Yes / Donated Human Milk Banking is a trending topic in healthcare management and has potential for business development opportunities at hospitals and independent organisations in developing countries. A preliminary definition of a Human Milk Bank “is a service established to recruit breast milk donors, collect donated milk, and then process, screen, store, and distribute the milk to meet infants’ specific needs for optimal health. Although there are indications about the beginning of such practices date back to the 2001’s, private sector human milk banking has gained momentum in terms of popularity and acceptability. There is evidence of the presence of human milk banks in the USA during the 1990’s, which potential was affected by the development of specialty formulas, safety issues linked with viral transmission, and lack of credible clinical research in this area. However, recent developments in clinical studies, government cooperation with medical research centres and health authorities have shown considerable improvement in the public view of Human Milk Bank’s creating a positive climate for private sector provision.

Background Benefits of breastfeeding for infants and mothers are well recognized. South Africa has a very low breastfeeding rate. Strategies to improve and promote exclusive breastfeeding rates include implementation of human milk banks (HMB). The North West Province started its first HMB in 2012 and the success and sustainability will depend on numerous factors, including identification of possible barriers to donation or receiving donor human milk. In support of such an intervention, the attitudes of each relevant stakeholders, mothers, community members and health care providers on acceptability of donating and receiving donated breastmilk is therefore important for the success of such an intervention Objectives The objective of this dissertation was determining the attitudes on acceptability regarding the donation and receiving of human breast milk for key stakeholders, namely mothers, healthcare workers and the elderly representing grandmothers. Methods This study was conducted at a public hospital and nearby clinics in North West province, South Africa using qualitative research methodology of focus group discussions (FGDs) for data collection. Eight focus groups discussed the attitudes, 3 of mothers of 0 to 12 month old infants (n=13), 3 of elderly participants older than 60 years (n=17) and 2 of healthcare professionals, working with infants younger than 1 year (n=11). Results Important attitudes on acceptability of receiving and donating human donor milk were identified from the literature and this research project. Stakeholders had safety and cultural concerns regarding donation and receiving of donated human milk. Participants also indicated the need for education that may improve the attitudes. These findings may inform future policy planning and HMB promotion in communities. The identified attitudes reflected barriers to exclusive breast feeding, donating and receiving breast milk. These included, the need for HIV screening; cultural beliefs relating to transfer of personality traits and bonding and fears of not having enough milk for their own infants; perceived changes in quality of donated milk during pasteurisation and transportation as well as HIV transmission. Conclusion The study identified important attitudes that may be possible barriers and fears to accepting or donating human breast milk. Some of the identified attitudes could also limit exclusive breast feeding. Further research is recommended to determine how prevalent the identified attitudes are in this and similar community settings. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015

Background Benefits of breastfeeding for infants and mothers are well recognized. South Africa has a very low breastfeeding rate. Strategies to improve and promote exclusive breastfeeding rates include implementation of human milk banks (HMB). The North West Province started its first HMB in 2012 and the success and sustainability will depend on numerous factors, including identification of possible barriers to donation or receiving donor human milk. In support of such an intervention, the attitudes of each relevant stakeholders, mothers, community members and health care providers on acceptability of donating and receiving donated breastmilk is therefore important for the success of such an intervention Objectives The objective of this dissertation was determining the attitudes on acceptability regarding the donation and receiving of human breast milk for key stakeholders, namely mothers, healthcare workers and the elderly representing grandmothers. Methods This study was conducted at a public hospital and nearby clinics in North West province, South Africa using qualitative research methodology of focus group discussions (FGDs) for data collection. Eight focus groups discussed the attitudes, 3 of mothers of 0 to 12 month old infants (n=13), 3 of elderly participants older than 60 years (n=17) and 2 of healthcare professionals, working with infants younger than 1 year (n=11). Results Important attitudes on acceptability of receiving and donating human donor milk were identified from the literature and this research project. Stakeholders had safety and cultural concerns regarding donation and receiving of donated human milk. Participants also indicated the need for education that may improve the attitudes. These findings may inform future policy planning and HMB promotion in communities. The identified attitudes reflected barriers to exclusive breast feeding, donating and receiving breast milk. These included, the need for HIV screening; cultural beliefs relating to transfer of personality traits and bonding and fears of not having enough milk for their own infants; perceived changes in quality of donated milk during pasteurisation and transportation as well as HIV transmission. Conclusion The study identified important attitudes that may be possible barriers and fears to accepting or donating human breast milk. Some of the identified attitudes could also limit exclusive breast feeding. Further research is recommended to determine how prevalent the identified attitudes are in this and similar community settings. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2015

O leite humano é livre de contaminantes e repleto de nutrientes, devendo permanecer assim até a hora do consumo. No entanto, condições higiênico-sanitárias inadequadas durante a coleta e o armazenamento do leite doado aos Bancos de Leite Humano podem ocasionar a presença de sujidades e contaminação do mesmo com microrganismos advindos das mãos da doadora ou do ambiente que a circunda. O objetivo dessa pesquisa foi verificar a qualidade sanitária de 76 amostras de leite humano ordenhado e enviado ao Banco de Leite Humano em Taubaté, SP e traçar o perfil sócio-econômico e ambiental de 27 doadoras cadastradas no Banco de Leite, assim como suas práticas higiênico-sanitárias durante a coleta e armazenamento do leite ordenhado. As análises microbiológicas mostraram que 100% das amostras estavam contaminadas com coliformes totais e termotolerantes, sendo que 30 amostras (39,48%) apresentaram contagens para coliformes totais acima de 2400 NMP/mL e 4 amostras (5,27%) apresentaram contagens para coliformes termotolerantes acima de 2400 NMP/mL. As amostras com menor índice de contaminação microbiológica eram provenientes de doadoras com maior nível de escolaridade. A maioria das doadoras declarou ser de cor branca, católicas, nascidas no Estado de SP e trabalham fora de casa. Todas realizaram o prénatal, sendo que a maioria utilizou a rede particular de saúde, teve parto cesariana e optando por ter poucos filhos. Todas possuem serviços de saneamento básico em suas residências. Os resultados das análises microbiológicas demonstraram que o emprego inadequado de normas higiênico-sanitárias durante a obtenção e manipulação do leite humano ordenhado cru são fatores que favorecem o crescimento microbiano no leite. / Human milk is free of contaminants and full of nutrients, and should remain so until consumption. However, sanitary conditions during collection and storage of milk donated to human milk banks can lead to soiling and contamination of microorganisms from the hands or the environment of the donor. The aim of this study was to assess the sanitary quality of 76 samples of human milk of Human Milk Bank in Taubaté, SP and trace the socio-economic and environmental of 27 donors registered in the Human Milk Bank, as well as hygienic practices and health during the collection and storage of milk. Microbiological analysis showed that 100% of the samples were contaminated with total coliforms and thermotolerant coliforms, and 30 samples (39.48%) showed total coliform counts for most of 2400 MPN/mL and 4 samples (5.27%) had scores for thermotolerant coliforms above 2400 MPN/mL. Samples with a lower rate of microbiological contamination were from donors with higher educational level. Most donors considered to be white, catholic, born in the State of SP and work outside the home. All received pre-natal, and most use the private network of health, had a cesarean section and choosing to have fewer children. All have basic sanitation services in their homes. The microbiological analysis results showed that the improper sanitary standards for the collection and handling of raw human milk predispose to microbial contamination of milk.

Background: Breast milk banks (BMBs) provide human donor breast milk to preterm infants when mothers are not able to provide breast milk themselves (Arslanoglu et al., 2010:20). Breastfeeding is the single most effective intervention to saving the lives of millions of children in developing countries (Bhutta & Labbok, 2011:378-380). BMBs form an integral part of the millennium development goals (MDGs) (Dempsey & Miletin, 2010:2) on reducing infant mortality and morbidity and are being implemented all over the world (Hartmann et al., 2007:667, Arslanoglu et al., 2010:20, Eidelman & Schanler 2012:827). Problem statement: BMBs can be established more effectively with an implementation tool in place. Currently, there is no tool available to guide the implementation of a BMB in South Africa; the only guidelines that could be found are those describing the operation of BMBs in other countries. Some of the BMBs already established in South Africa were implemented with the help of the South African Breast Milk Bank Reserve (SABR), but without a formalised guideline to provide implementation guidance. Aims and objectives: The purpose of this study was to adapt a current Kangaroo mother care (KMC) progress-monitoring tool and to adjust it according to the BMB setting in South Africa in order to provide a final suggested implementation tool for the implementation of BMBs. Method: An explorative, descriptive design with multiple phases was used. Different data sets were audited; including patient files, written reports, working files, research articles and policies. Observations were also made with regards to available equipment and designated BMB space. During phase one, a critical analysis was performed on research articles and websites regarding BMBs. The qualitative data was analysed by using content analysis. This information was adapted and contextualised in phase two. This phase entailed applying the adapted tool to the BMB setting of the selected regional hospital, which then led to phase three, in which the audited data was incorporated into the final suggested implementation tool resulting from this study. Results: The suggested tool, the North West Province BMB implementation tool, shared the six main constructs with the KMC progress-monitoring tool. The constructs are creating awareness, adopting the concept, taking ownership, evidence of practice, evidence of routine and integration and sustainable practice. However, some of the progress markers and instrument items were specifically relevant to the KMC setting and others to the BMB setting. On the other hand, some constructs overlapped, being relevant to both settings: for instance awareness by management, conscious decision to implement, mobilisation of resources (human, space and equipment), information about mothers’ other resources such as budget, patient records, staff orientation, evidence of discharge, policies and other written documents, and 1-2 year audit evidence and staff development. Conclusion: Adapting the KMC progress-monitoring tool led to the development of a suitable tool to guide BMB implementation. The tool is called the North West Province BMB implementation tool. This tool could be used to guide the implementation of a BMB in other hospitals in South Africa. / M (Dietetics), North-West University, Potchefstroom Campus, 2015

Background: Breast milk banks (BMBs) provide human donor breast milk to preterm infants when mothers are not able to provide breast milk themselves (Arslanoglu et al., 2010:20). Breastfeeding is the single most effective intervention to saving the lives of millions of children in developing countries (Bhutta & Labbok, 2011:378-380). BMBs form an integral part of the millennium development goals (MDGs) (Dempsey & Miletin, 2010:2) on reducing infant mortality and morbidity and are being implemented all over the world (Hartmann et al., 2007:667, Arslanoglu et al., 2010:20, Eidelman & Schanler 2012:827). Problem statement: BMBs can be established more effectively with an implementation tool in place. Currently, there is no tool available to guide the implementation of a BMB in South Africa; the only guidelines that could be found are those describing the operation of BMBs in other countries. Some of the BMBs already established in South Africa were implemented with the help of the South African Breast Milk Bank Reserve (SABR), but without a formalised guideline to provide implementation guidance. Aims and objectives: The purpose of this study was to adapt a current Kangaroo mother care (KMC) progress-monitoring tool and to adjust it according to the BMB setting in South Africa in order to provide a final suggested implementation tool for the implementation of BMBs. Method: An explorative, descriptive design with multiple phases was used. Different data sets were audited; including patient files, written reports, working files, research articles and policies. Observations were also made with regards to available equipment and designated BMB space. During phase one, a critical analysis was performed on research articles and websites regarding BMBs. The qualitative data was analysed by using content analysis. This information was adapted and contextualised in phase two. This phase entailed applying the adapted tool to the BMB setting of the selected regional hospital, which then led to phase three, in which the audited data was incorporated into the final suggested implementation tool resulting from this study. Results: The suggested tool, the North West Province BMB implementation tool, shared the six main constructs with the KMC progress-monitoring tool. The constructs are creating awareness, adopting the concept, taking ownership, evidence of practice, evidence of routine and integration and sustainable practice. However, some of the progress markers and instrument items were specifically relevant to the KMC setting and others to the BMB setting. On the other hand, some constructs overlapped, being relevant to both settings: for instance awareness by management, conscious decision to implement, mobilisation of resources (human, space and equipment), information about mothers’ other resources such as budget, patient records, staff orientation, evidence of discharge, policies and other written documents, and 1-2 year audit evidence and staff development. Conclusion: Adapting the KMC progress-monitoring tool led to the development of a suitable tool to guide BMB implementation. The tool is called the North West Province BMB implementation tool. This tool could be used to guide the implementation of a BMB in other hospitals in South Africa. / M (Dietetics), North-West University, Potchefstroom Campus, 2015

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2015-04-29T13:22:42Z No. of bitstreams: 1 Emmanuelle Lira Cariry.pdf: 1049232 bytes, checksum: 726b595b78450ce1e1d6d404a2f2153a (MD5) / Made available in DSpace on 2015-04-29T13:22:42Z (GMT). No. of bitstreams: 1 Emmanuelle Lira Cariry.pdf: 1049232 bytes, checksum: 726b595b78450ce1e1d6d404a2f2153a (MD5) Previous issue date: 2013-12-05 / Introdution: The importance of breastfeeding is something unquestionable nowadays. For many years it is common knowledge that is the best food for infants up to 06 months old. Since ancient times, women breastfed their children and, in some occasions, helped feeding other women¿s. Human Milk Banks and their donors are, today, what net-nurses were for more than two thousand years. Objective: Identify perceptions of mothers donors of milk in a human milk bank linked to a midsize Hospital in the hinterlad of Paraiba state. Methodology: The study was conducted by a qualitative approach with 21 milk donors of the Cajazeiras Human Milk Bank. Data collection was carried out by interviews with semi-structured script. The contents of the transcriptions were submitted to analysis and the thematic nuclei found were discussed. Results: the donors were 17 to 41 years old, all of them married or in non-legal consensual marriage and the great majority living only with their companions and children, half of them with paying jobs and the other half as housewives, and the majority of them were women who had more than one children. The following thematic nuclei emerged from the analysis: Altruism or solidarity with the imaginary mother and children, shown by "I donate to help the babies in need"; Social consciousness, avoiding waste, shown by "I had so much milk that it was going to waste"; Empowerment of the breast, or "the babies depend on me to be fed"; Desired pregnancy and history of loss, detected by the recurring stories of losses associated to the idea of a very precious pregnancy, "the doctor said that it was more likely that I would have multiple abortions than giving birth to a living child"; Family support, detecting that family presence can either help ("my mother is my role model and stimulates me a lot") or get in the way ("my mother-in-law was against it, she didn't want me to donate"); and Social support, shown from pre-natal care to the donation itself ("the nurse explained to me that it wouldn¿t lack milk to my baby, that the more you take, the more come"). Conclusion: the perceptions of mothers on milk donation were very positive, surrounded by ideas of solidarity, empathy and pride of their actions and demonstrate also that Health Promotion, from Primary Care at pre-natal care to a good welcome at the Maternity and the Human Milk Bank can be important determinants of the maintenance of breastfeeding and the decision to donate milk. / Introdução: A importância do aleitamento materno é hoje algo indiscutível. Há muitos anos sabe-se que é melhor alimento para menores de 06 meses. Desde a Antiguidade, mulheres amamentavam seus filhos e, em algumas situações, ajudavam a alimentar os de outras mães. Os bancos de leite humano e suas doadoras são, hoje, o que as amas de leite foram por mais de 02 mil anos. Objetivo: Identificar percepções de mães doadoras de leite em um banco de leite humano vinculado a hospital de médio porte no sertão da Paraíba. Método: O estudo foi conduzido por uma abordagem qualitativa com 21 doadoras do Banco de Leite Humano de Cajazeiras. A coleta de dados se deu por entrevistas com roteiro semiestruturado. Os conteúdos das transcrições foram submetidos a análise e foram discutidos os núcleos temáticos encontrados. Resultados: as doadoras tinham idade entre 17 e 41 anos, todas casadas ou em união consensual e a grande maioria residindo apenas com seu companheiro e seu filho ou filhos, metade delas trabalhando fora e a outra metade dona de casa, e a maioria era multípara. Como núcleos temáticos, surgiram das análises dos discursos: Altruísmo ou solidariedade a mãe e criança imaginárias demarcado por "doo para ajudar os bebês que precisam"; Consciência social do não-desperdício constatada pelo "eu tinha tanto leite que iria estragar"; Emponderamento do peito, ou "os bebês dependem de mim para se alimentar"; Gravidez desejada e histórico de perdas, constatado pelas recorrentes histórias de perdas associadas à ideia de uma gravidez muito preciosa, "o médico disse que era mais fácil eu abortar do que ter um bebê"; Suporte familiar, constatando-se que a presença dos familiares tanto pode ajudar muito ("minha mãe é meu exemplo, me estimula muito"), como atrapalhar bastante ("minha sogra era contra, não queria que eu doasse"); e Apoio social, visto no suporte desde o pré-natal até a doação em si ("a enfermeira me explicou que não vai faltar pro meu bebê, que quanto mais tira, mais leite vem"). Conclusões: as percepções das mães sobre a doação de leite foram bastante positivas, cercadas de ideias de solidariedade, empatia e orgulho das ações desempenhadas e demonstram também que as ações de promoção à saúde, desde a atenção básica no pré-natal até um bom acolhimento na maternidade e banco de leite podem ser determinantes importantes na manutenção do aleitamento e na decisão de doar leite.