Thesis (MNutr)--Stellenbosch University, 2012. / Please refer to full text for abstract.

Apesar da importância da alimentação saudável, já nos primeiros anos de vida, tem-se observado durante a infância baixo consumo de dieta saudável diversificada, e consumo elevado de alimentos processados, ricos em gordura, sal e açúcar. Entre os determinantes que influenciam os hábitos alimentares das crianças incluem-se a idade materna e a coabitação com as avós maternas. Por isso, o presente estudo teve como objetivo principal avaliar o efeito de intervenção para a promoção do aleitamento materno e da alimentação complementar saudável, junto a mães adolescentes e avós maternas, realizada nos primeiros 4 meses de vida da criança, sobre o cumprimento dos Dez Passos para uma Alimentação Saudável para Crianças Menores de 2 Anos, recomendados pelo Ministério da Saúde, no primeiro ano de vida; e como objetivo secundário avaliar a influência da duração do aleitamento materno exclusivo sobre a qualidade da alimentação da criança aos 12 meses de vida. Para isso, foi realizado ensaio clínico randomizado com 320 mães adolescentes e seus filhos, mais 169 avós maternas quando em coabitação, recrutados na maternidade do Hospital de Clínicas de Porto Alegre e randomicamente alocados para o grupo intervenção ou controle. A intervenção consistiu de seis sessões de aconselhamento em aleitamento materno e alimentação complementar saudável, a primeira na maternidade e as demais no domicílio, aos 7, 15, 30, 60 e 120 dias de vida da criança, por uma equipe composta por um pediatra, duas enfermeiras e uma nutricionista. Em todas as sessões abordou-se a importância da amamentação exclusiva nos primeiros 6 meses de vida e, na última, aos 120 dias, a ênfase foi na alimentação complementar saudável a ser introduzida na idade de 6 meses, com distribuição de livreto com conteúdo baseado nos Dez Passos para a Alimentação Saudável para Crianças Menores de 2 anos. As informações relativas à alimentação da criança foram obtidas mensalmente nos primeiros 6 meses de idade e, depois, a cada 2 meses até a criança completar 12 meses, mediante registro de frequência alimentar semanal, por entrevistadores cegos aos grupos aos quais as mães pertenciam. Para avaliar o cumprimento dos Dez Passos elaborou-se um sistema de escore que pontuou o cumprimento de cada passo: os passos cumpridos integralmente receberam dois pontos, os parcialmente cumpridos um ponto, e os não cumpridos não pontuaram (zero pontos). Considerou-se dieta saudável diversificada o consumo de frutas/hortaliças, carnes, feijões e cereais/tubérculos pelo menos 4 vezes na semana, além de baixo consumo (no máximo 1 vez por semana) de alimentos ricos em gordura, sal e açucares. O teste t de Student foi utilizado para comparar as médias dos escores dos grupos controle e intervenção, e o modelo de regressão multivariada de Poisson com estimação robusta foi utilizado para estimar o efeito da intervenção sobre o cumprimento dos passos. Para medir a associação entre duração do aleitamento materno exclusivo e a qualidade da alimentação da criança aos 12 meses, utilizou-se o modelo de regressão multivariada de Poisson com estimação robusta, adotando-se como ponto de corte a mediana do escore de toda a população estudada. A média dos escores obtidos no grupo intervenção foi maior que no grupo controle (12,4 ± 2,5 versus 10,5 ± 2,3, respectivamente; p = 0,00), sendo que a intervenção dobrou a chance de o escore ser maior ou igual à mediana (RR = 1,93; IC95% 1,44-2,58), e não houve influência da coabitação com a avó materna. Além disso, a intervenção aumentou em mais de 10 pontos percentuais o cumprimento de 6 dos 10 passos (passos 2 a 7), relativos à época de introdução, frequência, consistência e variedade dos alimentos complementares, além da flexibilidade de quem alimenta a criança quanto a horários e atitude frente à recusa dos alimentos. No entanto, a intervenção não afetou um dos passos mais importantes, a saber, o passo 8, que recomenda evitar açúcar, café, enlatados, frituras, refrigerantes, balas, salgadinhos e outras guloseimas. Houve associação entre duração da amamentação exclusiva e dieta diversificada saudável. A probabilidade de a criança consumir dieta mais saudável aos 12 meses de idade aumentou em 28% para cada mês de aleitamento materno exclusivo (RR 1,28; IC 95% 1,19 -1,38). / Despite the importance of healthy eating already in the early years of life, a pattern of low intake of healthy diverse diet and high consumption of processed foods and foods rich in fat, salt, and sugar has been observed during childhood. Maternal age and cohabitation with maternal grandmother are known to be among the factors that influence the dietary habits of children. Therefore, the objective of the present study was to assess the effect of an intervention designed to promote breastfeeding and healthy complementary feeding, directed at adolescent mothers and maternal grandmothers, and performed during the first 4 months of life, on compliance, during the first year of life, with the Ten Steps to Healthy Feeding for Children under Two Years, recommended by the Brazilian Ministry of Health. A secondary objective was to assess the influence of exclusive breastfeeding duration on the quality of the infant's diet at 12 months. In order to do that, a randomized clinical trial was conducted involving 320 adolescent mothers and their infants, plus 169 maternal grandmothers when cohabiting. Participants were recruited at the maternity ward of Hospital de Clínicas de Porto Alegre and randomly assigned to either the intervention or the control group. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding, the first one held at the maternity ward and the others at the mothers’ homes at 7, 15, 30, 60, and 120 days of life, by a team comprising a pediatrician, two nurses, and a nutritionist. All sessions addressed the importance of exclusive breastfeeding in the first 6 months of life; the last session, at 120 days, emphasized healthy complementary feeding, to be introduced as of 6 months of life. A booklet based on the Ten Steps was given to each mother at this session. Infant feeding information was collected monthly over the first 6 months of life and then every 2 months until 12 months, by recording weekly frequency of consumption of different foods. Interviewers were blind to group allocation. Compliance with the Ten Steps was assessed using a scoring system as follows: full compliance with a step received 2 points per step; partial compliance received 1 point; and noncompliance received 0 points (no score). Healthy diverse diet was defined as the intake of fruit/vegetables, meat, beans, and cereals/tubers at least 4 times weekly, and a low intake (maximum once weekly) of foods rich in fat, salt, and sugar. Student's t test was used to compare mean scores obtained in the intervention and control groups, and Poisson's multivariate regression model with robust estimation was used to estimate the effect of the intervention on compliance with the Ten Steps. The association between exclusive breastfeeding duration and quality of the infant's diet at 12 months was also assessed using Poisson's multivariate regression model with robust estimation, using the median score obtained in the whole sample as cut-off point. Mean scores obtained in the intervention group were higher than those obtained in the control group (12.4 ± 2.5 versus 10.5 ± 2.3, respectively; p = 0.00), and the intervention doubled the chance of the score being greater than or equal to the median (RR = 1.93; 95%CI 1.44-2.58). No influence of cohabitation with maternal grandmother was detected. The intervention increased compliance, by over 10 percentage points, with six of the Ten Steps (Steps 2 to 7), related to the time of introduction, frequency, consistency and variety of complementary foods, in addition to caretaker flexibility with regard to feeding times and attitude towards food refusal. Nevertheless, the intervention did not affect one of the most important steps, namely, Step 8, which recommends avoiding the intake of sugar, coffee, canned foods, fried foods, candies, processed snacks and other unhealthy foods. There was an association between exclusive breastfeeding duration and healthy diverse diet. The likelihood of the infant being on a healthy diet at 12 months of age increased by 28% for each additional month of exclusive breastfeeding (RR = 1.28; 95%CI 1.19-1.38).

xii, 169 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Infant feeding has received insufficient attention in the social sciences. Breastfeeding is an important public health concern because it provides many benefits for infants, mothers, and the community. Breastfeeding rates in the United States increased from their lowest point in the early 1970s, but remain below the federal goals established by the Healthy People 2010 program. This is particularly the case for exclusive breastfeeding. Sociological and feminist theorists have identified several factors that influence breastfeeding, such as social class, race, and state support for lactating women. This research uses the National Immunization Survey, which contains a random sample of nearly 30,000 infant-caretaker pairs in the United States, to examine the affect of these factors on breastfeeding duration and intensiveness. Hierarchical linear modeling is used to analyze individual mothers within U.S. states to determine how class, race, and state-level policies affect breastfeeding rates. The models show that education level and income are strongly associated with both duration and intensity of breastfeeding. African-American and Hispanic women tend to breastfeed less than their white counterparts. State-level variables, particularly the number of lactation consultants employed in a state per 1000 live births, increase the likelihood of breastfeeding. The results of this research are used to suggest policy recommendations that may increase the duration and intensity of breastfeeding. / Advisers: Robert O'Brien, Richard York

abstract: Exclusivity and duration of breastfeeding and the provision of human milk in the United States is suboptimal. In the absence of adequate banked donor human milk for distribution to all infants in need, many families choose to engage in the practice of Private Arrangement Milk Sharing (PAMS), partially facilitated through social media, to procure human milk for their infants. Evidence regarding the participant and infant characteristics and risk abatement practices is incomplete. This dissertation describes and explores the characteristics of recipient participants and infants, family constellation, donor screening practices, and related risk abatement strategies. Data was collected via on-line survey as a sub-group of a larger data set including donor participants and international participants. Binary logistic regression modeling of factors that contribute to consistent screening and risk abatement practices and important antecedents to engaging in PAMS was conducted. Results are contextualized within a tailored socioecological framework of factors affecting infant feeding practices. Tailoring was accomplished via qualitative descriptive analysis of participant responses applied to an existing breastfeeding framework. Participants in this sample were predominantly white, married, with a mean age of 32.9 years, with at least some college education and above median income. Risk abatement and screening practices were influenced by support of a healthcare provider during decision-making, college education, infant age and health status, having lactation support, birth type and birth attendant, and the duration and sources sought for learning about milk sharing. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2016

Apesar da importância da alimentação saudável, já nos primeiros anos de vida, tem-se observado durante a infância baixo consumo de dieta saudável diversificada, e consumo elevado de alimentos processados, ricos em gordura, sal e açúcar. Entre os determinantes que influenciam os hábitos alimentares das crianças incluem-se a idade materna e a coabitação com as avós maternas. Por isso, o presente estudo teve como objetivo principal avaliar o efeito de intervenção para a promoção do aleitamento materno e da alimentação complementar saudável, junto a mães adolescentes e avós maternas, realizada nos primeiros 4 meses de vida da criança, sobre o cumprimento dos Dez Passos para uma Alimentação Saudável para Crianças Menores de 2 Anos, recomendados pelo Ministério da Saúde, no primeiro ano de vida; e como objetivo secundário avaliar a influência da duração do aleitamento materno exclusivo sobre a qualidade da alimentação da criança aos 12 meses de vida. Para isso, foi realizado ensaio clínico randomizado com 320 mães adolescentes e seus filhos, mais 169 avós maternas quando em coabitação, recrutados na maternidade do Hospital de Clínicas de Porto Alegre e randomicamente alocados para o grupo intervenção ou controle. A intervenção consistiu de seis sessões de aconselhamento em aleitamento materno e alimentação complementar saudável, a primeira na maternidade e as demais no domicílio, aos 7, 15, 30, 60 e 120 dias de vida da criança, por uma equipe composta por um pediatra, duas enfermeiras e uma nutricionista. Em todas as sessões abordou-se a importância da amamentação exclusiva nos primeiros 6 meses de vida e, na última, aos 120 dias, a ênfase foi na alimentação complementar saudável a ser introduzida na idade de 6 meses, com distribuição de livreto com conteúdo baseado nos Dez Passos para a Alimentação Saudável para Crianças Menores de 2 anos. As informações relativas à alimentação da criança foram obtidas mensalmente nos primeiros 6 meses de idade e, depois, a cada 2 meses até a criança completar 12 meses, mediante registro de frequência alimentar semanal, por entrevistadores cegos aos grupos aos quais as mães pertenciam. Para avaliar o cumprimento dos Dez Passos elaborou-se um sistema de escore que pontuou o cumprimento de cada passo: os passos cumpridos integralmente receberam dois pontos, os parcialmente cumpridos um ponto, e os não cumpridos não pontuaram (zero pontos). Considerou-se dieta saudável diversificada o consumo de frutas/hortaliças, carnes, feijões e cereais/tubérculos pelo menos 4 vezes na semana, além de baixo consumo (no máximo 1 vez por semana) de alimentos ricos em gordura, sal e açucares. O teste t de Student foi utilizado para comparar as médias dos escores dos grupos controle e intervenção, e o modelo de regressão multivariada de Poisson com estimação robusta foi utilizado para estimar o efeito da intervenção sobre o cumprimento dos passos. Para medir a associação entre duração do aleitamento materno exclusivo e a qualidade da alimentação da criança aos 12 meses, utilizou-se o modelo de regressão multivariada de Poisson com estimação robusta, adotando-se como ponto de corte a mediana do escore de toda a população estudada. A média dos escores obtidos no grupo intervenção foi maior que no grupo controle (12,4 ± 2,5 versus 10,5 ± 2,3, respectivamente; p = 0,00), sendo que a intervenção dobrou a chance de o escore ser maior ou igual à mediana (RR = 1,93; IC95% 1,44-2,58), e não houve influência da coabitação com a avó materna. Além disso, a intervenção aumentou em mais de 10 pontos percentuais o cumprimento de 6 dos 10 passos (passos 2 a 7), relativos à época de introdução, frequência, consistência e variedade dos alimentos complementares, além da flexibilidade de quem alimenta a criança quanto a horários e atitude frente à recusa dos alimentos. No entanto, a intervenção não afetou um dos passos mais importantes, a saber, o passo 8, que recomenda evitar açúcar, café, enlatados, frituras, refrigerantes, balas, salgadinhos e outras guloseimas. Houve associação entre duração da amamentação exclusiva e dieta diversificada saudável. A probabilidade de a criança consumir dieta mais saudável aos 12 meses de idade aumentou em 28% para cada mês de aleitamento materno exclusivo (RR 1,28; IC 95% 1,19 -1,38). / Despite the importance of healthy eating already in the early years of life, a pattern of low intake of healthy diverse diet and high consumption of processed foods and foods rich in fat, salt, and sugar has been observed during childhood. Maternal age and cohabitation with maternal grandmother are known to be among the factors that influence the dietary habits of children. Therefore, the objective of the present study was to assess the effect of an intervention designed to promote breastfeeding and healthy complementary feeding, directed at adolescent mothers and maternal grandmothers, and performed during the first 4 months of life, on compliance, during the first year of life, with the Ten Steps to Healthy Feeding for Children under Two Years, recommended by the Brazilian Ministry of Health. A secondary objective was to assess the influence of exclusive breastfeeding duration on the quality of the infant's diet at 12 months. In order to do that, a randomized clinical trial was conducted involving 320 adolescent mothers and their infants, plus 169 maternal grandmothers when cohabiting. Participants were recruited at the maternity ward of Hospital de Clínicas de Porto Alegre and randomly assigned to either the intervention or the control group. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding, the first one held at the maternity ward and the others at the mothers’ homes at 7, 15, 30, 60, and 120 days of life, by a team comprising a pediatrician, two nurses, and a nutritionist. All sessions addressed the importance of exclusive breastfeeding in the first 6 months of life; the last session, at 120 days, emphasized healthy complementary feeding, to be introduced as of 6 months of life. A booklet based on the Ten Steps was given to each mother at this session. Infant feeding information was collected monthly over the first 6 months of life and then every 2 months until 12 months, by recording weekly frequency of consumption of different foods. Interviewers were blind to group allocation. Compliance with the Ten Steps was assessed using a scoring system as follows: full compliance with a step received 2 points per step; partial compliance received 1 point; and noncompliance received 0 points (no score). Healthy diverse diet was defined as the intake of fruit/vegetables, meat, beans, and cereals/tubers at least 4 times weekly, and a low intake (maximum once weekly) of foods rich in fat, salt, and sugar. Student's t test was used to compare mean scores obtained in the intervention and control groups, and Poisson's multivariate regression model with robust estimation was used to estimate the effect of the intervention on compliance with the Ten Steps. The association between exclusive breastfeeding duration and quality of the infant's diet at 12 months was also assessed using Poisson's multivariate regression model with robust estimation, using the median score obtained in the whole sample as cut-off point. Mean scores obtained in the intervention group were higher than those obtained in the control group (12.4 ± 2.5 versus 10.5 ± 2.3, respectively; p = 0.00), and the intervention doubled the chance of the score being greater than or equal to the median (RR = 1.93; 95%CI 1.44-2.58). No influence of cohabitation with maternal grandmother was detected. The intervention increased compliance, by over 10 percentage points, with six of the Ten Steps (Steps 2 to 7), related to the time of introduction, frequency, consistency and variety of complementary foods, in addition to caretaker flexibility with regard to feeding times and attitude towards food refusal. Nevertheless, the intervention did not affect one of the most important steps, namely, Step 8, which recommends avoiding the intake of sugar, coffee, canned foods, fried foods, candies, processed snacks and other unhealthy foods. There was an association between exclusive breastfeeding duration and healthy diverse diet. The likelihood of the infant being on a healthy diet at 12 months of age increased by 28% for each additional month of exclusive breastfeeding (RR = 1.28; 95%CI 1.19-1.38).

No primeiro ano de vida, os cuidados com a criança são de importância vital devido ao fenômeno do crescimento/desenvolvimento e sua dependência. Neste contexto, um fator imprescindível dentre suas necessidades básicas é a nutrição. Oferecer à criança alimentos que não o leite materno antes do sexto mês de vida é, em geral, desnecessário e pode deixar a criança mais susceptível a diarréias, infecções respiratórias e desnutrição. Entretanto, a introdução tardia de alimentos não lácteos no esquema alimentar infantil leva ao aparecimento de retardo de crescimento e deficiências nutricionais. O Ministério da Saúde, bem como a OMS, preconizam o aleitamento materno exclusivo até seis meses de idade e a oferta do leite materno até os dois anos. O objetivo deste estudo constituiu analisar o cuidado materno na alimentação das crianças menores que um ano, considerando o perfil da alimentação ofertada pelas mães e a compreensão que estas fazem destes cuidados às crianças. Trata-se de um estudo descritivo e exploratório, baseado em dados quantitativos e qualitativos. É parte de um projeto multicêntrico intitulado Deficiência de ferro em crianças entre 3 a 12 meses: compreensão de determinantes biológicos, sociais, e suas implicações para o incentivo ao aleitamento materno exclusivo. Foi realizado no ambulatório da Unidade Distrital de Saúde Dr. Marco Antônio Sahão, na cidade de Ribeirão Preto-SP e constituído por 122 mães. Os dados foram coletados através de um instrumento adaptado e entrevista após assinatura do Termo de Consentimento Livre e Esclarecido. Os dados quantitativos foram analisados no programa SPSS (versão 11.5), realizando-se uma distribuição simples de freqüência. O conteúdo das entrevistas foi categorizado com base na técnica de análise de conteúdo, modalidade temática. Observou-se que 5,7% recebiam AME, 10,6% estavam em AMP e 47,5% em AM. As demais 44 estavam desmamadas ou nunca mamaram. Das 70 crianças menores de 6 meses, 82,8 % faziam uso de água / chá, 61,4% continha frutas em sua dieta, 32,8 % consumiam legumes, 7,2 % verduras e um pequeno percentual caldo de carne e carne. Quando analisamos as crianças maiores de 6 meses, idade em que se recomenda a introdução da alimentação complementar, identificamos o consumo reduzido de verduras ( 55,8%), de carnes (65,4% ) e feijão (32,7%). Quanto à análise qualitativa, sobre a primeira categoria temática, identificamos os seguintes núcleos de sentido: a criança como centro de atenção; prover a criança de suas necessidades; alimentação como espaço de presença materna. Na segunda categoria temática, o significado os alimentos, depreendemos dois núcleos de sentido: o bom alimento é o que sustenta a criança; o bom alimento é o que tem vitaminas. Na terceira categoria temática, o significado da alimentação, identificou-se quatro núcleos de sentido: faz a criança ficar saudável e se desenvolver; a criança precisa comer muito e de tudo; é uma parte do processo da vida que ela aprende a comer; adaptando a criança à comida da família e a família à comida da criança. Tanto as mulheres como os profissionais de saúde carecem de melhor instrumentalização quanto a alimentação complementar e os guias alimentares que, embora representem um importante instrumento na educação nutricional, requerem adequações que considerem não só as crianças em aleitamento materno mas também as especificidades que ocorrem na alimentação infantil. Importante considerar a mulher como agente do cuidado na alimentação infantil e provê-la de suporte necessário a condução de práticas alimentares que atendam as recomendações para uma alimentação complementar adequada e oportuna. / In the first year of life, the care with child is vital importance due to the phenomenon of growth / development and its dependence. In this context, a vital factor among their basic needs is the nutrition. Offer the child food than breast milk before the sixth month of life is generally unnecessary and can leave the child more susceptible to diarrhea, respiratory infections and malnutrition. However, the late introduction of foods no milk in infant feeding scheme leads to the emergence of growth retardation, and nutritional deficiencies. The Ministry of Health and the OMS recommend exclusive breastfeeding up to 6 months of age and supply of milk up to two years old. The purpose of this study was examining the care of maternal nutrition in children less than one year old, considering the profile of the food offered by mothers and understanding that they do care for these children. This is a descriptive and exploratory study, based on quantitative and qualitative data. It is part of a multicentric project entitled \"Iron deficiency in children between 3 to 12 months: understanding determinants of biological, social and their implications for the encouragement of exclusive breastfeeding\". It was done in the Ambulatory Unit of the District Health Dr. Marco Antonio Sahão in the city of Ribeirão Preto-SP and formed by 122 mothers. The data were collected through an interview and adapted after the signature of the Free and Informed Consent Term. The figures quantitative were analyzed in SPSS (version 11.5), holding up a simple distribution of frequency. The content of the interviews was categorized based on technical analysis of content, thematic way. It was observed that 5.7% received AME, 10.6% were in AMP and 47.5% in AM. The other 44 were weaned or never breastfeeding. Of the 70 children under 6 months, 82.8% were using water / tea, 61.4% contained fruit in their diet, 32,8% consumed vegetables, 7.2% vegetables and a small percentage of meat and meat broth . When we analyses children older than 6 months, age at which recommends the introduction of supplementary feeding, identified the reduced consumption of vegetables (55.8%), meat (65.4%) and beans (32.7%). As for the qualitative analysis on the first thematic category, we identified the following clusters of meaning: the child as the centre of attention, provide the child of their needs; nutrition as an area of maternal presence. In the second thematic category, meaning the food, deduct two clusters of meaning: the good food is what sustains the child, the good food is what has vitamins. In the third thematic category, the meaning of food, there were identified four clusters of meaning: does the child stay healthy and develop, the child needs to eat well and everything, is a part of the process of life she learns to eat; adapting the child to the familys food and the familys food of the child. Both women and health care professionals need further instrumentation on complementary feeding and food guides that while representing an important tool in nutritional education, require adjustments they consider not only children in breastfeeding but also the specific features that occur in food child. Its important to consider the woman as the agent of care in infant feeding and it provides the support needs to the conduct of feeding practices that meet the recommendations for a timely and appropriate complementary feeding.

Magister Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

Master of Public Health - MPH / South Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.

Childhood overweight and obesity are public health concerns that have negative health consequences and affect many children. Efforts are needed to identify children who are at a higher risk of developing overweight and obesity so that early detection and treatment may be offered. The intent of this study was to investigate the differences in the effects of postpartum depression on infant feeding practices and infant weight gain between Hispanic and African American women. Data were obtained from Infant Feeding Practices Study 11, a longitudinal study involving mothers in their third trimester through infants first year of life. The overall test of model coefficient of complete cases (N = 192, missing = 443) was not statistically significant (x-² = 4.842, df =2, p = 0.089). The result of the overall test after multiple imputation (n = 289) remained insignificant (on average x-² = 4.031, df = 2, p = 0.133). However, results indicated a significant association between excessive infant weight gain and feeding practices (breast feeding vs. formula feeding; r = 0.207, p = 0.01), supporting previous research on the protective effect of breast feeding on excess infant weight gain. Positive social change implications include an understanding of how maternal and infant characteristics may identify early symptoms of maternal depression, through increased awareness and reduced incidents of childhood obesity and maternal postpartum depression.

Cultural practices influence infant feeding choices and have a significant impact on children’s physiological growth and cognitive development. This study examined cultural knowledge of infant feeding among woman in rural and urban Bangladesh. The findings of this research indicated that there was sufficient agreement among the respondents to constitute a single shared cultural model of infant feeding among participants in Bangladesh. Results also indicated intracultural variation within this model in terms of duration of exclusive breastfeeding, age at introduction of water, and weaning practices. Better understanding infant feeding can inform future programs aimed at improving early nutrition, growth, and development by providing information about actual practices and their cultural importance.