published_or_final_version / Public Health / Master / Master of Public Health

Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

Text in English / This study aimed at exploring Barriers to compliance with exclusive breastfeeding and timely introduction of complementary feeding practices in Ofla District, Tigray Region in Ethiopia. A quantitative exploratory descriptive study was conducted to explore and describe the barriers that restrict mothers /caregivers to comply with exclusive breast feeding practice until six months and with introduction of solid, semi-solid and soft foods at six months in Ofla District. Data were collected using structured questionnaire, from a total of 112 samples of which 75 mothers and care givers with children aged 0-5 months and 38 children aged 6-8 months participated. The data were entered into a computer and analysed though the Statistical Package for Social Sciences (SPSS) software. The findings revealed that there are barriers related Doer mothers and Non-Doer mothers perceived susceptibility, perceived severity, perceived benefits, perceived barriers, perceived self-efficacy, cues for actions, perceived social acceptability and positive and negative attitudes towards exclusive breastfeeding and initiation of complementary feeding. On the other hand, the participant’s perception of both groups with regard to perception of Divine (God’s) Will on two child feeding practices was insignificantly the same. Both groups perceived that children could get sometimes malnourished because of spiritual or supernatural causes. / Health Studies / M.A. (Public Health)

Ghana subscribed to the global target of reaching at least 50% of exclusive breastfeeding in the first six months of birth by the year 2030. Policies and programmes to promote exclusive breastfeeding have been formulated and implemented in the country. In spite of these efforts, existing evidence showed that the rate of exclusive breastfeeding in the first six months post-delivery has been declining over the past decade. It was therefore important to understand behavioural factors that influence exclusive breastfeeding among teenage-mothers and propose a behavioural conceptual model based on the understanding of exclusive breastfeeding from the perspective of the teenage-mothers and their social environments. The study was conducted in three phases using multistrand mixed methods within the pragmatism philosophical framework. The Theory of Planned Behaviour and the six steps framework for developing models to address public health issues were used as frameworks in the study. In the first phase, the researcher used qualitative exploratory descriptive design to gain an understanding of the behavioural determinants of exclusive breastfeeding from the perspective of teenagers aged between 13 - 19 years attending antenatal care services at public facilities. Data were generated through focus group discussions and analysed using Group-level thematic and content analysis. In the second phase, longitudinal descriptive correlational designs were used to establish the relationships between the exclusive breastfeeding intentions during the prenatal period and actual breastfeeding practices at six months post-delivery. Structured questionnaires were used to collect data during the last visit of antenatal care visits and six months post-delivery. Data generated were analysed through descriptive inferential statistics. In the last phase, the researcher used meta-inferences to identify the key concepts of conceptual model from the integrated qualitative and quantitative results. Theoretical triangulations were used to define and establish relationships between the concepts and to structure the conceptual model. The integrated results of the two phases of the study showed that exclusive breastfeeding practices among teenage-mothers within the social context of Ghana are determined by certain personal and social related behavioural factors. The approval of the exclusive breastfeeding practice by the teenagers’ mothers and nurses/midwives’ capabilities to provide effective breastfeeding education were the strongest determinants of exclusive breastfeeding up to six months among teenage-mothers in Ghana. From these results, the researcher proposed an integrated behavioural conceptual model that provides an understanding of exclusive breastfeeding practice and the process of promoting exclusive breastfeeding among teenage-mothers in the social context of Ghana. The findings of this study have implications for public health policy-makers, health services managers, health sciences education and further research. / Health Studies / D. Lit. et Phil. (Health Studies)