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)

Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013 / Breastfeeding is a major source of childhood nutrition and protection, but with South Africa having one of the highest HIV prevalence in the world the risk of HIV transmission from mother to infant through breastfeeding becomes a major issue. Infant mortality due to malnutrition and infections is also of great concern. Exclusive breastfeeding and giving antiretroviral drugs to the HIV-infected mother and the HIV-exposed infant is one of the most significant ways to improve infant survival rates and reduce transmission of HIV through breastfeeding. Whether HIV disease progression and its metabolic impact on the mother will affect the nutrient composition of breast milk is a question that arises. The aim of this study was to determine the possible association between the stage of HIV disease, as measured by the immunological markers, and the nutrient composition of breast milk. The study population consisted of 60 HIV infected female volunteers who were divided into two groups. Milk and blood samples were obtained from 30 HIV-positive women that was not on any ARV treatment and from 30 HIV-positive women that was on ARV treatment. Their HIV status and treatment regime were obtained from their files. Participants were also asked to complete a questionnaire. Macro-nutrients that were measured included lactose, proteins, fat, total solids and the energy content of the breast milk. This was done on the MIRIS Human milk analyser. The micro-nutrients that were measured were calcium and phosphate on the DXC 800 chemistry analyser. Blood analysis was included to determine the stage of HIV disease progression in the HIV-positive mothers and comprised of a CD4/CD8+ T cell count, viral load and a full blood count. CD4/CD8+ T cells were determined using flowcytometry on the BD FACScalibur. The COBAS AmpliPrep/COBAS TaqMan HIV-1 Test was used for the determination of the viral load and the full blood count was done using a Sysmex XT2000i haematology analyser. When comparing the analysed haematological variables, the white blood cells and red blood cells indicated a significant difference between the two groups. Both of the groups were anaemic. The CD3+ T cell count was higher and the CD4+ T cell count was lower than the reference range in both groups. The median CD4+ T cells and HIV-1 viral load for the HIV with treatment group was higher than the HIV-infected without treatment group. The analyzed milk data yielded no p-value of great significance, suggesting that there was no statistically significant difference recorded of the measured nutrients between mothers receiving treatment and those who did not receive any treatment for HIV. The Spearman Correlation Coefficient was used to determine if HIV disease progression would have an influence on the nutrients that were measured. For the HIV-infected without treatment group, a significant correlation was found between the HIV-1 viral load and percentage total solids in breast milk. For the HIV-infected with treatment group the only positive correlation was between the CD4+ T cell count and the percentage total solids and energy content of the breast milk. No strong positive correlation could be established between the immunological markers of HIV disease progression and the analysed nutrients in the breast milk. Taking this into consideration, HIV-positive mothers can breastfeed their babies even if their HIV status is at a more advance phase, but the emphasis should be placed on exclusive breastfeeding and getting the needed support to breastfeed.

Thesis (M. Tech. (Biomedical technology)) - Central University of technology, Free State, 2013 / Thirty-one years after the discovery and isolation of the human immunodeficiency virus (HIV) by French and American scientists, much progress has been made in basic research, clinical treatment, and public heath prevention. Although, much evidence of mother-to-child-transmission (MTCT) of HIV has been amassed since then, not much of it describes the effects of HIV on the nutrient composition of breast milk. The aim of this study was to determine the effects of HIV on the nutrient composition of breast milk, by studying two groups of adult lactating respondents from the same socio-economic background, who were chosen randomly and participated voluntarily. The study population consisted of 60 breastfeeding mothers, divided into two groups of 30 mothers each. Group one represented the control group of HIV non-infected mothers whereas group two consisted of HIV-infected mothers who did not receive any treatment. After a registered medical nurse took blood and breast milk samples, analysis was done on ethylenediamine tetra-acetic acid (EDTA) whole blood to determine the haematological and immunological parameters and breast milk was analyzed for nutrient composition. Standard laboratory operating procedures (SOP) were followed, throughout, to determine the parameters of the blood and breast milk samples. Results showed that associations between the socio-economic statuses (SES) of the two respondent groups could be established. Albeit differences were not significant, some were, however, detected in the number of people contributing to the household income of the respondents (p = 0.0051), their employment status (p < 0.0001) and the availability of water sources (p = 0.1124). It is believed that factors, such as the prevalence of HIV, if related to the different levels of SES may play an important role in the outcome of the health statuses of individuals at different levels of society. By implication, it is not the different levels of SES, but rather factors related to the different levels of SES that have an impact. Significant differences could be seen in the haematological variables between the two respondent groups: Red blood cell count (RBC) (p < 0.0001), hemoglobin (Hb) levels (p = 0.0119), hematocrit (Hct) (p = 0.0031), mean corpuscular volume (MCV) (p = 0.0005), mean corpuscular hemoglobin (MCH) (p = 0.0043) and monocyte count (p = 0.0275). These differences, however, were not significant to this study. Other differences that were significant were immunological parameters between the two respondent groups: CD4 cell count (p < 0.0001) and viral load, done only on the blood of the HIV-infected respondent group. The CD4 cell count is used as a guideline for the initiation of treatment for HIV-infected persons and is required to accurately assess the immune status of any patient at any given time. The viral load has long been established as a strong predictor of the rate of disease progression. The only significant difference in the breast milk composition was reflected in the following variables between the two groups: percentage (%) proteins (p < 0.0001) and calcium levels (p = 0.0081). The median and mean values of the percentage proteins were elevated in the subject group of mothers living with HIV, while calcium levels in the same group showed a decrease in both median and mean values. The lack of significant differences between the groups might be due to the small study population. If nothing else, this study highlights the need for further trials to evaluate the true effects of HIV on the nutrient composition of breast milk.

To determine the relationship between infant-feeding practices and diarrhoeal infections, a descriptive survey was conducted to infants between six to 12 months of age. A guided interview was conducted to 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results show that breast-feeding is routinely practiced by the majority of mothers and exclusive breast-feeding is very low, but supplementary feed in the form of formula or solids are introduced by the majority of respondents within the first three months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast-feeding should be promoted as an important intervention in the control of diarrhoea / Health Studies / M.A. (Nursing Science)

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction: An association between maternal human immunodeficiency virus (HIV) infection and Necrotizing Enterocolitis (NEC) in preterm infants has been reported. The impact of probiotics in an HIV-exposed very low birth weight (VLBW) infant on the occurrence of NEC is uncertain at present; however it is known that probiotics have protective effects against inflammation and prevent NEC. Postnatal growth restriction is a major issue in preterm, especially extremely-low-birth-weight (ELBW) infants and probiotics have been found to improve feeding tolerance in preterm infants. Human milk oligosaccharides (HMO) also known as the prebiotics of human milk, are known to have bifidogenic and anti-adhesive effects. Infants that receive human milk show a reduced incidence of NEC compared to those who receive infant formula. Very little is known about the composition of breast milk in the HIV-infected mother. Objective: The primary objective of the study was to assess the effect of probiotics on the incidence and severity of NEC in high-risk infants born to HIV-positive and HIV-negative women. The secondary objectives were to assess the effect of probiotic administration on feeding tolerance and growth outcomes of HIV-exposed but uninfected preterm infants, to describe the HMO composition of HIV-infected mothers breast milk and lastly to determine if HMO composition affects the incidence of NEC in HIV-exposed preterm very low birth weight infants. Patients and Methods: A randomized, double blind, placebo controlled trial was conducted for the period July 2011 to August 2012. HIV-exposed and HIV-unexposed premature (<34 weeks gestation) infants with a birth weight of ≥500g and ≤1250g were randomized to receive either a probiotic or a placebo. The probiotic consisted of 1x109 CFU, L. rhamnosus GG and B. infantis per day and was administered for 28 days. NEC was graded according to Bell’s criteria. Anthropometrical parameters and daily intakes were monitored. Breats milk samples were analysed for oligosaccharide content. Results: 74 HIV-exposed and 110 HIV-unexposed infants were enrolled and randomized (mean birth-weight, 987g; mean gestational 28.7 weeks). The incidence of death and NEC did not differ significantly between the HIV-exposed and unexposed groups but a significantly higher NEC incidence was found in the control group. There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z-scores for length and head circumference at day 28 than the unexposed group (p<0.01 and p=0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. Our results show significantly higher absolute concentrations of 2’-fucosyllactose, laco-N-tetraose and lacto-N-fucopentaose 1 and higher relative abundance of 3’-sialyllactose, difucosyl-lacto-N-tetraose and fucosyl-disialyllacto-N-hexaose in HIV-infected compared to -uninfected Secretor women. DSLNT concentrations were significantly lower in the breast milk of mothers whose infants developed NEC compared to infants without NEC. Conclusion: Probiotic supplementation reduced the incidence of NEC in the premature infants; however results failed to show a lower incidence of NEC in HIV-exposed premature infants. Probiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV-exposure. The data confirms previous reports that HIV-infected mothers have higher 3’sialyllactose milk concentrations. Most intriguing though, the data also indicates that low levels of DSLNT in the mother’s milk increase the infant’s risk for NEC, which is in accordance with results from previously published animal studies and warrants further investigation. / AFRIKAANSE OPSOMMING: Inleiding: ʼn Verwantskap tussen moederlike menslike immuniteitsgebreksvirus (MIV) en nekrotiserende enterokolitis (NEK) in premature babas is aangemeld. Die impak van probiotika in ʼn MIV-blootgestelde baie lae geboortemassa (BLGM) baba op die voorkoms van NEK is tans nog onseker, maar dit is wel bekend dat probiotika ʼn beskermende effek het teen inflammasie en die voorkoms van NEK. Nageboortelike groei beperkings is ʼn groot probleem in premature, veral ekstreme lae geboortemassa (ELGM) babas. Daar is gevind dat probiotika voeding toleransie in premature babas kan verbeter. Menslike melk oligosakkariede (MMO), ook bekend as die prebiotika van menslike melk, is bekend om bifidogeniese en anti-kleef effekte te hê. Babas wat moedersmelk ontvang toon ʼn verlaagde voorkoms van NEK in vergelyking met diegene wat baba formule melk ontvang. Baie min inligting is bekend oor die samestelling van borsmelk in die MIV-positiewe moeder. Doel: Die primêre doel van die studie was om die effek van probiotika op die voorkoms en die graad van NEK in hoë risiko babas van MIV-positiewe en MIV-negatiewe vroue te bepaal. Die sekondêre doelwitte was om die effek van probiotika op voeding verdraagsaamheid en groei uitkomste van MIV-blootgestelde, maar nie- geinfekteerde premature babas te evalueer sowel as die MMO samestelling van MIV-positiewe moeders se borsmelk te beskryf en laastens om die invloed van die MMO samestelling op die voorkoms van NEK in baie lae geboortegewig MIV-blootgestelde premature babas te beskryf. Pasiënte en Metodes: ʼn Gerandomiseerde, dubbelblinde, plasebo-beheerde studie is vir die tydperk Julie 2011 tot Augustus 2012 onderneem. MIV-blootgestelde en nie-blootgestelde premature (<34 weke) babas met 'n geboorte gewig van ≥500g en ≤1250g was ewekansig verdeel om probiotika of plasebo te ontvang. Die probiotika het bestaan uit 1x109 kolonie vormende eenhede, L. rhamnosus GG en B. infantis per dag en is toegedien vir 28 dae. NEK is gegradeer volgens Bell se kriteria. Antropometriese parameters en daaglikse inname is gemonitor. Borsmelk monsters is geanaliseer vir oligosakkaried inhoud. Resultate: 74 MIV-blootgestelde en 110 MIV-nie-blootgestelde babas is ingesluit en ewekansig ingedeel (gemiddelde geboorte gewig, 987g, gemiddelde gestasie 28,7 weke). Die voorkoms van die sterftes en NEK het nie beduidend verskil tussen die MIV-blootgestelde en nie-blootgestelde groepe nie, maar 'n beduidende verskil is gevind vir NEK voorkoms tussen die studie en die kontrole groep. Daar was geen verskil in die gemiddelde daaglikse gewigstoename tussen die behandelings groepe of MIV-blootstelling nie. Die MIV-blootgestelde groep het beduidend hoër z-tellings vir lengte en kopomtrek op dag 28 getoon teenoor die nie-blootgestelde groep (p <0.01 en p = 0,03, onderskeidelik). Daar was geen verskille in die voorkoms van voeding onverdraagsaamheid en abdominale distensie tussen die twee groepe nie. Ons resultate dui op aansienlik hoër absolute konsentrasies van 2'-fucosyllactose, laco-N-tetraose en lakto-N-fucopentaose 1 en hoër relatiewe voorkoms van 3'-sialyllactose, difucosyl-lakto-N-tetraose en fucosyl-disialyllacto-N-hexaose in MIV-positiewe vroue in vergelyking met-negatiewe Sekretor vroue. DSLNT konsentrasies was aansienlik laer in die melk van moeders wie se babas NEK ontwikkel het in vergelyking met babas sonder NEK. Gevolgtrekking: Probiotika aanvullings verminder die voorkoms van NEK in premature babas, maar die resultate kon nie ʼn laer voorkoms van NEK in MIV-blootgestelde premature babas bewys nie. Probiotiese aanvulling het geen invloed op groei uitkomste of die voorkoms van voeding onverdraagsaamheid in MIV-blootstelling getoon nie. Die data bevestig vorige verslae wat aandui dat MIV-besmette moeders hoër 3'sialyllactose borsmelk konsentrasies het. ʼn Interessante aspek is dat lae vlakke van DSLNT in die moeder se melk beduidend is van ʼn verhoogde risiko vir NEK, wat in ooreenstemming is met die resultate uit voorheen gepubliseerde dier studies en regverdig verdere ondersoeke.

A sustainable primary prevention strategy for infant iron deficiency anemia (IDA) was implemented and evaluated in a community with at-risk infants in northern Quebec, Canada. Communication strategies were used to promote iron-rich complementary food rather than iron-fortified formula, which can interfere with breastfeeding practice. This food-based approach has been successfully implemented in developing countries, but has not been applied in an industrialized country setting. / Mass media (i.e., radio dialogues, key messages, print material, point-of-purchase grocery store display) and interpersonal (i.e., homemade baby food cooking activity) communication strategies were developed in collaboration with community members and implemented in partnership with an existing community program. Reach and exposure of the strategies were measured using a questionnaire administered to a post-intervention sample (n = 45). Sales of promoted iron-rich infant food were examined pre- and post-intervention period. A repeat cross-sectional design was used for the impact evaluation. Two groups of mothers with infants, aged 7-10 months at Time 1 (n = 32) and Time 2 (n = 22) were interviewed. Outcome variables were infants' total iron and complementary food iron intakes measured by two 24-hour recalls. Secular trends in infants' hemoglobin values and milk type consumption were examined in the study community and two comparison communities. / Multiple communication channels increased awareness of IDA and influenced self-reported use of iron-rich infant food. Iron-rich infant food sales increased from pre- to post-intervention (p < 0.05). Complementary food intake iron increased between Time 1 (3.2 +/- 0.8 mg) and Time 2 (4.4 +/- 1.1 mg) (p < 0.05). The proportion of infants with anemia (hemoglobin < 110 g/L) significantly decreased from the period before (37.2%) to during (14.3%) the intervention (p < 0.05). No significant difference was found for this variable within the comparison communities. The proportion of infants receiving iron-fortified formula in the study community did not differ between Time 1 and Time 2, but increased from Time 1 (55%) to Time 2 (73%) (p < 0.05) in the comparison communities, indicating an erosion of breastfeeding practice. / These results suggest the effectiveness of communication strategies to improve infant iron nutrition in a community with good access to iron-rich infant food. The potential for this strategy in other communities warrants further investigation.

The objectives of this research were to determine the prevalence of anemia, and identify risk factors for anemia, in 9-month-old Cree infants living in northern Quebec. The prevalence of anemia (hemoglobin <110 g/L) was 25--32%, depending on the study sample. Iron deficiency was present in 28.2% of infants who could be classified and 14.4% had iron deficiency anemia. Fewer than 2% of infants had low birth weight (<2500 g) so most infants should have been born with adequate iron stores. One cause of anemia that was identified was a diet that was low in iron. Only 15.1% of infants were reported by guardians to eat meat daily and 28.5% were reported to never eat meat. Infants who were breastfed or cow's milk fed did not obtain sufficient iron for effective erythropoiesis. Compared with formula that was predominantly iron fortified, the odds ratio (OR) for anemia was 7.9 (95% CI 3.4--18.2) for breast milk and 5.0 (95% CI 2.0--12.7) for cow's milk. When milk type was controlled for, weight gain since birth was significantly associated with microcytic erythrocytes (OR comparing the highest tertile of weight gain to the lowest tertile 2.9, 95% CI 1.2--6.6). This indicates that fast-growing infants were not meeting their iron needs for growth. Another risk factor for anemia that was identified was common childhood infections. The prevalence of anemia among infants reported as recently unwell with an infection was higher than among infants reported as recently well (31.1% vs. 19.0%, chi2 = 4.27, p = 0.039). The prevalence of elevated blood lead was 2.7% and is not a major public health problem. No evidence for vitamin A deficiency was found. Serum retinol was positively associated with all iron status indicators. Cree infants who were given supplements containing vitamin A had a lower prevalence of anemia (hemoglobin <105 g/L) (10.8% vs 23.2%, chi2 = 5.97, p = 0.015). These results suggest a role for vitamin A in iron metabolism. To prevent anemia in aboriginal i

Thesis (PhD)--Macquarie University, Division of Humanities, Department of Modern History, 2003. / Bibliography: p. 417-478. / Introduction: breeding and feeding -- The medical man: sex, science and society -- Confined: women and obstetrics 1880-1899 -- The kindest cut? The caesarean section as turning point -- Reproduction in decline -- Resisting reproduction: women, doctors and abortion -- From obstetrics to paediatrics: the rise of the child -- The breast was best: medicine and maternal breastfeeding -- The deadly bottle and the dangers of the wet nurse: the "artificial" feeding of infants -- Surveillance and the mother -- Mothers and medicine: paradigms of continuity and change. / The late nineteenth and early twentieth centuries saw profound changes in Australian attitudes towards maternity. Imbibed with discourses of pronatalism and eugenics, the production of infants became increasingly important to society and the state. Discourses proliferated on "breeding", and while it appeared maternity was exulted, the child, not the mother, was of ultimate interest. -- This thesis will examine the ways wider discourses of population impacted on childbearing, and very specifically the ways discussions of the nation impacted on medicine. Despite its apparent objectivity, medical science both absorbed and created pronatalism. Within medical ideology, where once the mother had been the point of interest, the primary focus of medical care, increasingly medical science focussed on the life of the infant, who was now all the more precious in the role of new life for the nation. -- While all childbirth and child-rearing advice was formed and mediated by such rhetoric, this thesis will examine certain key issues, including the rise of the caesarean section, the development of paediatrics and the turn to antenatal care. These turning points can be read as signifiers of attitudes towards women and the maternal body, and provide critical material for a reading of the complexities of representations of mothers in medical discourse. / Mode of access: World Wide Web. / 478 p

To determine the relationship between infant-feeding practices and diarrhoeal infections, a descriptive survey was conducted to infants between six to 12 months of age. A guided interview was conducted to 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results show that breast-feeding is routinely practiced by the majority of mothers and exclusive breast-feeding is very low, but supplementary feed in the form of formula or solids are introduced by the majority of respondents within the first three months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast-feeding should be promoted as an important intervention in the control of diarrhoea / Health Studies / M.A. (Nursing Science)

PhDPH / Department of Public Health / The benefits of breastfeeding, particularly exclusive breastfeeding, are well recognized. It can reduce the risk of mortality related to malnutrition, otitis media and respiratory infection. Breastfeeding may also decrease the risk of obesity in later life for infants who have been breastfed for more than six months. Besides, breastfeeding improves cognition, and children who have been breastfed show higher intelligence quotient test scores and improved school performance. In addition, long-period breastfeeding is associated with a reduced risk of breast cancer and ovarian cancer for mothers. The World Health Organization and United Nations International Children’s Emergency Fund recommended exclusive breastfeeding for six months and breastfeeding to two years and beyond. However, this study showed that only 27% of children under six months have had been exclusively breastfed. In this situation, an intervention programme was required. The aim of this study was to develop an intervention programme to promote exclusive breastfeeding strategies in Limpopo Province. Intervention mapping was used to guide the development of a programme. A convergent, parallel mixed-method was used wherein qualitative and quantitative data were collected and analysed concurrently. A qualitative approach was used to assess the implementation of exclusive breastfeeding and to explore challenges experienced by health care workers in the implementation of exclusive breastfeeding in Limpopo Province. This was carried out by means of in-depth interviews with 30 professional nurses. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. A quantitative approach was used to determine the factors that influence exclusive breastfeeding. Reliability and validity of the instrument was ensured through extensive literature review and test-retest methodology. Questionnaires were distributed to 400 respondents. Tesch’s eight steps of data analysis was used to analyse qualitative data. The Statistical Package for the Social Sciences, version 26, was used to analyse the quantitative data. The results were merged, and the interpretation discussed. Five higher-order themes emerged from quantitative data analysis. The themes emerged from qualitative data were confirmed by the findings from statistical data, thus merging both qualitative and quantitative data. Findings were presented to the stakeholders, managers and dieticians and their inputs further confirmed and supported the findings. The findings informed the development of an intervention programme. The intervention comprises of the three components, training of community health workers, healths talks focusing on lactating mothers and health talks focusing on families and community. The developed intervention was validated by the stakeholders and the results were analysed through simple descriptive statistics where the data were summarized using frequency distributions and graphic representations. The results revealed that the programme was feasible, compatible and applicable to current practice. Recommendations were made and topics for further research were also suggested. / NRF