<p>The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. </p><p>Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found.</p><p>Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. </p><p>The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society. </p>

The dissertation deals with the infant mortality decline in Iceland during the 19th and early 20th Century. It shows that despite its low degree of urbanization, pre-transitional Iceland displayed higher infant mortality rates than most other European countries. Levels are only comparable with a few areas in Europe, all of whom were known for a tradition of artificial feeding of newborns. In the Icelandic case, infants were either not breastfed at all or were weaned at a very young age. Another characteristic of infant mortality in Iceland were huge fluctuations during epidemics. Because of the isolation of the country, several diseases that had become endemie in other societies, such as measles, became dangerous epidemics in Iceland and affected all age groups. After 1850 the effects of epidemics declined and 20 years later there was a steep decline in infant mortality. By the beginning of the 20th Century infant mortality in Iceland was lower than in most other societies. Although epidemics often had important temporary consequences upon infant mortality level in pretransitional Iceland, being breastfed or not was without doubt the most important determinant of infant survival. There were huge differences in infant mortality levels between areas where breastfeeding was common and those where newborns were artificially fed. Towards the turn of the 20th Century significant changes occurred. Even though there were still differences in infant mortality between those babies who were breastfed and those who were not, infant survival had improved greatly and survival chances of Icelandic newborns that were fed artificially became in an international perspective relatively good. Midwives played a central role in the infant mortality decline in Iceland. Growing secularization during the second part of the 19th Century improved educational opportunities for women and also changed the content of education. Improved educational opportunities were reflected in changes in the education of midwives. At the same time there was growth in the publication of books that directly dealt with the issue of infant health. The increase in the number of educated midwives was a factor of central importance. The interaction between midwives and a literate population was most likely the key to infant survival in the Nordic countries. This study shows that that the custom to breastfeed spread earlier in areas with higher literacy. Not only is it plausible that the interest in changing prevailing traditions was directly related to literaey levels of individuai mothers, it is also shown that midwives had the best education in areas where literacy rates were high. On the other hand, the remarkable improvements in infant survival obtained towards the end of the 19th Century were scarcely linked to changes in the economic structure. Those factors only started to play an important role in the 20th Century. In its initial stages, changes in infant feeding and improvements in personal hygiene were more important / digitalisering@umu

<p>The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district.</p>

The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found. Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society.

This thesis assesses the effectiveness of the National Prevention of Mother to Child Transmission of HIV (PMTCT) programme in 3 sites in South Africa, and the quality of infant feeding counselling across four countries, Botswana, Kenya, Malawi and Uganda . Implementation and outcome of PMTCT services were very different across the 3 sites. The Paarl site is achieving results comparable to clinical trial studies with a HIV-free survival rate of 85% at 36 weeks, while Umlazi is somewhat lower (74%) and Rietvlei, with HIV-free survival of 64%. Maternal viral load, prematurity and site were independent risk factors for infection and/or death. The regression analysis suggests that some of this difference is explained by the differences in quality of health systems across the sites. Traditional risk factors (e.g. viral load, prematurity) do not seem to explain the substantial differences in HIV-free survival between the Paarl and Rietvlei sites. The overall mortality rate for HIV exposed infants in this cohort was 155 per 1000 live births at 36 weeks, a level higher than most other HIV exposed cohorts. The excess mortality is occurring almost completely amongst HIV infected infants who had a nine fold increased risk of mortality compared with HIV exposed but HIV negative infants. There was no significant difference in 36 week survival rates between those HIV exposed but uninfected infants and those who were not HIV exposed, Hazard ratio 0.7 (95% CI 0.3-1.5). With respect to HIV and infant feeding most health workers across the four countries (234/334, 70%) were unable to correctly estimate the transmission risks of breastfeeding. Exposure to PMTCT training made little difference to this. Infant feeding options were mentioned in 307 out of 640 (48%) observations of PMTCT counselling session and in only 35 (5.5%) were infant feeding issues discussed in any depth; of these 19 (54.3%) were rated as poor. South Africa was similar with only two out of thirty four HIV positive mothers being asked about essential conditions for safe formula feeding before a decision was made. This body of work has demonstrated that the gap between efficacy and effectiveness can be significant.

Early life factors play important roles in disease susceptibility in later life. However, the relationship between dietary factors in early life on childhood growth, especially linear growth, remains unclear. This research aimed to improve our understanding of the associations between dietary factors in early life (i.e., infant feeding practices and age of introduction of solid foods) and childhood growth, especially using ulnar length as a surrogate measure of length/height, in a cross-sectional study of 1634 mother-child dyads across eight study centers in the National Children's Study Formative Research in Anthropometry in the United States from 2011-2012 (Chapter 1). Chapter 2 described the data acquisition and preprocessing procedures used in this research and provide practical guidelines of data quality control. In Chapter 3, predictive models for exclusive breastfeeding (XBR) initiation and duration was developed. Discriminant analysis revealed maternal sociodemographic factors had greater discriminating abilities to predict XBR initiation and XBR for 6 months, compared to child birth characteristics and maternal perinatal factors. Chapter 4 demonstrated that ulnar length can serve as an accurate and reliable surrogate measure of recumbent length in healthy infants/children aged 0-1.9 years and of height in healthy children aged 2-5.9 years, respectively. Bland-Altman plots and mixed-effects linear regression analyses showed that the three simple and portable tools (i.e., caliper, ruler, and grid) used to measure ulnar length could be used interchangeably in terms of prediction accuracy. Chapter 5 focused on assessing the interplay among gestational weight gain (GWG), birthweight, infant feeding practices, and childhood anthropometrics. Longer duration of breastfeeding reduced the positive associations of GWG and birthweight with weight-for-age z-scores, weight-for-height/length z-scores, and body mass index-for age z-scores in non-Hispanic Whites. These findings underscore the importance of promoting breastfeeding among women with excessive GWG to mitigate childhood obesity. Longer breastfeeding and a later age at introduction of solid foods had positive effects on ulnar length, a linear growth parameter of upper extremity, in Hispanics. Future prospective research aiming to investigate the underlying mechanisms that drive ethnic variation in these associations between early life dietary factors and childhood growth is warranted (Chapter 6). / text

<p>The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district.</p>

Research show evidence for benefits of breastfeeding and that infant-feeding-plans are supportive. Family-centered care is the theoretical framework. Family support is crucial for successful breastfeeding. It is important that society creates opportunities for mothers to breastfeed and contribute information and support by healthcare professionals. The aim of this study was to evaluate how the midwives and child healthcare nurses found that the newest breastfeeding strategy influenced their breastfeeding- and rearing support in the County of Jönköping. The method was a questionnaire with mainly quantitative and partly qualitative approach. The questionnaire consisted of fifteen questions and was distributed to 272 people, response rate was 58 %. The result showed that the professionals were updated with current breastfeeding-strategy and they were using infant-feeding-plans, which were considered positive for the chain of care. Most respondents reckoned that they since 2011 had increased the time allocated, and individual customization of information and support. Breastfeeding-delegate-nurses were familiar, supportive and positive for the chain of care. The document Breastfeeding Plan should not be changed now, but should eventually improve the inclusion of non-Swedish speaking persons, fathers and the mothers who won’t breastfeed. Experience and education were positive factors. The strategy was supported by the healthcare professions. / Tidigare forskning har visat stark evidens för amningens fördelar och att amningsplaner är ett stöd för mödrar. Som teoretisk ram används familjefokuserad omvårdnad, då familjens stöd är centralt för en lyckad amning. Det är viktigt att samhället ger goda förutsättningar samt att vårdpersonal ger stöd och information. Studiens syfte var att utvärdera hur barnmorskor, barnsjuksköterskor och distriktssköterskor bedömde att den nyaste amningsstrategin med amningsplaner och amningsombud påverkat deras amnings- och uppfödningsstödjande arbete i landstinget i Jönköpings län. Metoden var en enkätstudie med huvudsakligen kvantitativ och delvis kvalitativ ansats. Enkäten omfattade femton frågor och distribuerades till 272 personer, svarsfrekvensen var 58 %. Resultatet visade att vårdprofessionerna var uppdaterade med amningsstrategi och använde amningsplaner, vilka ansågs positiva för vårdkedjan. Amningsombuden var välkända, stödjande och positiva för vårdkedjan. Majoriteten av respondenterna bedömde att de sedan 2011 ökat avsatt tid och individanpassningen av information och -stöd, trots att det även tidigare prioriterats. Önskemål fanns att dokumentet Amningsplan inte ska förändras i nuläget, men så småningom bör förbättra inkluderingen av icke-svensktalande, fäderna och de mödrar som inte ska amma sitt barn. Vårdprofessionernas arbets- och livserfarenhet samt amningsutbildning var positiva faktorer. Amningsstrategin hade ett genomgående stöd från yrkesgrupperna från samtliga sjukvårdsområden oavsett ålder och verksamhetsår.

Este trabalho teve como objetivo investigar a compreensão de crianças e adolescentes sobre alimentação saudável. Utilizou-se como base metodológica o Método Clínico Piagetiano, que possibilita ao pesquisador acompanhar e compreender o pensamento do sujeito. Foram realizadas 28 entrevistas, individuais, com crianças e adolescentes entre 7 e 19 anos. A coleta de dados foi realizada mediante entrevista, composta de um roteiro de perguntas básicas e situações, envolvendo alimentação. As respostas foram organizadas, categorizadas e analisadas, a partir dos objetivos e hipóteses iniciais da pesquisa. Identificou-se a existência de diferentes concepções a respeito da alimentação saudável, que foram classificadas em três níveis. Verificou-se que, em um primeiro momento, o sujeito utiliza em suas explicações apenas uma variável envolvida no conceito de alimentação saudável ou vale-se em um momento de um aspecto e, em nova situação, de outro. Em um segundo nível, passa a trabalhar com variáveis diferentes, referindo aspectos relacionados à alimentação saudável, mas eles encontram-se isolados, não são relacionados pelos sujeitos, parecem ser independentes. O sujeito ainda não consegue visualizá-las com sendo parte de uma totalidade. Observa-se uma evolução gradativa até o nível no qual o sujeito compreende a relação existente entre as variáveis, aplicando em diferentes situações/contextos. Acredita-se que essas concepções apresentam uma hierarquia e a passagem de um nível mais simples para o seguinte é construída, de forma gradual e contínua, estando diretamente relacionada ao processo de equilibração e aos demais fatores do desenvolvimento cognitivo. / This work aimed to investigate the understanding of children and adolescents about healthy eating. The Piaget's Clinical Method was used as methodological basis, which allows the researcher to monitor and understand the thinking of the subject. Twenty eight single interviews were conducted, with children and adolescents between 7 and 19 years. Data collection was conducted through interviews, consisting of a script of basic questions and situations involving food. The answers were categorized and analyzed, from the initial assumptions and objectives of the research. The existence of different conceptions of healthy eating was identified and classified into three levels. It was found that, at first, the subject uses in his explanations only one variable involved in the concept of healthy food or uses one aspect at a time and a new situation from another. On a second level, works with different variables, referring to aspects of healthy eating, but they are isolated, not related by subject, appear to be independent. The subject still cannot view it as being part of a totality. There is a gradual evolution to the level where the subject understands the relationship between the variables, applying in different situations/contexts. It is believed that these concepts have a hierarchy and the passage of a simple level to the next is built in a gradual and continuous, being directly related to the process of balancing and the other factors of cognitive development.

Este trabalho teve como objetivo investigar a compreensão de crianças e adolescentes sobre alimentação saudável. Utilizou-se como base metodológica o Método Clínico Piagetiano, que possibilita ao pesquisador acompanhar e compreender o pensamento do sujeito. Foram realizadas 28 entrevistas, individuais, com crianças e adolescentes entre 7 e 19 anos. A coleta de dados foi realizada mediante entrevista, composta de um roteiro de perguntas básicas e situações, envolvendo alimentação. As respostas foram organizadas, categorizadas e analisadas, a partir dos objetivos e hipóteses iniciais da pesquisa. Identificou-se a existência de diferentes concepções a respeito da alimentação saudável, que foram classificadas em três níveis. Verificou-se que, em um primeiro momento, o sujeito utiliza em suas explicações apenas uma variável envolvida no conceito de alimentação saudável ou vale-se em um momento de um aspecto e, em nova situação, de outro. Em um segundo nível, passa a trabalhar com variáveis diferentes, referindo aspectos relacionados à alimentação saudável, mas eles encontram-se isolados, não são relacionados pelos sujeitos, parecem ser independentes. O sujeito ainda não consegue visualizá-las com sendo parte de uma totalidade. Observa-se uma evolução gradativa até o nível no qual o sujeito compreende a relação existente entre as variáveis, aplicando em diferentes situações/contextos. Acredita-se que essas concepções apresentam uma hierarquia e a passagem de um nível mais simples para o seguinte é construída, de forma gradual e contínua, estando diretamente relacionada ao processo de equilibração e aos demais fatores do desenvolvimento cognitivo. / This work aimed to investigate the understanding of children and adolescents about healthy eating. The Piaget's Clinical Method was used as methodological basis, which allows the researcher to monitor and understand the thinking of the subject. Twenty eight single interviews were conducted, with children and adolescents between 7 and 19 years. Data collection was conducted through interviews, consisting of a script of basic questions and situations involving food. The answers were categorized and analyzed, from the initial assumptions and objectives of the research. The existence of different conceptions of healthy eating was identified and classified into three levels. It was found that, at first, the subject uses in his explanations only one variable involved in the concept of healthy food or uses one aspect at a time and a new situation from another. On a second level, works with different variables, referring to aspects of healthy eating, but they are isolated, not related by subject, appear to be independent. The subject still cannot view it as being part of a totality. There is a gradual evolution to the level where the subject understands the relationship between the variables, applying in different situations/contexts. It is believed that these concepts have a hierarchy and the passage of a simple level to the next is built in a gradual and continuous, being directly related to the process of balancing and the other factors of cognitive development.