acase@tulane.edu / Community Based Nutrition (CBN) began implementation in Ethiopia in 2009 in four regions with the objective of improving maternal and child nutrition. Among other interven-tions, CBN scaled up behavior change communication (BCC) to promote household practices and behaviors known to be associated with improved child nutrition. Nutrition BCC was pri-marily delivered through a cadre of Voluntary Community Health Workers (VCHWs). Program exposure was measured using household reports of contact with VCHWs for nutrition BCC. This quasi-experimental study used data collected from two rounds of household surveys be-fore and after program implementation. The design of this study used the natural variation in CBN implementation to allow post hoc categorization of communities into high/low program intensity groups. This enabled an evaluation of the differences in nutrition outcomes associated with the different categories of program intensity that were observed in the sample. Community-level program intensity was measured using the percentage of households reporting VCHW exposure in each community, dichotomized into high or low at the sample mean. We found evidence of a scale up in CBN over the two survey rounds: Mean households reporting exposure to a VCHW in the previous six months increased significantly, as did the mean households in communities with high VCHW intensity. The association between selected nutrition behavior outcomes and the program was evaluated using three approaches: (i) an examination of the association between cluster change in the outcomes and community intensity of Volunteer Community Health Workers (VCHWs); (ii) examination of the association be-tween individual-level outcomes and community intensity of VCHWs; and (iii) examination of the association between the outcomes behaviors and household exposure to VCHWs. We found plausible evidence that CBN scale up was associated with greater dietary di-versity and more women eating the same or more in pregnancy. We also found that living in a higher VCHW intensity community or having exposure to VCHWs was associated with more women receiving IFA in pregnancy, but that this association was not modified by the survey round. We did not find consistent evidence that that the increases in VCHW intensity or expo-sure were associated with improvements in colostrum, hand washing, or minimum meal frequency. These results imply that community-based programs of this intensity can bring about change in nutrition behaviors linked to improved nutrition. / 1 / Lisa Saldanha

INTRODUCTION/BACKGROUND UNICEF introduced a community infant and young child feeding (cIYCF) training and counselling package in 2010, which was implemented in Zimbabwe for community counsellors (CCs) in rural districts. The training package is generic for programming and capacity development on community-based IYCF counselling skills. The implementation includes a set of 15 pre/post-test questions on different aspects of IYCF practices. No analysis of the training pre- and post-tests for the package has been documented in literature. The main aim of the research was therefore to analyse training records on the training in Zimbabwe and identify specific IYCF practices that might require additional attention. The mini-dissertation presents recommendations for the Ministry of Health and Child Care/Welfare Zimbabwe for possible follow up. METHODS The study used a quasi-experimental design. We retrieved pre- and post-test training records on the 15 questions from 19 districts where training had been conducted from the Zimbabwe National Nutrition Department of the Ministry of Health and Child Care/Welfare. Fifteen districts were included for the educational material case-study experience presented in manuscript 1, while 13 districts satisfied the inclusion criteria for the in-depth analysis in manuscript 2. SPSS (version 17.1) was used to do a t-test mean comparison of the proportions of CCs giving correct responses before and after training. ANOVA was used to compare changes in proportions of correct responses from pre- to post-training by district and province. Post hoc analysis was done to determine where differences lay. A p value of < 0.05 was accepted for statistical significance. Graphical trends of proportions of CCs giving correct responses pre- and post-training for individual questions by district were generated and presented in manuscript 2. RESULTS The training package is valuable in taking IYCF training to community level. In manuscript 1, a total of 966 CCs evaluated the training. Ninety-one per cent of CCs evaluated all the training components on average as good, while 0.2% evaluated them as unsatisfactory. In manuscript 2, we used 88% of the retrieved data for analysis. ANOVA results of the percentage change in CCs giving correct responses pre- to post-test by district were not significant (p>.05) for all the questions except question 8 on milk production and the baby’s suckling stimulus. The mean comparison t-test of proportions (pre- and post-test) was significant for all 15 questions (p<.05). Three different trends were observed in the proportions of CCs giving correct responses to different questions. CONCLUSION Our results demonstrate the value of analysing the records of the pre- and post-training test training package to inform follow-up on aspects needing additional attention. The different trends in proportions of CCs giving correct responses have implications for the knowledge base on specific IYCF practices in the communities served by the CCs. We recommend analysis of similar training records where such training is planned or has taken place to inform the implementation process. For Zimbabwe we recommend follow-up of the CCs with training to address the issues raised in our findings. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

INTRODUCTION/BACKGROUND UNICEF introduced a community infant and young child feeding (cIYCF) training and counselling package in 2010, which was implemented in Zimbabwe for community counsellors (CCs) in rural districts. The training package is generic for programming and capacity development on community-based IYCF counselling skills. The implementation includes a set of 15 pre/post-test questions on different aspects of IYCF practices. No analysis of the training pre- and post-tests for the package has been documented in literature. The main aim of the research was therefore to analyse training records on the training in Zimbabwe and identify specific IYCF practices that might require additional attention. The mini-dissertation presents recommendations for the Ministry of Health and Child Care/Welfare Zimbabwe for possible follow up. METHODS The study used a quasi-experimental design. We retrieved pre- and post-test training records on the 15 questions from 19 districts where training had been conducted from the Zimbabwe National Nutrition Department of the Ministry of Health and Child Care/Welfare. Fifteen districts were included for the educational material case-study experience presented in manuscript 1, while 13 districts satisfied the inclusion criteria for the in-depth analysis in manuscript 2. SPSS (version 17.1) was used to do a t-test mean comparison of the proportions of CCs giving correct responses before and after training. ANOVA was used to compare changes in proportions of correct responses from pre- to post-training by district and province. Post hoc analysis was done to determine where differences lay. A p value of < 0.05 was accepted for statistical significance. Graphical trends of proportions of CCs giving correct responses pre- and post-training for individual questions by district were generated and presented in manuscript 2. RESULTS The training package is valuable in taking IYCF training to community level. In manuscript 1, a total of 966 CCs evaluated the training. Ninety-one per cent of CCs evaluated all the training components on average as good, while 0.2% evaluated them as unsatisfactory. In manuscript 2, we used 88% of the retrieved data for analysis. ANOVA results of the percentage change in CCs giving correct responses pre- to post-test by district were not significant (p>.05) for all the questions except question 8 on milk production and the baby’s suckling stimulus. The mean comparison t-test of proportions (pre- and post-test) was significant for all 15 questions (p<.05). Three different trends were observed in the proportions of CCs giving correct responses to different questions. CONCLUSION Our results demonstrate the value of analysing the records of the pre- and post-training test training package to inform follow-up on aspects needing additional attention. The different trends in proportions of CCs giving correct responses have implications for the knowledge base on specific IYCF practices in the communities served by the CCs. We recommend analysis of similar training records where such training is planned or has taken place to inform the implementation process. For Zimbabwe we recommend follow-up of the CCs with training to address the issues raised in our findings. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Introduction: Adequate nutrition knowledge, positive attitudes and perceptions, and good practices of parents on infant and young child feeding (IYCF), among others, are essential for the optimal growth of children. Hence, the involvement of both parents in IYCF is essential. Aim: To explore and describe the involvement of both biological parents and caregivers in IYCF in Mzimba-north district, Malawi by assessing their nutrition knowledge, attitudes, perceptions and practices, and identifying the factors that affected their involvement. Study design: A cross sectional descriptive study employing quantitative and qualitative research methodologies. Setting: Five agriculture extension planning areas in Mzimba-north district, Malawi. Sampling technique: Stratified random sampling in the quantitative domain and purposive sampling in the qualitative domain. Sample: Quantitative domain: Households [mothers (n = 154) and fathers (n = 127)] with children aged zero to 24 months and caregivers (n = 4) where the biological parents were absent. Qualitative domain: A different sample of fathers (n = 41), mothers (n = 53) and local leaders (n = 3). Methodology: Quantitative domain: Participants were stratified into three groups based on the age of their children, i.e. <six months, six to 12 and >12 to 24 months. Data were collected using modified FAO nutrition knowledge, attitudes and practices (KAP) questionnaires. Data were analysed using Stata version 14.0 and Microsoft Excel 2013 version. The Chi-square, Fisher’s exact and McNemar's tests were used to compare the nutrition KAP between males and females. Testing was done at 0.05 significance level. Qualitative domain: Eleven focus group discussions (FGDs): five with males and six with females, and three in-depth interviews with three local leaders were conducted using three interview guides (one for each group). Creswell’s method of data analysis was used to identify themes and sub-themes. Ethical approval was obtained from the Ethics Committee, Faculty of Natural and Agricultural Sciences, University of Pretoria (Ref no EC151204-26) and the Ministry of Agriculture, Mzuzu Agriculture Development Division, Malawi. Results: Quantitative domain: More than half of the participants knew the recommended IYCF practices. More than 80% of the participants showed positive attitudes on the appropriate IYCF practices. No significant differences were observed between the male and female participants’ mean knowledge scores and their responses on the attitude statements (P > 0.05). All participants with children <six months reported having their children breastfed both during the previous day and night. Half of the children <six months were exclusively breastfed. Poor food diversity with low consumption of animal foods was observed for children aged six to 24 months. The majority of the participants reported to have given their children food from only two food groups out of seven food groups. Qualitative domain: The participants identified the roles of mothers, fathers and local leaders in IYCF; mothers had direct roles while fathers and local leaders had supporting roles. The roles and influence of grandmothers on IYCF were also discussed. The participants identified the motivating factors and the factors limiting parental involvement in IYCF, and made recommendations on improving parental involvement in IYCF. Conclusion: Findings from the qualitative study were in support of quantitative study findings. Both parents were involved in IYCF. However, mothers had direct roles while fathers had supporting roles. Good nutrition knowledge, positive attitudes and perceptions, and poor practices on IYCF were reported. Recommendations: Participants in the FGDs made recommendations on improving parental involvement in IYCF. Recommendations are also made for future research and the implementation of IYCF practices in Mzimba-north district, Malawi. / Dissertation (MSc)--University of Pretoria, 2017. / Food Science / MSc / Unrestricted

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The revised Infant and Young Child Feeding Policy (IYCFP) 2013 encourages HIV-positive mothers to also exclusively breastfeed for six months, and to continue breastfeeding for a year with introduction of appropriate complementary feeding, while their children receive antiretroviral treatment. The aim of this study was to determine knowledge and practices of the Primary Health Care Workers (PHCWs) related to the implementation of the revised IYCFP 2013 in the Blouberg Municipality of Capricorn District, Limpopo Province. Methods: A quantitative descriptive study was conducted on 103 PHCWs. The questionnaire was closed ended. The questionnaire was developed based on the contents of the revised IYCFP 2013. A simple random sampling technique was used to sample nurses irrespective of the category. Data were analyzed through SPSS Software v23.0. Results: Most participants were females (91.3%), category were Professional Nurses (44.7%), aged between 31 and 40 years (44.7%) and also mostly worked for >10 years (56.3%). The results revealed that 97.1% of the participants have good knowledge about infant and young child feeding, 68% of participants were not trained on the revised IYCFP 2013, resulting to only 32% of participants having a good practice of this policy. Also 44.7% of the participants reported that they were not aware if clinics had a copy of this policy. The results further revealed that 92.2% of the participants reported that clinics still receive, keep and issue infant formula to HIV positive mothers, which maybe the reason the dieticians still receive requests for Infant Formulas to be delivered to HIV-positive mothers. Conclusion: There is a need for monitoring and evaluation to ensure availability and vi implementation of the revised IYCFP 2013; and also the need for in-service training on this policy in order to improve the capacity to implement the revised IYCFP 2013. Key Concepts Revised IYCFP 2013; knowledge; practice; implementation; PHCWs; infant and young child feeding.

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.

Magister Scientiae (Nutrition Management) - MSc(NM) / The Ministry of Health in Malawi promotes exclusive breastfeeding for the first six months of life and continued breastfeeding with appropriate complementary feeding up to two years or beyond. This policy applies to all children unless there are medical indications. Baby Friendly Hospital Initiative (BFHI) is a strategy that contributes to the attainment of this policy. BFHI is a strategy to increase early and exclusive breast feeding rates among mothers. This study is a pilot to evaluate the success of the BFHI initiative in Malawi.Study design. A cross- sectional cohort study of women and their infants, 0-5 months,attending BFHI and non-BFHI accredited health facilities in Blantyre district of Malawi ] between the period from 28th April to 30th September, 2008 was conducted.Data Collection: An in-depth face-to-face interview using an open-ended structured questionnaire was conducted among 202 mothers of infants within the first week of birth.A convenient sample of 102 mothers was selected from prima gravida mothers at a semiurban BFHI accredited facility while the other 100 were from semi-urban non-BFHI accredited facilities. This sample was used for the descriptive component of the study.From the 202 mothers, 30 from the BFHI and 30 from the non-BFHI Accredited health facility(s) were selected randomly as the sample for the longitudinal cohort of the study at 3 and 5 months respectively.Analysis of results: Data was analyzed using SPSS for Windows. Frequencies were tallied for categorical variables and mean standard deviations were computed for continuous variables. Chi-square p-values with health facility type as classification were computed to determine the difference between BFHI and non-BFHI accredited health facility groups for all relevant variables.Results Exclusive breastfeeding rates differed significantly (p- value, 0.0000) within one week after birth (99% for the BFHI versus 68% for the non-BFHI facilities).Thirty percent of the mothers from the BFHI accredited health facility practiced exclusive breastfeeding up to 5 months as compared to none of the mothers in non-BFHI accredited health facilities.All 202 mothers had ever breast feed in both facilities throughout the 5 months study period.Mothers and mothers-in-law were the significant source of complementing breast milk before 6 months of age,[ 25% more influence of mothers and mothers in-law in the non-BFHI accredited facility when compared to BFHI accredited facility].Conclusion:The BFHI strategy has the potential to successfully influence mothers to adhere to global and national recommendations on optimal breastfeeding practices. Special efforts should be made to continue support of and provide information to new mothers during the first week after delivery and unto few months after birth as mothers seem to introduce complementary foods early and prior to the recommended period of 6 months.

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<p>&nbsp / </p> <p align="left">This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. <b><font face="Times New Roman">Objectives: </font></b><font face="Times New Roman">To describe the demographic characteristics of the study population / Toexplore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines / &nbsp / To establish the nurse counselors&rsquo / perspectives on the infant feeding policy and guidelines for HIV positive mothers / To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers.</font></p>

<p>&nbsp / </p> <p align="left">This study explores the challenges faced by nurse counselors in the implementation of HIV and Infant Feeding Policy in Amathole District of the Eastern Cape. <b><font face="Times New Roman">Objectives: </font></b><font face="Times New Roman">To describe the demographic characteristics of the study population / Toexplore the challenges faced by nurse counselors in the implementation of current HIV and infant feeding policy and guidelines / &nbsp / To establish the nurse counselors&rsquo / perspectives on the infant feeding policy and guidelines for HIV positive mothers / To examine the support system available to the nurse counselors who give infant feeding advice to HIV positive mothers.</font></p>