Thesis (Ph.D.)--University of Western Australia, 2008.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1985.

Thesis (Ph. D.)--University of Massachusetts Amherst, 2010. / Includes bibliographical references (p. 205-225).

Thesis (Ph. D.)--Georgia State University, 2009. / Title from title page (Digital Archive@GSU, viewed July 20, 2010) Wendy Simonds, committee chair; Dawn Baunach, Denise Donnelly, committee members. Includes bibliographical references (p. 146-147).

Thesis (M.D.)--University of Hong Kong, 2003. / Includes bibliographical references (leaves 193-220) Also available in print.

Thesis (M.M.) Florida State University, 2005. / Advisor: Jayne M. Standley, Florida State University, College of Music. Title and description from dissertation home page (viewed 7-11-07). Document formatted into pages; contains 63 pages. Includes biographical sketch. Includes bibliographical references.

Thesis (MNutr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Introduction Breastfeeding is a key child survival strategy. Mixed feeding (predominant and partial breastfeeding as defined by the World Health Organisation) during the first six months of life is associated with childhood morbidity and mortality, especially in resource-limited settings, and carries the highest risk of HIV transmission through breastfeeding. When compared to exclusive breastfeeding, predominant, partial or no breastfeeding increases the risk for pneumonia and diarrhoea-related mortality. National exclusive breastfeeding rates are poor and have not improved significantly over the past fourteen years, supporting investigation into the contextual factors that influence infant feeding practices. Aim The study aimed to determine the feeding practices of primary caregivers of infants (0-5.9 months) and the influencing factors in Avian Park and Zwelethemba in Worcester, in the Western Cape Province of South Africa, in order to make recommendations, where appropriate. Methods The study was conducted from April to August 2011. A cross-sectional community-based survey was performed using a structured questionnaire. Focus group discussions were held with mothers, fathers and maternal and paternal grandmothers of infants younger than six months, and health care workers (formally trained professionals and counsellors) working in child health. Results One hundred and forty primary caregivers were interviewed. All caregivers were the biological mother of the infant. Seventy-seven percent (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four percent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially, and 31% (n=43) did not breastfeed. Ninety percent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were one month old. Forty-four percent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were three months old. Knowledge of the health and economic benefits of breastfeeding supported initiation but several barriers to exclusive breastfeeding remained. The main barriers were 1) the widely-held perception that infants needed water and nonprescription medicines, 2) the concern that milk alone does not satisfy the infant, 3) inadequate infant feeding education and support by the health system, 4) the lack of community-based postnatal support, 5) convention and family influence, 6) mothers separated from their infants and 7) local beliefs about maternal behaviour and breastfeeding. HIV infection exerted a significant influence on infant feeding choice (p<0.001) and none of the HIV-infected mothers breastfed (n=19). Forty-five percent (n=19) of the formula feeding mothers over-diluted the milk, and early supplementation of formula milk with food was common. Health care workers and maternal grandmothers were the key role-players in infant feeding information and support. Conclusion Exclusive breastfeeding during the first six months of life was a rare practice in these communities. Water, formula milk and/or food were introduced at an early age. HIV-infection discouraged breastfeeding and formula feeding practices proved to be poor. Comprehensive education and support at antenatal, intrapartum and postnatal level seemed lacking and community perceptions and convention contributed to mixed feeding practices. Mothers seemed ill equipped to negotiate infant feeding practices with roleplayers at home. / AFRIKAANSE OPSOMMING: Inleiding Borsvoeding is ‘n sleutelstrategie ter ondersteuning van kinderoorlewing. Gemengde voeding (hoofsaaklike en gedeeltelike borsvoeding, soos omskryf deur die Wêreldgesondheidsorganisasie) gedurende die eerste ses maande van lewe, sowel as geen borsvoeding, word geassosieer met kindersiektes and -sterftes, veral in gebiede met beperkte hulpbronne waar babas vatbaar is vir wanvoeding, gastroënteritis en longontsteking. Gemengde voeding dra ook die hoogste risiko vir MIV-oordrag deur borsvoeding. Nasionale eksklusiewe borsvoedingskoerse is swak en het nie oor die laaste veertien jaar verbeter nie. Dit dien as motivering vir die ondersoek na kontekstuele faktore wat babavoedingspraktyke beïnvloed. Doelwit Die doelwit van die navorsingsstudie is om voedingspraktyke van primêre versorgers van babas (0-5.9 maande) en die invloedryke faktore te bepaal in Avian Park en Zwelethemba in Worcester in die Wes-Kaap Provinsie van Suid-Afrika, om sodoende aanbevelings te kan maak waar gepas. Metodes Die studie is uitgevoer van April tot Augustus 2011. ‘n Gemeenskapsgebaseerde deursnee-opname is uitgevoer deur gebruik te maak van ‘n gestruktureerde vraelys. Fokusgroepbesprekings is uitgevoer met moeders, vaders, en oumas (aan moeders- en vaderskant) van babas jonger as ses maande, en gesondheidswerkers (formeel opgeleide werkers en beraders) wat in kindersorg werk. Resultate ‘n Onderhoud is met eenhonderd-en-veertig primêre versorgers gevoer. Al die versorgers was die biologiese moeder van die baba. Sewe-en-sewentig persent (n=108) het borsvoeding begin. Ten tye van die studie het 6% (n=8) eksklusief geborsvoed. Vier-en-negentig persent (n=132) het suboptimale borsvoedingspraktyke beoefen: 36% (n=51) het hoofsaaklik geborsvoed, 27% (n=38) het gedeeltelik geborsvoed en 31% (n=43) het nie geborsvoed nie. Negentig persent (n=126) van die moeders het water gegee, van wie 83% (n=104) dit gedoen het voordat hul babas een maand oud was. Vier-en-veertig persent (n=61) van die moeders het voedsel of formulemelk gegee, van wie 75% (n=46) dit gedoen het voordat hul babas drie maande oud was. Kennis van die gesondheids- en ekonomiese voordele van borvoeding het moeders ondersteun om te begin borsvoed, maar daar was steeds verskeie faktore wat eksklusiewe borsvoeding belemmer het. Die belangrikste hindernisse was 1) die algemene siening dat babas water en nie-voorskrif medisynes benodig, 2) die kommer dat alleenlik melk nie die baba bevredig nie, 3) ontoereikende babavoedingsonderrig en ondersteuning deur die gesondheidstelsel, 4) die gebrek aan gemeenskapsgebaseerde nageboorte-ondersteuning, 5) gebruike en die invloed van gesinslede, 6) moeders geskei van hul babas en 7) plaaslike sienings rakende moeders se gedrag en borsvoeding. MIV-infeksie het ‘n wesenlike invloed op voedingskeuse gehad (p<0.001) en geen van die MIV-positiewe moeders het geborsvoed nie (n=19). Vyf-en-veertig persent (n=19) van die formule voedende moeders het die melk oorverdun en vroeë supplementasie van formulemelk met kos was algemeen. Gesondheidswerkers en oumas was die kernrolspelers ten opsigte van baba-voedingsinligting en ondersteuning. Gevolgtrekking Eksklusiewe borsvoeding gedurende die eerste ses maande van lewe was ‘n seldsame praktyk in hierdie gemeenskappe. Water, formulemelk en/of voedsel is op ‘n vroeë ouderdom bekendgestel. MIV infeksie het borsvoeding ontmoedig en formulevoedingspraktyke was swak. Omvattende opvoeding en ondersteuning op voorgeboorte-, intrapartum- en nageboortevlak het ontbreek, en sienings en gebruike het bygedra tot gemengde voedingspraktyke. Dit het geblyk dat moeders nie toegerus was om oor babavoedingspraktyke met ander belanghebbendes by die huis te onderhandel nie.

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Agradecemos a compreensão. on 2018-06-21T12:42:00Z (GMT) / Submitted by DANIELLE MARINHO VIEGAS EMÍLIO (dannibtu13@gmail.com) on 2018-06-24T20:39:51Z No. of bitstreams: 1 texto finalizado Danielle.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-06-26T12:07:06Z (GMT) No. of bitstreams: 1 emilio_dmv_me_bot.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) / Made available in DSpace on 2018-06-26T12:07:06Z (GMT). No. of bitstreams: 1 emilio_dmv_me_bot.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) Previous issue date: 2018-05-03 / Introdução: O aleitamento materno, além das propriedades nutritivas e imunológicas, propicia momentos essenciais de interação mãe-bebê. Quando o recém-nascido, especialmente o prematuro, é separado da mãe devido à sua internação em uma Unidade Neonatal, diversos fatores podem prejudicar o início do aleitamento materno e sua duração. Pesquisas com crianças nascidas a termo mostram que dentre vários fatores, a percepção de autoeficácia materna está associada com maior tempo de amamentação exclusiva e desmame mais tardio; entretanto, pouco se sabe sobre o papel da autoeficácia em mães de prematuros. Objetivos: Avaliar a percepção de autoeficácia em mães de prematuros durante a internação e após a alta e sua associação com a manutenção do aleitamento materno e desmame. Método: Trata-se de um estudo longitudinal, com 47 mães de prematuros cujos dados sociodemográficos e clínicos foram obtidos a partir de entrevista realizada até o terceiro dia após o nascimento e dos prontuários médicos do bebê. Entre três e sete dias após início da amamentação foram aplicados dois questionários para avaliação de autoeficácia: a) com relação aos cuidados (Perceived Maternal Parenting Self-Efficacy – PMP); b) com relação à amamentação (Brastfeeding Self-Efficacy Scale – Short-Form – BSE - SF). No primeiro retorno após a alta hospitalar do bebê, o BSES – SF foi reaplicado, e 60 dias após o nascimento foi verificado no prontuário, ou por contato telefônico se os bebês continuavam sendo amamentados. Resultados: A mediana da idade gestacional foi de 32 semanas e o tempo médio de internação foi de 20 dias. Na alta 85% dos prematuros estavam em aleitamento materno exclusivo, e até 60 dias após o nascimento 31,7% continuaram em aleitamento materno exclusivo. Nenhuma mãe pontuou para baixa autoeficácia, e altos índices de autoeficácia foram predominantes em mães com maior idade, multíparas e cujo recém-nascido teve melhor vitalidade ao nascer. A autoeficácia não se associou com tempo de amamentação, mas nascer pequeno para a idade gestacional foi fator de proteção e maior idade materna foi fator de risco para o desmame. Conclusão: A alta autoeficácia na amamentação não se associou com risco de desmame. As taxas de aleitamento materno foram elevadas na alta hospitalar mas caíram drasticamente 60 dias após o nascimento, o que sinaliza para a necessidade de retornos mais frequentes aos serviços de saúde após a alta para continuar encorajando o aleitamento materno, dando orientações técnicas ajustadas às necessidades individuais de cada mãe, visando aumentar seu empoderamento, sua percepção de autoeficácia e confiança em sua capacidade de amamentar. / Introduction: Breastfeeding propitiates not only nutritional and immunological advantages, but also essential moments of mother-baby interaction. According to the literature, when a newborn, especially if premature, is separated from the mother to be admitted into a Neonatal Unit, several factors can impair breastfeeding and its duration. Research with infants born at full-term shows that among several factors maternal perception of self-efficacy is associated with exclusively breastfeeding for a longer period and weaning at a later date. However, little is known about the role of self-efficacy in mothers of premature babies. Objectives: Evaluating the perception of self-efficacy in mothers of premature babies during hospitalization and after discharge and its association to breastfeeding and weaning. Methodology: A longitudinal study with 47 mothers of premature babies whose sociodemographic and clinical data were obtained through an on-site interview conducted up to three days after birth and from the baby’s medical charts. From three to seven days after they first started breastfeeding, two questionnaires were used to evaluate self-efficacy: a) the - Perceived Maternal Parenting Self-Efficacy (PMP-E); and b) the Breastfeeding Self-Efficacy Scale – Short-Form (BSES-SF). On the first consultation after discharge the BSES-SF questionnaire was applied once more and and 60 days after birth medical charts were consulted or by phone contact to check whether the mother was still breastfeeding. Results: Average gestational age was 32 weeks at birth and the children were admitted for an average of 20 days. 85.1% of the children were discharged on exclusive breastfeeding and up to 60 days after birth 31.7% continued on exclusive breastfeeding. No mother had a low score on self-efficacy and high levels of self-efficacy were predominant in older mothers who had given birth before and whose children had higher Apgar scores. No mother scored for low self-efficacy, and high self-efficacy rates were predominant in older mothers, multiparous, and whose newborn had better vitality at birth.Self-efficacy was not associated with breastfeeding time but being small for gestational age appeared as a protective factor and having an older mother a risk factor for weaning. Conclusion: The high self-efficacy in breastfeeding was not associated with risk of weaning. Breastfeeding rates were high at hospital discharge but dropped dramatically 60 days after birth, signaling the need for more frequent returns to post-discharge health services to continue encouraging breastfeeding, providing technical guidance tailored to individual needs of each mother, in order to increase their empowerment, their perception of self-efficacy and confidence in their ability to breastfeed.

A controlling maternal feeding style can have negative consequences for child weight and eating style (Ventura & Birch, 2008). Mothers who breastfeed during the first year exert lower levels of control over child feeding (Farrow & Blissett, 2008). Explanations for this relationship speculate that experience of breastfeeding reduces control as breastfeeding requires an infant-led approach (Taveras et al. 2004) or alternatively that maternal attitudes predict both initiation of breastfeeding and later maternal control (Farrow & Blissett, 2006a). The nature of this relationship is explored in this thesis. Mothers reported their intended and actual feeding style during milk feeds when pregnant and at six months postpartum using a modified version of the Child Feeding Questionnaire (Birch, Fisher, Grimm-Thomas, Markey, Sawyer, & Johnson. 2001). Maternal use of control in the form of scheduling and encouraging milk feeds was evident. A high level of control was associated with a shorter breastfeeding duration (p < 0.001). Control beliefs were present prenatally with intended breastfeeding duration inversely associated with intended control. Furthermore, attitudes towards the infant-led nature of breastfeeding were associated with both breastfeeding duration and control. Breastfed infants need to be fed to infant demand and amount consumed is immeasurable whilst formula feeding is open to maternal manipulation. A belief that breastfeeding was inconvenient was associated with scheduling feeds whilst concerns over milk intake and low confidence were associated with encouraging feeds. Whilst scheduling feeds was a stable behaviour predictive from prenatal intention, encouraging feeds was fluid and related to maternal experience. Concerns about infant size or feeding difficulties increased use of encouraging feeds. Maternal desire for control may therefore drive breastfeeding duration, explaining the association between breastfeeding and later feeding style. The findings have important implications for breastfeeding duration, early programming of appetite and bodyweight and later maternal feeding style.