o processo elencaram-se 10 variáveis relativas aos cuidados com a aplicação e conservação da imunoglobulina e sala de aplicação, sendo em ambos os casos o serviço classificado de acordo com o percentual de desconformidade em: adequado (até 10%), parcialmente adequado (de 10 a 20%) e inadequado (superior a 20%). Apenas dois locais de aplicação (P7 e P9), tiveram estrutura e processo considerados adequados. Apesar de terem estrutura classificada como adequada, nove locais tiveram processo parcialmente adequado (C2, C3, C4, P3 e P10) ou inadequado (C1, P2, P5 e P8). As principais falhas de estrutura foram relativas à climatização, disponibilidade de medicamentos e materiais para uso em caso de choque anafilático, sala exclusiva para aplicação de imunobiológicos e protocolo de uso da palivizumabe disponível e, no caso do processo, a não aplicação da imunoglobulina em crianças hospitalizadas, falta de supervisão do médico durante a aplicação, falha na temperatura de conservação do produto e não aplicação no mês anterior à sazonalidade. De acordo com os resultados, pode-se verificar que o risco de hospitalização em Unidade de Terapia Intensiva por doença/sintomatologia respiratória foi diretamente proporcional ao número de falhas (p=0,007; OR=1,29, IC=1,07-1,56). Conclui-se que a avaliação da estrutura do programa de uso da imunoglobulina palivizumabe no Estado de São Paulo é, em geral, mais favorável que o processo. Os resultados evidenciaram aumento médio da chance de internação por doença/sintomatologia respiratória de 29% a cada falha no recebimento das doses. / The palivizumab immunoglobulin health program was introduced in 2007 in São Paulo State and it was initiated nationally in 2013, aiming at being administered to highly risk children for respiratory syncytial virus infections. Since its beginning, such a program has remained with no systematic evaluation. The objetive of the present research was evaluate the palivizumab immunoglobulin health program in São Paulo State. For doing so, 16 places of palivizumab application in São Paulo State were considered: five of which are reference centers for special immunobiologicals and other 11 places of application. The theoretical framework adopted for the evaluation was the one proposed by Donabedian. Structural and processual data on the program was obtained by interviewing each worker responsible for the immunoglobulin in each application place. As for the evaluation of the program outcomes, the childrens mothers/responsible were also interviewed with the aim of identifying the association between palivizumab dose failure and respiratory-related hospitalizations in the seasonality period of respiratory syncytial virus. A total of 693 children/responsibles (85.1% of the eligible individuals) composed the research, all of which made part of the program in the period March-August of 2014, being the data collection performed between March and September of the same year. The data was analysed by the punctual and intervalar odds ratio, with a confidence interval of 95% and a statistical significance fixed at 5%. To the evaluation of program structure, 30 variables preconized by the public health policies were considerated; regarding the program process, 10 variables related to the immunoglobulin care of application and conservation and room of application were considered. Structure and process were both classificated as its nonconformity rate in: adequate (less than 10%), partially adequate (from 10% to 20%) and inadequate (greater than 20%). Only in two of the application places (P7 and P9) structure and process were found to be inadequate. Despite having an adequate structure, in nine places the process was found to be either partially adequate (C2, C3, C4, P3 and P10) or inadequate (C1, P2, P5 and P8). The main structural failures were the ones related to: climate control, availability of materials and medicines used in anaphylactic shock, exclusive room for immunobiological application and palivizumab usage protocol availability and, regarding the process, the absence of application in hospitalized children, absence of medical care during the immunoglobulin administration, inappropriate temperature for immunoglobulin conservation and absence of application prior to the respiratory syncytial virus seasonality. According to the results, the hospitalization risk in intensive care unit due to respiratory disease and related-symptoms was directly proportional to the number of dose failures (p=0.007; OR=1.29, IC=1.07-1.56). As a conclusion for the evalution, the structure of the São Paulo State palivizumab immunoglobulin health program is in general more favorable than the process. As for the results, they an average increasing of 29% in respiratory-related hospitalizations in intensive unit to each dose failure in palivizumab adminstration.

Orientador: Cristina Maria Garcia de Lima Parada Parada / Resumo: O programa de uso da imunoglobulina palivizumabe teve início em 2007 no Estado de São Paulo e em 2013 estendeu-se nacionalmente, sendo destinado a crianças com maior risco para a infecção pelo Virus Sincicial Respiratório (VSR). Desde seu início, o programa permanece sem avaliação sistemática. O objetivo dessa pesquisa foi avaliar o programa de uso da imunoglobulina palivizumabe no Estado de São Paulo. Foram avaliados os 16 locais de aplicação: cinco Centros de Referência para Imunobiológicos Especiais (CRIE) e 11 postos de aplicação existentes no Estado de São Paulo, seguindo o referencial de avaliação proposto por Donabedian. Dados de estrutura e processo foram obtidos por entrevista com os responsáveis pela aplicação da imunoglobulina; para avaliação de resultado foram entrevistadas as mães das crianças do programa, visando identificar a associação entre falha na tomada do palivizumabe e a necessidade de hospitalização em Unidade de Terapia Intensiva por doença ou sintomatologia respiratória no período de sazonalidade do VSR. Participaram desta pesquisa 693 crianças/responsáveis (85,1% da população elegível), que ingressaram no programa entre março e agosto de 2014, sendo a coleta de dados realizada entre março e setembro do mesmo ano. Para análise de resultado foi utilizado o odds ratio pontual e intervalar com intervalo de confiança de 95%, considerando-se associações estatisticamente significativas se p < 0,05. Para avaliação de estrutura foram consideradas 30 variáveis... (Resumo completo, clicar acesso eletrônico abaixo) / Doutor