Magister Scientiae (Nutrition Management) - MSc(NM) / Globally, health workers play a critical role in the establishment and sustenance of breastfeeding due to their frequent contacts with mothers at the antenatal clinics, maternity/birthing units, Primary Health Care Centres (PHC) and postpartum clinics. Their knowledge and attitude regarding breastfeeding will affect the quality of information about infant and young child feeding practices passed along to mothers who visit their health facilities.

Magister Scientiae (Nutrition Management) - MSc(NM) / Despite evidence-based proof on the benefits of breastfeeding, little progress has been made globally to improve breastfeeding rates (The Lancet, 2016), including in South Africa. Despite many attempts to improve breastfeeding rates worldwide, women are still choosing to stop breastfeeding or avoid it due to various factors (The Lancet, 2016). Aim: To explore the factors influencing the exclusive breastfeeding rate within the first 14 weeks postpartum with mothers in the Khayelitsha Eastern Substructure.

Bakgrund: Från det att barnet är fött till dess att barnet börjar skolan är det BVCsköterskans roll att främja hälsa och förhindra hälsoproblem. BVC-sköterskans roll är även att informera om amningens stärkande effekter samt att stödja mödrar när de behöver det. Syfte: Att belysa vilka erfarenheter sjuksköterskor inom barnhälsovården har av varför mödrar slutar helamma under barnets första sex månader. Metod: Intervjustudie med kvalitativ innehållsanalys med induktiv ansats där 17 sjuksköterskor inom barnhälsovården intervjuades under våren 2020. Resultat: Analysen av intervjuerna resulterade i fyra kategorier: Snabb introduktion av vanlig mat, Bröstmjölken räcker inte till, Helamning är tidskrävande och smärtsamt och Påverkar det sociala livet. Konklusion: Mödrar vill vanligtvis amma sina barn men amningen kan även göra att de känner sig låsta eller pressade. Flertalet mödrar saknar kännedom om att amning emellanåt kan vara svår och kan ta tid att få igång ordentligt. Det finns många gånger en oro hos mödrarna att bröstmjölken inte är tillräcklig. Omkring fyra månaders ålder kan barnet börja få smakportioner och i samband med detta erhåller mödrarna en barnmatsbok. Barnet blir även mer aktiv vid fyra månaders ålder och det kan då vara enklare och mer spännande att ge vanlig än att bara amma. / Background: From the moment the child is born until he/she starts school it is in the line of duty of the pediatric primary care nurse to promote health and prevent possible health issues. Among other things, the pediatric primary nurse also has an obligation to inform new mothers of the beneficial effects of breastfeeding and provide support to them, when needed. Aim: To examine what experiences pediatric primary nurses have to why mothers stop breastfeeding conclusively during the child’s first six months of life. Method: An interview study with a qualitative inductive approach, where seventeen pediatric primary nurses was interviewed during the spring of 2020. Results: The results of the interview were divided into four different categories: Quick introduction of regular food, The breastmilk is not enough, Breastfeeding is time-consuming and painful and Effects of the social life. Conclusion: New mothers generally wants to breastfeed their child. However, breastfeeding can make them feel pressured and trapped. Several mothers have lack of knowledge regarding breastfeeding may sometimes be hard and take a while to get sorted. Many times the new mothers are worried that the breastmilk is not enough for their child. When a child is around four months old he or she may start to eat samples of food. When this happens, the mother normally receives a book about food for infant children. On account of the child normally becomes more active at four months old it may also be easier and more exciting to give actual food, rather than solely breastfeeding.

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Enligt World Health Organizations rekommendationer bör kvinnor uteslutande amma sina barn under de första sex levnadsmånaderna. Amning medför kortsiktiga och långsiktiga hälsofördelar för både mamman och barnet och innebär miljömässiga och ekonomiska vinster både på individ och samhällsnivå. Trots detta sjunker amningsfrekvensen och det är i skrivande stund bara en tredjedel av världens spädbarn som helammas upp till sex månaders ålder. I Sverige har andelen helammade barn minskat under de senaste 30 åren och frekvensen fortsätter att sjunka. Detta är ett stort folkhälsoproblem där barnmorskan har en central uppgift i sitt arbete att främja och stödja kvinnor till amning.  Syftet var att undersöka vilka faktorer som bidrar till att kvinnor helammar sitt barn. Vald metod var en integrativ litteraturöversikt med en flerstegsprocess framställd av Whittemore och Knafl. Sexton artiklar inkluderades i resultatet, varav åtta kvantitativa, sjukvalitativa och en av mixad metod. All data insamlades via databaserna PubMed och CINAHL under våren 2023. I resultatet sammanställs fem kategorier som svarar på syftet: aktivt stöd från barnmorskan genom hela vårdkedjan, stöd från partner och omgivning, bemötande och motivation, kunskap och evidensbaserad information samt skyddsfaktorer och riskfaktorer till helamning. Slutsatsen var att kvinnor helammar i större utsträckning när de haft ett aktivt stöd från barnmorskan genom hela vårdkedjan. Ett individanpassat stöd med respekt för kvinnans autonomi var viktigt. Motivationen att helamma ökade i de fall barnmorskan uppmuntrade och stärkte kvinnornas upplevelse av självförmåga samt visade tilltro till deras nya roll som ammande mödrar. Att ha en stödjande partner samt att kvinnorna fick adekvat och evidensbaserad information om amning var också avgörande. Inkonsekventa och motsägelsefulla amningsråd minskade förtroendet för vårdgivarna och påverkade amningen negativt. Gemensamma riktlinjer för amningsstöd bör utformas inom vårdverksamheten och varje barnmorska bör hålla sig uppdaterade kring evidensbaserad kunskap om amning. / World Health Organization recommend women to exclusively breastfeed their children until the age of six months. Breastfeeding contributes to short-term and long-term health benefits for both the mother and child and entails environmental and economic gains at an individual and societal level. Despite this, breastfeeding rates are decreasing and currently only one third of the children worldwide are exclusively breastfed up to the age of six months. In Sweden, exclusive breastfeeding has decreased over the last 30 years and continues to do so. This is a major public health problem where midwives play a central role in their work to promote and support women to breastfeed. The aim was to investigate which factors contribute to women exclusively breastfeeding their children. The chosen method was an integrative literature review based on Whittemore and Knafl´s multi-stepprocess. Sixteen articles were included in the results, eight quantitative, seven qualitative and one of mixed method. All data were collected via the databases PubMed and CINAHL in the spring of 2023. The results compiled five categories: active support from the midwife throughout the care-chain, supportive partner and friends, treatment and motivation, knowledge and evidence-based information as well as protective factors and risk factors for exclusive breastfeeding. Women exclusively breastfeed longer when they recieve active support from midwives throughout the entire care-chain. Individuaized care and respect for womens autonomy was important. The motivation to breastfeed increased when the midwife encouraged and strengthened the womans self-efficacy and showed trust in their new role as breastfeeding mothers. Having a supportive partner as well as receiving adequate and evidence-based information about breastfeeding from midwives were also important. Inconsistent breastfeeding advice from care givers negatively affected their motivation. It is important that midwives create common guidelines for support and remain updated on evidence-based breastfeeding knowledge.

This research examined two interrelated issues relevant to maternal and neonatal health in Pakistan, namely, the rising rates of C-section delivery and low rates of exclusive breastfeeding. By using the Andersen's health behavioral model to frame two empirical studies, the data from the Pakistan Demographic and Health Survey (PDHS) 2012-13 was used. The first empirical study examined the correlation between place of delivery and the odds of cesarean section in Pakistan. Not all Pakistani women have an equal chance of delivering at a health facility where C-section delivery takes place; therefore, the study modeled mode of delivery as a two-step process. In the first step, place of delivery was a function of medical indications and various sociodemographic and community factors. Women who delivered at a health facility were included in the second step, where C-section was a function of medical indications and type of facility (private, public). It is found that women who delivered at a private health facility were more likely to have a C-section, even after controlling for the effects of medical/clinical factors, which is concerning. Findings suggest that the private maternal health sector in Pakistan may be over-medicalizing childbirth. The second study examined this paradox of low exclusive breastfeeding in Pakistan, taking into account not only individual-level characteristics of the child and parents, but also place and mode of delivery, sociocultural factors, and community composition. The sample consisted of 1,044 children 0-5 months old, currently living with their mothers. Binary logistic regressions of exclusive and predominant breastfeeding found women who delivered vaginally, whether at home or health care facility were more likely than mothers who delivered via C-section to predominantly breastfeed their infant, and that mothers who delivered vaginally at a health care facility were more likely than their peers who delivered via C-section to exclusively breastfeed their infants. Collectively, the findings of both empirical studies suggest that private maternal health care services in Pakistan may be facilitating medically unnecessary C-sections, either for profit making or time management. An extended and integrated policy regarding medically unnecessary C-section delivery and low rates of exclusive breastfeeding is needed in Pakistan to address both issues together effectively.

Exclusive breastfeeding has been recognised as an important public health tool for the primary prevention of child morbidity and mortality. Consequently, the WHO and UNICEF have recommended exclusive breastfeeding for the first six months after delivery, followed by introduction of complementary foods and continued breastfeeding for 24 months or more. Even so, however, efforts to promote exclusive breastfeeding have either achieved limited successes or run into severe problems due in part to poor understanding of the several influences on the practice. As a social institution and more importantly the basic unit of society, the aim of this study was to seek an in-depth understanding of family influences on exclusive breastfeeding in rural Ghana. Using a qualitative method with unstructured interviews as data collection instrument, a total of fourteen respondents comprising breastfeeding women and family from Moglaa in the Savelugu/Nanton Municipality in Ghana participated in this study. All Interviews were audio taped, transcribed, and analysed using seven analytic procedures. Four themes emerged in relation to the forms of family influences on exclusive breastfeeding: family knowledge of exclusive breastfeeding; collective sense of duty; family beliefs and practices; and learning to breastfeed. Given how the family participate and influence infant feeding practices, it is suggested that public health education must aim at increasing the familiarity of family members on breastfeeding recommendations and also endeavour to work with traditional and religious leaders so as to modify and/or discourage practices that involve feeding newborns with herbal teas and ritual concoctions.

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.

The aim of this study was to explore, describe and interpret the experiences of Immunodeficiency Human Virus (HIV) infected mothers regarding exclusive breastfeeding in the first six months of the infant’s life. This was a qualitative study with phenomenology as a design as the study was about lived experiences. The sample consisted of HIV infected mothers aged 18 years and above who opted for exclusive breastfeeding for the first six months of their infant’s lives. Purposive sampling was used. Data was collected through one to one semi structured interviews of fifteen mothers of babies aged six to twelve months. The study revealed that mothers had both positive and negative experiences which were influenced by among others; the level of support the mothers received, disclosure of HIV status and health education received at the health facility. The findings of the study revealed a low level of understanding of the Infant and Young Child Feeding Policy by health professionals / Health Studies / M.A. (Health Studies)

Introdução-O aleitamento materno promove vantagens para a criança, mulher e sociedade. Entretanto as taxas de amamentação, principalmente o aleitamento materno exclusivo estão abaixo dos níveis desejados em diversos países. A identificação dos determinantes da interrupção precoce e a quantificação da interação destes fatores é crucial para estabelecer, avaliar e promover políticas públicas em prol das práticas de amamentação. Objetivo-Estimar os efeitos dos fatores associados à prevalência do aleitamento materno exclusivo, predominante e continuado no primeiro e segundo anos de vida em países da América Latina e Caribe no período de 2000 a 2016. Métodos-Foram utilizados microdados coletados no projeto Monitoring and Evaluation to Assess and Use Results Demographic and Health Survey. Para complementar as informações foram recolhidos dados agregados do World Bank. Os indicadores analisados foram aleitamento materno exclusivo (AME), aleitamento materno predominante (AMP) e aleitamento materno continuado (AMC) no primeiro e segundo anos de vida; os valores foram expressos em prevalência e estratificados por quintos de riqueza. Selecionou-se o último inquérito disponível de cada país da América Latina e Caribe com dados entre os anos de 2000 e 2016. As variáveis foram selecionadas segundo disponibilidade e enquadramento no modelo conceitual proposto por ROLLINS et al. (2016). O modelo utilizado no estudo foi elegido após análise com Regressão de Poisson e, posteriormente, foi realizada análise logística multinível de efeitos mistos para quantificar o efeito de cada determinante do efeito fixo ajustado pelo efeito randômico. Resultados-A variação das prevalências dos indicadores foi de 7,4% a 60,3% no AME, 13,9% a 71% no AMP, 35,0% a 86,6%no AMC no primeiro ano e 18,9% a 55,0% no AMC no segundo ano de vida. Bolívia e Guatemala se destacam por apresentar as maiores taxas de AME, 60,3% e 54,2%, respectivamente. Os países apresentaram maior prevalência dos indicadores nos quintos inferiores de renda, destacando-se as associações do padrão de aumento da magnitude do efeito negativo à medida que o quinto de renda aumenta. O AME e AMP se associaram diretamente à \"amamentação na primeira hora\", \"estado conjugal\" e \"queria o último filho; \"idade materna\" e \"status de trabalho\" se associaram inversamente aos indicadores AMC no 1º e 2º anos de vida. Na análise de efeitos mistos, os indicadores AME e AMP se associaram diretamente a \"amamentação na primeira hora\" e \"estado conjugal\" e inversamente às variáveis \"local do parto\" e \"status de trabalho\". A escolaridade materna apresentou associação inversa com os indicadores AMP, AMC no 1º e 2º anos de vida e o quinto de riqueza apresentou associação inversa com todos os indicadores estudados. O AME apresenta maior variância explicada pelo nível individual, enquanto o AMC no 2º ano de vida sofre grande influência pelo nível contextual (8,99e-15% e 69,7%, respectivamente). Conclusão-As variáveis relacionadas ao indivíduo foram as que melhor explicaram a variância do modelo para o AME, AMP e AMC no 1º ano de vida. As variáveis relacionadas ao contexto explicam maior variabilidade da prevalência do AMC no 2º ano de vida, exibindo a maior interferência do PIB e de influências de âmbito nacional. / Introduction-Breastfeeding promotes benefits for the child, woman and society. However, breastfeeding rates, especially exclusive breastfeeding, are below desired levels in many countries. The identification of the determinants of the interruption precociated and the quantification of interaction factors are crucial to establish, evaluate and promote public policies in breastfeeding practices. Objective-Estimate the effects of factors associated with the prevalence of exclusive, predominant and continued breastfeeding in the first and second years of life in Latin American and Caribbean countries from 2000 to 2016.Methods- We used microdata collected in the project Monitoring and Evaluation to Assess and Use Results Demographic and Health Survey. In addition to the information, aggregated World Bank data was collected. The indicators analyzed were exclusive breastfeeding (EB), predominant breastfeeding (PB) and continuous breastfeeding (CB) in the first and second years of life; the values were expressed in prevalence and stratified by quintiles of wealth. The last available survey of each Latin American and Caribbean country with data between the years 2000 and 2016 was selected. The variables were selected according to availability and framing in the conceptual model proposed by ROLLINS et. al. (2016). The model used in the study was chosen after analysis with Poisson Regression and later, multi-level mixed-effects logistic analysis was performed to quantify the effect of each determinant of the fixed effect adjusted by the random effect. Results- The prevalence of indicators ranged from 7.4% to 60.3% EB, 13.9% to 71% in PB, 35.0% to 86.6% in CB in the first year, and 18.9% to 55.0% in CB in the second year of life. Bolivia and Guatemala stand out for having the highest rates of EB, 60.3% and 54.2%, respectively. The countries presented a higher prevalence of indicators in the lower quintiles of income, especially the associations of the pattern of increase of the magnitude of the negative effect as the fifth of income increases. EB and PB were directly associated with \"first-time breastfeeding\", \"marital status\" and \"wanted the last child; \"maternal age\" and \"work status\" were inversely associated with the CB indicators in the 1st and 2nd years of life. In the mixed effects analysis, the EB and PB indicators were directly associated with \"first-hour breastfeeding\" and \"marital status\" and inversely to the variables \"place of birth\" and \"work status\".The maternal schooling presented an inverse association with the PB, CB indicators in the 1st and 2nd years of life, and the fifth of the wealth had an inverse association with all the indicators studied. The EB shows greater variance explained by the individual level, while the CB in the second year of life suffers great influence at the contextual level (8.99e-15% and 69.7%, respectively). Conclusion- The variables related to the individual were the ones that best explained the variance of the model for EB, PB and CB in the 1st year of life. The variables related to the context explain a greater variability of the prevalence of CB in the second year of life, showing the greater interference of GDP and national influences.