Objetivos: Objetivos: Avaliar o crescimento de crianças amamentadas cujas mães haviam inserido um implante de liberação de etonogestrel no pós-parto imediato. Métodos: Ensaio clínico aberto, randomizado, controlado e paralelo de mulheres pós-parto que foram randomizadas em blocos para inserção precoce (até 48 horas pós-parto antes da alta) ou convencional (6 semanas após o parto) de um implante etonogestrel. O desfecho primário foi o peso médio do bebê aos 12 meses (360 dias), e uma diferença de >=10% entre os grupos foi considerada clinicamente significativa. Os desfechos secundários foram a comprimento da criança, o perímetro cefálico e a circunferência braquial. Estas variáveis foram medidas no início e aos 14 e 40, 90, 180, 270 e 360 dias pós-parto. O modelo de regressão linear de efeitos mistos foi utilizado para avaliar os desfechos, com um poder de 80%, e um nível de significância de 1% para o desfecho primário e 0,3% para os desfechos secundários, devido à correção para múltiplas hipóteses. Resultados: De junho a agosto de 2015, um total de 100 mulheres foram randomizadas para inserção precoce ou convencional do implante de etonogestrel no pós-parto. As características sociodemográficas foram semelhantes entre os grupos, exceto no nível de escolaridade, que foi maior no grupo de inserção convencional (88% vs. 70% no grupo de inserção precoce, p = 0,02). Não houve diferença no peso do bebê em 360 dias entre os grupos [precoce: (média ± desvio padrão) 10060,3 ± 1156,0 g vs convencional: 9812,1 ± 1270,3g, estimativa da diferença de média 321,6g, intervalo de confiança 95% (IC): -183,5 A 495,7]. As curvas de crescimento do comprimento e as curvas dos perímetros cefálico e braquial também não diferiram entre os grupos. Conclusões: Não há diferença no crescimento das crianças amamentadas, em 12 meses, cujas mães receberam a inserção do implante liberador de etnogestrel precocemente comparado com a inserção pós-parto convencional. / Objective: To evaluate the growth of breastfed children whose mothers had inserted an etonogestrel-releasing implant in the immediate postpartum period. Methods: An open, randomized, controlled, and parallel trial of postpartum women who were block randomized to early (up to 48 hours postpartum before discharge) or conventional (at 6 weeks postpartum) insertion of a etonogestrel implant. The primary outcome was average infant weight at 12 months (360 days), and a difference of >=10% between groups was considered clinically significant. The secondary outcomes were infant\'s lenght, head and arm circumferences. These variables were measured at baseline and at 14 and 40, 90, 180, 270, and 360 days postpartum. The mixed-effects linear regression model was used to evaluate the outcomes, with a power of 80%, and a significance level of 1% for primary outcome and 0.3% for secondary outcomes, due to correction for multiple hypothesis testing. Results: From June to August of 2015, a total of 100 women were randomized to either early or conventional postpartum etonogestrel insertion. Sociodemographic characteristics were similar between the groups, except for educational attainment, which was higher in the conventional insertion group (88% vs. 70% in the early insertion group, p=.02). There was no difference in infant weight at 360 days between the groups [early: (mean ± standard deviation) 10060.3 ±1156.0 g vs conventional: 9812.1 ± 1270.3g, mean difference estimate 321.6g, 95% confidence interval (CI): - 183.5 to 495.7]. The growth curves of the lenght and the curves of the head and arm circumferences did not differ between the groups. Conclusion: There is no difference in growth at 12 months among breastfed infants whose mothers underwent early compared with conventional postpartum insertion of the etonogestrel implant.

Magister Public Health - MPH / Breastfeeding impacts on the health of both the mother and infant and has been noted as being influenced by physiological, physical, socio-economic and environmental factors. The undisputed benefit of exclusive breastfeeding for both the mother and child has led to the global prioritisation of the promotion, protection and support of breastfeeding with the adoption of the Baby Friendly Hospital Initiative (BFHI) strategy. Baby Friendly Hospital (BFH) status is awarded to a maternity unit when they are found to be complying with set criteria Ten Steps to successful Breastfeeding. South Africa has implemented a re-evaluation system for retention of accreditation status, by reassessing accredited facilities every three years. The respective provinces are tasked with monitoring the implementation of BFHI in their public health facilities. Internal monitoring reports, completed by the Western Cape Provincial Department of Health, reflect erosion of key steps between national reassessments. Aim: To describe the experiences, challenges and successes of BFHI implementation in the BFH accredited facilities in the Cape Town geographical health district. Methodology: An explorative qualitative study was conducted. One key informant interview, ten in-depth interviews with champions for BFHI in the maternity facilities and two focus group discussions with frontline staff working at these facilities were used to collect data. The data was analysed using thematic content analysis to identify the main themes related to the successes and challenges experienced with the maintenance of the required practices related to BFHI accreditation. Results: Participants reported that the implementation of the BFHI impacted positively on the health of both mothers and infants. Fewer children were being admitted for common childhood illnesses such as diarrhoea subsequent  to BFHI implementation. Mothers were recovering more quickly after delivery and less complications related to delivery, such as postpartum bleeding, were observed after the implementation of BFHI. BFHI implementation had a positive impact on the attitudes of maternity staff to breastfeeding promotion, protection and support. Subsequent to being awarded BFH status, facilities are tasked with maintaining the implemented practices. Challenges to maintaining the practices included lack of implementation of BFHI practices at clinics, lack of support from facility managers and support staff such as counsellors. The internal assessments implemented as supportive monitoring structures are considered by participants to be a demotivating process and concerns were raised about non nursing staff assessing nursing practices. Conclusion: The potential impact of this strategy on infant and maternal health must be realized by the implementers of BFHI, before the strategized aim is achieved. Co-ordination and support by all role players is vital to the success and elimination of challenges experienced with implementation and maintenance of the BFH strategy. / South Africa

1 Abstract The thesis discusses breastfeeding in terms of cultural anthropology. The theoretical part describes breastfeeding in the historical and social context, while also focusing on the current situation in Slovakia. The research part of the thesis analyzes selected group of eleven Slovak university educated women of the present generation of nursing mothers. The basic research hypothesis is that society and culture affects the relationship of selected group of mothers to breastfeeding. The paper uses the method of semi-structured interviews and participatory observation. Basic sets of issues reflect subjective views and experiences of mothers with these problems. The work concluded that breastfeeding among university-educated mothers is significantly affected. To a large extent, breast feeding is structured in relation to social pressure, and it is also prevalent in women's distinctive individuality.

The purpose of this study was to investigate how routine, day-to-day public health nursing (PHN) practice in one BC health authority affected health outcomes related to breastfeeding initiation and duration, infant immunizations, and household tobacco use within the population of perinatal women who were a high priority for additional and ongoing PHN services. Using administrative data from the integrated public health information system (iPHIS), outcomes for the priority population were compared to those of the general population of new mothers receiving usual PHN services. Additionally, through semi-structured interviews with PHNs, this study explored how the context of the work environment influenced PHN practice, and ultimately the achievement of those outcomes. Based on a philosophical foundation of critical realism, and a theoretical framework of critical caring, a mixed methods case study design was used to study PHN practice, as it existed day-to-day, amidst the array of ever changing organizational influences. Results from the statistical analysis of administrative data and thematic analysis of PHN interviews and organizational guiding documents, showed that priority women, who received five or more postnatal contacts from PHNs initiated breastfeeding in higher proportions than non-priority women, and continued breastfeeding to 18 months in the same proportion as non-priority mothers. Rates of breastfeeding duration for priority women were higher than expected based on current literature. Children of priority mothers were fully immunized in a slightly higher, but not significantly different proportion than children of the non-priority population, also at rates higher than expected. Although high rates of household tobacco use among this group of priority women did not appear to be influenced by PHN contact, the relationships that developed between priority women and PHNs suggest that organizational support for tobacco cessation activities may be a missed opportunity. Thematic analysis of PHN interviews and guiding documents provided background context and clarification for the kinds of organizational factors and underlying mechanisms that may have influenced the ability of PHNs to provide additional and ongoing support to priority perinatal women in achieving these three outcomes of interest. Finally, the theory of critical caring was verified and extended through the experiences and explanations of PHNs, with the addition of “navigating organizational complexity” to the original seven carative health promoting processes. / Graduate

Magister Public Health - MPH / Background: Appropriate and adequate infant feeding practices are an important factor in achieving optimal health in infants. Inappropriate and inadequate infant feeding practices contribute significantly to ill-health in infants. Both WHO and UNICEF recommend exclusive breastfeeding for the first six months both in the context of HIV and otherwise unless exclusiv formula feeding can meet each of five conditions: acceptable, feasible, affordable, sustainable and safe (AFASS). The modes of infant feeding include exclusive breastfeeding, formula feeding and mixed feeding. Medical recommendations and social pressures related to infant feeding in high HIV-prevalence low-income communities may have shifted infant feeding practices. The aim of this study was to explore factors influencing infant feeding practices and decision making among women in one such community, Kabwata Township, in Lusaka, Zambia. Method: An exploratory qualitative study was conducted at Kabwata Health Centre in Kabwata Township in Lusaka, Zambia. Convenient sampling was used to recruit 32 women for focus group discussions and three key informants (two nurses and one social worker) for individual interviews. Verbal consent was received from all participants. Semi-structured interview guides were used to elicit discussion by all participants. Discussions were tape recorded and transcribed verbatim. Thematic data analysis was used to analyze the qualitative data. Results: Most FGD participants reported that they themselves initiated breastfeeding soon after giving birth, but not all of them breastfed exclusively for the first six months, as is currently recommended. The major factors influencing infant feeding included; influence from family and friends, stigma and discrimination, influence from health care providers, practical realities such as maternal employment and poverty, and cultural/traditional practices. Conclusion: While breastfeeding is valued and accepted, most women do not or cannot exclusively breastfeed for six (6) months for various reasons. Paradoxically, the social value of breastfeeding and the knowledge that breast milk can transmit HIV reinforce mixed feeding as the predominant feeding practice. Key informants reported that women attending health care services at Kabwata health centre were encouraged and taught to breastfeed their infants exclusively for six months. There is a need to re-look at the way the women are being encouraged, taught and supported so that the apparent knowledge and acceptance of breastfeeding can translate into improved infant feeding practices. Awareness campaigns need to include all stakeholders including family members, the community, employers and the women themselves in order to make exclusive breastfeeding easier for the women.

The overall aim of this thesis was to describe the prevalence of breastfeeding in preterm infants and to evaluate the effectiveness and mother’s experiences of proactive person-centred telephone support after discharge. Furthermore, to describe the duration of breastfeeding and risks of ceasing breastfeeding up to 12 months. The first study, a register study with data from the Swedish Neonatal Quality register (SNQ), included breastfeeding data at discharge from 29 445 preterm infants born from 2004-2013. The results demonstrated that the prevalence of exclusive breastfeeding among preterm infants in Sweden decreased during the study period, especially among extremely preterm infants (<28 weeks). We also performed a multicentre randomised controlled trial (RCT) of 493 breastfeeding mothers of preterm infants discharged from six neonatal units in Sweden. The intervention consisted of a proactive breastfeeding telephone support system in which a breastfeeding support team called the mothers once everyday up to 14 days after discharge. The control group received reactive support; the mothers were invited to call the breastfeeding support team if they wanted to talk or ask any questions (i.e., usual care). The RCT demonstrated that the intervention did not affect exclusive breastfeeding at eight weeks after discharge (primary outcome) or up to 12 months. The proactive support did not affect maternal breastfeeding satisfaction, attachment, quality of life or method of feeding (secondary outcomes). However, parental stress was significantly reduced in mothers in the intervention group. Mothers in the intervention group were significantly more satisfied and involved in the support and felt empowered compared with mothers in the control group, who experienced reactive support as dual. Further findings showed that a lower maternal educational level, partial breastfeeding at discharge and longer stay in the neonatal unit increased the risk of ceasing breastfeeding during the first 12 months of postnatal age. In conclusion, the trend for exclusive breastfeeding at discharge in preterm infants is declining, which necessitates concern. The evaluated intervention of telephone support did not affect breastfeeding, in the short-or long-term. However, maternal stress was reduced and mothers were significantly more satisfied with the proactive support and felt empowered by the support.

Recommendations on breastfeeding in the United States suggest that infants should be exclusively breastfed for six months with continued breastfeeding in conjunction with complementary foods for at least one year. However, only 22.30% of women are exclusively breastfeeding when their infant reaches the age of six months, which indicates the existence of barriers hindering prolonged breastfeeding. In this study, I consider the factors related to information-seeking behavior that may influence breastfeeding rates. Specifically, I focus on the relationship between the sources a woman selects to receive information about breastfeeding and her level of breastfeeding self-efficacy, which has been shown to be a significant predictor of breastfeeding success. A sample of 222 breastfeeding women was recruited for participation in this study. Participants completed a mixed-methods survey, and the results of the survey were analyzed using applied thematic analysis, correlation, and regression analysis. Women who participated in this study used non-expert online information sources most frequently when searching for information related to breastfeeding. Criteria women used most frequently when choosing an information source included source affordances (e.g., convenience and quickness), information characteristics (e.g., variety of information and information quality), and source characteristics (e.g., source expertise). Hypotheses for this study posited a relationship between source characteristics (i.e., expertise, trustworthiness, goodwill, and social support) and breastfeeding self-efficacy; all hypotheses were supported, and expertise, trustworthiness, goodwill, and social support were found to have a significant positive relationship with breastfeeding self-efficacy. Source expertise was found to be the strongest predictor of breastfeeding self-efficacy among those that were measured for this study; however, it is not an individual significant predictor when modeled alongside the remaining source characteristics. Implications of this study stress the importance of access to quality information related to breastfeeding and continued research on the development of breastfeeding self-efficacy in various demographic populations and over the span of a breastfeeding relationship.

Infants and young children in the Northwest province of Nigeria are susceptible to malnutrition. Inappropriate and inadequate breastfeeding and complementary feeding result in stunting, underweight, and wasting. The purpose of this cross-sectional study was to examine current feeding practices of infants not older than 2 years and their nutritional status in Northwest Nigeria. The theory of planned behavior was adopted in this research. With a total sample size of 3,861, multiple linear regression was adopted as a predictive analysis to delineate the correlation between two or more independent variables and one continuous dependent variable. Also, adopted was an independent t test to demonstrate the statistical difference between the mean of the dependent variable and that of the independent variable. The coefficient of determination (R2) indicated that the change in underweight associated with exclusive breastfeeding (EBF) was 8.1%. The overall regression model was significant, F(18, 879) = 4.29, p < .05, adj. R2 = .06 predicted underweight in infants under 6 months of age. The coefficient of determination (R2) indicated that the changes in underweight associated with age appropriate complementary (CP) feeding was 8.0%. The overall regression model was significant, F(18, 2,944) = 14.29, p < .05, adj. R2 = .08. The model predicted underweight in infants 624 months of age. The results from this study can be used in the reinforcement of EBF and age appropriate CP guidelines and policies by the extension of paid leave, implementing flexibility in working hours, and private space to breastfeed.

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

Background: Breastfeeding twins implies that the mother breastfeeds children of the same age and the children can be breastfed either together or separately. There are many benefits with breastfeeding twins, including the fostering of attachment. Breastfeeding is often represented as a natural and easy process, however, many mothers find the experience to be challenging. Aim: This study aimed to describe how mothers experience breastfeeding twins. Method: The study was conducted through a meta synthesis where qualitative research was included. Searches for articles were made through the electronic databases PubMed and CINAHL. A total of ten scientific studies with qualitative design were included. Results: The results are based on four main themes; 1) Experiences of physically influential factors. The mothers experienced difficulties breastfeeding twins simultaneously and found it time-consuming. 2) Experiences of psychologically influential factors. The mothers felt insecure and were afraid that there wouldn’t be enough breastmilk for both twins. 3) Experiences of support from the surroundings. The support from the mothers’ partner and her surroundings was shown to be important and improved the conditions for breastfeeding the twins. Finally, 4) Experiences of the community's influence. The mothers experienced some benefits during hospitalisation with the twins but mostly disadvantages, which complicated the breastfeeding. Conclusion: Mothers’ experiences of breastfeeding twins were found to be both negative and positive as seen from a physical and psychological perspective. The results indicate the importance of support from the healthcare staff when breastfeeding, which further promotes the attachment between the mother and her children. The nurse has a significant role in encouraging the mother's self-efficacy, independence and motivation to breastfeed her twins for as long as the mother and the children wishes. / Bakgrund: Tvillingamning innebär att mamman ammar syskon i samma ålder och barnen kan ammas var för sig eller samtidigt. Det finns många fördelar med att amma tvillingar, bland annat främjar det anknytningen. Amning framställs ofta som en naturlig och enkel process, men för många mammor upplevs tvillingamningen som svår och mer utmanande än de kunnat föreställa sig. Syfte: Syftet med arbetet var att beskriva hur mammor upplever det att tvillingamma. Metod: Syftet besvarades genom en metasyntes där forskning med kvalitativ ansats inkluderades. Artikelsökningarna genomfördes i databaserna PubMed och CINAHL och resulterade i tio vetenskapliga kvalitativa studier. Resultat: Resultatet sammanfattades genom fyra huvudsakliga teman; 1) Upplevelser av fysiskt påverkande faktorer. Mammorna upplevde att det var svårt att amma två barn samtidigt och att amningen var tidskrävande. 2) Upplevelser av psykiskt påverkande faktorer. Mammorna kände osäkerhet och rädsla över att bröstmjölken inte skulle räcka till båda tvillingarna. 3) Upplevelser av stöd från omgivningen. Stöd från partner och andra personer i omgivningen var viktigt och ökade förutsättningarna för att amma tvillingarna. Slutligen 4) Upplevelser av samhällets påverkan. Mammorna upplevde vissa fördelar men mestadels nackdelar med att vistas på sjukhus med sina tvillingar, vilket försvårade amningen. Slutsats: Mammor upplevde amningen både som något positivt och negativt sett från ett fysisk samt psykiskt perspektiv. Resultatet visade även på betydelsen av stödet mammor erhöll från sjukvårdspersonal kring sin amning, vilket kan gynna anknytningen/bindningen mellan tvillingarna och mamman. Sjuksköterskan har en viktig roll i att främja mammornas självkänsla, självständighet och motivation till att amma sina tvillingar så länge som mamman och barnet önskar.