Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

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See Afrikaans / Dissertation (M(Communication Pathology))--University of Pretoria, 2005. / Speech-Language Pathology and Audiology / unrestricted

Early deficits in childhood growth and development contribute to long-term problems that can persist into adulthood, including poor psychosocial wellbeing and reduced adult income. According to recent estimates, more than 200 million children worldwide fail to reach their full developmental potential. Underdevelopment is particularly widespread among children in Zambia; approximately 40% of Zambian children under five years of age are stunted due, in large part, to widespread malnutrition. It is a tremendous challenge for the public health care system in the country to address this burden. In this thesis, I investigate the capacity of rural health workers in Southern Province, Zambia to treat acute malnutrition among children under 5 years of age. Data presented in this thesis were collected from several sources. Information regarding current guidelines, trainings for treatment of acute malnutrition and supply chain for supplemental nutritious and ready-to-use therapeutic foods were collected during key informant interviews performed with nutritionists (n=4) and rural health workers (n=5) in Lusaka and Southern Province, Zambia. Nutritionists working within the health care system at the national, provincial and district levels were interviewed, as were rural health workers selected from a sample of health centers. Information on child nutrition was collected using 24-hour food recall questionnaires that were administered to mothers from a sample of households (n=215) in Southern Province. Data were analyzed with qualitative and quantitative methods. Outcomes of interest included the following: capability of rural health workers to address and treat acutely malnourished children; average daily consumption of carbohydrate, protein and fruit containing meals and snacks among infants; maternal perception of child growth and development as compared to other children of the same age; and mothers’ satisfaction with nutrition information and services provided by their local health centers. The first key finding of this study was that only 40% of rural health workers had been trained in the treatment of acute malnutrition within the last five years, while 100% of nutritionists had received training within the last two years. The second key finding was that infants six to 12 month old in the study sample were reported to have low protein and high carbohydrate consumption. On average, children consumed protein 0.75 times per day and carbohydrates 3.24 times per day. The third key finding was that mothers appeared to overestimate the development of their children. Despite the high rate of childhood stunting in the study sample (38%), 76% of mothers felt their child was the same height or taller than other children of the same age and sex, and close to 75% of mothers felt their child learned at the same speed as or quicker than other children of the same age and sex. These findings suggest that there are currently inadequate resources and capabilities within the Zambian health care system to properly manage the high rate of child malnutrition and stunting in the country. In order to have a greater effect on the reduction of stunting in children, efforts to better disseminate resources from the national level to the rural health centers for the treatment of chronic and acute malnutrition should be considered. Necessary resources include better access to trainings for rural health workers, anthropometric tools to measure levels of malnutrition and supplemental nutritious foods or ready-to-use therapeutic foods to treat children who are moderately or severely malnourished should be increased.

Globally, nearly 40% of under-five deaths occur in the first 28 days after birth. Neonatal mortality is concentrated in sub-Saharan Africa and South Asia with an estimated 80% of all neonatal deaths occurring in the two regions. Low quality of care has been associated with poor health outcomes in low-and middle-income countries (LMICs). Low quality of intrapartum care has been shown to be strongly associated with poor newborn outcomes. Improving access to high-quality neonatal care for small and sick newborns is crucial to reducing preventable deaths in the immediate newborn period. Over the last two decades, significant advances have been made in measuring the coverage, quality and equity of maternal health services. However, few studies to-date have explored the quality of care for small and sick newborns in resource-constrained settings. Those studies conducted in low-and middle-income settings demonstrate that in-patient service readiness for small and sick newborns is low. While there have been increasing efforts to develop and standardize metrics for measuring facility readiness for this population, few studies to-date have explored the effective coverage – a term used to denote utilization adjusted for quality – of services for emergency newborn care in such settings. Recommendations for intervention packages for small and sick newborns have largely focused on secondary and tertiary levels of care, leaving the role of community and peripheral facilities under-explored. Central to the agenda of improving the coverage of high-quality services for small and sick newborns is also strengthening the capacity of health workforce that participate in their care. A plethora of training packages and supervision strategies have been tried and tested in LMICs for improving emergency obstetric care with the focus on emergency newborn limited to a few complications. These human resources initiatives have been criticized for being fragmented in implementation. Little is known about the quality of training and supervision for emergency newborn care competencies for the rural health workforce in under-resourced settings. This dissertation is presented in three papers to help evaluate specific components of quality and coverage for the small and sick newborn population in LMICs. Paper one identifies and describes the breadth of strategies used to successfully translate evidence-based community interventions for the management of newborns with possible serious bacterial infections (PSBI), enabling the generation of a common and consistent taxonomy for practitioners and researchers in this domain. Paper two uses quantitative methods to examine the service readiness and effective coverage of services for small and sick newborns at the sub-district and district levels in rural Ghana. Paper three, using a mixed-methods design, assesses health worker perceptions of the quality and gaps in training, supervision and tele-mentoring activities for emergency obstetric and newborn care in rural Ghana.

Includes bibliography. / In this thesis the foundations of affective development are discussed. The context of development is considered to be the relationship between infant and caregiver. The theoretical bases of developmental psychology and the practice of clinical psychology have been drawn on and applied to a model of promotive and preventive work. Affective development may be enhanced by psychologists, and it is therefore important for them to consider promotion of mental health as well as more traditional ways of therapeutic intervention. A survey was done in four infant clinics in Cape Town, and had the aim of establishing whether health care workers in this context were doing anything to promote affective development. There seemed to be minimal intervention in this regard. The second aim of the research section of this thesis addressed the question of whether there might be a place within the clinic structures for educational psychologists. To this end groups of caregivers were set up, and a pilot promotive programme was administered and evaluated over five sessions. In general the response of the mothers was positive. In the final chapter some of the particular strains that are placed on South African families are considered. Finally recommendations and ideas for establishing programmes that seek to promote affective development in contexts other than clinics are discussed.

This study examined practicum students ' beliefs and experiences abo ut developmentally appropriate practice (DAP) prior to a practicum experience and following it. Another goal was to examine differences between the practicum students' majors and their pre- and posttest DAP beliefs and experiences scores. Finally, this investigation sought to determine the differences between practicum students' DAP beliefs and experiences and the amount of time they spent in a practicum setting. A total of 95 students completing a practicum in the Adele and Dale Young Child Development Laboratory in the infant (Group I) or the 2-year-old classroom (Group 2) participated in the study. The students completed the Teacher Beliefs and Praclices Survey: Infan/s and Toddlers, as well as the Teacher Beliefs and Praclices Survey: Jnfanls if they were in Group I, or the Teacher Beliefs and Praclices Survey: Toddlers, if they worked with Group 2. The questionnaire consisted of two sections. The items on the first part were designed to assess the practicum students' beliefs about DAP. The second part of the questionnaire measured practicum students' experiences and activities in the infant or toddler classroom. Findings from the infants and toddlers measure indicate that the practicum students did show a statistically significant increase from pretest to posttest in their DAP beliefs, and a statistically significant decrease in DAP experiences. This might suggest that the students were able to understand the theories and philosophies of DAP; however, interpreting the guidelines of DAP into classroom practice in the short time associated with the practicum was a difficult task. Results also showed a statistically significant difference between practicum students of different majors and their DAP beliefs and experiences prior to the practicum experience as compared to after. Practicum students with majors in family, consumer, and human development with an emphasis in human development showed the greatest increases in their DAP beliefs over time. Students majoring the early childhood education and related majors showed a statistically significant increase in their DAP experiences between pre- and posttest. Finally, analyses to determine the relationship between practicum students' DAP beliefs and experiences and the amount of time they spent in a practicum setting showed that Group I (infants) had a statistically significant increase in DAP belief scores, even though they spent less time in the practicum setting. Group II (toddlers), who spent a longer time in the practicum selling, had a statistically significant increase in DAP experience scores. Implications of these findings for teacher educators and students are presented. Recommendations for future research are also included.

A series of five experiments was conducted to determine whether operant or respondent factors controlled the emission of a particular vocalization ( "Q" ) by human infants 16 to 18 months old. Experiment 1 consisted of a pilot investigation of the effects of an autoshaping procedure on three infants' vocal behavior. All three subjects demonstrated increased emission of the target sound during the CR period. Experiments 2 through 4 attempted to replicate the findings of Experiment 1 under controlled conditions, and failed to do so. Experiment 5a presented infant subjects with a discrete-trial operant procedure (having the identical temporal parameters as the autoshaping procedure used in Experiments 1 through 4) , during which subjects received rewards only after emitting the target sound. All three experimentally naive subjects in this condition emitted the target sounds, and each met an acquisition criterion of 15 successive trials with at least one target response (CR) per trial. Subjects in Experiment 5b were exposed to the autoshaping procedure employed in Experiments 1 through 4; in addition, they were rewarded verbally for emitting the target sound at any time during the session. One of these three subjects increased her rate of target sound emission, but never met the acquisition criterion. The results suggest that vocalizations of subjects in this age range are susceptible to response-reinforcer (operant) manipulations and not to stimulus-stimulus (Pavlovian) associations. This conclusion differs from the findings of previous investigations that used younger infant subjects, suggesting that subject age may be important when conditioning vocalizations. Further research is also recommended to determine the utility of employing autoshaping procedures with humans.

Understanding the adaptational responses and ecocultural niche of the Navajo adolescent mother from her perspective provides a richness of information about a little-studied population . The overall purpose of this study was to explore the ecocultural factors determined to be significant in the decision of a Navajo adolescent mother to remain in high school or drop out of high school. Thirty Navajo adolescent mothers recruited from two small reservation towns in eastern Arizona participated in the study. Navajo adolescent mothers in the study participated in a one and one half hour semistructured accommodations interview, and completed a Family Resource Scale and a Family Support Scale. An assessment tool, the Bayley Scales of Infant Development, was administered to infants and toddlers of Navajo adolescent mothers. Computation of effect sizes determined the magnitude of difference between the two groups. Findings indicated that (a) Navajo adolescent mothers who remained in high school had more family support than those who dropped out of high school, (b) Navajo adolescent mothers who remained in high school had more family resources than those who dropped out of high school, and (c) Navajo adolescent mothers who remained in high school made greater adaptations than those who dropped out of high school. An additional question focused on the relationship between Navajo adolescent mothers' current enrollment in school and the cognitive and motor performance development of their children. Findings indicated that children born to Navajo adolescent mothers in the drop-out group scored higher on both the cognitive and motor performance tests of development than those infants born to the in-school group mothers.

Advances in medical technology have provided the mechanisms for sustaining life in premature and low-birthweight infants, resulting in the survival of more of these infants. Low-birthweight (LBW) and preterm infants are placed at risk by a number of medical complications, including intraventricular hemorrhage (IVH). The outcome of low-birthweight infants with intraventricular hemorrhage has been the subject of a great deal of research and continues to be a much-discussed topic in the medical and psychological communities. As more data become available, it appears that more questions arise concerning the later neuodevelopmental and neuropsychological outcome of these infants. For this reason, research concerning the later status of infants born with intraventricular hemorrhage is needed. The purpose of this study was to determine if there are differences in cognitive and motor functioning among infants with intraventricular hemorrhage (IVH), infants who were low birthweight (LBW), and normal-birthweight (NBW) infants. Forty-four subjects (10 with mild IVH, 9 with severe IVH, 12 LBW, and 13 NBW), who were born between January 1, 1984, and June 1, 1985, and were either patients in the neonatal intensive care unit at University of Utah Medical Center (the IVH and LBW infants) or were residents of the well-baby nursery (the NBW infants) at University of Utah Medical Center, served as the sample population. The subjects were tested at 3 to 4.5 years of age using the Stanford-Binet Intelligence Scales (Fourth Edition) and the motor section of the McCarthy Scales of Children's Abilities. In addition, infant medical data were obtained from medical records, and demographic data were collected including mother's age at time of birth, family income, mother's and father's education level, and birth order of the infant. The MIVH, SIVH, and LBW groups had significantly lower gestational ages and birthweights and significantly more medical complications than did the NBW group. The MIVH and SIVH groups also had significantly lower birthweight and gestational ages than did the LBW group, but approximately equivalent numbers of medical complications. Significant group differences were found only between the MIVH and NBW groups on the McCarthy motor score, with the MIVH group appearing to outperform the NBW group following statistical manipulation with analysis of covariance. No other significant group differences were found. Further research with a larger sample is recommended in order to more fully understand the later outcome following LBW and IVH.