O refluxo gastro-esofágico é considerado fator responsável pela dificuldade alimentar na infância. A ocorrência de experiências negativas como vômitos, regurgitações, muitas vezes associadas a engasgos, esofagite, disfagia, odinofagia, pirose e dor retroesternal geram comportamentos de aversão ou recusa alimentar e desorganizam o processo de deglutição e alimentação. O presente estudo teve por objetivo avaliar a deglutição em crianças com diagnóstico clínico de refluxo gastroesofágico (RGE). Foram selecionadas 37 crianças, com diagnóstico clínico de refluxo gastro-esofágico e refluxo gastro-esofágico associado a queixas de dificuldades alimentares, com idades variando de 7 meses a 3 anos e 1 mês, idade média de 15,35 meses, sendo 25 (67,6%) do gênero masculino e 12 (32,4%) do gênero feminino. Participaram do grupo controle 15 crianças, saudáveis (estado geral e nutricional), que foram cuidadosamente triadas para assegurar adequado desenvolvimento neuropsicomotor e ausência de sintomas de refluxo gastro-esofágico e problemas respiratórios de repetição, na faixa etária de 6 meses a 3 anos e 2 meses, idade média de 20,5 meses; 9 (60,0%) do gênero feminino e 6 (40,0%) do gênero masculino. Para a avaliação funcional da deglutição foram utilizadas dietas de consistências líquida, pastosa e sólida em volume inicialmente de 5 ml e após em volume livre, habitualmente utilizado pela criança. Na avaliação videofluoroscópica, utilizou-se das dietas de consistências líquida e pastosa, em volume livre para o leite e 5 ml para a dieta pastosa, adicionadas ao contraste de bário. As crianças com refluxo gastro-esofágico apresentaram alterações na avaliação clínica com ingestão menos freqüente de consistência sólida, presença de náusea, recusa alimentar, engasgos e irritabilidade alimentar. Na avaliação objetiva para o alimento de consistência líquida houve penetração laríngea e movimento compensatório de cabeça em extensão, sendo este último também observado para o alimento de consistência pastosa. Entretanto, não houve diferença entre os tempos das fases da deglutição. O estudo permitiu concluir que crianças com RGE apresentam dificuldades relacionadas à aceitação alimentar, porém os tempos da dinâmica orofaríngea da deglutição não se alteram. / Gastroesophageal reflux is considered cause of infants feeding disorder. Negative experience such as vomiting, regurgitation; several times may be associated to choking, dysphagia and painfull swallowing produce aversion or feed refusal and causes a break up in the swallowing and feeding processes. This study evaluated the swallowing process in children with gastroesophageal reflux (GER), confirmed clinically and radiographically. We selected 37 children, with GER and GER complaints of feeding disorders, ages range from 7 months to 37 months, mean age of 15,4 months, consisted 25 males (67,6%) and 12 females (32,4%). The control group (GC) consisted of 15 healthy children (general and nourishing states), carefully chosen for not having any symptoms of GER, repetitive breathing disorders or developmental delays. The ages varied form 6 to 38 months, with mean age of 20,5 months, being 6 males (40%) and 9 females (60%). Swallowing evaluation (functional) considered three diets consistency: liquid, semi-solid and solid, beginning with 5 ml followed by free volume taken habitually by children. Free volume of milk and 5 ml of semi-solid, mixed with barium, were used during the videofluoroscopy. Children with GER presented alteration in clinical evaluations on 64,9% (n=24) and the control group on 13,3% (n=2), swallowing less diet solid diet, presents nausea, feeding refusal, choking and irritation. Videofluoroscopy evaluation for liquids, showed laryngeal penetration on 61,8 % (n =21) , GC 33,3% (n=5), and backward compensatory movement in 64,7% (n=22) e GC 0%, it was similar for the semi-solid diet 41,2% (n=14) e GC (n=0). There was no difference in time of the swallowing phases. This study shows that children with GER present difficulties to accepting feeding although no alteration on the oropharyngeal dynamics timing of swallowing was founded.

The purpose of the study was to identify factors associated with the delay in the initiation of breastfeeding to premature infants before discharge from hospital. The need for this research is evident in the current practice of feeding premature infants after a nasogastric tube is removed. The study sought to provide answers to delayed initiation of breastfeeding to premature infants before discharge from hospital. Fifty members of staff in the Sick Neonate Unit and 50 mothers of premature infants participated in the study. Self-administered data collection instruments were used to collect data from mothers of premature infants and staff of a Sick Neonate Unit in the hospital. The results showed that sociodemographic factors of staff 15 (f=30%) were 31-40 years old, and young nursing staff have decreased knowledge of breastfeeding as compared to senior and older staff members. Maternal demographic factors 36 (f=73.5%) were single and 13 (f=26.5) were married. Married mothers were more likely to breastfeed with the support of the partner than unmarried mothers. Health service factors staff views towards breastfeeding were 11(f=22.0% staff members were neutral about breastfeeding, and Eighteen (f=36.0%) staff members strongly disagreed to other methods of infant feeding. Maternal breastfeeding knowledge was one of the factors under maternal breastfeeding factors because it showed that 48 mothers (f=98.0%) did not have breastfeeding knowledge. Descriptive statistics were used to analyse data. / Health Studies / M.A. (Health Studies)

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)

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)

As intensive care of preterm infants and high-risk infants has evolved, the practice of close physical contact between parents and their infants has been curtailed, with the separation of mothers and their infants more the norm than the exception (Browne, 2004). However, in the past two decades, the physiologic and socio-emotional benefits of close physical contact between parents and their high-risk infants has been revisited, with the practice of Kangaroo Mother Care (skin-to-skin contact) dramatically increasing in neonatal care units worldwide (Browne, 2004). Although research on Kangaroo Mother Care’s effects is plentiful, literature reveals gaps in the research pertaining to the experiences of midwives and nurses in its practice (Chia, 2006 & De Hollanda, 2008). As the role of midwives/nurses has been identified as crucial for Kangaroo Mother Care practice, this gap was recognised, and impelled this research study to be conducted in order to further extend the practice of KMC for its benefits to infants and their families. Due to current staff shortages and poorly resourced neonatal facilities in our local hospitals, local data on midwives’ experiences of Kangaroo Mother Care was perceived to be a vital first step in exploring these experiences. The purpose of this qualitative study was to explore the lived experiences of midwives regarding the Kangaroo Mother Care initiative at a selected tertiary level hospital in the Ethekwini District. Interpretive phenomenology informed this study design, data collection and analysis. As Kangaroo Mother Care is a complex phenomenon, an interpretive paradigm allowed the researcher to access the meaning of participants’ experiences as opposed to explaining their predicted behaviour. Purposive sampling was used by the researcher to select the eight midwives working in the tertiary hospital in the Ethekwini District. The midwives were selected from the neonatal unit during August 2011. Data was collected through a single in-depth interview with each participant in the neonatal unit. The interviews were recorded and later transcribed verbatim to facilitate analysis. Colaizzi’s method of data analysis and representation was utilised. Eleven themes emerged from the analysis of the data. Themes were aligned to the research objectives and included the participants’ experiences of conceptualisations, experiences, hindering and facilitating factors of Kangaroo Mother Care. Conceptualisations were aggregated into two themes pertaining to a physiological concept of KMC and an emotive concept of KMC. The physiological concept regarded the catalytic action of KMC as a promotive agent in health through its effect in increasing average weight gain. Furthermore, KMC was seen as a protective agent in reducing cross-infection and hypothermia. These findings aligned with findings from authors in the literature review. An emotive concept of KMC was revealed by the participants’ input regarding the effect of the skin-to-skin contact in facilitating maternal-infant attachment through bonding. This study finding is supported by current literature. Lived experiences emerged regarding the theme of KMC in maternal instinct and capability, which findings encompassed increased maternal confidence and competence with which several authors concurred. Factors considered as hindering KMC included five themes which emerged as maternal concerns, increased work-load, lack of training, management support and resource scarcity. Contrary to these, facilitators of KMC included the need for motivation and education as well as the provision of a comfortable environment conducive to the practice of Kangaroo Mother Care. A number of recommendations for nursing practice, nursing education, communities and research based on the findings from the study were made available to relevant stakeholders. If implemented effectively, these recommendations may assist in the continued and increasing practice of KMC; resulting in its beneficial effects changing infants’ and families’ lives. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)

MCur / Department of Advanced Nursing Science / See the attached abstract below

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)

Thesis (M. Tech.) - Central University of Technology, Free State, 2010 / Early detection of mother-to-child transfer of Human Immunodeficiency Virus (HIV-1) is of the utmost importance for monitoring the success of intervention strategies, as well as for optimal treatment of HIV-positive children. Serology can only be used confidently after 18 months, as remaining antibodies from the mother may give false positive results. This leaves only molecular methods for early detection of the virus; unfortunately, the technology is still too expensive for general use. The aim of this project was to develop and validate a cost-effective, fast, early detection method for HIV infection in infants. PCR was chosen as the developmental method, a technique that amplifies proviral sequences of HIV DNA, detecting HIV infection in peripheral blood mononuclear cells (PBMC) from infants of seropositive women during neonatal (age less than 28 days) and post-neonatal periods. A method based on the commercial Roche HIV-1 DNA assay was chosen for implementation on the Roche LightCycler instrument. The published primer set was used to detect both HIV-1 DNA and an internal control. The target DNA for use as internal control was constructed from the plasmid pBR322 so that an AT-rich part of the plasmid was flanked by the HIV-1 primer-binding sites. The resulting amplicon was cloned into a vector and multiplied in E. coli. Amplification of the plasmid by PCR in the Roche LightCycler in the presence of SYBR Green created an amplicon having a Tm different (81 ± 1°C ) from that of the HIV-1 amplicon (84 ± 1°C) so that post-amplification melting can be used to differentiate between HIV-1 and internal control. After construction of the internal control, the reaction conditions were optimised so that the internal control would amplify strongly only in the absence of HIV-1 target DNA. Then 50 previously tested patient samples were analysed using the assay developed here. Only half of the known positive samples came up positive in the assay, indicating that it is not sensitive enough for diagnostic use in its current form. Various ways of improving the sensitivity are suggested for further development of the assay as described here.

Thesis (M. Diac. (Spelterapie)) / Die navorser het met hierdie intervensiestudie hanteringsriglyne vanuit ʼn Gestaltperspektief vir ouers met ʼn eiesinnige kleuter ontwikkel. Om bogenoemde te bereik, is slegs die eerste drie fases, asook Stap 1 van Fase 4 van Rothman en Thomas se Design & Development-model voltooi. Fase 1, naamlik die probleemanalise en projekbeplanning, het gefokus op die identifisering en betrek van respondente, die verkryging van toegang tot en samewerking van respondente, ʼn behoeftebepaling van die populasie, die analisering van die geïdentifiseerde probleem en die bepaling van die doelstellings en doelwitte. Deur die bestudering van bestaande literatuur en natuurlike voorbeelde, sowel as die identifisering van funksionele elemente van suksesvolle modelle is Fase 2, naamlik die insameling en sintese van data, suksesvol voltooi. Tydens Fase 3, naamlik die ontwerpfase, is ʼn waarnemingsisteem ontwikkel en prosedures vir die intervensie gespesifiseer. Deur die ontwikkeling van ʼn prototipe is Stap 1 van Fase 4, naamlik vroeë ontwerp en ontwikkeling, voltooi. Gevolgtrekkings en aanbevelings is vanuit die bevindinge gemaak. / Social Work