No / Lecturers Fiona Meddings and Jan Porter of the division of midwifery and women’s health at the School of Health Studies at the University of Bradford detail the difficulties faced by UK Pakistani women in making informed choices on breastfeeding.

La lactancia materna (LM) es la manera óptima de alimentación del recién nacido. La OMS recomienda que se amamante a los recién nacidos de manera exclusiva durante 6 meses y que se continúe junto con alimentación complementaria al menos, hasta los 2 años de vida. Solo una minoría de los recién nacidos se benefician de la lactancia materna. En Europa en general, y en España, en particular, el inicio de la LM alcanza cifras adecuadas, sin embargo, su exclusividad baja rápidamente a los 4 y 6 meses y es muy baja a partir de los 6 meses postparto. La mediana de duración de lactancia materna exclusiva (LME) en España es de 3 meses y a los 6 meses un 53.1% de los lactantes no recibe ya leche materna. Uno de los factores individuales que afecta al inicio y duración de la LM es la actitud de la madre hacia la misma. Una mujer con actitud positiva hacia la LM, es más propensa a amamantar y lo hará durante más tiempo que la mujer con actitud menos positiva. La Iowa Infant Feeding Attitude Scale (IIFAS) es un cuestionario de 17 ítems que se desarrolló para predecir la elección del método de alimentación infantil, así como la duración de la LM; puntuaciones más altas indican que las mujeres son más propensas a amamantar. Objetivos. El objetivo general de esta tesis doctoral es describir y explicar la relación de la actitud hacia la lactancia materna en el inicio y duración de la misma. Los objetivos específicos son: (i) aportar una herramienta válida y fiable en la población española (hombres y mujeres), para la medición de la actitudes respecto a la alimentación de los recién nacidos; (ii) valorar la utilidad predictiva de la puntuación obtenida durante el embarazo de la escala IIFAS-S, para predecir el inicio de la LM, la LME al alta y a los 5 meses después del parto; (iii) evaluar qué variables estructurales e individuales modulan el efecto de la actitud sobre el inicio de la LM, LME al alta y a los 5 meses postparto. Metodología. Estudio observacional longitudinal, con seguimiento de un año a una muestra de mujeres embarazadas y sus parejas captadas en varios departamentos y áreas de salud de la zona este de España. El estudio se llevó a cabo en dos fases tras un proceso estándar de traducción lingüística de la escala IIFAS. Resultados. Ninguno de los 17 ítems de la escala IIFAS se consideró inapropiado para el contexto español. Según la evaluación de los traductores y retrotraductores, la dificultad de la traducción fue baja y no se detectaron diferencias semánticas, ni problemas de lectura y comprensión. Conclusiones. La versión española reducida de la escala IIFAS, la escala IIFAS-S de nueve ítems, se obtuvo mediante criterios de mejora de la fiabilidad y poder predictivo de los ítems. La escala IIFAS-S presenta una estructura unidimensional y los resultados de fiabilidad y validez son adecuados, tanto en padres como en mujeres. La escala IIFAS-S es un buen predictor del inicio de la lactancia materna, pero no de la LME durante la estancia hospitalaria y a los 5 meses posparto. Las principales variables que influyen en la decisión de iniciar la LM son la edad, la actitud materna y la experiencia previa de la madre. La actitud materna hacia la lactancia no tiene un efecto independiente sobre la LME durante el ingreso hospitalario, que está condicionada por variables relacionadas con las dificultades durante el postparto y la capacidad de la madre para afrontarlas, así como por variables estructurales del hospital, como la acreditación IHAN. Entre las mujeres que amamantaban de forma exclusiva al alta, la LME a los 5 meses posparto está relacionada con aspectos personales de la madre, como su actitud hacia la lactancia, el nivel de autoeficacia para la misma y la edad, con aspectos relacionados con la atención hospitalaria posparto, como la acreditación IHAN, con las dificultades y problemas de lactancia y con el contacto de la madre con grupos de apoyo tras el alta.

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)

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)

Includes bibliographical references (p. 51-57). / Exclusive breastfeeding (mother's milk only, with the exclusion of all other food or drink) reduces breast milk transmission of HIV compared with mixed feeding. This study was part of formative work for a community-based un-blinded randomised controlled trial (RCT) in an urban township with high antenatal HIV prevalence in KwaZulu-Natal (KZN), South Africa. The RCT sought to determine whether an integrated package of home-based care delivered by community health workers (CHWs) increases uptake of prevention of mother-to-child-transmission (PMTCT) interventions and improves neonatal outcomes. One example of where counselling is used is in Behaviour Change Communication (BCC) approaches. A counselling booklet, used by CHWs during home visits, was part of the integrated package. The primary objective of this study was to document the socio-cultural context in which infant feeding and caring decisions were made. The secondary objective was to field test the draft counselling booklet for the RCT. Methods This qualitative study used focus groups (n=8 groups) and individual interviews (n=6). All participants, of unknown HIV status, were purposively sampled from the study site. The focus group participants included, in separate groups, eight MRC researchers; 14 pregnant women (two separate groups of seven each); six non-pregnant women; eight older women; five men and 15 CHWs (separated into two groups). Results Data showed that socio-cultural factors, like the lack of social support systems; uncertainty regarding the role of men in infant feeding and caring issues; local beliefs and practices that encouraged risky infant caring practices; the lack of supply of formula and CHWs' lack of breastfeeding knowledge and experience; and HIV-related stigma may directly or indirectly, drive mothers to practice non-exclusive infant feeding. BCC principles acknowledge that people are affected greatly by social pressures exerted not only by their peers, but also by their larger communities (Bentley et al., 1999). For vi example, with regard to the support systems, both pregnant as well as younger women felt that feeding and caring decisions regarding their infants were mostly made by older women ' their husbands were seldom involved in such decisions. In relation to HIV-related stigma, many pregnant women felt that some clinics were not very supportive regarding HIV disclosure. In terms of health system factors, CHWs said that they were sometimes ill-equipped to deal with issues of disclosure due to a lack of training and confusion around the key feeding and caring messages. With regard to infant caring practices, the data revealed risky practices (using soap enemas and inappropriate hand washing practices), even amongst CHWs. Participants said they would share the booklet with others in the community as it taught them important lessons regarding infant feeding and caring practices. For some, the pictures in the booklet enhanced their understanding of 'old' messages. Participants identified several weaknesses in the booklet and suggested that it be less repetitive; that voluntary counselling and testing (VCT) be given priority in earlier rather than later visits; that unfamiliar terms is explained; more pictures included; and the general tone of messages improved. Literacy rates were low among older women and some men in the study. Conclusion and Recommendations Socio-cultural factors drive mothers to practice non-exclusive feeding and care for their infants in ways that may unwittingly increase the risk of HIV transmission. There is a need for CHWs to include family members in discussions about feeding so that they can change their thinking around infant-feeding and caring issues. The data suggests that VCT is not given priority in the counselling booklet and support is lacking in some clinics, therefore policy makers should ensure that support for VCT becomes a priority in the future. Furthermore, some CHWs were confused about the messages they are disseminating, therefore, the training that facility managers give to CHWs should be adapted to suit socio-cultural contexts so that CHWs are better equipped to communicate messages pertaining to infant feeding and caring appropriately to mothers. With the data revealing general acceptability of risky infant caring practices, even amongst CHWs, the vii health system needs to look at how it will effectively change health-related practices among health professionals. With literacy rates being low among older women and some men in the study, it was therefore recommended that gaining skills in materials design and improving CHWs' understanding of the BCC process, booklets such as this one needs to be designed together with the primary user in mind.

Exclusive breastfeeding and holistic maternity care are strategic to improving maternal and infant health outcomes in Nigeria. This thesis aimed at informing policies and interventions to promote breastfeeding and to improve Nigerian mother’s experiences in antenatal and intrapartum care. The study in this research focused upon psychological dynamics underlying societal culture around maternity and breastfeeding. Using quantitative method, attitudes toward breastfeeding and health orientation were surveyed in 400 Nigerian men and women using the Iowa Infant Feeding Attitude Scale (IIFAS) and the Multidimensional Health Locus of Control Scale (MHLoC). There were more positive attitudes toward breastfeeding in males, participants in the 20-29-year-old age category, and in those who identified as single. Higher internal HLoC was associated with more positive attitudes to breastfeeding and higher EHLoC scores were associated with more negative attitudes to formula feeding. The second study explored the experience of pregnancy and childbirth in Nigerian women. Qualitative interviews with 12 women implied that Nigerian women perceive pregnancy and childbirth as a multidimensional experience comprising physiological and psychological elements and also as risky. Control mechanisms that reflected internal HLoC included choosing multiple antenatal care sources to obtain holistic care, adopting new technology in bridging perceived communication gaps with health care providers and adopting physical and mental strategies in controlling the somatic and sensory changes that accompany pregnancy. Pregnancy and childbirth were viewed through an external HLoC lens as spiritual, and reflected in an entrenched belief in the intervention of deity to mitigate pain and risk associated with childbirth. These results have implications for practice, intervention and policy to promote breastfeeding at the societal level and improve maternity services for the current and next child-bearing generation.

The study investigated the feasibility of the Ottawa decision support tool to assist HIV positive mothers' infant feeding choice. The aim was to explore and describe the feasibility of the Ottawa Decision Support Tool (ODST) in counselling HIV infected pregnant women on decision-making regarding the choice of safe infant feeding. The finding of this study will assist and support HIV positive mothers to be independent decision makers in choosing an infant feeding option for their babies. A descriptive qualitative research approach guided the researcher to explore and describe the feasibility of the ODST to assist HIV positive mothers' infant feeding choice. This study is based on the Ottawa decision support framework (ODSF). Three focus group that comprised midwives as participants were conducted. The first focus group was conducted in January 2013 and the two subsequent ones in August 2013. Data was analysed using a framework approach. The following themes emerged from data-analysis: • Appropriateness • Receptiveness of intervention • Effectiveness Conclusions were drawn based on the attained objectives of the study. The overall conclusion was that the ODST is feasible to assist HIV positive mothers' infant feeding choice. Limitations of the study were identified and recommendations were made for nursing practice, nursing education and further research. / MCur, North-West University, Potchefstroom Campus, 2015

The study investigated the feasibility of the Ottawa decision support tool to assist HIV positive mothers' infant feeding choice. The aim was to explore and describe the feasibility of the Ottawa Decision Support Tool (ODST) in counselling HIV infected pregnant women on decision-making regarding the choice of safe infant feeding. The finding of this study will assist and support HIV positive mothers to be independent decision makers in choosing an infant feeding option for their babies. A descriptive qualitative research approach guided the researcher to explore and describe the feasibility of the ODST to assist HIV positive mothers' infant feeding choice. This study is based on the Ottawa decision support framework (ODSF). Three focus group that comprised midwives as participants were conducted. The first focus group was conducted in January 2013 and the two subsequent ones in August 2013. Data was analysed using a framework approach. The following themes emerged from data-analysis: • Appropriateness • Receptiveness of intervention • Effectiveness Conclusions were drawn based on the attained objectives of the study. The overall conclusion was that the ODST is feasible to assist HIV positive mothers' infant feeding choice. Limitations of the study were identified and recommendations were made for nursing practice, nursing education and further research. / MCur, North-West University, Potchefstroom Campus, 2015

Background: An estimated 9.7% of U.S. infants and toddlers are considered overweight. Hispanic infants persistently show higher prevalence rates for being overweight compared to black and white infants. Little is known about factors promoting excessive infant weight gain in Latinos. Purpose: Primary aim of this study was to describe multidimensional factors and maternal feeding practices that may correlate with infant overfeeding in Latina mothers. A secondary aim was to determine whether there was an association between these factors and infant weight gain. Subjects: Sixty-two low-income immigrant Latina mothers and their infants ages 4-12 months receiving assistance through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design: A descriptive correlational cross-sectional study. Methods: A native Spanish-speaking investigator who guided the participants through the options administered all the measures. Measures included: acculturation indicators; maternal feeding beliefs; maternal feeding practices; maternal knowledge and self-efficacy; food availability/insecurity indicators; infant’s temperament; infant’s 24-hour dietary recall; and infant’s height and weight measures. Univariate and multiple linear regressions were used to examine relationships. Results: Over 25% of infants were at >85th percentile for weight-for-length, and 21% were at > 98th percentile. Among infants at the >85th percentile for weight-for-length, 27% of the mothers wished their infants were heavier. Three-quarters of the participants were not currently breastfeeding their infants (74.2%). Healthier maternal feeding practices were inversely correlated with maternal age and the number of people living at home. Multiple regression results showed infant’s age and maternal education as significant positive predictors of less controlling maternal feeding practices. None of the analyzed factors were significant predictors of infant’s weight gain. Conclusion: Future research is needed to further delineate the primary driving forces behind immigrant Latina mothers’ feeding decisions and practices. Given the protective benefit of breastfeeding in reducing the risk of early childhood and adult obesity, present intervention efforts should focus primarily on the promotion of healthy feeding practices that encourage and support exclusive breastfeeding among this ethnic group.

Oral feeding competency is a primary requirement for preterm infant hospital release. Currently there is no widely accepted method to objectively measure oral feeding. Feeding consists primarily of the integration of three individual feeding events: sucking, breathing, and swallowing, and the objective of feeding coordination is to minimize aspiration. The purpose of this work was to quantify the infant feeding process from signals obtained during bottle feeding and ultimately develop a measure of feeding coordination. Sucking was measured using a pressure transducer embedded within a modified silicone bottle block. Breathing was measured using a thermistor embedded within nasal cannula, and swallowing was measured through the use of several different piezoelectric sensors. In addition to feeding signals, electrocardiogram (ECG) signals were obtained as an indicator of overall infant behavioral state during feeding. Event detection algorithms for the individual feeding signals were developed and validated, then used for the development of a measurement of feeding coordination. The final suck event detection algorithm was the result of an iterative process that depended on the validity of the signal model. As the model adapted to better represent the data, the accuracy and specificity of the algorithm improved. For the breath signal, however, the primary barrier to effective event detection was significant baseline drift. The frequency components of the baseline drift overlapped significantly with the breath event frequency components, so a time domain solution was developed. Several methods were tested, and it was found that the acceleration vector of the signal provided the most robust representation of the underlying breath signal while minimizing baseline drift. Swallow signal event detection was not possible due to a lack of available data resulting from problems with the consistency of the obtained signal. A robust method was developed for the batch processing of heart rate variability analysis. Finally a method of coordination analysis was developed based on the event detection algorithm outputs. Coordination was measured by determining the percentage of feeding time that consisted of overlapping suck and breath activity.