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INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Introduction: Exclusive breastfeeding (EBF) contributes towards reducing infant and young child mortality however global EBF rates are sub-optimal. One of the factors that influences a mothers‟ choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa has adopted the ICMBS, the Code was only legislated in December 2012 to ensure compliance. Aim: To do a baseline assessment of the extent of ICMBS violations in the South African advertising media including magazines, newspapers, television (TV) and radio. Methods: In this cross-sectional study data were collected on multiple occasions. Data were collected by means of recording and/or screening daily broadcasts from four TV channels (SABC 1, 2, 3 and e.tv), nine commercial radio stations, 116 different magazines and 10 different newspapers for ICMBS violations. This study was done within a period of four months between November 2012 and January 2014. Violations pertaining to advertising media include advertising or promoting infant formula, other milk products marketed for children up to 36 months of age (e.g. growing-up milk or follow-on milk), foods for infants younger than six months, any other food or beverages marketed or represented to be suitable for the use as partial or total replacements of breast milk, and feeding bottles and teats to the general public (article 5.1 of the ICMBS). Results: A total number of 30 violations were identified from 117 baby product advertisements that were published in eight of the 169 screened magazines. No violations were found from advertisements on TV, radio or in newspapers. The majority of advertisements that violated article 5.1 of the ICMBS, were advertisements of feeding bottles (60%), followed by advertisements of growing-up milk (20%) and feeding teats (16.7%). Only one violation (3.3%) was an advertisement of infant food for infants younger than six months. Advertisements with violations were advertising baby products from 11 different companies. More than half of the violations (56.7%) were published in two editions from the same magazine, or inserts within that magazine, who‟s target group was pregnant women. Eight advertisements with violations (26.6%) were published in family magazines, three (10%) were published in baby magazines, and two (6.7%) were published in lifestyle magazines. Conclusion: According to the present baseline study, ICMBS violations were only found in a small percentage (4.7%) of magazines targeted mainly at pregnant women. However, although the present study included the majority of available South African magazines distributed in South Africa, not all the available newspapers, TV channels and radio stations were included in the sample size. The true extent of ICMBS violations in the South African advertising media may therefore be higher. It can also not be concluded that BMS companies use only magazines to advertise products pertaining to the scope of the ICMBS. A follow-up study need to determine the impact of legislating the Code on ICMBS violations in advertising media. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

INTRODUCTION Exclusive breastfeeding (EBF) for the first six months of an infant‟s life is recognized by the World Health Organisation (WHO) and the United Nations Children‟s Fund (UNICEF) as the most effective and essential strategy for optimal growth and prevention of infant mortality. One of the factors that influences a mothers choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa (SA) has voluntarily adopted the ICMBS in 1981 to help protect and promote EBF, the exclusive breastfeeding rates in SA remain very low (<8%). In a renewed attempt to protect and promote exclusive breastfeeding in SA, the code has been legislated in December 2012 to ensure compliance. AIM To assess the extent of ICMBS violations in health facilities in four Provinces in SA. DESIGN This was cross-sectional study. A purposive stratified cluster sample of eight to twelve health facilities was drawn in four Provinces (Gauteng, North-West, Free-State and Eastern Cape) in SA. Fixed structured interviews were conducted by trained fieldworkers with three health workers from each of the 40 health facilities to determine the extent of ICMBS violations as well as awareness of the ICMBS. The receipt of free gifts, free/low cost supplies/samples of formula milk, bottles or teats, and free materials or equipment from companies who sell breast-milk substitutes (BMS), infants foods/drinks and bottles or teats (violation of articles 6.2, 6.3, 6.6, 6.8, 7.3 and 7.4 of the ICMBS) were determined. RESULTS A total number of four violations were reported by four health workers from three of the 40 health facilities (7.5%). ICMBS violations were reported only in Gauteng Province with no violations in North West, Free State or Eastern Cape Province. All four violations involved the receipt of free gifts for personal use (including a pen, booklet, calendars and booklet/poster) from a BMS company (Nestlé), violating article 7.3 of the ICMBS. Health workers from four health facilities also reported the receipt of information materials and/or equipment for use in the facility, including leaflets, maternal and infant feeding product booklets and water bags from Nestlé. However, since the brand name of a product within the scope of the ICMBS was not visible on any of the materials or equipment, none of these gifts constituted a violation. In terms of ICMBS awareness, 46 health workers (38%), including the four health workers who received gifts, from 19 health facilities situated mainly in Eastern Cape and Gauteng Province were familiar with the ICMBS. CONCLUSIONS Violations were reported in 7.5% of health facilities, including the health facilities where health workers were aware of the code. Implementation and training of the ICBMS in health facilities is there for warranted. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Introduction: Exclusive breastfeeding (EBF) contributes towards reducing infant and young child mortality however global EBF rates are sub-optimal. One of the factors that influences a mothers‟ choice to exclusively breastfeed her child, is the marketing of breast milk substitutes. The International Code of Marketing of Breast-milk Substitutes (ICMBS) was developed to promote, protect and support EBF. Although South Africa has adopted the ICMBS, the Code was only legislated in December 2012 to ensure compliance. Aim: To do a baseline assessment of the extent of ICMBS violations in the South African advertising media including magazines, newspapers, television (TV) and radio. Methods: In this cross-sectional study data were collected on multiple occasions. Data were collected by means of recording and/or screening daily broadcasts from four TV channels (SABC 1, 2, 3 and e.tv), nine commercial radio stations, 116 different magazines and 10 different newspapers for ICMBS violations. This study was done within a period of four months between November 2012 and January 2014. Violations pertaining to advertising media include advertising or promoting infant formula, other milk products marketed for children up to 36 months of age (e.g. growing-up milk or follow-on milk), foods for infants younger than six months, any other food or beverages marketed or represented to be suitable for the use as partial or total replacements of breast milk, and feeding bottles and teats to the general public (article 5.1 of the ICMBS). Results: A total number of 30 violations were identified from 117 baby product advertisements that were published in eight of the 169 screened magazines. No violations were found from advertisements on TV, radio or in newspapers. The majority of advertisements that violated article 5.1 of the ICMBS, were advertisements of feeding bottles (60%), followed by advertisements of growing-up milk (20%) and feeding teats (16.7%). Only one violation (3.3%) was an advertisement of infant food for infants younger than six months. Advertisements with violations were advertising baby products from 11 different companies. More than half of the violations (56.7%) were published in two editions from the same magazine, or inserts within that magazine, who‟s target group was pregnant women. Eight advertisements with violations (26.6%) were published in family magazines, three (10%) were published in baby magazines, and two (6.7%) were published in lifestyle magazines. Conclusion: According to the present baseline study, ICMBS violations were only found in a small percentage (4.7%) of magazines targeted mainly at pregnant women. However, although the present study included the majority of available South African magazines distributed in South Africa, not all the available newspapers, TV channels and radio stations were included in the sample size. The true extent of ICMBS violations in the South African advertising media may therefore be higher. It can also not be concluded that BMS companies use only magazines to advertise products pertaining to the scope of the ICMBS. A follow-up study need to determine the impact of legislating the Code on ICMBS violations in advertising media. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2004Bitstream added on 2014-06-13T18:31:54Z : No. of bitstreams: 1 pagliari_av_me_araca.pdf: 502519 bytes, checksum: c3e78ebb5faf7a92ff598d7f5d916c09 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação para o Desenvolvimento da UNESP (FUNDUNESP) / O leite materno é, indiscutivelmente, o alimento ideal para os primeiros meses de vida da criança, mas existem situações que impossibilitam ou dificultam seu consumo. Nestes casos, fórmulas infantis, leite de vaca integral diluído e leite de soja podem ser oferecidos. Este trabalho pretende avaliar o leite como contribuinte para a ingestão diária de flúor em crianças e como fator de risco para o desenvolvimento de fluorose dentária. A primeira parte procura estimar esta contribuição, partindo da concentração de flúor no leite humano, leite de vaca, leite em pó e fórmulas infantis, encontrada em pesquisas publicadas. Os resultados indicam que os leites materno e de vaca in natura não oferecem risco ao desenvolvimento de lesões de fluorose dentária esteticamente inaceitáveis em dentes decíduos ou permanentes, o mesmo ocorrendo para a ingestão de leite em pó quanto aos dentes permanentes. Já as fórmulas infantis e o leite em pó, comercializados no Brasil, preparados em água com concentração ótima de flúor (0,7 mg/L), podem contribuir com uma ingestão diária de flúor acima do limite considerado seguro, podendo provocar o aparecimento de lesões de fluorose em dentes decíduos. A segunda parte deste trabalho teve como objetivos determinar os teores de flúor de fórmulas infantis (n=7), leites (n=10) e leites de soja (n=3), em pó, produzidos em território nacional e adquiridos em Araçatuba-SP e avaliar a possibilidade de desenvolvimento de fluorose dentária, esteticamente inaceitável, com o consumo destes produtos. As amostras de pó foram reconstituídas em água deionizada e analisadas em duplicata pelo método eletrodo específico, após difusão facilitada por hexametildisiloxano... / Mother's milk is, unquestionably, the ideal food for children's first months of life, however, there are situations that make its consumption impossible. In these cases, infant formulas, cow's diluted whole milk and soy-milk can be offered. This paper intends to evaluate milk as a contributor for children's daily fluoride ingestion and as a risk factor to develop dental fluorosis. The first part estimates this contribution by the fluoride concentration of human milk, in natura cow's milk, powder-milk, infant formulas obtained from publications specialized on the subject. The results indicate that that human milk and in natura cow's milk do not offer risk to the development of esthetically unacceptable lesions of dental fluorosis in deciduous or permanent teeth, the same occurring with powder-milk ingestion for the permanent teeth. The infant formulas and powder-milk commercialized in Brazil, prepared in water with optimal fluoride concentration (0.7 mg F/L) can contribute to daily fluoride ingestion above the limit considered as safe for the development of fluorosis in deciduous teeth. The second part of this paper had the purpose to determine the fluoride content in infant formulas (n=7), powder-milk (n=10) and soy-milk (n=3) produced in the national territory and acquired in Araçatuba - SP, and evaluate the possibility to develop esthetically unacceptable dental fluorosis by consuming these products. The powder samples were reconstituted in deionized water and doublechecked through the potentiometrical method after hexametyldisiloxane facilitated diffusion... (Complete abstract, click electronic access below)

Orientador: Suzely Adas Saliba Moimaz / Resumo: O leite materno é, indiscutivelmente, o alimento ideal para os primeiros meses de vida da criança, mas existem situações que impossibilitam ou dificultam seu consumo. Nestes casos, fórmulas infantis, leite de vaca integral diluído e leite de soja podem ser oferecidos. Este trabalho pretende avaliar o leite como contribuinte para a ingestão diária de flúor em crianças e como fator de risco para o desenvolvimento de fluorose dentária. A primeira parte procura estimar esta contribuição, partindo da concentração de flúor no leite humano, leite de vaca, leite em pó e fórmulas infantis, encontrada em pesquisas publicadas. Os resultados indicam que os leites materno e de vaca in natura não oferecem risco ao desenvolvimento de lesões de fluorose dentária esteticamente inaceitáveis em dentes decíduos ou permanentes, o mesmo ocorrendo para a ingestão de leite em pó quanto aos dentes permanentes. Já as fórmulas infantis e o leite em pó, comercializados no Brasil, preparados em água com concentração ótima de flúor (0,7 mg/L), podem contribuir com uma ingestão diária de flúor acima do limite considerado seguro, podendo provocar o aparecimento de lesões de fluorose em dentes decíduos. A segunda parte deste trabalho teve como objetivos determinar os teores de flúor de fórmulas infantis (n=7), leites (n=10) e leites de soja (n=3), em pó, produzidos em território nacional e adquiridos em Araçatuba-SP e avaliar a possibilidade de desenvolvimento de fluorose dentária, esteticamente inaceitável, com o consumo destes produtos. As amostras de pó foram reconstituídas em água deionizada e analisadas em duplicata pelo método eletrodo específico, após difusão facilitada por hexametildisiloxano... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Mother's milk is, unquestionably, the ideal food for children's first months of life, however, there are situations that make its consumption impossible. In these cases, infant formulas, cow's diluted whole milk and soy-milk can be offered. This paper intends to evaluate milk as a contributor for children's daily fluoride ingestion and as a risk factor to develop dental fluorosis. The first part estimates this contribution by the fluoride concentration of human milk, in natura cow's milk, powder-milk, infant formulas obtained from publications specialized on the subject. The results indicate that that human milk and in natura cow's milk do not offer risk to the development of esthetically unacceptable lesions of dental fluorosis in deciduous or permanent teeth, the same occurring with powder-milk ingestion for the permanent teeth. The infant formulas and powder-milk commercialized in Brazil, prepared in water with optimal fluoride concentration (0.7 mg F/L) can contribute to daily fluoride ingestion above the limit considered as safe for the development of fluorosis in deciduous teeth. The second part of this paper had the purpose to determine the fluoride content in infant formulas (n=7), powder-milk (n=10) and soy-milk (n=3) produced in the national territory and acquired in Araçatuba - SP, and evaluate the possibility to develop esthetically unacceptable dental fluorosis by consuming these products. The powder samples were reconstituted in deionized water and doublechecked through the potentiometrical method after hexametyldisiloxane facilitated diffusion... (Complete abstract, click electronic access below) / Mestre

Background: At pH 5.5, a clear demineralization of the enamel is seen and is thus considered to be the criticalpH. Bovine milk has several different properties that protect against caries. Calcium and phosphate can prevent the progression of caries as well as some proteins in bovine milk. The replacement of bovine milk with plant-based alternatives has become increasingly common. The aim of this study is to analyze if different milk substitutes create a greater disturbance of the oral cavity’s neutral pH than bovine milk.  Methods: Twenty dental students participated to the study. Saliva samples were collected to analyze pH. Prior to sampling participants were asked to rinse mouth with one product at a time. There were five different products: bovine milk, oat milk, soy milk, almond milk and 10% sucrose solution. Baseline of saliva was taken prior to rinsing. After rinsing samples were taken at two different time points. Between products participants were asked to rinse with water. pH measurements were made after sampling of saliva. The results were analyzed with Microsoft® Excel and SPSS.  Results: Significant differences were found in saliva pH when bovine milk, almond milk and soy milk were compared to 10% sucrose solution at time 15, otherwise no significant differences were found.  Conclusions: No significant difference between bovine milk and milk substitutes was found when rinsing with the products in the pH of saliva.

Thesis (MPH.) -- University of Limpopo, 2022 / Background: The Mother baby friendly initiative (MBFI) is an initiative that was launched in 1991 as a global programme to create an environment that enables and supports women to breastfeed their infants, providing advice to mothers and practical assistance to promote breastfeeding. This initiative plays an important role in improving infant’s nutritional status, growth, development and health for both mother and infant and supports exclusive breastfeeding. MBFI aims at increasing breastfeeding rate by supporting, protecting and promoting breastfeeding in health facilities. Aim: of the study is to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at Standerton hospital. Method: A qualitative descriptive design was used to explore the knowledge and challenges related to the implementation of the mother-baby friendly initiative at selected hospital. Purposive sampling of the healthcare providers were the target population for the study as they are responsible for the implementation of MBFI in the hospital. In this research, data collected were in a form of interviews, audiotapes and written notes from interviews. Tesch’s eight steps in data analysis was used to analyse data. Results: The studies key theme and sub theme give the study’s findings and perspective of the issues found. The studies key theme were: 1. Knowledge of participants on MBFI at Standerton hospital, 2. Views about current practices of MBFI at Standerton –hospital and 3. Challenges regarding MBFI implementation at Standerton. MBFI was considered significant in the facility, however, due to inconsistences and challenges faced by the nurses the initiative was not fully implemented to improve breastfeeding rates. Conclusion: the study conclude that nurse’s had some knowledge on the MBFI initiative as they understood their role in breastfeeding advocacy and enhancing maternal and child health. There were significant challenges in MBFI implementation such as shortage of staff, lack of resources and training that hindered MBFI compliance and mothers not receiving the full benefits of the initiative, which contribute to decreased breastfeeding rates within the facility.

Esofagite Eosinofílica é uma doença inflamatória crônica restrita ao esôfago e imune mediada por antígenos. Sua prevalência descrita varia desde 0,4%, numa população geral, até 15% em pacientes com sintomas de disfagia. Já se conhece sua associação com doenças atópicas, anafilaxia e alergia alimentar, sendo o leite de vaca um dos principais alimentos envolvidos. Existem relatos recentes de casos em que pacientes foram diagnosticados com esofagite eosinofílica após serem submetidos à imunoterapia oral com o alimento causador de sua alergia alimentar mediada por IgE. Porém, em nenhum destes casos foi avaliado previamente se os mesmos pacientes já não apresentavam eosinofilia esofágica latente e/ou sintomas subjetivos sugestivos da doença. Considerando que, atualmente, um dos tratamentos mais promissores para alergia alimentar é a imunoterapia oral, justificou-se a necessidade de entender se esofagite eosinofílica seria de fato uma complicação do tratamento, ou se seria uma condição pré ou coexistente. Portanto, o objetivo deste trabalho foi avaliar a frequência de eosinofilia esofágica em pacientes com anafilaxia à proteína do leite de vaca. Foram analisados 89 pacientes matriculados no ambulatório de alergia alimentar do HC-FMUSP, com mediana de idade de 8 anos e que apresentavam anafilaxia ao leite de vaca. Todos foram submetidos à endoscopia digestiva alta com biópsias de esôfago, estomago e duodeno. Dados demográficos, comorbidades atópicas, uso de medicações e sintomas gastrointestinais foram analisados e comparados. A frequência de eosinofilia esofágica foi de 38,2% (34 de 89 pacientes). Em 15 dos 34 pacientes com eosinofilia esofágica, foi completada a investigação para esofagite eosinofílica com uso de inibidor de bomba de prótons em dose plena por 8 semanas antes de uma segunda endoscopia. Identificou-se, portanto, cinco pacientes (7,1%) com eosinofilia esofágica responsiva a inibidor de bomba de prótons e 10 pacientes com esofagite eosinofílica (14,2%). No grupo total de pacientes com eosinofilia esofágica (n=34) encontrou-se 29,4% de pacientes com quadro clínico gastrointestinal ausente; 23,5% oligossintomáticos, e apenas 47% com sintomas sugestivos de disfunção esofágica e, destes últimos, nem todos apresentavam sintomas esofágicos persistentes. Pode-se concluir que a frequência de esofagite eosinofílica descrita no grupo estudado foi significativamente superior à estimada na população geral e uma das mais altas descritas em grupos de pacientes com fatores de risco específicos. Também foi observada uma grande parcela de pacientes com eosinofilia esofágica, sendo muitos assintomáticos ou oligossintomáticos, surgindo o questionamento se esta não seria uma doença latente, de início precoce, insidioso e não relacionada diretamente como complicação de tratamentos atuais / Eosinophilic esophagitis is a chronic inflammatory disease, which occurs in the esophagus and is immune mediated by antigens. Its observed prevalence varies between 0.4% in the general population to 15% in patients with dysphagia. Its association with atopic diseases, anaphylaxis and food allergy has already been recognized. Cow\'s milk is one of the main food sources involved. There are recent reports of cases in which patients were diagnosed with eosinophilic esophagitis after being submitted to oral immunotherapy with the food that causes the IgE mediated allergy. However, in none of these cases was it previously determined if the same patients did not already present latent esophageal eosinophilia and/or subjective symptoms suggestive of the disease. Considering that, currently, one of the most promising treatment for food allergy is oral immunotherapy, the need to understand if eosinophilic esophagitis could be a treatment complication, or if it is a coexistent or preexistent condition, is justified. Therefore, the objective of this study was to evaluate esophageal eosinophilia frequency in patients with anaphylaxis to cow\'s milk protein. We analyzed eighty-nine patients registered in the Food Allergy Unit of the HCFMUSP, with a median age of 8 years, who presented cow\'s milk anaphylaxis. All of them were submitted to digestive endoscopy as well as esophagus, stomach, and duodenum biopsies. We also analyzed and compared demographic data, atopic comorbidities, use of medication, and gastrointestinal symptoms. The frequency of esophageal eosinophilia was 38.2% (34 of 89 patients). In 15 of the 34 patients with esophageal eosinophilia, full investigation for the disease was carried out using a proton pump inhibitor at full dose for eight weeks prior to a second endoscopy. From this, five patients (7.1%) had the proton pump inhibitor-responsive esophageal eosinophilia phenotype, and ten patients were diagnosed with eosinophilic esophagitis (14.2%). In the whole group of patients with esophageal eosinophilia (n = 34), it was found 29.4% of patients with an absent gastrointestinal clinical condition, 23.5% were oligosymptomatic, and only 47% had symptoms suggestive of esophagic dysfunction. Of these, not all presented persistent esophagic symptoms. It is possible to conclude that the frequency of eosinophilic esophagitis observed in this group was significantly higher than the estimated for the general population, and one of the highest observed in groups of patients with specific risk factors. A large portion of patients with esophageal eosinophilia were oligosymptomatic or asymptomatic, raising the question if this would not in fact be a latent disease, with a precocious beginning, insidious and not directly related to current treatments complications