Master of Public Health - MPH / Evidence on the benefits of breastfeeding for child survival, growth and development is published extensively. Breastfeeding is an "unequalled" way of providing ideal food to infants and young children to promote good health, growth, development and to attainment of their full potential. Despite initiatives and programmes to promote uptake of exclusive breastfeeding, this practice remains sub-optimal in Zimbabwe. This study explored factors that influence breastfeeding decisions and practices based on mothers' own breastfeeding experiences. Methodology: This study employed a phenomenological research design. Information collected from mothers using in-depth interviews was triangulated with that from key informants. Interviews were audio-tape recorded and transcribed verbatim in Ndebele and then translated to English. Thematic analysis was used to compare various accounts from study participants to identify similar and related themes. Findings: Mothers could not differentiate exclusive breastfeeding from predominant and partial breastfeeding. Barriers to exclusive breastfeeding were: (i) Poor understanding of exclusive breastfeeding and its benefits; (ii) Use of herbal infusions; (iii) Practice of giving babies water; (iv) Perceived insufficient breastmilk production; (v) Myths and misconceptions; (vi) Breast conditions; (vii) Tradition (viii) the HIV epidemic; and (ix) Employment. Enabling factors were: (i) Adequate food for the lactating mother; (ii) Family support; (iii) Support from husband; and (iv) Knowledge of the benefits of exclusive breastfeeding.

Class of 2015 Abstract / Objectives: In 2011, the American Academy of Pediatrics released an updated urinary tract infection guideline that addressed diagnosis, antibiotic treatment, and duration of therapy in children ages 2-24 months. The objectives of this study were to evaluate the appropriateness of antibiotic prescribing and compare outcomes between age groups. Methods: This retrospective chart review included patients aged 1 month through 12 years admitted to a regional academic medical center from January through July 2014 and diagnosed with UTI or pyelonephritis. Patients were identified using ICD-9 codes. Demographic information, antibiotic treatment, length of stay, and complications were collected and the chi square statistical test was used to compare results between age groups. Results: There were 104 patients included in this study. The most common bacteria cultured were Escherichia coli (85%). Ceftriaxone (71%) and cephalexin (30%) were the most commonly prescribed empiric and discharge antibiotic, respectively. Based on guideline recommendations and culture results, inappropriate antibiotic selection only occurred with 7% of the orders while inappropriate prescribing occurred 35% of the time. Readmission within 90 days occurred in 15% of patients aged 2-24 months (guideline age group) and in 14% of all other patients (P>0.05). Conclusions: There was no difference between age groups with respect to inappropriate antibiotic prescribing or complications for pediatric UTI treatment and inappropriate antibiotic dosing occurred more frequently than inappropriate selection. More research is necessary to assess the impact of the guidelines on prescribing practices and factors associated with inappropriate prescribing.

M.Cur. (Obstetrics and Neonatal Nursing) / A premature baby is physiologically and neurologically immature and does not always react as desired to the extra-uterine environment. A possible way to stimulate babies is by playing slow baroque music to them. The purpose of the study was to determine what effect slow baroque.music has on the heart rate, respiratory rate, saturation, blood pressure and motor movements of premature babies. The effect of slow baroque music on premature babies was investigated by means of an extensive literature study, but only limited research on premature babies was found. A preparatory study was used to determine whether slow baroque music has a positive effect on the behaviour of premature babies. Ten premature babies were then used as case studies to determine the effect of slow baroque music on their heart and respiratory rates, saturation, blood pressure and motor movements. The following conclusions were reached by statistically processing the results: • Slow baroque music had a positive and significant effect on the babies' respiratory rate and motor movements. • The heart rate, saturation and blood pressure of the babies showed a slight positive effect only. Nursing guidelines were established for playing baroque music to premature babies and recommendations were made for further research.

Master of Public Health - MPH / Factors that influence exclusive breastfeeding in Namibia are important, especially in light of the implementation of the Baby and Mother Friendly Initiative. Infant feeding practices, especially breastfeeding, are important public health issues, particularly in the prevention of HIV transmission from mother to child. This thesis determined the prevalence of exclusive breastfeeding and measures the association of demographic and service-related factors on exclusive and non-exclusive breastfeeding practices. / South Africa

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Twenty-four 7.5- to 8-month old infants were presented with two manipulanda and given either behavior-contingent or noncontingent experience with an object. Infants in the contingent group learned and remembered the controlling action for up to 1 week (t(11)=2.83, p

Docosahexaenoic acid (22:6n-3) and arachidonic acid (20:4n-6) are deposited in large amounts in membrane phospholipids of the developing central nervous system (CNS). High levels of 22:6n-3 are found in synaptic terminals and retina, and are important for normal visual development and function. 20:4n-6 and22:6n-3 are supplied in human milk. In contrast, infants fed formula rely completely on endogenous synthesis of 20:4n-6 and 22:6n-3 from linoleic (18:2n-6) and a-linolenic (18:3n-3) acid, respectively. Levels of 22:6n-3 in the blood lipids of infants fed formula are lower than in infants fed human milk. Concern over the supply of 22:6n-3 led to clinical trials in which premature infants were fed formulas containing fish oils as a source of 22:6n-3. Piglets, which have a similar lipid metabolism and perinatal timing of the brain growth spurt to humans, have a lower percentage of 22:6n-3 in blood, liver and CNS tissues when fed formula with 30% of fatty acids as18:2n-6 and 0.8% 18:3n-3, compared to sow milk. It was hypothesized that the low blood and tissue 22:6n-3 in formula-fed piglets was due to inappropriate quantities and/or ratios of dietary 18:2n-6 and 18:3n-3 limiting the synthesis of 22:6n-3. Thus, the main objectives of this thesis were to determine. (1) if 22:6n-3 is an essential dietary nutrient for the term gestation piglet, (2) if appropriate quantities and ratios of 18:2n-6 and 18:3n-3 in formula will support CNS membrane accretion of 20:4n-6 and 22:6n-3, comparable to piglets fed varying amounts of 22:6n-3 in natural milk, and (3) if lower blood phospholipid 22:6n-3 consistently reflects reduced 22:6n-3 in the CNS. Initial studies (Experiment I) showed that formula with 4% 18:3n-3 supported a similar percentage of22:6n-3 in piglet liver and CNS membrane lipids to sow milk, but was associated with lower brain weight. Deposition of 22:6n-3 in brain was influenced by the formula 18:3n-3 content. The 18:2n-6:18:3n-3 ratio (22:1and 37:1) seemed to be important, however, when formulas contained 1% 18:3n-3. Low levels of fish oil in formula, similar to those used in clinical trials, were effective in supplying 22:6n-3 to the developing piglet brain (Experiment II). The efficacy of 18:3n-3 in supporting the deposition of 22:6n-3 in the brain was estimated to be at least 20% that of dietary 20:5n-3 plus 22:6n-3. With increasing dietary fish oil, however, levels of eicosapentaenoic acid (20:5n-3) increased and 20:4n-6decreased in plasma, liver and retina, but not brain (Experiment III). This suggests regulatory mechanisms may exist to maintain relatively constant levels of 20:4n-6 and 20:5n-3 in brain. Milk 22:6n-3 varies with maternal intake of 22:6n-3. The effect of milk 22:6n-3 content was studied in piglets fed milk with 0.1% or 1.5% 22:6n-3 obtained from sows fed usual pig diets containing vegetable fats without or with fish oil, respectively (Experiment IV). Consumption of 1.5 vs 0.1% 22:6n-3 from sow milk resulted in 300% higher 22:6n-3 in liver and blood phospholipids and 11% higher 22:6n-3 in cerebrum of nursing piglets. Despite similar milk 20:4n-6, the % 20:4n-6 in tissues other than the brain was lower in piglets fed high22:6n-3 sow milk. Thus, high intakes of n-3 fatty acids decrease 20:4n-6 in piglet liver and blood lipids. The blood phospholipid % 22:6n-3 in piglets fed formulas containing 18:2n-6 and 18:3n-3 but not their long-chain derivatives, was lower than in piglets fed 22:6n-3 in natural milk, consistent with published findings in formula-fed infants. However, in contrast to circulating lipids, formulas with 4% 18:3n-3 maintained similar levels of 22:6n-3in the piglet CNS compared to milk. These studies show that blood phospholipid 22:6n-3 and 20:4n-6 are not specific indices of effects in CNS lipids. This thesis has shown (1) 22:6n-3 is not essential in the diet of the term piglet, if adequate 18:3n-3 is given, (2) fish oils are an effective source of 22:6n-3 for deposition in the developing brain, (3) high dietary n-3fatty acids interfere with 20:4n-6 metabolism, and (4) blood lipid 20:4n-6 and 22:6n-3 do not accurately reflect CNS fatty acids. / Land and Food Systems, Faculty of / Graduate

In early Infancy, limited ingestion of vitamin E, especially the α-tocopherol form, and/or a high, intake of polyunsaturated fatty acids are reflected as a low serum tocopherol level. This vitamin E deficiency state is probably responsible for the development of an anemia characterized by abnormal erythrocyte hemolysis. Edema and skin changes may also be present. In order to ascertain the tocopherol status of infant formulas available in Canada, thirty-six representative formulas were chemically analyzed for vitamin E and polyunsaturated fatty acid contents. For the tocopherol analysis, a combination of the Emmerie-Engel procedure and two-dimensional thin-layer chromatography was used. An alkaline isomerization technique was chosen for the polyunsaturated fatty acid analysis. The vitamin E status of the various formulas was assessed in relation to three criteria of tocopherol adequacy - the α-tocopherol-to-PUFA ratio, the α-tocopherol content, and the level of International Units of vitamin E. With the exception of one formula which was supplemented with vitamin E, the twenty-one formulas based on fresh or modified cow's milk often contained insufficient tocopherol to meet the various criteria of adequacy. A large per cent of the vitamin E content in these formulas was present as α-tocopherol. The polyunsaturated fatty acid content was relatively low. In general, the fifteen proprietary formulas had much higher levels of vitamin E and polyunsaturated fatty acids than the formulas based on fresh or modified cow's milk. For many of the proprietary products, α-tocopherol constituted only a small part of the vitamin E content. Four of the proprietary formulas (including three which had been fortified with vitamin E) contained sufficient amounts of vitamin E to satisfy the three standards of adequacy. On the basis of the chemical analysis results, it is recommended that all infant formulas be supplemented with sufficient amounts of vitamin E. to meet the various criteria of adequacy. In this way, the risk of vitamin E deficiency in early childhood should be minimal. The present study is also concerned with past, present, and future trends in infant feeding practices. In the 1960's, the ready-to-feed hospital feeding systems, which are usually based on a proprietary preparation,were introduced in Canada. A survey conducted among Canadian hospitals indicated that the use of such systems has become widespread. At the same time, the popularity of the hospital-prepared formula system has declined. Consequently, the use of modified cow's milk formulas has declined in Canadian hospitals. However, such formulas are frequently used for home-feeding of infants. No definite trends were noted in the frequency of breast-feeding. / Land and Food Systems, Faculty of / Graduate

Background: The fetal origins hypothesis poses that adverse intrauterine conditions predispose to cardiovascular and metabolic diseases in adulthood. Evidence is accumulating that similar mechanisms to those identified for physical disorders may also apply to psychiatric disorders. Focusing on the activity of neurophysiological systems thought to regulate emotions from very early in life may be key to understanding how maternal stress in pregnancy impacts on the developing baby with possible long-lasting consequences for behaviour and psychopathology. Respiratory Sinus Arrhythmia (RSA), "vagal tone", is thought to reflect autonomic regulatory capabilities that may underpin emotion regulation. However, little is known about possible fetal origins of vagal tone. Animal studies increasingly point to sex differences in the effects of prenatal stress, and this is supported by human studies of the prenatal origins of cardiovascular functioning and psychopathology. The current investigation examines whether prenatal depression and anxiety predict vagal tone in infancy, and whether the associations are modified by infant sex. Method: Two hundred mothers and infants from a high-risk consecutive community sample were examined prospectively from the first trimester of pregnancy until 29 weeks postnatal. Maternal self-reports of stress (EPDS and STAI) were collected in pregnancy (20 and 32 weeks) and postnatally (5 weeks and 29 weeks). Vagal tone was ascertained across five procedures, the "Helper-Hinderer" social evaluation task, toy exploration and the "Still Face" paradigm (2 minutes of social engagement, followed by 2 minutes of maternal unresponsiveness and concluded by 2 minutes of social reunion). Results: Principal Component Analysis of the RSA scores yielded a one-factor solution explaining over 70% of the variance, and so mean of RSA scores was used as the index of overall vagal tone, and the difference between overall and RSA during the Still Face as the estimate of vagal withdrawal. There were no main effects of prenatal maternal depression or anxiety on vagal tone or vagal withdrawal. However, there were significant prenatal stress by sex of infant interactions. Follow-up analyses revealed that increasing maternal depression and anxiety at 20 weeks gestation were associated with decreasing vagal tone in males and increasing vagal tone in females. Vagal withdrawal in response to the still face showed similar patterns i.e. decreased in males and increased in girls with elevated maternal anxiety at 32 weeks gestation. These associations were not explained by possible confounding variables assessed in pregnancy, nor by postnatal maternal depression and anxiety. Conclusions: The findings support the fetal origins hypothesis for vagal tone and vagal withdrawal, but only in interaction with sex of the infant. Longitudinal study is required to determine conditions under which increasing vagal tone and withdrawal in girls associated with prenatal depression and anxiety, and decreasing vagal tone and withdrawal in boys, are associated with later resilience or vulnerability to psychopathology.

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