Introdução: O baixo peso ao nascer (BPN) representa risco crucial para as crianças. Em contrapartida, a amamentação é considerada a estratégia de maior impacto na redução da mortalidade em crianças menores de cinco anos. O aleitamento materno exclusivo (AME) é recomendado até o sexto mês de vida, devendo ser complementado até dois anos de idade ou mais. Crianças com consumo alimentar inadequado desde a infância tendem ao desenvolvimento precoce de sobrepeso e obesidade, além de outras doenças crônicas associadas. Objetivo: Verificar o padrão de aleitamento materno (AM) e as práticas de alimentação complementar de lactentes menores de um ano nascidos com baixo peso e analisar a influência de determinantes individuais e contextuais. Métodos: Estudo transversal com dados de 64 municípios brasileiros (incluindo as capitais e Distrito Federal) que abrangeu 5115 lactentes menores de um ano com BPN da Pesquisa de Prevalência de Aleitamento Materno (PPAM) em Municípios Brasileiros, 2008. O questionário continha questões sobre a prática de AM e sobre o consumo de todos os grupos alimentares nas últimas 24 horas. A tese gerou três manuscritos: 1) Descreve as práticas de aleitamento materno, o consumo de líquidos e alimentos semi-sólidos nas últimas 24 horas e os indicadores de consumo alimentar de lactentes entre seis e 11,9 meses segundo estratos de BPN. 2) Avalia os determinantes individuais e contextuais do AME. 3) Analisa a influência de determinantes individuais e contextual sobre a dieta diversificada e sobre o consumo de alimentos ultraprocessados em lactentes de seis a 11,9 meses com BPN. Nos manuscritos 2 e 3, os determinantes individuais corresponderam às características socioeconômicas (representadas pela proxy escolaridade materna), dos lactentes (idade; sexo), maternas (faixa etária; situação de trabalho; paridade) e aos serviços de saúde (local de acompanhamento ambulatorial). No manuscrito 2 foi incluído também o \'nascimento em Hospital Amigo da Criança (HAC)\'. Os determinantes contextuais corresponderam às características dos municípios, representadas pelas variáveis \'número de Bancos de Leite Humano (BLH) por mil nascidos vivos\' e \'Índice de Desenvolvimento Humano do município\' no manuscrito 2, e \'prevalência estimada de desnutrição infantil\' como proxy de pobreza, no manuscrito 3. Para análise, utilizou-se regressão de Poisson com estrutura multinível e adotou-se nível de significância de 5%. Resultados: Descritos de acordo com cada manuscrito produzido: 1) No estrato de muito BPN o AME até 60 dias e 90 dias foi mais elevado do que nos demais, mas com intervalos de confiança superpostos. A prevalência de AME em menores de seis meses apresentou patamar semelhante nos três estratos de peso ao nascer. A prevalência de AM na primeira hora de vida e o AM foram mais prevalentes entre os nascidos com 2000 a 2499g. Observou-se consumo elevado de alimentos ultraprocessados (AUP) em lactentes de 6|-9 e de 9|-12 meses, sendo esta prevalência maior quanto maior o PN. As prevalências dos indicadores de consumo alimentar estão aquém do recomendado. 2) O AME foi mais prevalente entre lactentes cujas mães tinham de 20 a 35 anos (RP=1,35; IC95%=1,09-1,69), não trabalhavam fora (RP=1,36; IC95%=1,08-1,71) ou estavam em licença maternidade(RP=1,30; IC95%=1,06-1,59); lactentes que nasceram em HAC (RP=1,22; IC95%=1,09-1,37) e que residiam em municípios com maior número de BLH por mil nascidos vivos (RP=1,42; IC95%=1,14-1,76). 3) Aproximadamente 59% dos lactentes consumiram alimentos ultraprocessados, enquanto 29% apresentaram dieta diversificada. Crianças cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,66; IC95%=1,23-2,24), tinham escolaridade superior (RP=1,37; IC95%=1,18-1,60) e trabalhavam fora de casa (RP=1,29; IC95%=1,12-1,49) foram mais propensas a oferecer uma alimentação diversificada. O consumo de alimentos ultraprocessados foi maior entre lactentes cujas mães residiam em municípios com prevalência de desnutrição infantil inferior a 10% (RP=1,17; IC95%=1,04-1,31), eram mais jovens (RP=1,30; IC95%=1,15-1,46) e multíparas (RP=1,16; IC95%=1,03-1,30). Conclusões: A tese evidenciou o efeito independente de estratégias que integram a Política Nacional de Aleitamento Materno. Nascer em HAC, residir em município com maior disponibilidade de BLH e o direito à licença maternidade remunerada exercem influência positiva sobre a prática de AME. Este resultado aponta para a necessidade de expansão da cobertura dessas estratégias com vistas ao cumprimento das metas de AM propostas pela OMS. Foi detectado impacto de fatores individuais e contextuais sobre a qualidade da dieta que demandam o desenvolvimento de estratégias eficazes para aumentar o consumo de alimentos in natura ou minimamente processados e diminuir o consumo de ultraprocessados nesta população vulnerável. / Introduction: Low birth weight (LBW) represents a major risk to children. On the other hand, breastfeeding is recognized as the strategy with the greatest impact on reducing childhood mortality. Thus, exclusive breastfeeding (EBF) is recommended up to the sixth month of the child\'s life and should be complemented up to two years of age or more. Inadequate nutrition during early childhood is associated with early development of overweight, obesity, and other chronic diseases. Objectives: 1) To verify the breastfeeding pattern and complementary feeding practices of infants under one year of age who were born with low weight and, 2) to assess the influence of its individual and contextual determinants. Methods: This cross-sectional analysis included 5,115 infants less than one year of age born with LBW from the Second National Survey of Breastfeeding Prevalence (IIPPAM). The survey evaluated the situation of breastfeeding and complementary feeding in 64 Brazilian municipalities (including capitals and the Federal District). Dietary data was collected using a questionnaire with dichotomous questions about breastfeeding practices and consumption of foods from all food groups in the previous 24 hours. The thesis generated three manuscripts as follows: 1) The first one describes breastfeeding practices, consumption of any liquids (including non-human milk) and semi-solid foods in the last 24 hours, and indicators of young child feeding practices of infants between six and 11.9 months according to birth weight strata. 2) The second manuscript evaluates individual and contextual determinants of exclusive breastfeeding. 3) The third one assesses the influence of individual and contextual factors on dietary diversity and on consumption of ultraprocessed foods in LBW infants between six and 11.9 months of age. The individual-level-factors studied on manuscripts 2 and 3 were: socioeconomic (represented by the proxy maternal education), infants (age, sex), maternal (age range, work situation, parity), and health services (type of outpatient follow-up). The individual-level-factor \'being born in a Baby-Friendly Hospital (BFH)\' was also studied on manuscript 2. The community-level factors studied at the second level in the manuscript 2 included municipalities\' characteristics (number of Human Milk Banks (HMB) per thousand live births in each municipality in 2007, and Human Development Index of the municipality, used as proxy of poverty). The community-level factor studied at the second level in manuscript 3 was municipal prevalence of childhood malnutrition, used as a proxy for poverty. The individualized effect of the study factors on the outcome was evaluated using multilevel Poisson regression analysis. For all manuscripts, a significance level of 5% was adopted. Results: Summary of the findings of each manuscript produced: 1) In the stratum of very LBW, the rates EBF up to 60 and 90 days were higher among very LBW infants compared to others, however with overlapping confidence intervals. The overall prevalence of breastfeeding in infants under six months was similar among the groups. The rates of breastfeeding in the first hour of life and total breastfeeding were both higher among those born with weight between 2000 and 2499g. A high consumption of ultraprocessed foods was observed among infants aged 6|-9 and 9|-12 months, and it was noted that the higher the birth weight the higher was the prevalence of consumption. The prevalence of food groups consumption indicators are below the recommended. 2) EBF was more prevalent among infants born with LBW whose mothers were 20-35 years old, those who did not work outside the home or were on paid maternity leave; those born in a BFH; and those who lived in municipalities with the highest number of HMB per thousand live births. 3) Approximately 59% of infants consumed ultraprocessed foods, while 29% achieved dietary diversity. Mothers with the highest education level, those who worked outside the home, and who lived in municipalities with a prevalence of child malnutrition below 10% were more likely to offer a diverse diet. Consumption of ultra-processed foods was higher among infants whose mothers were younger, multiparous, and who lived in municipalities with a prevalence of child malnutrition below 10%. Conclusions: The thesis augments the evidence that integrated actions of the National Breastfeeding Program already implemented in Brazil - BFH Initiative, Brazilian Network of HMB, and adoption of labor laws for paid maternity leave - are associated with EBF even in the vulnerable population of infants born with LBW. Our results also suggest the need to expand and intensify the coverage of these strategies in order to meet the goals of breastfeeding proposed by the World Health Organization. Our findings also indicate the effects of individual and community-level factors on the dietary quality of this population, suggesting a need for developing effective strategies to increase consumption of unprocessed or minimally processed foods, while decreasing the ultra-processed counterpart for this vulnerable population.

Lietuvoje išimtinai kūdikius iki 6 mėn. žindo tik 25, 7 proc. motinų, o 14 proc. jau nuo 1 gyvenimo mėnesio davė arbatos. Tyrimais yra nustatyta, kad žindymo ir laktacijos valdymo mokymas nėštumo metu, gali prailginti išimtinio žindymo trukmę.Tikslas – nustatyti nėščiųjų mokymo apie žindymo ir laktacijos valdymą įtaką išimtinio žindymo(IŽ) paplitimui, papildomo maitinimo(PM) įvedimo pradžiai bei įvertinti motinų žinias ir pastangas, siekiant spręsti su žindymu susijusias problemas.Uždaviniai: 1. Įvertinti nėščiųjų mokymo apie žindymą įtaką IŽ paplitimui ir trukmei; 2.Įvertinti nėščiųjų mokymo apie žindymą įtaką PM įvedimo pradžiai; 3.Įvertinti išklausiusių ir neišklausiusių mokymo apie žindymą motinų žinias ir pastangas siekiant spręsti su žindymu susijusias problemas; 4. Išsiaiškinti motinų nuostatas apie žindymo trukmę ir veiksnius, galinčius ją įtakoti; 5. Nustatyti motinų požiūrį į personalo pagalbą pradedant žindyti.Tyrimo metodas. Tyrimas buvo atliktas VU Sporto medicinos, reabilitacijos ir slaugos instituto ir RMC bazėje 2006-2008 metais. Naudojant anoniminę anketą-klausimyną buvo apklaustos 50 moterų, auginančios 6-18 mėn. amžiaus vaikus ir išklausiusios prenatalinį žindymo ir laktacijos valdymo pagrindų kursą (poveikio grupė(PG)), ir 50 moterų (kontrolinė grupė(KG)), auginančių tokio paties amžiaus vaikus ir neišklausiusios tokio kurso. Klausimyno pirmoje dalyje buvo siekiama išsiaiškinti moterų žindymo ir papildomo maisto įvedimo praktiką, nuostatas apie sėkmingo... [toliau žr. visą tekstą] / In Lithuania only 25.7% of babies are exclusively breastfed (BF) up to 6 months. Evidence has proved that prenatal teaching on BF and lactation management(LM) can prolong exclusive BF. Objective: to determine the influence of prenatal BF training over the rates of exclusive BF and the initiation of complementary feeding(CF) and to assess the mothers‘ knowledge and efforts in solving BF-related problems. Tasks: 1.Assess the influence of prenatal BF training over the rates and length of exclusive BF. 2. Assess the influence of prenatal BF training over the initiation of CF. 3. Assess the knowledge and efforts in solving BF-related problems by mothers who have undergone and who haven‘t undergone prenatal BF training. 4. Determine mothers‘ attitudes toward the length of BF and the factors influencing this length. 5. Determine mothers’ attitudes toward the personnel’s assistance at the initiation of BF. Methods: The investigation was carried out at the IRSMN at the MF of VU and the NNC in 2006 – 2008. The survey included 50 women raising children aged 6–18 months, having completed a prenatal BF and LM course (“intervention group” IG) and 50 - raising children of the same age but having not completed such course (“control group” CG). The first part of the anonymous questionnaire was aimed at determining the practices of BF and initiating CF, the successful BF factors, the assessment of assistance in BF and trust in nurses in solving BF-related problems; the second - a test aimed at... [to full text]

Motivation Processed complementary food labels should protect and promote optimal breastfeeding and complementary feeding practices, important determinants of child survival, growth and development, and provide information regarding safe and appropriate use. However, there is a lack of formal guidelines from international normative bodies on the appropriate marketing of complementary foods. In recognition of the need for interim guidance, the Maternal, Infant and Young Child Working Group developed the Draft Guide for Marketing Complementary Foods, which provides practical guidance on how the marketing (including labelling) of processed complementary foods and supplements can be informed by the principles of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly (WHA) resolutions in a way that supports optimal infant and young child feeding. Aim The aim of this study was to describe the extent to which the labelling practices (as a sub-set of marketing practices) of processed complementary food sold in South Africa comply with international guidance on the marketing of complementary foods that is fully aligned with the principles of the Code and subsequent relevant WHA resolutions (the Draft Guide for Marketing Complementary Foods). Methods Employing a cross-sectional study design, products were purchased from a sample of 17 retail grocery stores, three wholesale grocery stores, three retail pharmacies and three baby chain stores in the Gauteng, Western Cape and KwaZulu-Natal provinces from June to August 2011. Purchased products were then compared with a master list of complementary food products compiled through desk research, and missing products were identified and purchased. Label information was captured, then blinded and the order of products randomised. The Draft Guide for Marketing Complementary Foods was used to create a checklist with pre-set answers and accompanying criteria against which the captured labelling practices were then analysed. Results One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction, while 32 (20%) labels used phrases implying that the product was suitable for use before six months of age. Thirty-seven (23%) labels used images of infants appearing to be younger than six months. Only 20 (13%) labels carried a message regarding the importance of exclusive breastfeeding for the first six months of life, and none provided a message on the importance of the addition of complementary foods from six months together with continued breastfeeding to two years or beyond. Eight (5%) labels recommended feeding the product in a bottle and two labels (1%) used an image of a feeding bottle. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer’s infant formula. All labels provided label information in an appropriate language, but 102 (64%) labels relegated required label information to small text and were thus not easy to read. Only six (4%) labels failed to provide instructions for safe and appropriate use, while 44 (28%) did not include safety messages in their preparation and use instructions. Ten (6%) labels did not provide storage instructions, and 27 (17%) labels did not provide necessary warnings. Nutrient content claims, nutrient comparative claims, nutrient function/other function claims and reduction of disease risk claims were found on 126 (79%), eight (5%), 117 (73%) and 10 (6%) labels, respectively. Conclusion The labelling practices of processed complementary food labels in South Africa do not fully comply with international guidance on the marketing of complementary foods (the Draft Guide for Marketing Complementary Foods) and so do not sufficiently protect and promote optimal infant and young child feeding practices, revealing much room for improvement. Such guidance must be refined and formalised by international normative bodies and adopted into national legislation to assist manufacturers in ensuring that their complementary food labels meet an accepted standard and contribute towards the safe and appropriate use of processed complementary foods. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

Motivation Processed complementary food labels should protect and promote optimal breastfeeding and complementary feeding practices, important determinants of child survival, growth and development, and provide information regarding safe and appropriate use. However, there is a lack of formal guidelines from international normative bodies on the appropriate marketing of complementary foods. In recognition of the need for interim guidance, the Maternal, Infant and Young Child Working Group developed the Draft Guide for Marketing Complementary Foods, which provides practical guidance on how the marketing (including labelling) of processed complementary foods and supplements can be informed by the principles of the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly (WHA) resolutions in a way that supports optimal infant and young child feeding. Aim The aim of this study was to describe the extent to which the labelling practices (as a sub-set of marketing practices) of processed complementary food sold in South Africa comply with international guidance on the marketing of complementary foods that is fully aligned with the principles of the Code and subsequent relevant WHA resolutions (the Draft Guide for Marketing Complementary Foods). Methods Employing a cross-sectional study design, products were purchased from a sample of 17 retail grocery stores, three wholesale grocery stores, three retail pharmacies and three baby chain stores in the Gauteng, Western Cape and KwaZulu-Natal provinces from June to August 2011. Purchased products were then compared with a master list of complementary food products compiled through desk research, and missing products were identified and purchased. Label information was captured, then blinded and the order of products randomised. The Draft Guide for Marketing Complementary Foods was used to create a checklist with pre-set answers and accompanying criteria against which the captured labelling practices were then analysed. Results One hundred and sixty product labels of 35 manufacturers were analysed, none of which complied with all checklist criteria. Fifty-six (35%) labels did not provide an appropriate age of introduction, while 32 (20%) labels used phrases implying that the product was suitable for use before six months of age. Thirty-seven (23%) labels used images of infants appearing to be younger than six months. Only 20 (13%) labels carried a message regarding the importance of exclusive breastfeeding for the first six months of life, and none provided a message on the importance of the addition of complementary foods from six months together with continued breastfeeding to two years or beyond. Eight (5%) labels recommended feeding the product in a bottle and two labels (1%) used an image of a feeding bottle. Nineteen (12%) labels suggested a daily ration too large for a breastfed child, and 32 (20%) potentially promote the manufacturer’s infant formula. All labels provided label information in an appropriate language, but 102 (64%) labels relegated required label information to small text and were thus not easy to read. Only six (4%) labels failed to provide instructions for safe and appropriate use, while 44 (28%) did not include safety messages in their preparation and use instructions. Ten (6%) labels did not provide storage instructions, and 27 (17%) labels did not provide necessary warnings. Nutrient content claims, nutrient comparative claims, nutrient function/other function claims and reduction of disease risk claims were found on 126 (79%), eight (5%), 117 (73%) and 10 (6%) labels, respectively. Conclusion The labelling practices of processed complementary food labels in South Africa do not fully comply with international guidance on the marketing of complementary foods (the Draft Guide for Marketing Complementary Foods) and so do not sufficiently protect and promote optimal infant and young child feeding practices, revealing much room for improvement. Such guidance must be refined and formalised by international normative bodies and adopted into national legislation to assist manufacturers in ensuring that their complementary food labels meet an accepted standard and contribute towards the safe and appropriate use of processed complementary foods. / Thesis (MSc (Nutrition))--North-West University, Potchefstroom Campus, 2013.

This cross-sectional exploratory and descriptive quantitative study explored the factors that impact on feeding practices of infants 0-12 months, encountered in the Child Welfare Clinic in Tema Manhean Health Centre and to determine the possible factors that lead to malnutrition. The population for this study comprised all infants who attended the Child Welfare Clinic at the Tema Manhean Health Centre. Three hundred and ninety infants participated in this study. Data was collected by means of a structured questionnaire and analysed using the Statistical Package for the Social Sciences (SPSS) Version 20. Findings of the study revealed that a larger number of the mothers were still breastfeeding at the time of data collection. All infants aged six months or older were given complementary foods. Some of the factors found to be associated with infant malnutrition included education of mother, employment status of mother, marital status, cultural practices and parity. / Health Studies / M.A.(Public Health)

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected hospitals in Kabul Province. The results of logistic regression models indicated that mothers' knowledge, attitudes, and practices regarding complementary feeding were statistically significant predictors of stunting in children, Ï?2 (9, N = 306) = 45.33, p < .001; Ï?2 (9, N = 306) = 26.71, p < .01; and Ï?2 (9, N = 306) = 56.97, p < .001 respectively. The strongest predictor was mothers' practicing responsive feeding, where mothers who did not practice responsive feeding were 7.1 times more likely to have stunted children than mothers who practiced responsive feeding. Moreover, the results indicated that mothers' knowledge, attitudes, and practices of complementary feeding were statistically significant predictors of underweight in children, Ï?2 (9, N = 306) = 37.49, p < .001; Ï?2 (9, N = 306) = 41.15, p < .001; and Ï?2 (9, N = 306) = 44.64, p < .001. The implications for positive social change include reviewing nutrition policies, investing in nutrition programs, and operationalizing nutrition education and behavior change interventions for promoting appropriate complementary infant feeding practices in Afghanistan.

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)

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)