Background: The government in Taiwan has promoted breastfeeding in recent years yet, exclusive initiation rates and continuation of breastfeeding remain low. Maternal attitudes have been found to be better predictors of infant feeding method during the postpartum period than socio-demographic factors. Understanding maternal attitudes related to infant feeding in Taiwan will support the development of better targeted, more effective health promotion programs aimed at increasing breastfeeding rates. Objectives: To examine maternal attitudes toward breastfeeding and the relationship of these factors to breastfeeding duration at six weeks postpartum. The Iowa Infant Feeding Attitude Scale (IIFAS) was translated into Chinese for this study; a secondary aim of the study was to assess the psychometric properties of the translated tool. Design: A prospective longitudinal study. Setting: A public hospital in Taichung City, Taiwan. Participants: Using convenience sample. 140 in-hospital breastfeeding mothers were recruited in the hospital setting to complete the IIFAS. A total of 120 (86%) completed 3 week follow-up interview and of those who continued to breastfeed 102 women (100%) were contacted at 6 weeks and completed the study protocol. Methods: Following a systematic translation procedure, mothers completed IIFAS questionnaire in the hospital. Then, participating women were contacted by telephone at three weeks and six weeks postpartum to obtain information regarding infant feeding status and duration. Results: Maternal breastfeeding attitudes were the only predictive factor of the breastfeeding duration (p=0.05). The Cronbach’s alpha for internal consistency was 0.73. In-hospital IIFAS scores significantly predicted infant feeding methods at six weeks postpartum. 72.9% (n=102) of the mothers were breastfeeding their infants, of which 37 mothers (26.4%) were exclusively breastfeeding, 65 mothers (46.4%) were partially breastfeeding at three weeks postpartum. These102 breastfeeding mothers were continued to be followed through six weeks postpartum. 62.1% (n=87) were still breastfeeding their infants, of which 34 mothers (24.3%) were exclusively breastfeeding and 53 mothers (37.9%) were partially breastfeeding at six weeks postpartum. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Conclusions: Maternal attitudes were related to breastfeeding duration. This study provides evidence that the translated version of the IIFAS is a valid and reliable tool to assess breastfeeding attitudes among Taiwanese mothers in the population tested. Breastfeeding rates showed that the low rates of exclusive breastfeeding. Health professionals might use this tool to identify mothers at increase risk for not continuing with exclusive breastfeeding and intervention strategies need to be developed to improve rates of successful exclusive breastfeeding.

MPH, Faculty of Health Sciences, University of theWitwatersrand, 2011 / Introduction: In South Africa, over 25% of all babies born each year are exposed to HIV. The high antenatal HIV sero-prevalence rates coupled with high levels of maternal morbidity and mortality advocate for high quality maternal and child health care, which should include resilient PMTCT programs. This study aimed to explore infant feeding practices selected by HIV-positive women enrolled on a PMTCT program and describe some of the reasons for their choices, within the first 6 months postpartum. The study also reports on infant feeding practice and HIV status of the infant. Methodology: The study was a cross-sectional study which was carried out within the Perinatal Research Unit at Chris Hani Baragwanath hospital in Soweto. A sample of 200 women enrolled in the PMTCT program was interviewed, using a semi-structured questionnaire, during April 2007 – June 2007. Results: The study revealed that 84.5% of the study population had received infant feeding counseling. There was a high rate of exclusive formula feeding (EFF=84.5%), with lower exclusive breastfeeding (EBF=14%) and mixed feeding (MF=1.5%) rates. The corresponding HIV transmission rates were EFF – 26% (n=44/169); EBF – 75% (n=21/28); MF – 100% (n=3/3). The study demonstrated that babies born to mothers who did not receive information on infant feeding were twice as likely to be HIV positive (OR=2.43), which was statistically significant. The study also showed that the timing of the counseling was critical – all mothers who received counseling 6 weeks or more after delivery had HIV-positive babies. The overwhelming majority of women (78%) indicated that they would breast feed their babies if they were HIV-negative. Conclusion: The study demonstrated the vital role of infant feeding counseling in antenatal care and PMTCT programs. It illustrated that it was critically important that all HIV-infected women receive infant feeding counseling as soon as possible after the HIV diagnosis is made, prior to delivery and highlighted the importance of reinforcement of infant feeding choice at every antenatal care visit, for every woman. 5 The key recommendations focus on the need for: • Improved Antenatal care for all pregnant women • Improved care for HIV-positive pregnant women • Improvements in infant feeding counseling for HIV positive women • Integration of Maternal, Child health and PMTCT programs • Intensification of ongoing prevention efforts • The need for further research to: o identify some of the reasons HIV positive women choose certain infant feeding modalities throughout the country, and the challenges associated with these; and o critically evaluate the training that health care workers and counselors receive, regarding infant feeding counseling.

Introdução - A alimentação de boa qualidade quando oferecida à criança pequena, determina o pleno desenvolvimento deste indivíduo em todas as fases de sua vida com repercussão para as gerações futuras. Bebês e crianças pequenas dependem inteiramente de seus cuidadores para saber o que, quando e como comer. Objetivo - Caracterizar barreiras e facilitadores na adoção da alimentação complementar em crianças de 6 a 12 meses, sob a ótica de cuidadores. Métodos - Trata-se de um estudo com abordagem qualitativa que utilizou a técnica do grupo focal em dois encontros, o primeiro com mães frequentadoras de uma Unidade Básica de Saúde em um município da região metropolitana de São Paulo e o segundo com mães que frequentam uma clínica de pediatria privada no município de São Paulo. Para abordar as questões de gênero realizou-se entrevistas em profundidade com pais que foram abordados individualmente. O tema central de todos os encontros foi a alimentação complementar das crianças entre 6 e 12 meses, por meio de roteiros previamente estabelecidos. Os relatos foram gravados, rigorosamente transcritos e deles constituíram-se as seguintes categorias de análise: Crenças, opiniões e atitudes; Influências formais e informais sobre as práticas de alimentação complementar; Papel dos Fatores Socioeconômicos e Questões de gênero. Resultados - Os sistemas de crenças familiares afetam as práticas de alimentação das crianças. As influências informais, tais como redes de apoio de familiares e parentes, redes sociais, internet se digladiam e ganham espaço sobre as formais, caracterizadas pelas orientações recebidas pelo pediatra e outros profissionais de saúde. Há uma transformação evidente no papel do pai, que abarca atitudes de compartilhamento e envolvimento com os filhos, porém a divisão de tarefas entre os gêneros é desigual e revela sobrecarga para a mãe. Os dilemas e dúvidas são de toda ordem e independem da realidade sociocultural. Conclusões - Os serviços de saúde pela proximidade que possuem na abordagem da pessoa e das famílias encontram-se numa situação privilegiada para orientar. É necessário, porém, que sejam capazes de providenciar informação e apoio nas questões mais cruciais sobre alimentação complementar de forma clara e com exemplos, instrumentalizados pelo conhecimento do impacto que cada escolha provoca e desta forma motivar os cuidadores a um novo comportamento ou mudança. Que seja incluída orientação com explicação sobre o impacto da parentalidade responsiva. Que as intervenções incluam participação do pai e das avós e que as mensagens, além da mãe, se estendam a ambos e por fim, que a Internet seja utilizada como veículo por fontes confiáveis para a propagação das mensagens sobre alimentação complementar. / Introduction - A good quality diet in young children promotes optimal development during all phases of life and impacts future generations. Babies and young children are reliant on their caregivers to know what, when and how to eat. Objective - To characterize barriers and facilitators for adopting complementary feeding in infants aged 6-12 months, from the perspective of caregivers. Methods - A qualitative study using the focus group technique was conducted. Two meetings were held, the first involved mothers who were users of a Primary Health Unit in a city located in the metropolitan region of São Paulo, whereas the second involved mothers who were clients of a private pediatric clinic in São Paulo city. Gender-specific issues were addressed by holding in-depth interviews with each father separately. The central theme for all meetings was complementary feeding of infants aged 6-12 months using pre-established scripts. Participant narratives were recorded, carefully transcribed, and the following categories of analysis derived from them: Beliefs, opinions and attitudes; Formal and informal influences on complementary feeding practices; Role of Socioeconomic Factors and Gender Issues. Results - The belief systems of family members influence child feeding practices. Informal influences, such as support networks of family members and relatives, social networks and internet increasingly compete with formal influences such as guidance from the pediatrician and other health professionals. There was a clear shift in the role of fathers, encompassing attitudes of sharing and involvement with the children, although the division of tasks between genders was skewed, with mothers overburdened. All manner of dilemmas and doubts emerged, independently of sociocultural situation. Conclusions - Health services, given their proximity to both the individual and families, are best placed to provide guidance. However, they must be able to provide clear information and support on the most crucial issues concerning complementary feeding with examples. This must be supported by knowledge on the impact of each choice, thereby encouraging caregivers to modify behavior or change. Guidance with explanation of the impact of responsive parenting should be included. Interventions should involve fathers and grandmothers, where messages should be directed to both these groups, besides the mother. Lastly, the internet should be used as vehicle by reliable sources of information to communicate messages about complementary feeding.

No primeiro ano de vida, os cuidados com a criança são de importância vital devido ao fenômeno do crescimento/desenvolvimento e sua dependência. Neste contexto, um fator imprescindível dentre suas necessidades básicas é a nutrição. Oferecer à criança alimentos que não o leite materno antes do sexto mês de vida é, em geral, desnecessário e pode deixar a criança mais susceptível a diarréias, infecções respiratórias e desnutrição. Entretanto, a introdução tardia de alimentos não lácteos no esquema alimentar infantil leva ao aparecimento de retardo de crescimento e deficiências nutricionais. O Ministério da Saúde, bem como a OMS, preconizam o aleitamento materno exclusivo até seis meses de idade e a oferta do leite materno até os dois anos. O objetivo deste estudo constituiu analisar o cuidado materno na alimentação das crianças menores que um ano, considerando o perfil da alimentação ofertada pelas mães e a compreensão que estas fazem destes cuidados às crianças. Trata-se de um estudo descritivo e exploratório, baseado em dados quantitativos e qualitativos. É parte de um projeto multicêntrico intitulado Deficiência de ferro em crianças entre 3 a 12 meses: compreensão de determinantes biológicos, sociais, e suas implicações para o incentivo ao aleitamento materno exclusivo. Foi realizado no ambulatório da Unidade Distrital de Saúde Dr. Marco Antônio Sahão, na cidade de Ribeirão Preto-SP e constituído por 122 mães. Os dados foram coletados através de um instrumento adaptado e entrevista após assinatura do Termo de Consentimento Livre e Esclarecido. Os dados quantitativos foram analisados no programa SPSS (versão 11.5), realizando-se uma distribuição simples de freqüência. O conteúdo das entrevistas foi categorizado com base na técnica de análise de conteúdo, modalidade temática. Observou-se que 5,7% recebiam AME, 10,6% estavam em AMP e 47,5% em AM. As demais 44 estavam desmamadas ou nunca mamaram. Das 70 crianças menores de 6 meses, 82,8 % faziam uso de água / chá, 61,4% continha frutas em sua dieta, 32,8 % consumiam legumes, 7,2 % verduras e um pequeno percentual caldo de carne e carne. Quando analisamos as crianças maiores de 6 meses, idade em que se recomenda a introdução da alimentação complementar, identificamos o consumo reduzido de verduras ( 55,8%), de carnes (65,4% ) e feijão (32,7%). Quanto à análise qualitativa, sobre a primeira categoria temática, identificamos os seguintes núcleos de sentido: a criança como centro de atenção; prover a criança de suas necessidades; alimentação como espaço de presença materna. Na segunda categoria temática, o significado os alimentos, depreendemos dois núcleos de sentido: o bom alimento é o que sustenta a criança; o bom alimento é o que tem vitaminas. Na terceira categoria temática, o significado da alimentação, identificou-se quatro núcleos de sentido: faz a criança ficar saudável e se desenvolver; a criança precisa comer muito e de tudo; é uma parte do processo da vida que ela aprende a comer; adaptando a criança à comida da família e a família à comida da criança. Tanto as mulheres como os profissionais de saúde carecem de melhor instrumentalização quanto a alimentação complementar e os guias alimentares que, embora representem um importante instrumento na educação nutricional, requerem adequações que considerem não só as crianças em aleitamento materno mas também as especificidades que ocorrem na alimentação infantil. Importante considerar a mulher como agente do cuidado na alimentação infantil e provê-la de suporte necessário a condução de práticas alimentares que atendam as recomendações para uma alimentação complementar adequada e oportuna. / In the first year of life, the care with child is vital importance due to the phenomenon of growth / development and its dependence. In this context, a vital factor among their basic needs is the nutrition. Offer the child food than breast milk before the sixth month of life is generally unnecessary and can leave the child more susceptible to diarrhea, respiratory infections and malnutrition. However, the late introduction of foods no milk in infant feeding scheme leads to the emergence of growth retardation, and nutritional deficiencies. The Ministry of Health and the OMS recommend exclusive breastfeeding up to 6 months of age and supply of milk up to two years old. The purpose of this study was examining the care of maternal nutrition in children less than one year old, considering the profile of the food offered by mothers and understanding that they do care for these children. This is a descriptive and exploratory study, based on quantitative and qualitative data. It is part of a multicentric project entitled \"Iron deficiency in children between 3 to 12 months: understanding determinants of biological, social and their implications for the encouragement of exclusive breastfeeding\". It was done in the Ambulatory Unit of the District Health Dr. Marco Antonio Sahão in the city of Ribeirão Preto-SP and formed by 122 mothers. The data were collected through an interview and adapted after the signature of the Free and Informed Consent Term. The figures quantitative were analyzed in SPSS (version 11.5), holding up a simple distribution of frequency. The content of the interviews was categorized based on technical analysis of content, thematic way. It was observed that 5.7% received AME, 10.6% were in AMP and 47.5% in AM. The other 44 were weaned or never breastfeeding. Of the 70 children under 6 months, 82.8% were using water / tea, 61.4% contained fruit in their diet, 32,8% consumed vegetables, 7.2% vegetables and a small percentage of meat and meat broth . When we analyses children older than 6 months, age at which recommends the introduction of supplementary feeding, identified the reduced consumption of vegetables (55.8%), meat (65.4%) and beans (32.7%). As for the qualitative analysis on the first thematic category, we identified the following clusters of meaning: the child as the centre of attention, provide the child of their needs; nutrition as an area of maternal presence. In the second thematic category, meaning the food, deduct two clusters of meaning: the good food is what sustains the child, the good food is what has vitamins. In the third thematic category, the meaning of food, there were identified four clusters of meaning: does the child stay healthy and develop, the child needs to eat well and everything, is a part of the process of life she learns to eat; adapting the child to the familys food and the familys food of the child. Both women and health care professionals need further instrumentation on complementary feeding and food guides that while representing an important tool in nutritional education, require adjustments they consider not only children in breastfeeding but also the specific features that occur in food child. Its important to consider the woman as the agent of care in infant feeding and it provides the support needs to the conduct of feeding practices that meet the recommendations for a timely and appropriate complementary feeding.

Made available in DSpace on 2016-03-22T17:27:41Z (GMT). No. of bitstreams: 1 Regina.pdf: 478033 bytes, checksum: 67ff75ed3d915515733eee9e6b7786b5 (MD5) Previous issue date: 2004-12-08 / The mother s milk offers several advantages and benefits for the baby as for the mother and also for the society because it reduces the infant morbidity and mortality especially in developing countries. The period elapsed between the birth and the first breastfed have showed a positive association with high breastfeeding indicatives. The maternal, maternity and newly baby characteristics have influence on the beginning of breastfeeding. This study was carried out to trace the profile of the maternity s patients in Pelotas and to relate the characteristics of the mothers, of the babies and maternities with the beginning of breastfeeding. Were interviewed 2741 mothers. The beginning of the breastfeeding in the first time was inversely associated with: age, maternal education and family income evidencing a dose-response effect. The mothers that had a baby for caesarean section had a twice risk of not breastfeed in the first hour of the baby s life (p < 0.001). To be born at the only hospital of the city that adopted the Baby Friendly Hospital Iniciative increased meaningful the breastfeeding in the first hour / O aleitamento materno oferece inúmeras vantagens e benefícios tanto para o bebê quanto para a mãe e também para a sociedade, uma vez que diminui a morbi-mortalidade infantil, especialmente em países em desenvolvimento. O período decorrido entre o nascimento e a primeira mamada tem mostrado associação positiva com maiores índices de aleitamento assim como com sua maior duração. As características maternas, das maternidades e dos recém-nascidos têm influência sobre o início da amamentação. Este estudo buscou traçar o perfil das pacientes das maternidades de Pelotas e relacionar as características maternas, do bebê e das maternidades com o início da amamentação. Foram entrevistadas 2741 mães. O início da amamentação na primeira hora esteve inversamente associado com: idade, escolaridade materna e renda familiar, evidenciando-se efeito dose-resposta. As mães cujo parto foi cesáreo tiveram um risco cerca de duas vezes maior de não amamentar na primeira hora de vida (p<0,001). Nascer no único hospital da cidade que adotava a Iniciativa Hospital Amigo da Criança aumentou significativamente as chances dos bebês mamarem na primeira hora

Apesar da importância da alimentação saudável, já nos primeiros anos de vida, tem-se observado durante a infância baixo consumo de dieta saudável diversificada, e consumo elevado de alimentos processados, ricos em gordura, sal e açúcar. Entre os determinantes que influenciam os hábitos alimentares das crianças incluem-se a idade materna e a coabitação com as avós maternas. Por isso, o presente estudo teve como objetivo principal avaliar o efeito de intervenção para a promoção do aleitamento materno e da alimentação complementar saudável, junto a mães adolescentes e avós maternas, realizada nos primeiros 4 meses de vida da criança, sobre o cumprimento dos Dez Passos para uma Alimentação Saudável para Crianças Menores de 2 Anos, recomendados pelo Ministério da Saúde, no primeiro ano de vida; e como objetivo secundário avaliar a influência da duração do aleitamento materno exclusivo sobre a qualidade da alimentação da criança aos 12 meses de vida. Para isso, foi realizado ensaio clínico randomizado com 320 mães adolescentes e seus filhos, mais 169 avós maternas quando em coabitação, recrutados na maternidade do Hospital de Clínicas de Porto Alegre e randomicamente alocados para o grupo intervenção ou controle. A intervenção consistiu de seis sessões de aconselhamento em aleitamento materno e alimentação complementar saudável, a primeira na maternidade e as demais no domicílio, aos 7, 15, 30, 60 e 120 dias de vida da criança, por uma equipe composta por um pediatra, duas enfermeiras e uma nutricionista. Em todas as sessões abordou-se a importância da amamentação exclusiva nos primeiros 6 meses de vida e, na última, aos 120 dias, a ênfase foi na alimentação complementar saudável a ser introduzida na idade de 6 meses, com distribuição de livreto com conteúdo baseado nos Dez Passos para a Alimentação Saudável para Crianças Menores de 2 anos. As informações relativas à alimentação da criança foram obtidas mensalmente nos primeiros 6 meses de idade e, depois, a cada 2 meses até a criança completar 12 meses, mediante registro de frequência alimentar semanal, por entrevistadores cegos aos grupos aos quais as mães pertenciam. Para avaliar o cumprimento dos Dez Passos elaborou-se um sistema de escore que pontuou o cumprimento de cada passo: os passos cumpridos integralmente receberam dois pontos, os parcialmente cumpridos um ponto, e os não cumpridos não pontuaram (zero pontos). Considerou-se dieta saudável diversificada o consumo de frutas/hortaliças, carnes, feijões e cereais/tubérculos pelo menos 4 vezes na semana, além de baixo consumo (no máximo 1 vez por semana) de alimentos ricos em gordura, sal e açucares. O teste t de Student foi utilizado para comparar as médias dos escores dos grupos controle e intervenção, e o modelo de regressão multivariada de Poisson com estimação robusta foi utilizado para estimar o efeito da intervenção sobre o cumprimento dos passos. Para medir a associação entre duração do aleitamento materno exclusivo e a qualidade da alimentação da criança aos 12 meses, utilizou-se o modelo de regressão multivariada de Poisson com estimação robusta, adotando-se como ponto de corte a mediana do escore de toda a população estudada. A média dos escores obtidos no grupo intervenção foi maior que no grupo controle (12,4 ± 2,5 versus 10,5 ± 2,3, respectivamente; p = 0,00), sendo que a intervenção dobrou a chance de o escore ser maior ou igual à mediana (RR = 1,93; IC95% 1,44-2,58), e não houve influência da coabitação com a avó materna. Além disso, a intervenção aumentou em mais de 10 pontos percentuais o cumprimento de 6 dos 10 passos (passos 2 a 7), relativos à época de introdução, frequência, consistência e variedade dos alimentos complementares, além da flexibilidade de quem alimenta a criança quanto a horários e atitude frente à recusa dos alimentos. No entanto, a intervenção não afetou um dos passos mais importantes, a saber, o passo 8, que recomenda evitar açúcar, café, enlatados, frituras, refrigerantes, balas, salgadinhos e outras guloseimas. Houve associação entre duração da amamentação exclusiva e dieta diversificada saudável. A probabilidade de a criança consumir dieta mais saudável aos 12 meses de idade aumentou em 28% para cada mês de aleitamento materno exclusivo (RR 1,28; IC 95% 1,19 -1,38). / Despite the importance of healthy eating already in the early years of life, a pattern of low intake of healthy diverse diet and high consumption of processed foods and foods rich in fat, salt, and sugar has been observed during childhood. Maternal age and cohabitation with maternal grandmother are known to be among the factors that influence the dietary habits of children. Therefore, the objective of the present study was to assess the effect of an intervention designed to promote breastfeeding and healthy complementary feeding, directed at adolescent mothers and maternal grandmothers, and performed during the first 4 months of life, on compliance, during the first year of life, with the Ten Steps to Healthy Feeding for Children under Two Years, recommended by the Brazilian Ministry of Health. A secondary objective was to assess the influence of exclusive breastfeeding duration on the quality of the infant's diet at 12 months. In order to do that, a randomized clinical trial was conducted involving 320 adolescent mothers and their infants, plus 169 maternal grandmothers when cohabiting. Participants were recruited at the maternity ward of Hospital de Clínicas de Porto Alegre and randomly assigned to either the intervention or the control group. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding, the first one held at the maternity ward and the others at the mothers’ homes at 7, 15, 30, 60, and 120 days of life, by a team comprising a pediatrician, two nurses, and a nutritionist. All sessions addressed the importance of exclusive breastfeeding in the first 6 months of life; the last session, at 120 days, emphasized healthy complementary feeding, to be introduced as of 6 months of life. A booklet based on the Ten Steps was given to each mother at this session. Infant feeding information was collected monthly over the first 6 months of life and then every 2 months until 12 months, by recording weekly frequency of consumption of different foods. Interviewers were blind to group allocation. Compliance with the Ten Steps was assessed using a scoring system as follows: full compliance with a step received 2 points per step; partial compliance received 1 point; and noncompliance received 0 points (no score). Healthy diverse diet was defined as the intake of fruit/vegetables, meat, beans, and cereals/tubers at least 4 times weekly, and a low intake (maximum once weekly) of foods rich in fat, salt, and sugar. Student's t test was used to compare mean scores obtained in the intervention and control groups, and Poisson's multivariate regression model with robust estimation was used to estimate the effect of the intervention on compliance with the Ten Steps. The association between exclusive breastfeeding duration and quality of the infant's diet at 12 months was also assessed using Poisson's multivariate regression model with robust estimation, using the median score obtained in the whole sample as cut-off point. Mean scores obtained in the intervention group were higher than those obtained in the control group (12.4 ± 2.5 versus 10.5 ± 2.3, respectively; p = 0.00), and the intervention doubled the chance of the score being greater than or equal to the median (RR = 1.93; 95%CI 1.44-2.58). No influence of cohabitation with maternal grandmother was detected. The intervention increased compliance, by over 10 percentage points, with six of the Ten Steps (Steps 2 to 7), related to the time of introduction, frequency, consistency and variety of complementary foods, in addition to caretaker flexibility with regard to feeding times and attitude towards food refusal. Nevertheless, the intervention did not affect one of the most important steps, namely, Step 8, which recommends avoiding the intake of sugar, coffee, canned foods, fried foods, candies, processed snacks and other unhealthy foods. There was an association between exclusive breastfeeding duration and healthy diverse diet. The likelihood of the infant being on a healthy diet at 12 months of age increased by 28% for each additional month of exclusive breastfeeding (RR = 1.28; 95%CI 1.19-1.38).

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.

Breast milk is the optimal source of nourishment for babies, providing positive nutritional and psychosocial benefits for infants' growth and development. Rates for initiation of breastfeeding and exclusive breastfeeding at 6 months in the United States are well below the target rates for the Healthy People 2020 Maternal, Infant, and Children's Health objectives. Using Ajzen's theory of planned behavior, the purpose of this project was to ascertain how knowledge and attitudes influenced a mother's intent to breastfeed during her hospital stay and the likelihood of exclusive breastfeeding continuing after discharge. A convenience sample of 68 postpartum mothers was recruited from women who delivered a viable infant between January and March 2017 at a large urban teaching hospital. Mothers completed the 17-question 5-point Likert scale instrument, the Iowa Infant Feeding Attitude Scale, and demographic information before discharge from the hospital. Mothers who planned to breastfeed and mothers who did not plan to breastfeed scored above the midpoint on the scale; however, women who intended to breastfeed after discharge scored significantly higher (p < .001). Demographic variables were not significant with the exception of education level. Women with higher education levels scored higher on the scale and were more likely to plan to breastfeed after discharge than women with lower levels of education. Findings may promote social change through development and implementation of tailored nursing interventions, such as community prenatal education and clinical reinforcement, which will support initiation of breastfeeding in the hospital setting and exclusivity of breastfeeding upon discharge.

Bakgrund: Helamning är när det nyfödda barnet enbart får bröstmjölk, vitaminer och läkemedel vilket rekommenderas i 6 månader till alla världens mödrar. Amning har många positiva fördelar för både barnet och modern. När amningen inte fungerar bidrar det ofta till negativa känslor av skuld, oro och misslyckande. För att hjälpa mödrarna att få amningen att fungera bedrivs amningsstöd av vårdpersonalen på olika sätt. Amningsstöd beskrivs som en blandning av praktisk hjälp, information och psykiskt stöd. Det har visats att amningsstöd både ökar durationen av helamning och mödrarnas tro på den egna förmågan. Syfte: Syftet är att studera hur amningsstöd upplevs av nyblivna mödrar. Metod: En litteraturstudie baserad på 16 vetenskapliga studier med kvalitativ ansats. De databaser som användes var CINAHL, PubMed och SveMed. Resultat: Utifrån de inkluderade studiernas resultat framkom det att mödrarnas upplevelser av amningsstöd kunde delas in i positiva och negativa upplevelser. De positiva upplevelserna hade att göra med bemötande, ageranden och social miljö som upplevdes stödjande, samt ett adekvat praktiskt stöd och uppföljning efter hemgång. Bekräftelse, uppmuntran, praktiska tips och ett individuellt utformat amningsstöd värderades högt av många mödrar. De negativa upplevelserna handlade om bemötande, information, praktiskt- och känslomässigt stöd som upplevts bristande, samt otillräcklig tid. Motstridiga råd, ett kallt bemötande och för lite tid med personalen var några faktorer som bidrog till en negativ upplevelse. Slutsats: När amningsstödet resulterade i att mödrarna kände sig bekräftade, bra bemötta och bidrog med praktisk kunskap upplevdes det positivt. Amningsstöd som istället bidrog till förvirring och känslor av att inte vara prioriterad eller unik som individ upplevdes som negativt. Resultaten från denna studie kan bidra till utveckling av ett personcentrerat amningsstöd. / Background: Exclusive breastfeeding is when the newborn baby receives only breastmilk, vitamins and medicine in terms of nutrition. This is what is recommended globally, to all women the first six months of their baby’s life. Breastfeeding comes with multiple benefits for both the baby and the mother. Encountering breastfeeding difficulties often results in negative emotions such as guilt, worry and failure. To help these mothers towards successful breastfeeding, different kinds of breastfeeding support are used by health care professionals. Breastfeeding support is described as a mixture of practical help, information and psychological support. Research has shown that breastfeeding support increases both the duration of exclusive breastfeeding and the mothers faith in their own ability to breastfeed. Aim: To study the experiences of new mothers concerning breastfeeding support. Method: A literature review based on sixteen scientific articles with qualitative inquiry. The databases used were CINAHL, PubMed and SveMed. Results: The results of the included articles on the experiences of breastfeeding support could be divided into positive and negative experiences. The positive experiences were related to how the health care workers treated them, acted and the social environment. Also fulfilling practical support and follow-up was considered positive. Factors greatly valued were confirmation, encouragement, practical tips and follow-up after leaving the hospital. The negative experiences described themes of attitudes, information, time and also practical- and emotional support that were all lacking. Factors contributing to negative experiences were conflicting advice, harsh attitudes and not enough time with the health care professionals.   Conclusion: It was received as positive experiences when the breastfeeding support resulted in feelings of confirmation, being well treated and given the practical knowledge the mothers needed. When the support instead resulted in confusion and feelings of not being a priority or a unique individual it became a negative experience. The results of this study can be a foundation for the development of breastfeeding support focusing on every unique mother.

Thesis (MNutr)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Introduction A paucity of data exists regarding growth patterns and nutrition-related problems in infants (<12 months) on antiretroviral treatment (ART) and the infant feeding knowledge, beliefs, attitude and practices of their caregivers. Aim To describe the growth and nutrition-related problems of infants (<12 months) attending the Antiretroviral (ARV) clinic at Red Cross Children’s Hospital, as well as the knowledge, attitudes, beliefs and practices of their caregivers concerning infant feeding. Methods A cross-sectional, descriptive study was conducted with census sampling. Thirty infants and 31 caregivers were included in the sample. Anthropometric measurements were performed and interviewer-administered questionnaires were utilised to obtain the knowledge, attitude, beliefs and practices of the caregivers. The mean Z-score of each measurement as well as the weight-for-age, length-for-age, weight-forlength and bodymass index-for-age for each infant were determined, analysed, interpreted and described according to the World Health Organisation (WHO) growth standards for children. Results Thirty-nine percent (n=11) of the mothers (n=28) did not receive infant feeding counselling prior to delivery, while only 9 (32%) received the minimum number of at least 4 sessions, as prescribed by the Department of Health. It was not assessed whether the counselling occurred before delivery. The mean age of the infants was 6.9 (SD 3.3) months. Eighty-three percent (n=25) had an opportunistic infection prior to data collection. Twenty-three percent (n=7) were underweight-forage and 40% (n=12) of the infants were stunted. Vomiting and diarrhoea were the most common nutrition-related problems experienced. A statistical significant positive correlation (p=0.003) was found between an infant’s duration on ART and W/A z-score. Only two caregivers were breastfeeding at the time of data collection, but 34% (n=10) of the other caregivers had at some stage breastfed their infant. Formula feeding practices were poor. Sixty-two percent (n=18) were not preparing the feeds correctly and only six (21%) were correctly cleaning and sterilising the bottles. Thirty-nine percent (n=11) of the infants were not receiving an adequate amount of milk per day. Sixty-five percent (n=11) of the infants (>six months) did not receive a diet the previous day which met the minimum WHO dietary diversity indicator and only 18% (n=3) received a minimum acceptable diet. Caregivers had an average knowledge concerning infant feeding. Thirteen percent (n=4) knew the correct definition of exclusive breast- or formula feeding. Sixty-eight percent (n=21) did not know what mixed feeding meant, or the dangers associated with it. Most caregivers (n=25, 81%) knew that oral rehydration solution had to be given when infants developed diarrhoea, but only 48% (n=15) knew how to prepare it and only 6% (n=2) knew how to administer it. Seventy-five percent (n=9) of caregivers did not know what should be done when experiencing breast problems. Sixty-four percent (n=19) of the caregivers believed that if a HIV-positive woman breastfeeds she would definitely transmit HIV to her infant. Conclusion The infant sample showed a variety of erratic growth patterns with a high prevalence of underweight and stunting. Infant feeding knowledge of caregivers was average, but not deemed sufficient to translate into appropriate, safe and optimal infant feeding practices. The breastfeeding prevalence was low. Formula preparation, feeding and hygiene practices were poor and dietary intake of infants was not optimal. The quality and quantity of HIV infant feeding counselling sessions received at antenatal clinic visits were poor and need to be addressed. / AFRIKAANSE OPSOMMING: Inleiding Daar is 'n tekort aan data oor groeipatrone en voedingsverwante probleme by babas (<12 maande) op antiretrovirale behandeling asook die babavoedingkennis, -oortuigings, -houdings en -praktyke van hul versorgers. Doelwit Om ondersoek in te stel na die groei- en voedingsverwante probleme by babas (<12 maande) in die antiretrovirale kliniek by Rooikruis-kinderhospitaal, sowel as die babavoedingkennis, - oortuigings, -houdings en -praktyke van hul versorgers. Metodes 'n Beskrywende dwarssnitstudie is met sensussteekproefneming onderneem. Dertig babas en 31 versorgers is by die steekproef ingesluit. Antropometriese metings was gedoen en onderhoude was met behulp van vraelyste gevoer ten einde inligting oor die versorgers se kennis, houdings, oortuigings en praktyke te bekom. Elke baba se gemiddelde z-telling per meting sowel as die gewig-vir-ouderdom, lengte-vir-ouderdom en liggaamsmassa-indeks-vir-ouderdom was volgens die Wêreldgesondheidsorganisasie (WGO) se groeistandaarde vir kindersbepaal, ontleed, vertolk en beskryf. Resultate Altesaam 39% (n=11) van die moeders (n=28) het nie voor die bevalling voorligting oor babavoeding ontvang nie, terwyl slegs 9 (32%) die Departement van Gesondheid se voorgeskrewe minimum 4 sessies, deurloop het. Dit was nie bepaal of hierdie sessies voor die bevalling ontvang was nie. Die gemiddelde ouderdom van die babas was 6,9 (standaardafwyking 3,3) maande. 'n Totaal van 83% (n=25) het voor data-insameling 'n opportunistiese infeksie gehad, 23% (n=7) was ondergewig-vir-ouderdom, en 40% (n=12) van die babas se lengtegroei was ingekort. Die algemeenste voedingsverwante probleme was braking en diarree. Daar blyk 'n statisties beduidende positiewe korrelasie (p=0.003) te wees tussen die duur van die baba se antiretrovirale behandeling en sy/haar gewig-vir-ouderdom-z-telling. Slegs twee versorgers het hul babas ten tyde van die studie geborsvoed, hoewel 34% (n=10) van die versorgers in 'n stadium geborsvoed het. Voedingspraktyke met die gee van melkformule was swak. Altesaam 62% (n=18) het die melkformule verkeerd aangemaak en slegs ses (21%) het die bottels behoorlik skoongemaak en gesteriliseer. Nege-en-dertig persent (n=11) van die babas het te min melk per dag ontvang. Vyf-en-sestig persent (n=11) van die babas (>6 maande) se melkinname die vorige dag het nie aan die minimum WGO aanbevole dieetdiversiteitsaanwyser voldoen nie, en slegs 18% (n=3) het 'n minimum aanvaarbare dieet gevolg. Versorgers se kennis ten opsigte van babavoeding was gemiddeld, met net 13% (n=4) wat die korrekte omskrywing van eksklusiewe bors- of formulevoeding geken het. 'n Totaal van 68% (n=21) het nie geweet wat gemengde voeding beteken of watter gevare dit inhou nie. Die meeste versorgers (n=25, 81%) het geweet dat orale rehidrasie oplossing toegedien moet word wanneer babas aan diarree ly, maar slegs 48% (n=15) het geweet hoe om dit aan te maak en 'n skrale 6% (n=2) hoe om dit toe te dien. Vyf-en-sewentig persent (n=9) van die versorgers het nie geweet wat om te doen as hulle probleme met hul borste ervaar nie. Altesaam 64% (n=19) van die versorgers het geglo dat 'n MIV-positiewe vrou definitief haar baba MIV sal gee indien sy hom/haar sou borsvoed. Samevatting Die steekproef babas het 'n verskeidenheid onreëlmatige groeipatrone getoon en baie was ondergewig of het ook dwerggroei getoon. Versorgers se kennis van babavoeding was gemiddeld, maar nie voldoende om tot toepaslike, veilige en optimale babavoedingspraktyke aanleiding te gee nie. Die voorkoms van borsvoeding was laag. Melkformulevoorbereiding, - voeding en -higiëne was swak, en babas se voedinginname was nie ideaal nie. Die gehalte van en hoeveelheid voorligting oor MIV-babavoeding met besoeke aan voorgeboorteklinieke was swak en moet aangespreek word.