Breast-feeding by Human Immunodeficiency Virus (HIV) positive mothers poses a risk of transmitting HIV infection from the mother to the baby. This study attempted to describe and explore the knowledge of antenatal women in Gaborone, Botswana on the transmission of HIV through breast-feeding. The research results, obtained from interview schedules, revealed that the respondents had: a greater knowledge of transmission of HIV in adults than mother-to-child-transmission (MTCT); a moderate understanding of infant feeding methods; poor understanding of the risk of HIV transmission through different infant feeding methods and feelings that infant feeding method reveals ones HIV status, which indicate stigma and discrimination. The study findings may assist health care providers to intensify educational programmes and counselling in the antenatal clinics and communities to reduce MTCT. / Health Studies / M. A. (Health Studies)

Objetivo: El objetivo del estudio fue evaluar si la alimentación complementaria Baby Led Weaning tiene efecto protector de la malnutrición por exceso en preescolares y determinar sus características sociodemográficas y la proporción de preescolares con normopeso y malnutridos por exceso que recibieron este tipo de alimentación. Tuvo un alcance de niños cuyos padres y/o madres pertenecen a grupos de redes sociales de maternidad o paternidad asociados a profesionales de la salud. Metodología: El diseño fue observacional, analítico, retrospectivo tipo caso control, 38 casos y 66 controles con una relación caso control de 1/1.73. La población de estudio estuvo conformada por niños de uno u otro sexo de 24 a 60 meses de edad. Se utilizó una red de contactos de profesionales de la salud para difundir la encuesta virtual. Los datos recabados de duración de lactancia, método de alimentación complementaria y tipo de parto y otros de interés fueron extrapolados a Excel y posteriormente al software SPSS para determinar la asociación y el OR para estudio de casos y controles. Resultados: En el análisis descriptivo se obtuvo mayor participación de los países de Argentina y Perú. En su mayoría, los casos y controles fueron del género femenino con edad media de 34.17 meses. En el análisis inferencial se obtuvo una OR de 0.187 (IC 95% 0.078-0.444), lo que significa que la Alimentación Complementaria BLW reduce significativamente el riesgo de padecer malnutrición por exceso en (1-0.187=0.81) 81%, respecto a los que tuvieron Alimentación Complementaria Convencional. Conclusión: Se concluye que la AC BLW tiene efecto protector de malnutrición por exceso en preescolares, sin embargo, se deben realizar estudios de cohorte para evaluar prospectivamente la evolución del infante desde que se inicia la AC hasta los 60 meses, considerando otras variables biopsicosociales. / Objective: The objective of the study was to evaluate if the Complementary Feeding Baby Led Weaning (AC BLW) has a protective effect against malnutrition due to excess in preschool children and to determine their sociodemographic characteristics and the proportion of preschool children with normal weight and malnourished by excess who received this type of feeding. It had a scope of children whose fathers and / or mothers belong to maternity or paternity social network groups associated with health professionals. Methodology: The design was observational, analytical, retrospective, case-control type, 38 cases and 66 controls with a case-control ratio of 1 / 1.73. The study population consisted of children of either sex between 24 and 60 months of age. A network of contacts of health professionals was used to disseminate the virtual survey. The data collected on the duration of lactation, the method of complementary feeding and the type of delivery, and others of interest, were extrapolated to Excel and later to the SPSS software to determine the association and the OR for a case-control study. Results: In the descriptive analysis, greater participation was obtained from the countries of Argentina and Peru. Most of the cases and controls were female with a mean age of 34.17 months. In the inferential analysis, an OR of 0.187 (95% CI 0.078-0.444) was obtained, which means that the AC BLW significantly reduces the risk of suffering from malnutrition due to excess in (1-0.187 = 0.81) 81%, with respect to the who had Conventional Complementary Food (AC CV). Conclusion: It is concluded that AC BLW has a protective effect against malnutrition due to excess in preschool children, however, cohort studies should be carried out to prospectively evaluate the evolution of the infant from the beginning of the AC to 60 months, considering other biopsychosocial variables. / Tesis

O nascimento pré-termo é um dos principais eventos para o aumento do risco de morbimortalidade infantil. O aleitamento materno exclusivo (AME) é uma das ações de grande efetividade para promover e proteger a saúde infantil. A transição da alimentação por gavagem para o AME representa um período importante para o processo de amamentar um prematuro. Objetivo: Avaliar a efetividade da translactação com avaliação da prontidão oral para o AME em bebês nascidos muito prematuros em comparação com o uso do copo conforme rotina do serviço. Casuística e método: Ensaio clínico randomizado prospectivo com 64 díades mãe-filhos nascidos com < 32 semanas e/ou < 1.500g, acompanhados desde o nascimento até dois meses após a alta hospitalar. Os prematuros foram randomizados em dois grupos: experimental (GE), que realizou avaliação de prontidão oral e translactação para transicionar a alimentação por gavagem para a amamentação; e controle (GC), que utilizou o copo conforme a rotina do setor para essa transição. Os dados foram obtidos por meio dos prontuários e de entrevistas com as mães, respeitando-se os procedimentos éticos. Resultados: Após testes estatísticos, os grupos foram considerados homogêneos quanto às variáveis socioculturais e perinatais. No GE, a prevalência do AME (62,1%) foi proporcionalmente o dobro dos prematuros do GC na primeira quinzena após a alta hospitalar (p = 0,028). O risco relativo do GC para interrupção do AME antes da primeira quinzena após a alta foi de 81% (1,08-3,03; IC 95%) mais risco que o GE. A redução absoluta do risco foi de 30% (7,2-54,1; IC 95%) e o NNT foi de 3 (2,0-14; IC 95%). No GE, dentre os bebês que se encontravam em AME na alta, praticamente 70% continuaram na primeira quinzena, reduzindo para 50% no primeiro e segundo mês após a alta. No GC, 45,8% dos prematuros continuaram o AME na primeira quinzena, com crescente aumento dos que tinham interrompido o AME no primeiro mês (65,2%) e segundo mês (72,7%) após a alta hospitalar. As curvas de sobrevida de Kaplan-Meier sobre a duração mediana de AME após a alta hospitalar foram estatisticamente diferentes pelo teste de Log Rank (p = 0,012). No GE, a duração média do AME foi mais que o dobro do GC, com tempo máximo de 163 vs. 146 dias (p = 0,011). Na regressão logística multivariável constatou-se associação entre maior prevalência de AME na primeira quinzena após a alta hospitalar e o menor tempo de internação e o maior número de vezes que sugou na mãe na última semana antes da alta. Controladas essas duas variáveis, a chance de AME para o GE foi cinco vezes mais que o GC na primeira quinzena após a alta hospitalar. Conclusão: A translactação com avaliação da prontidão oral foi mais efetiva que o uso do copo para a transição da alimentação por gavagem para o AME dos bebês muito prematuros com maior prevalência e maior duração do AME e menor risco de desmame na primeira quinzena após a alta hospitalar. / Pre-term birth is one of the main causes of children morbimortality. Exclusive breastfeeding (AME) is one of the most effective actions (considering the cost-benefit relationship) in promoting and protecting children\'s health. The transition from gavage feeding to exclusive breastfeeding (EB) represents an important period for the process of feeding a premature. Objective: Evaluate the effectiveness of translactation with oral readiness for EB in very premature babies compared with the use of a glass according to the service routine. Case study and method: prospective randonmized clinical trial.The study used a sample including 64 mother-child dyads, with babies born prior to 32 weeks or weighing < 1500g, who were followed from birth to at least two months after being discharged from hospital. The prematures were randonmized into two groups; experimental (EG), in which they were evaluated for oral readiness and translactation for the transition from gavage feeding to breastfeeding, and the control group (CG) , which used the glass, according to the nusrsing sector\'s routine procedure. Data were collected through patients\'s records and interviews with the mothers. Ethical preocedures were rigorously followed during the study. Results: After the statistical tests, the groups were considered homogeneous in regards to sociocultural and perinatal variables. In the EG, the prevalence of EB (62,1%) was proportionally two times higher than that found in the CG, in the first quarter after hospital discharge (p=0,028). CG relative risk for interrupting EB before the first quarter after hospital discharge was 81% (1,08 - 3,03; IC 95%), which was greater than that found in the EG. Absolute risk reduction was 30% (7,2 - 54,1; IC 95%) and the NNT was 3 (2,0 - 14; IC 95%). In the EG, among the babies who were being breastfed at hospital discharge, practically 70% continued in the first quarter, reducing to 50% in the first and second quarter after hospital dismissal.In the CG, less than half (45,8%) of the prematures continued with the EB in the first quarter, with an increase among those who had interrupted the EB in the first month (65,2%) and second month (72,7%) after being discharged from hospital. The Kaplan-Meier survival curves on theEB median duration after hospital discharge were statistically different according to the Log Rank test (p=0,012). In the EG, the average duration was more than double, with the maximum time of 163 days (p=0,011). In the CG, maximum EB time was 146 days. Multivariate logistic regression detected an association between higher EB prevalence in the first quarter after hospital discharge, the shorter period of hospitalization and the greater number of times the child was breastfed in the last week before hospital discharge. With thse two variables controlled, the chances for EB (exclusive breastfeeding) was five times greater in the EG than for the CG in the first quarter, after hospital discharge. Conclusion: Translactation with oral readiness evaluation proved to be more effective than the glass during the transition from gravage feeding to EB in very premature babies in regards to greater prevalence, duration and less risk of weaning in the first quarter after hospital discharge.

Um instrumento de avaliação da prontidão do prematuro para início da alimentação no seio materno foi desenvolvido e validado em seu conteúdo, aparência, confiabilidade e especificidade. É dividido em categorias (idade corrigida, organização comportamental, postura oral, reflexos orais e sucção não nutritiva), com pontuação de 0 a 2 segundo desempenho do prematuro, em cada categoria, e escore final máximo de 36 pontos. Em continuidade ao processo de validação, o presente estudo teve por objetivo geral testar a validade de critério concorrente do instrumento de avaliação da prontidão do prematuro para iniciar a transição da alimentação gástrica para via oral, correlacionando o escore obtido, durante a aplicação do instrumento, com a ingesta de leite mediada pela técnica da translactação. Trata-se de estudo correlacional aprovado pelo Comitê de Ética em Pesquisa. Participaram do estudo 43 díades mães-prematuros da unidade neonatal de um hospital universitário de Ribeirão Preto-SP. O instrumento foi aplicado antes de o prematuro ter iniciado alimentação láctea por via oral e, a seguir, foi verificado o desempenho do bebê ao colocá-lo para sugar o seio materno, mediado pela translactação, em cuja seringa quantificou-se o volume de leite ingerido. Para medir o grau da correlação linear entre os volumes de leite ingerido e os escores de prontidão, utilizou-se o coeficiente de correlação linear de Pearson. Para predizer limites de volume de leite a ser ofertado ao prematuro na seringa da translactação, a depender do escore obtido com aplicação do instrumento, foi utilizada a regressão linear simples. O escore de prontidão do prematuro mostrou uma correlação positiva e forte com o volume de leite (r=0,795 e p<0,001) ingerido, ou seja, quanto maior o escore obtido com aplicação do instrumento, maior o volume de leite que o prematuro conseguiu ingerir com a técnica da translactação, evidenciando uma alta validade concorrente do instrumento. O escore explicou 63% da variabilidade do volume de leite quantificado na seringa (r²=0,632), e cada unidade aumentada no escore elevou em 0,847ml a quantidade de leite ingerida pelo prematuro por meio da translactação. Foi possível predizer o volume de leite que o prematuro ingere com auxílio da translactação, com intervalo de confiança de 95%, a partir do valor do escore, propondo-se a seguinte adaptação dos resultados para uso na prática clínica: escores de 23 a 24 - 1ml; 25 a 26 - 2ml; 27 a 28 - 4ml; 29 a 30 - 6ml; 31 a 33 - 8ml e de 34 a 36 - 10ml. Concluiu-se que o instrumento possui alta validade concorrente evidenciada pela correlação positiva e forte entre o escore de prontidão do prematuro e o volume de leite ingerido com auxílio da translactação. Os resultados obtidos são úteis e aplicáveis à prática clínica, auxiliando os profissionais de saúde a iniciar a amamentação materna precocemente e de forma mais objetiva e segura em prematuros / An instrument to assess the premature baby\'s readiness to begin breastfeeding was desgined and validated regarding its content, appearance, reliability and specificity. It is divided into categories (correcte age, behavioral organization, oral posture, oral reflexes, non-nutritive sucking), with scores ranging between 0 and 2 according to the performance of the premature baby in each category, adding up to a maximum final score of 36 points. Continuing the process of validation, the present study general aimed to test the concurrent criterion validity of the instrument for assessing the readiness of preterm infants to begin the transition from gastric to oral correlating the scores obtained during the application of the instrument, with the ingestion of milk-mediated technique translactation. This correlational study was approved by the local Research Ethics Committee. The participants were 43 mother-premature baby dyads of the neonatal unit of a university hospital of Ribeirão Preto, São Paulo, Brazil. The instrument was applied before the premature baby began to breastfeed and, then, the baby\'s performance was verified while sucking at the mother\'s breast, mediated by translactation, in which a syringe showed the volume of milk that was ingested. The degree of linear correlation between the volume of milk ingested and the readiness scores was measured using Pearson\'s linear correlation. Simple linear regression was used to predict the milk volumes to be offered to the premature baby through the translactation syringe, depending on the score obtained with the instrument. The premature baby\'s readiness score showed a strong positive correlation with the ingested milk volume (r=0.795 and p<0.001), i.e., the higher the score obtained on the instrument, the greater the milk volume ingested by the premature baby aided by the translactation technique, thus revealing the instrument\'s high concurrent validity. The score explained 63% of the variability of milk volume measured by the syringe (r²=0.632), and each unit added to the score added 0.847ml to the amount of milk ingested by the premature with the aid of translactation, with a confidence interval of 95%, based on the score, proposing the following adaptation of the results for use in clinical practice: scored of 23 to 24 - 1ml; 25 to 26 - 2ml; 27 to 28 - 4ml; 29 to 30 - 6ml; 31 to 33 - 8ml and 34 to 36 - 10ml. In conclusion, the instrument shows high concurrent validity evidenced by the strong positive correlation between the readiness score of the premature baby and the volume of milk ingested with the aid of translactation. The obtained results are useful and applicable to clinical practice, and, thus, help healthcare professionals to initiate early breastfeeding in a safer and more objective way in premature babies

Orientador: Maria Antonieta de Barros Leite Carvalhaes / Resumo: Objective: To analyze feeding history and maternal experience with breastfeeding infants with cleft lip and palate. Method: descriptive, cross - sectional, double - approach study: quantitative and qualitative, performed at the outpatient clinic of a reference hospital. Data were collected through structured interviews with 150 mothers; 6 mothers participated in the qualitative study. Univariate and multiple logistic regression analyzes were used, adopting as criterion for inclusion in the multiple model p≤0.20. To consider a factor as associated to the outcome, p was considered critical <0.05, in the multiple analysis. These analyzes were performed in the SPSS program. For the qualitative approach the sample was selected for convenience. The statements of the mothers were transcribed in their entirety and analyzed according to the theoretical framework of content analysis according to the steps proposed by Graneheim and Lundman. After analyzing all the qualitative interviews, a framework was constructed with the themes found from the testimonies, being categorized in themes and sub-themes. Results: Less than half of the mothers knew of the prenatal diagnosis and this factor was associated with exclusive breastfeeding in the first week of life, the physician was responsible for the prenatal guidelines. The prevalent type of fissure was unilateral incisive transforamen and on nutritional status, eutrophy prevailed. The strengths, difficulties and challenges faced by the birth ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Submitted by ALINE GODOI LUIZ null (alineegodoi@hotmail.com) on 2017-04-23T20:31:22Z No. of bitstreams: 1 Dissertação - Mestrado Acadêmico - Aline Godoi Luiz.pdf: 4090282 bytes, checksum: 3d6cb5c3c3fdca7bd11a8e4fe8ab34c3 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-04-25T19:52:36Z (GMT) No. of bitstreams: 1 luiz_ag_me_bot.pdf: 4090282 bytes, checksum: 3d6cb5c3c3fdca7bd11a8e4fe8ab34c3 (MD5) / Made available in DSpace on 2017-04-25T19:52:36Z (GMT). No. of bitstreams: 1 luiz_ag_me_bot.pdf: 4090282 bytes, checksum: 3d6cb5c3c3fdca7bd11a8e4fe8ab34c3 (MD5) Previous issue date: 2017-02-23 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Objetivo: Analisar a história alimentar e a experiência materna com a amamentação de lactentes com fissura labiopalatina. Método: estudo descritivo, transversal, de dupla abordagem: quantitativo e qualitativo, realizado no ambulatório de um hospital de referência. Os dados foram coletados por meio de entrevistas estruturadas com 150 mães; 6 mães participaram do estudo qualitativo. Foram realizadas análises de regressão logística univariada e múltipla, adotando-se como critério para inclusão no modelo múltiplo p≤0,20. Para considerar um fator como associado ao desfecho foi considerado p crítico <0,05, na análise múltipla. Essas análises foram realizadas no programa SPSS. Para a abordagem qualitativa a amostra foi selecionada por conveniência. Os depoimentos das mães foram analisados segundo o referencial da análise de conteúdo de acordo com os passos propostos por Graneheim e Lundman. Após a análise das entrevistas qualitativas, os depoimentos foram categorizados em temas e subtemas. Resultados: Menos da metade das mães souberam do diagnóstico da fissura no pré-natal e esse fator associou-se com o aleitamento materno exclusivo na primeira semana de vida, sendo o médico o responsável pelas orientações no pré-natal. O tipo de fissura prevalente foi o transforame incisivo unilateral e sobre o estado nutricional, prevaleceu a eutrofia. Foi constatado também, através das análises do conteúdo latente, as fortalezes, dificuldades e desafios frente ao nascimento de um filho com fissura labiopalatina Conclusão: evidenciou-se a importância da orientação dos profissionais de saúde e da época de descoberta do diagnóstico da fissura, facilitando assim o processo de enfrentamento e o aleitamento materno. Demonstra-se a necessidade da capacitação prévia de todos os profissionais que irão atuar no pré e pós-natal. / Objective: To analyze feeding history and maternal experience with breastfeeding infants with cleft lip and palate. Method: descriptive, cross - sectional, double - approach study: quantitative and qualitative, performed at the outpatient clinic of a reference hospital. Data were collected through structured interviews with 150 mothers; 6 mothers participated in the qualitative study. Univariate and multiple logistic regression analyzes were used, adopting as criterion for inclusion in the multiple model p≤0.20. To consider a factor as associated to the outcome, p was considered critical <0.05, in the multiple analysis. These analyzes were performed in the SPSS program. For the qualitative approach the sample was selected for convenience. The statements of the mothers were transcribed in their entirety and analyzed according to the theoretical framework of content analysis according to the steps proposed by Graneheim and Lundman. After analyzing all the qualitative interviews, a framework was constructed with the themes found from the testimonies, being categorized in themes and sub-themes. Results: Less than half of the mothers knew of the prenatal diagnosis and this factor was associated with exclusive breastfeeding in the first week of life, the physician was responsible for the prenatal guidelines. The prevalent type of fissure was unilateral incisive transforamen and on nutritional status, eutrophy prevailed. The strengths, difficulties and challenges faced by the birth of a child with cleft lip and palate were also verified through latent content analysis. Conclusion: the importance of the guidance of health professionals and the time of discovery of the diagnosis of fissure was evidenced, facilitating thus the coping process and breastfeeding. It demonstrates the need for prior training of all the professionals who will work in the pre- and post-natal period.

Um instrumento de avaliação da prontidão do prematuro para início da alimentação no seio materno foi desenvolvido e validado em seu conteúdo, aparência, confiabilidade e especificidade. É dividido em categorias (idade corrigida, organização comportamental, postura oral, reflexos orais e sucção não nutritiva), com pontuação de 0 a 2 segundo desempenho do prematuro, em cada categoria, e escore final máximo de 36 pontos. Em continuidade ao processo de validação, o presente estudo teve por objetivo geral testar a validade de critério concorrente do instrumento de avaliação da prontidão do prematuro para iniciar a transição da alimentação gástrica para via oral, correlacionando o escore obtido, durante a aplicação do instrumento, com a ingesta de leite mediada pela técnica da translactação. Trata-se de estudo correlacional aprovado pelo Comitê de Ética em Pesquisa. Participaram do estudo 43 díades mães-prematuros da unidade neonatal de um hospital universitário de Ribeirão Preto-SP. O instrumento foi aplicado antes de o prematuro ter iniciado alimentação láctea por via oral e, a seguir, foi verificado o desempenho do bebê ao colocá-lo para sugar o seio materno, mediado pela translactação, em cuja seringa quantificou-se o volume de leite ingerido. Para medir o grau da correlação linear entre os volumes de leite ingerido e os escores de prontidão, utilizou-se o coeficiente de correlação linear de Pearson. Para predizer limites de volume de leite a ser ofertado ao prematuro na seringa da translactação, a depender do escore obtido com aplicação do instrumento, foi utilizada a regressão linear simples. O escore de prontidão do prematuro mostrou uma correlação positiva e forte com o volume de leite (r=0,795 e p<0,001) ingerido, ou seja, quanto maior o escore obtido com aplicação do instrumento, maior o volume de leite que o prematuro conseguiu ingerir com a técnica da translactação, evidenciando uma alta validade concorrente do instrumento. O escore explicou 63% da variabilidade do volume de leite quantificado na seringa (r²=0,632), e cada unidade aumentada no escore elevou em 0,847ml a quantidade de leite ingerida pelo prematuro por meio da translactação. Foi possível predizer o volume de leite que o prematuro ingere com auxílio da translactação, com intervalo de confiança de 95%, a partir do valor do escore, propondo-se a seguinte adaptação dos resultados para uso na prática clínica: escores de 23 a 24 - 1ml; 25 a 26 - 2ml; 27 a 28 - 4ml; 29 a 30 - 6ml; 31 a 33 - 8ml e de 34 a 36 - 10ml. Concluiu-se que o instrumento possui alta validade concorrente evidenciada pela correlação positiva e forte entre o escore de prontidão do prematuro e o volume de leite ingerido com auxílio da translactação. Os resultados obtidos são úteis e aplicáveis à prática clínica, auxiliando os profissionais de saúde a iniciar a amamentação materna precocemente e de forma mais objetiva e segura em prematuros / An instrument to assess the premature baby\'s readiness to begin breastfeeding was desgined and validated regarding its content, appearance, reliability and specificity. It is divided into categories (correcte age, behavioral organization, oral posture, oral reflexes, non-nutritive sucking), with scores ranging between 0 and 2 according to the performance of the premature baby in each category, adding up to a maximum final score of 36 points. Continuing the process of validation, the present study general aimed to test the concurrent criterion validity of the instrument for assessing the readiness of preterm infants to begin the transition from gastric to oral correlating the scores obtained during the application of the instrument, with the ingestion of milk-mediated technique translactation. This correlational study was approved by the local Research Ethics Committee. The participants were 43 mother-premature baby dyads of the neonatal unit of a university hospital of Ribeirão Preto, São Paulo, Brazil. The instrument was applied before the premature baby began to breastfeed and, then, the baby\'s performance was verified while sucking at the mother\'s breast, mediated by translactation, in which a syringe showed the volume of milk that was ingested. The degree of linear correlation between the volume of milk ingested and the readiness scores was measured using Pearson\'s linear correlation. Simple linear regression was used to predict the milk volumes to be offered to the premature baby through the translactation syringe, depending on the score obtained with the instrument. The premature baby\'s readiness score showed a strong positive correlation with the ingested milk volume (r=0.795 and p<0.001), i.e., the higher the score obtained on the instrument, the greater the milk volume ingested by the premature baby aided by the translactation technique, thus revealing the instrument\'s high concurrent validity. The score explained 63% of the variability of milk volume measured by the syringe (r²=0.632), and each unit added to the score added 0.847ml to the amount of milk ingested by the premature with the aid of translactation, with a confidence interval of 95%, based on the score, proposing the following adaptation of the results for use in clinical practice: scored of 23 to 24 - 1ml; 25 to 26 - 2ml; 27 to 28 - 4ml; 29 to 30 - 6ml; 31 to 33 - 8ml and 34 to 36 - 10ml. In conclusion, the instrument shows high concurrent validity evidenced by the strong positive correlation between the readiness score of the premature baby and the volume of milk ingested with the aid of translactation. The obtained results are useful and applicable to clinical practice, and, thus, help healthcare professionals to initiate early breastfeeding in a safer and more objective way in premature babies

O nascimento pré-termo é um dos principais eventos para o aumento do risco de morbimortalidade infantil. O aleitamento materno exclusivo (AME) é uma das ações de grande efetividade para promover e proteger a saúde infantil. A transição da alimentação por gavagem para o AME representa um período importante para o processo de amamentar um prematuro. Objetivo: Avaliar a efetividade da translactação com avaliação da prontidão oral para o AME em bebês nascidos muito prematuros em comparação com o uso do copo conforme rotina do serviço. Casuística e método: Ensaio clínico randomizado prospectivo com 64 díades mãe-filhos nascidos com < 32 semanas e/ou < 1.500g, acompanhados desde o nascimento até dois meses após a alta hospitalar. Os prematuros foram randomizados em dois grupos: experimental (GE), que realizou avaliação de prontidão oral e translactação para transicionar a alimentação por gavagem para a amamentação; e controle (GC), que utilizou o copo conforme a rotina do setor para essa transição. Os dados foram obtidos por meio dos prontuários e de entrevistas com as mães, respeitando-se os procedimentos éticos. Resultados: Após testes estatísticos, os grupos foram considerados homogêneos quanto às variáveis socioculturais e perinatais. No GE, a prevalência do AME (62,1%) foi proporcionalmente o dobro dos prematuros do GC na primeira quinzena após a alta hospitalar (p = 0,028). O risco relativo do GC para interrupção do AME antes da primeira quinzena após a alta foi de 81% (1,08-3,03; IC 95%) mais risco que o GE. A redução absoluta do risco foi de 30% (7,2-54,1; IC 95%) e o NNT foi de 3 (2,0-14; IC 95%). No GE, dentre os bebês que se encontravam em AME na alta, praticamente 70% continuaram na primeira quinzena, reduzindo para 50% no primeiro e segundo mês após a alta. No GC, 45,8% dos prematuros continuaram o AME na primeira quinzena, com crescente aumento dos que tinham interrompido o AME no primeiro mês (65,2%) e segundo mês (72,7%) após a alta hospitalar. As curvas de sobrevida de Kaplan-Meier sobre a duração mediana de AME após a alta hospitalar foram estatisticamente diferentes pelo teste de Log Rank (p = 0,012). No GE, a duração média do AME foi mais que o dobro do GC, com tempo máximo de 163 vs. 146 dias (p = 0,011). Na regressão logística multivariável constatou-se associação entre maior prevalência de AME na primeira quinzena após a alta hospitalar e o menor tempo de internação e o maior número de vezes que sugou na mãe na última semana antes da alta. Controladas essas duas variáveis, a chance de AME para o GE foi cinco vezes mais que o GC na primeira quinzena após a alta hospitalar. Conclusão: A translactação com avaliação da prontidão oral foi mais efetiva que o uso do copo para a transição da alimentação por gavagem para o AME dos bebês muito prematuros com maior prevalência e maior duração do AME e menor risco de desmame na primeira quinzena após a alta hospitalar. / Pre-term birth is one of the main causes of children morbimortality. Exclusive breastfeeding (AME) is one of the most effective actions (considering the cost-benefit relationship) in promoting and protecting children\'s health. The transition from gavage feeding to exclusive breastfeeding (EB) represents an important period for the process of feeding a premature. Objective: Evaluate the effectiveness of translactation with oral readiness for EB in very premature babies compared with the use of a glass according to the service routine. Case study and method: prospective randonmized clinical trial.The study used a sample including 64 mother-child dyads, with babies born prior to 32 weeks or weighing < 1500g, who were followed from birth to at least two months after being discharged from hospital. The prematures were randonmized into two groups; experimental (EG), in which they were evaluated for oral readiness and translactation for the transition from gavage feeding to breastfeeding, and the control group (CG) , which used the glass, according to the nusrsing sector\'s routine procedure. Data were collected through patients\'s records and interviews with the mothers. Ethical preocedures were rigorously followed during the study. Results: After the statistical tests, the groups were considered homogeneous in regards to sociocultural and perinatal variables. In the EG, the prevalence of EB (62,1%) was proportionally two times higher than that found in the CG, in the first quarter after hospital discharge (p=0,028). CG relative risk for interrupting EB before the first quarter after hospital discharge was 81% (1,08 - 3,03; IC 95%), which was greater than that found in the EG. Absolute risk reduction was 30% (7,2 - 54,1; IC 95%) and the NNT was 3 (2,0 - 14; IC 95%). In the EG, among the babies who were being breastfed at hospital discharge, practically 70% continued in the first quarter, reducing to 50% in the first and second quarter after hospital dismissal.In the CG, less than half (45,8%) of the prematures continued with the EB in the first quarter, with an increase among those who had interrupted the EB in the first month (65,2%) and second month (72,7%) after being discharged from hospital. The Kaplan-Meier survival curves on theEB median duration after hospital discharge were statistically different according to the Log Rank test (p=0,012). In the EG, the average duration was more than double, with the maximum time of 163 days (p=0,011). In the CG, maximum EB time was 146 days. Multivariate logistic regression detected an association between higher EB prevalence in the first quarter after hospital discharge, the shorter period of hospitalization and the greater number of times the child was breastfed in the last week before hospital discharge. With thse two variables controlled, the chances for EB (exclusive breastfeeding) was five times greater in the EG than for the CG in the first quarter, after hospital discharge. Conclusion: Translactation with oral readiness evaluation proved to be more effective than the glass during the transition from gravage feeding to EB in very premature babies in regards to greater prevalence, duration and less risk of weaning in the first quarter after hospital discharge.

Horses are herbivores and can graze for up to 20 hours per day. It is well known that animals are motivated to perform natural behaviours and horses have, except from a physiological need to graze, a strong motivation to perform their natural feeding behaviour. This review aimed to give insight into how horses are kept, how the way they are kept affects their behaviour and welfare, if there are reasons why some horses cannot be kept on pasture, and if alternative feeding strategies can improve horse welfare by allowing horsesto perform their natural feeding behaviour. Most horses are kept in stables and are put on feeding regimes that do not resemble their natural feeding behaviour. This can lead to development of stereotypies, and when prevented from carrying out their feeding behaviour, oral stereotypies such as crib-biting can result. Horses kept free range display very few, if any, stereotypies and is therefore the best way to keep horses from a welfare approach. However, obesity and grass-related illnesses can restrict horses from being kept on pasture, thus, alternative feeding methods for stabled horses is imperative. Use of edible bedding, presenting several types of forage, providing ad libitumforage, or using slow feeders are alternative methods that could be implemented by horseowners and caretakers to improve horse welfare. Horses can however respond differently to these methods and a method that suits one horse might not be appropriate for another.

Vertical transmission of HIV is still a growing concern in South Africa. Breastfed infants are still at risk as HIV is present in breast milk, leaving HIV-positive mothers unsure of the best feeding option for their infants. However, there are various infant feeding techniques that HIV-positive mothers can use to supplement breastfeeding and flash-heat is one of them. Flash-heat is heat treating expressed breast milk to deactivate HIV for infant feeding. This study explored the possibility of HIV-positive mothers to practice flash-heating method for their infants exclusively for four months as a strategy to prevent vertical transmission of HIV. A descriptive, explorative and contextual design using a mixed method was used to obtain data from mothers in a post natal ward at Tembisa hospital. The mixed method used was useful in identifying the number of HIV-positive mothers who would adopt the flash-heat technique, the characteristics of mothers whom the technique could be promoted to, the factors that influence/affect the choice of infant feeding for these mothers, as well as their feelings associated with the feeding technique. Most (74%) mothers had a positive response to the flash-heat technique compared to 10% who were uncertain. They believed that heat treating their breast milk would result in their infants being HIV-free. In addition they believed that this method was cheaper than formula feeding and expressed positive feelings about touching their breast milk while expressing with no adverse feelings of expressing into a glass jar. Furthermore, findings of this study indicated that HIV-positive mothers in a public health facility would adopt flash-heat as an alternative infant feeding method. Thus practical guidelines to promote this feeding method were proposed. The proposed draft guidelines which promote the use of the flash-heat infant feeding method for HIV-positive mothers in public sector facilities will be communicated to relevant authorities such as the National Department of Health. These guidelines support the new policy shift to exclusive breastfeeding as a child survival strategy in South Africa. / Health Studies / D.Litt. et Phil. (Health Studies)