D.Cur. / The feeding of low birth weight babies remains a challenge. Mother's milk is deficient in protein, calcium, magnesium and phosphate. These elements need to be supplemented in order for the low birth weight baby to grow under optimal conditions. The objective of the study was to compare the growth of the low birth weight baby, who was only fed mothers milk, to the low birth weight babay who was fed mother's milk with a commercial fortifier, using mass, lenght and head circumference as a guide. The literature study has shown that there are different methods which can be used to compliment the deficiencies in mothers's milk, for example: premature milk formula, alternating mother's milk with premature milk formula, additional additives to mother's milk and commercial fortifiers. Previous research of mother's milk fortifiers has shown that the biochemistry has positvely influenced their growth. Six patients were used in the experimental group and received 25% mother's milk and 75% fortifier. The control group consisted of eight babies who only received mother's milk. All the babies met the criteria and reached the 1600 gram weight by the time the study was completed. The Mann Whitney U test was used to calculate the results. No significant statistical growth was seen in any of the areas tested. It was concluded that mother's milk should be fortified, despite the results of the study, as mother's milk is definitely deficient in certain nutrients. It is possible to use mother's milk fortifiers in a stronger consentration.

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The Special Supplemental Food Program for Women, Infants and Children (WIC) is a public health intervention targeted to reach a high risk pregnant population in order to promote beneficial effects on pregnancy outcome. The ultimate goal of this research was to examine the pregnancy outcomes, relative to selected biological, socio-demographic and nutritional risk variables, of pregnant women enrolled in the Virginia WIC Program. The study proposed that duration of WIC participation is associated with improved pregnancy outcomes, including higher infant birth weight, a decrease in low birth weight (LBW) and decreased incidences of prematurity, neonatal mortality and abnormal births. Nutritional and non-nutritional risk variables and birth outcomes were examined in 2,133 pregnant women enrolled in the Virginia WIC Program from December 1, 1984 to September 30, 1985. A WIC Pregnant Women Tracking Form was the designed instrument utilized by staff at health department clinic sites to record the data at time of program entry. Duration of participation in WIC was calculated by weeks and stratified into three groups by months (or trimesters) of participation. Results indicated that this subject population was demographically and nutritionally at higher risk for poor pregnancy outcomes. Stratification by demographic subpopulations showed the most vulnerable may be those prenatal subjects less than 18 years of age, and of black racial/ethnic status. Statistical analyses between the duration of indicated a positive correlation participation, especially when in the WIC Program and pregnancy birth weight, LBW, and birth stratified by trimester, outcome described by complications. It was concluded that for this high risk group of prenatal subjects, increased participation in the WIC Program is associated with enhanced pregnancy outcomes. While these findings suggest that birth weight and birth outcome differences are a function of WIC participation, other related factors may be basis for this causal effect. / M.S.

Abstract: Introduction: Exclusive breastfeeding for the first six months of an infant's life is recommended worldwide. In 1998 the South African Demographic and Health Survey (SADHS) showed that only 10% of mothers exclusively breastfeed at three months. As the HIV virus is transmissible via breast milk, UNAIDS (2002) recommends that women in developing countries should be given a choice of feeding method after being counselled on the risks and benefits of breast feeding versus formula feeding. As a result, the Prevention of Mother-to-Child Transmission (PMTCT) programme was launched in KwaZulu-Natal with the aim of providing interventions to prevent Mother-to-Child Transmission of the HIV virus. However, research has shown that infant feeding practices are influenced by numerous factors. Ultimately mothers will feed their infants in a manner they feel comfortable with, even if it is not always the most appropriate choice. Aim: The aim of this study was to determine and compare current infant feeding practices and some of the factors that influenced these practices among Zulu mothers with 0 - 6 month old infants attending PMTCT and non-PMTCT clinics in Central Durban, KwaZulu-Natal. Methodology: A cross-sectional, descriptive survey was conducted amongst 150 mothers sampled from three non-PMTCT clinics and 150 mothers sampled from three PMTCT clinics. Systematic random sampling of mothers attending the two types of clinics was used to ensure an equal number of mothers· with infants aged 0 - < 6 weeks, 6 - < 14 weeks and 14 weeks to 6 months. The number of mothers interviewed per clinic was determined proportionate to clinic size. Interviews were conducted in Zulu by trained fieldworkers according to a structured interview schedule consisting of 87 open- and closed-ended questions. Summary of most important findings and conclusion: Overall, one quarter of the mothers attending non-PMTCT and one third of mothers at PMTCT clinics were practising exclusive breastfeeding at the time of the survey. The general trend was that mothers attending PMTCT clinics were more inclined than those attending non-PMTCT clinics to breastfeed their infants exclusively (34% versus 24% respectively) or to formula feed (16,7% versus 12,7% respectively). Furthermore, there was a significant decline in exclusive breastfeeding and predominant breastfeeding with increasing infant age in both clinic groups. The opposite held true for mixed feeding and formula feeding in that infants were more inclined to mixed feeding or formula feeding with increasing infant age. In both clinic groups, exclusive breastfeeding was the method of choice in the 0 - < 6 week age category, while a preference for mixed feeding was shown in the 6 - < 14 week category. This trend persisted in the 14 week - < 6 month age category, especially in the non-PMTCT clinics, while there was a small but pronounced increase in formula feeding amongst PMTCT mothers. Although these findings can be explained as a result of implementing the PMTCT programme, the positive trends observed in non-PMTCT clinics serve as an indicator that the Integrated Nutrition Programme (INP) and Baby Friendly Hospital initiative have also had an impact on the feeding choices mothers make. Despite the limited duration of the PMTCT programme at the time of the study, indicators of the impact of the intervention include that a lower percentage of PMTCT mothers introduced foods and/or liquids in addition to breast milk to their infants before six months of age compared to non-PMTCT mothers. Furthermore, more mothers attending PMTCT clinics were shown how to breastfeed and were more likely to have received information about formula feeding. Despite these indicators of a positive impact of the PMTCT programme, the mean age for introducing liquids and/or solids in addition to breast milk was about six weeks and the incidence of this practice was very high for both groups. The similar incidence of formula feeding observed between the two clinic groups suggests the presence of constraints to safe infant feeding choices among mothers attending PMTCT clinics. As observed, infant feeding practices were still not ideal in either of the two clinic groups. However, the high level of antenatal clinic attendance documented for both groups serves as evidence that, if opportunities for providing mothers with appropriate infant feeding advice are utilized optimally, the antenatal clinic could serve as an ideal medium through which infant feeding education can take place, especially as the clinic-based nursing staff were cited as the most important source of infant feeding information by both groups of mothers in the antenatal and postnatal phases. The documented infant feeding practices should be interpreted against the backdrop of factors such as socio-demographic characteristics of the mothers, availability of resources such as social support from peers and significant others and reigning infant feeding beliefs that could influence infant feeding decisions. Predictors of exclusive breastfeeding in PMTCT and non-PMTCT clinics were determined by means of multivariate logistic regression analysis. Significant values were obtained for both clinic groups in terms of the infant not having received liquids in addition to breast milk. No additional predictors were found amongst mothers attending non-PMTCT clinics, however predictors amongst mothers attending PMTCT clinics included whether the mother had not visited the clinic since the infant's birth, whether she practiced demand feeding and whether she was experiencing stress at the time of the study. The limited number of predictors of exclusive breastfeeding documented in this study, especially among non-PMTCT mothers may be explained by the fact that infant feeding behaviour is multifactorial by nature and the interaction between factors that influence feeding choice is strong. / Thesis (M.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.

Thesis (MNutr--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction Malnutrition, in both adults and children, is a problem worldwide with negative health consequences. The World Health Organization (WHO) and Food and Agricultural Organization (FAO) of the United Nations (UN) therefore initiated the implementation of country-specific food-based dietary guidelines (FBDGs) to be used as an educational tool to address nutrition-related health issues. They further suggested consumer testing to evaluate the comprehension and cultural acceptability thereof prior to the release of country-specific FBDGs. Focus group discussions (FGDs) were recommended for consumer testing. Aim The aim of this study was to assess the comprehension and applicability of the 2007 version of the preliminary South African paediatric food-based dietary guidelines (PFBDGs) for healthy infants aged 6–12 months in Soshanguve and Ga-Rankuwa. Specific objectives included qualitative evaluation of exposure to preliminary PFBDGs, participants’ interpretation thereof, cultural acceptability and practical application of the guidelines. Socio-demographic information was collected to determine whether these factors could potentially exert an influence on the comprehension and applicability of the FBDGs. This study could further inform emerging efforts to update public health initiatives to educate mothers/caregivers of infants. Methodology An observational, cross-sectional study design was followed, incorporating both qualitative and quantitative research methods. FGDs were utilised to assess comprehension of the PFBDGs and gather insight into perceptions, attitudes and appropriateness of the PFBDGs. Quantitative data were collected by means of a questionnaire regarding the socio-demographic profiles of participants. Setting This study focused on two small, densely populated towns, Soshanguve and Ga-Rankuwa, in the north western district of Tshwane in the Gauteng province of South Africa. The areas represent relatively low socio-economic communities that include a mix of formal and informal urban setting. Participants Twenty-seven Northern Sotho-speaking mothers and caregivers of infants aged 6–12 months participated in a total of six FGDs. Each FGD was attended by between three and six participants. Results None of the participants had previous exposure to the PFBDGs, although they were familiar with most of the concepts. Guidelines were generally well received and understood, but a few were misinterpreted; particularly those pertaining to “enjoy time with your baby”, “increase your baby’s meals to five times per day” and “teach your baby to drink from a cup”. These needed further explanation and rephrasing by the investigator to improve their comprehensibility. The guideline pertaining to breastfeeding was the most familiar, well accepted and most generally applied. Quantitative results indicated no significant difference between the socio-demographic profiles of participants in Soshanguve and Ga-Rankuwa. Participants’ education level, employment status and housing conditions were considered a good representation of the population. It appears that socio-demographic circumstances may affect exposure to, and interpretation and application of the PFBDGs. Conclusion Many of the adjustments recommended from this research is consistent with the changes incorporated in the recently published revised PFBDGs. Supportive documentation, educational material and health campaigns tailored to specific socio-demographic groups may further enhance the interpretation of the revised guidelines and their exposure to the public, once tested and adopted. / AFRIKAANSE OPSOMMING: Inleiding Wanvoeding onder kinders en volwassenes, is ʼn wêreldwye probleem wat, as dit nie aangespreek word nie, ernstige gesondheidsgevolge kan inhou. Die Wêreldgesondheidsorganisasie (WGO) en die Voedsel-en-landbou-organisasie (VLO) het die implementering van voedselgebaseerde dieetriglyne (VGDR) spesifiek aan elke land geïnisieer sodat dit as opleidingshulpmiddel kan dien om voedselverwante gesondheidsprobleme op te los. Daar is voorgestel dat verbruikers die riglyne in fokusgroepbesprekings (FGBs) evalueer om begrip en die kulturele toepaslikheid van bevolking-spesifieke riglyne te toets voordat dit bekendgestel word. Doel Die doel van die studie was om begrip en die toepassing van die 2007 weergawe van die voorlopige Suid-Afrikaanse pediatriese voedselgebaseerde dieetriglyne (PVGDR) vir gesonde kinders van 6–12 maande te bepaal. Spesifieke doelwitte het kwalitatiewe evaluering ten opsigte van blootstelling, deelnemers se interpretasie, kulturele aanvaarbaarheid en praktiese toepassing van die riglyne ingesluit. Sosiodemografiese inligting is ingesamel om te bepaal of daar ʼn verband bestaan tussen hierdie omstandighede en die begrip en toepassing van PVGDR’s. Hierdie studie kan toekomstige pogings ondersteun om openbare-gesondheidsprogramme by te werk en om moeders en versorgers oor babas in te lig. Ontwerp Die studieontwerp was ’n waarnemende deursnit met kwalitatiewe en kwantitatiewe navorsingsmetodes. FGBs was gebruik om die begrip van die PVGDR’s te bepaal en insigte oor die persepsies, houdings en geskiktheid van die PVGDR’s in te samel. Kwantitatiewe data is ingesamel met ʼn vraelys oor die sosiodemografiese profiele van deelnemers. Omgewing Die studie het gefokus op twee klein, digbevolkte stedelike gebiede, Soshanguve en Ga-Rankuwa in Tshwane, die noord-westelike distrik van die provinsie Gauteng in Suid-Afrika. Die areas verteenwoordig relatief lae sosio-ekonomiese gemeenskappe met ʼn mengsel van formele en informele stedelike nedersettings. Deelnemers Die studiegroep het 27 Noord-Sotho-sprekende moeders en versorgers ingesluit wat aan altesaam 6 FGB’s deelgeneem het. Tussen drie en ses deelnemers het elke FGB bygewoon. Resultate Geen deelnemers was voorheen aan PVGDR’s blootgestel nie, hoewel die meerderheid met meeste van die begrippe bekend was. Die riglyne was oor die algemeen goed aanvaar en verstaanbaar, maar ʼn paar was verkeerd geïnterpreteer; veral “geniet tyd saam met jou baba”, “vermeerder jou baba se maaltye na vyf kere per dag” en “leer jou baba om uit ʼn koppie te drink”. Verduideliking en herformulering was nodig om begrip te verbeter. Die riglyne oor borsvoeding was die bekendste, was die beste aanvaar en was in die algemeen toegepas. Kwantitatiewe resultate het aangedui dat die sosiodemografiese profiel van deelnemers uit Soshanguve en dié uit Ga-Rankuwa nie beduidend verskil nie. Deelnemers se opleidingsvlak, werkloosheidstatus en huislike omstandighede het die populasie goed verteenwoordig. Daar is bevind dat sosiodemografiese omstandighede blootstelling aan en begrip en toepassing van PVGDR’s kan beïnvloed. Gevolgtrekking Baie van die wysigings wat voorgestel is deur hierdie studie, stem ooreen met die verandering wat aangebring is in die onlangs gepubliseerde hersiene PVGDR’s. Ondersteunende dokumente, opvoedkundige materiaal en gesondheidsveldtogte vir spesifieke sosiodemografiese groepe sal die korrekte interpretasie van riglyne asook openbare bewusmaking bevorder. Die riglyne kan, met minimale aanpassings, suksesvol as ʼn voedingsverwante opvoedkundige hulpmiddel in die gemeenskap gebruik word. Baie van hierdie aanpassings is reeds aangebring tydens die ontwikkeling van die veranderde PVGDR’s. Die bevindinge van die studie kan ʼn kernbydrae tot die voorstelle lewer, en aanduidings vir voorstelle vir verdere ontwikkeling en evaluering oplewer.

Background: The health benefits and economic gains of exclusive breastfeeding for the mothers and the new-born are well-documented in the literature as discussed in the background and the rationale for this study. The effectiveness of the social cognitive based interventions in promoting breastfeeding among women in general is also documented. However, there is lack of evidence regarding social-cognitive strategies that could be used to promote exclusive breastfeeding practices among primiparous mothers in Ethiopia means that current exclusive breastfeeding promotion interventions or strategies may not produce the expected outcomes. This assumption seems to be supported by low rate of early initiation of breastfeeding in country (52.1% instead of at least 75% as recommended by WHO) and shorter period of breastfeeding (one month) among mothers in Addis Ababa (CSA and ICF 2012) despite various strategies and interventions that have been implemented. Aims: The study was conducted with the aim of determining the social-cognitive predictors of exclusive breastfeeding among primiparous mothers during the first six months post-delivery with the view of developing social-cognitive strategies to promote exclusive breastfeeding practices among primiparous mothers in Addis Ababa, Ethiopia. Research design and method: The study was carried out within the quantitative positivist paradigm. The study was divided into two phases. The researcher used quantitative longitudinal, descriptive, exploratory and correlational designs to determine the social cognitive predictors of exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia within the first six months post-delivery. The results of the first phase assisted the researcher to design social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers using a Delphi survey. A Delphi survey design was used to assist the researcher to develop the social-cognitive strategies to promote exclusive breastfeeding among primiparous mothers. It consisted of three rounds of mailed self-completion questionnaires. The Delphi was supported with critical review and synthesis of literature throughout the strategies’ development process. Descriptive summary statistics were used to analyse the prenatal breastfeeding behaviour of 141 primiparous mothers followed from the last antenatal care visits up to six months after delivery. Bivariate correlational and multiple logistic regression analyses were used to identify the social cognitive determinants and predictors of exclusive breastfeeding within the first hour post-delivery and six months thereafter. Findings: Positive breastfeeding outcome expectancy and high breastfeeding self-efficacy were identified as the independent social cognitive predictors of exclusive breastfeeding among primiparous mothers in Ethiopia. These predictors were used to develop social cognitive strategies to promote exclusive breastfeeding, which comprise six main components: (1) scientific evidence for the strategies, (2) the rationale for the strategies, (3) the aim of the strategies, (4) the scope of the strategies, (5) the guiding principles, and (6) the key results areas. These strategies were developed and validated with the inputs from 37 experts on breastfeeding and social cognitive theory. Two key results areas (build individual capacity for exclusive breastfeeding and create an enabling environment) and five strategic objectives were formulated and validated. Conclusions: The successful implementation of the social cognitive strategies to promote exclusive breastfeeding among primiparous mothers in Addis Ababa, Ethiopia as described above will require among others (1) in-service training on social cognitive skills for healthcare providers with focus on how to build self-efficacy and outcome expectancy, (2) the development of self-efficacy and outcome expectance assessments tools relevant to the Ethiopian context, and (3) additional support and resources from the healthcare managers. Recommendations: To the researcher recommend that programs aimed at promoting exclusive breastfeeding practices among primiparous mothers should be based on the combined attributes of positive social cognitive outcome expectance and high breastfeeding self-efficacy. Further research is needed to develop assessment tools for breastfeeding self-efficacy and outcome expectancy before the implementation of the proposed strategies. / Health Studies / D. Litt. et Phil. (Health Studies)

Indiana University-Purdue University Indianapolis (IUPUI) / Objectives: To determine (1) whether prescribed and delivered energy and protein intakes during the first two weeks of life met Ziegler’s estimated requirements for Very Low Birth Weight (VLBW) infants, (2) if actual energy during the first week of life correlated with time to regain birth weight and reach full enteral nutrition (EN) defined as 100 kcal/kg/day, (3) if growth velocity from time to reach full EN to 36 weeks’ postmenstrual age (PMA) met Ziegler’s estimated fetal growth velocity (16 g/kg/day), and (4) growth outcomes at 36 weeks’ PMA. Study design: Observational study of feeding, early nutrition and early growth of 40 VLBW infants ≤ 30 weeks GA at birth in three newborn intensive care units NICUs. Results: During the first week of life, the percentages of prescribed and delivered energy (69% [65 kcal/kg/day]) and protein (89% [3.1 g/kg/day]) were significantly less than theoretical estimated requirements. Delivered intakes were 15% less than prescribed because of numerous interruptions in delivery and medical complications. During the second week, the delivered intakes of energy (90% [86 kcal/kg/day]) and protein (102% [3.5 g/kg/day]) improved although the differences between prescribed and delivered were consistently 15%. Energy but not protein intake during the first week was significantly related to time to reach full EN. Neither energy nor protein intake significantly correlated with days to return to birth weight. The average growth velocity from the age that full EN was attained to 36 weeks’ PMA (15 g/kg/day) was significantly less than the theoretical estimated fetal growth velocity (16 g/kg/day) (p<0.03). A difference of 1 g/kg/day represents a total deficit of 42 - 54 grams over the course of a month. At 36 weeks’ PMA, 53% of the VLBW infants had extrauterine growth restriction, or EUGR (<10th percentile) on the Fenton growth grid and 34% had EUGR on the Lubchenco growth grid. Conclusions: The delivered nutrient intakes were consistently less than 15% of the prescribed intakes. Growth velocity between the age when full EN was achieved and 36 weeks’ PMA was 6.7% lower than Ziegler’s estimate. One-third to one-half of the infants have EUGR at 36 weeks’ PMA.