Thesis (MPH.) -- University of Limpopo, 2019 / Introduction: Exclusive breastfeeding for six months, with introduction of appropriate complimentary feeding at six months, continuing to 2 years and beyond comes highly recommended. Although breastfeeding rates have improved in South Africa, the prevalence still remains lower than the Rome target of 50%, supporting investigation into factors that influence infant feeding practices. Aim: The aim of this study was to describe infant feeding practices and to determine the factors influencing infant feeding practices of mothers and care givers of infants in the Polokwane Municipality - Limpopo Province. Methods: A cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire. Interviews only were conducted to gather quantitative data. The questionnaires were administered to the mothers, one mother at a time. Chi–square tests were used to determine the relationship between selected variables, where p<0.05 was set as level of significance. Results: A total of 146 mothers participated in the study. All were biological mothers of infants. Ninety-four percent of the mothers initiated breastfeeding, however, at the time of data collection 8% of mothers had stopped. Of those who had stopped breastfeeding, 5% stopped earlier than one month after initiation. Thirty-nine percent of mothers breastfed exclusively, while 61% practiced mix feeding. A positive association between breast feeding practices and age of the mother (p<0.036) was observed. The reasons mothers reported for stopping breastfeeding were: mother was ill (45.4%) and going back to school or work (27.3%). Reasons for not breastfeeding were cited as: medical condition, not enough milk and infant refusal to breastfeed at 33.3%. Health workers are the main source of HIV information (77%). Mothers believe that HIV-positive women should breastfeed their infants (57%). Conclusion: breastfeeding initiation is well practiced. Exclusive breastfeeding during the first six months is rarely practiced. Infant formula and solid foods were introduced at an early age. Young mothers tend to stop exclusive breastfeeding compared to older mothers.

Thesis (MPH. ) --University of Limpopo, 2014 / The aim of this study was to determine the knowledge and practices of mothers with regard to exclusive breastfeeding in the Mahwelereng Local Area of the Waterberg District, Limpopo Province. A quantitative study was conducted by using a researcher-administered structured questionnaire at six clinics in the Mahwelereng Local Area. A simple random sampling method was used to select the hundred and seventy five mothers who had babies of less than six months old from whom data was collected. Data was analysed with the assistance of the statistician by using the SPSS software program. Data is presented applying descriptive and inferential statistics. Less than half (74; 42.3%) of the responding mothers were practising exclusive breastfeeding despite the fact that 137 (78.3%) of them were given information about exclusive breastfeeding. There is an association between knowledge of exclusive breastfeeding (Chi-Square= 14.039; Sig=0.000 p<0.05) and exclusive breastfeeding practice. There is no association between exclusive breastfeeding practice and HIV status (Chi-Square=2.444; Sig=0.118; p>0.05). Challenges that mothers faced in relation to practising exclusive breastfeeding were work-related, school-related, health-related, pressure from family to mix-feed, and a lack of knowledge. However, 42.9% of the respondents indicated that they did not have any challenges with regard to the practice of breastfeeding. It was, therefore, recommended that one-on-one counselling about exclusive breastfeeding needs to be intensified and maternity leave should be extended to six months. The majority of respondents showed adequate knowledge of what exclusive breastfeeding was because they were counselled about breastfeeding although they were not practising it. Key words: Exclusive breastfeeding, mothers, knowledge, practices, mix-feeding.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2007. / Introduction In order to address poor breastfeeding rates, both nationally and internationally, there is a great need for ongoing breastfeeding training for students of health care professions and health care workers (HCWs). Despite the availability of courses, there is a need for new approaches to ensure greater and more effective coverage in breastfeeding training. The students of today relate well to the use of computers in the learning environment. It was therefore deemed appropriate to explore this training method as a means to enhance the breastfeeding learning experience for students of health care professions and, more specifically, for undergraduate dietetic students. This study was aimed at adapting and validating an Indian computer-based undergraduate breastfeeding training module, intended for use by South African (SA) undergraduate dietetic students, in order to assess whether computer-based learning in breastfeeding training could address the relevancy of the topic, assess how students view the learning experience and determine whether it could contribute to a gain in knowledge of the subject. Methods An Indian computer-based undergraduate breastfeeding training module in PowerPoint format was adapted to suit the SA scenario. It was converted into web-based interactive material using the Virtual Training Studio (VTS) software tool. The adapted module was assessed for face and content validity by 19 peer reviewers and 17 third year Stellenbosch University (SU) dietetic students, by means of a self-administered questionnaire. A focus group discussion was also conducted with the third year students. The impact of the adapted module on knowledge was evaluated by means of a pre- and post-knowledge test on a total of 29 second year SU (n=14) and University of the Western Cape (UWC, n=15) dietetic students. Results All of the peer reviewers and students were of the opinion that their information technology (IT) skills were sufficient to complete the adapted module. The majority of the peer reviewers (94%, n=17) also indicated that they had adequate IT facilities and that it was feasible to administer the module. Peer reviewers and students enjoyed the presentation and delivery mode of the adapted module. Third year students indicated that computer-based learning (CBL) was a “nice way of learning”, but pleaded that it should not be used as the sole source of instruction. The majority of the peer reviewers and students (53%, n=19) rated the mode of learning to be equally effective compared to conventional lectures, 35% rated it as being more effective and 11% as less effective. Eighty six percent of peer reviewers and students felt that the information in the adapted module was sufficient to enable the students to take the necessary preventive- or treatment action. The majority (91%) were of the opinion that the information in the adapted module was appropriate for the specific needs and cultural context in SA. There was a significant increase in the knowledge test scores for second year students at SU and UWC. Conclusion The SA VTS breastfeeding training module can be integrated effectively as part of multi-media methods to increase knowledge and enhance breastfeeding training for undergraduate dietetic students, as well as other students of health care professions and, possibly, HCWs in institutions striving to become Baby Friendly.

Thesis (MPH.) -- University of Limpopo, 2022 / BACKGROUND: Exclusive breastfeeding in South Africa to date has not seen progress. The data that is available show that most mothers do initiate breastfeeding immediately after delivery of the baby, but its continuation to the first six months is still a challenge. Although its benefits to the mother and baby are mostly known, it is not translated into positive outcomes as recommended by WHO i.e. to feed the baby with breast milk only, no water, no solids except for medicines that have been prescribed for the first six months. OBJECTIVES: To explore and describe perceptions of breastfeeding mothers regarding factors contributing to exclusive breastfeeding for the first six months at Mugodeni Grace Health centre. METHODS: A qualitative, exploratory and descriptive phenomenological method was used in the study, which was conducted at Mugodeni Grace Health Centre. The convenience sampling strategy was used to recruit participants and the sample size was determined by data saturation. Face-to-face in-depth semi-structured interviews were conducted with nine participants in Xitsonga, using an interview guide and were audio taped with the consent of the participants and transcribed verbatim. Data was analysed using Tesch open coding approach. RESULTS: Three themes and nine subthemes emerged from the data analysis, which includes maternal knowledge of breastfeeding, support systems for exclusive breastfeeding and social and cultural influences leading to non-exclusive breastfeeding CONCLUSION: Exclusive breastfeeding for the first six months is a societal issue, which need the involvement of society as a whole to perceive it differently for it to be successful, a family-centred approach in which the father has a role to be part of it to assist and support the mother. Continuous support from the family and health facilities by knowledgeable health practitioners is desired. The study revealed that some nurses were practising wrong breastfeeding practices in front of community members. This made mothers to lose confidence in them as people who can be consulted in case of breastfeeding challenges. Cultural beliefs and myths should be handled in a culturally sensitive manner. Working mothers should be taught to negotiate and make a plan for breastfeeding with the employer during pregnancy and to know of their rights at work viii regarding breastfeeding. Mothers should be taught to breastfeed for eight to twelve times per day. They should also be taught about the causes of crying in babies and shown practical skills on how to latch and how to calm the crying baby.

Rationale: There is limited research available in South Africa that explores the breastfeeding experience among adolescent mothers; most of the studies were conducted in developed countries. One such study relating to the above mentioned developed countries stated that social and commitment factors influence the decision to breastfeed by adolescents. Furthermore, while adolescent mothers appreciate the benefits of breastfeeding, pain, public exposure and perceived complexities related to breastfeeding create barriers for them. The researcher was unable to ascertain if similar ambiguities exist among adolescent mothers in South Africa, and in the Eastern Cape (EC) in particular with its high rates of adolescent pregnancy. In order to attempt to develop age appropriate recommendations to assist adolescent mothers with their breastfeeding journey, the researcher undertook this research study to answer the following question: What are the breastfeeding experiences of adolescent mothers in the Nelson Mandela Bay Heath District (NMBHD)? Aim: The research aim was to determine the experiences of adolescent mothers regarding breastfeeding in NMBHD. Methods: The study implemented a qualitative research approach. To enhance the design, the researcher utilised an explorative, descriptive and contextual research design. The ethical principles that guided this study were autonomy, nonmaleficence, beneficence and justice. Fourteen adolescent mothers, attending PHC facilities in the NMBHD participated in the study. Participants were chosen from a purposive sampling technique and data were collected from semi-structured interviews, compromising of individual interviews. The researcher analysed the data using the using the eight steps of the Tesch analysis technique. Data was also analysed by an independent coder. Results obtained from the Tesch approach were compared to that of the independent coder results. Thereafter, the major themes and sub-themes that related to the study objectives were identified. Results: Three themes and 10 sub-themes were identified. Lack of knowledge and poor adherence to EBF, perceived breastmilk insufficiency, as well as incorrect infant feeding advice given by maternal mothers and grandmothers were associated with early introduction of complementary feeding. Most participants were motivated to breastfeed due to its economic and bonding benefits, as well as seeing their infant‟s progress in growth. Challenges of breastfeeding mentioned by the participants include: lack of support from the fathers of their infants and from health care providers, breast milk leakage, and the foul smell associated with the leaking of breast milk. The participants of the study also had suggestions to help improve the support given to adolescent mothers by health care providers in PHC facilities. Conclusions and recommendations: In conclusion, this study‟s findings revealed that adolescent mothers may need extra age appropriate education and support to assist them in breastfeeding successfully at PHC facilities, the community and schools. Maternal mothers and grandmothers were found to be the primary source of a support network for most adolescent mothers as opposed to health care providers who were categorised as being the secondary source of support. Thus, breastfeeding promotion tailored at maternal mothers and grandmothers would be beneficial in improving their knowledge about the recommended infant feeding practices and consequently aid in providing appropriate support and advice to adolescent mothers. Additionally, training and attitude modification of health care providers is needed to provide adolescent mothers with age-appropriate, effective and sensitive care and counselling.

The Department of Health in South Africa, as in many countries, has developed a policy guideline and recommendations for feeding of infants of HIV positive mothers. This is aimed at providing midwives with detailed and sound information about HIV and infant feeding practices based on current understanding of HIV and exclusive breastfeeding for the first six months of the infant’s life. The policy states that breastfeeding is a significant and preventable mode of HIV transmission to infants and there is an urgent need to educate, counsel and support women and families, so that they can make decisions about how best to feed infants in the context of HIV (http://www.doh.gov.za/aids/doc/feeding/html.2005-03-07). Speaking to midwives from the Provincial Hospitals in the Nelson Mandela Metropole, the researcher became aware of the midwives’ often-expressed unhappiness about the new policy from the Department of Health on exclusive breastfeeding. Midwives complained about the dilemma with which they are faced regarding infant feeding practices. They could not understand the advocacy of exclusive breastfeeding, when breastfeeding is recognised as one of the modes of Mother-to-Child Transmission (MTCT) of HIV. The aim of the study was to help, support and encourage midwives to implement the policy of exclusive breastfeeding. The objectives of the study were to: • Explore and describe the experiences and perceptions of midwives related to promoting exclusive breastfeeding in HIV positive first-time mothers. • Make recommendations to the Department of Health regarding the support and help that can be given to midwives to encourage their implementation of the exclusive breastfeeding policy. The researcher made use of a qualitative, phenomenological, descriptive, explorative and contextual design. Permission for conducting the research was iv obtained from relevant authorities, and participants were asked to sign a consent form before the researcher proceeded with the study. Collection of data was done by means of unstructured interviews using an audiotape recorder. Once data was saturated, the interviews were transcribed verbatim and analysed, using the steps described by Tesch’s (1990 in Creswell, 1994: 153) method of descriptive analysis. Field notes were also taken to record non-verbal communication during the interviews. In order to ensure trustworthiness of the study, the ethical principles of Guba’s model (in Krefting, 1991:215), namely truth-value, applicability, consistency and neutrality were used. The services of an independent coder were utilised and a consensus meeting was held between the researcher and the independent coder in order to discuss the identified themes. Prior to the consensus meeting, the independent coder was provided with interview transcripts and a protocol to guide the data analysis. Following the data analysis, a literature control was undertaken to highlight the similarities and differences found in the data analysis. Three themes with sub-themes were identified. The participants expressed positive views on the policy of exclusive breastfeeding in HIV positive first-time mothers. They were satisfied with the policy and viewed the policy of exclusive breastfeeding as an effective contribution to feeding options of babies born of HIV positive first-time mothers. However, the participants identified several factors hindering the effective implementation of the policy of exclusive breastfeeding in HIV positive first-time mothers. Factors identified were staffshortages, lack of cooperation among staff members regarding promotion of exclusive breastfeeding, lack of information regarding the CD4 count of patients on admission in the ward, cultural beliefs, lack of training among staff members and inadequate counseling facilities to ensure privacy and confidentiality for mothers. Participants also experienced a variety of emotions related to exclusive breastfeeding such as happiness, confidence, helplessness, frustration, worry and concern, stress and exhaustion. Based on the findings of the study, guidelines were developed and recommendations made concerning nursing practice, nursing education and nursing research.

First eleven leaves not numbered / The purpose of this study was to identify, explore and describe the potential contributing factors of the upsurge of HIV among children aged three to eighteen months in the Mangaung Metropolitan area of the Free State Province in South Africa. The study was conducted at five primary healthcare facilities and one hospital in the Mangaung metropolitan municipality of the Free State Province with sixty randomly selected mothers of children testing HIV-positive for the first time between the ages of three and eighteen months. The convergent mixed-methods research design was opted for, according to which both qualitative and quantitative data were collected at the same health facilities selected by means of cluster sampling. The review of medical records, unstructured interviews, and structured questionnaires were used for qualitative and quantitative data collection, while random cluster sampling was used for participant selection. Thematic data analysis was applied for the interpretation of recurrent patterns of qualitative and quantitative data. The study results revealed that mothers were well-informed about the prevention of mother-to-child-transmission. The main factors that contributed to more children testing HIV positive after the routine tests were conducted at ten weeks included non-adherence factors to PMTCT prescripts mainly by mothers, such as: babies were not brought to the clinics for testing and immunisations at ten weeks, and that mothers acquired HIV infection during the breastfeeding period. Some other potential contributing factors were late antenatal booking which lead to the delay in initiation of antiretroviral treatment, nonadherence to antiretroviral therapy during pregnancy, and mixed feeding. The themes that emerged from the qualitative data were psychological factors, emotional factors, socioeconomic factors, missed opportunities, risky behaviour, as well as women disempowerment; while some mothers were left with unanswered questions. The results of the qualitative part complemented the quantitative findings as they uncovered the factors that led to the deviation from the PMTCT prescripts by the mothers. The study’s recommendations include PMTCT psychological assessment and counselling; partner and community involvement; women empowerment; and that couple testing at antenatal and postnatal clinics should be a national policy subjected to protracted monitoring and evaluation processes. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / Breastfeeding is particularly important in resource-poor regions of the world, where limited access to clean water increases the risk of diarrhoeal disease if replacement feeding is used. However, human immunodeficiency virus type 1 (HIV-1) is transmitted through human milk. Purpose of the study The purpose of this study was to describe the determinants contributing to exclusive breastfeeding in HIV-infected mothers of infants aged 0 to 6 months who attend an NGO Health Centre in Elandsdoorn Village. Methods A quantitative research approach using a non-experimental cross-sectional study was undertaken to conduct this study. A self-reported study questionnaire was used to collect data from study participants. Purposive sampling was used to sample 75 mothers from 18 to 45 years of age who were HIV-positive. SPSS version 23 was used to analyse the data. Results The study results indicated that there are determinants contributing to exclusive breastfeeding and a need to establish a more comprehensive approach to educating pregnant women on reproductive health issues, and exclusive breastfeeding in particular. Factors contributing to low levels of exclusive breastfeeding included breast problems, societal influence, maternal health concerns, insufficient support, fear of stigmatisation, and babies’ health concerns. This caused mothers to discontinue exclusive breastfeeding. Conclusions The intention of this study was to reveal the determinants of exclusive breastfeeding affecting mothers who are HIV-infected and breastfeeding their infants. / Health Studies / M.P.H.

Text in English / The study was conducted to determine the knowledge and to describe attitudes of HIV positive women on exclusive breastfeeding in Mopani District (the Greater Letaba Sub-District, Limpopo), South Africa. A quantitative, exploratory and descriptive design was adopted in this study to describe the knowledge and attitudes of HIV positive women on exclusive breastfeeding. The researcher used a self-developed structured questionnaire to collect data. Descriptive and inferential statistics were used to describe data. The SPSS software version 21.0 was used to analyse data and this were displayed in tables and figures. A total of 123 participants were included in the study. The study concluded that HIV positive women have good knowledge and positive attitude on exclusive breastfeeding. / Health Studies / M.P.H.