acase@tulane.edu / Community Based Nutrition (CBN) began implementation in Ethiopia in 2009 in four regions with the objective of improving maternal and child nutrition. Among other interven-tions, CBN scaled up behavior change communication (BCC) to promote household practices and behaviors known to be associated with improved child nutrition. Nutrition BCC was pri-marily delivered through a cadre of Voluntary Community Health Workers (VCHWs). Program exposure was measured using household reports of contact with VCHWs for nutrition BCC. This quasi-experimental study used data collected from two rounds of household surveys be-fore and after program implementation. The design of this study used the natural variation in CBN implementation to allow post hoc categorization of communities into high/low program intensity groups. This enabled an evaluation of the differences in nutrition outcomes associated with the different categories of program intensity that were observed in the sample. Community-level program intensity was measured using the percentage of households reporting VCHW exposure in each community, dichotomized into high or low at the sample mean. We found evidence of a scale up in CBN over the two survey rounds: Mean households reporting exposure to a VCHW in the previous six months increased significantly, as did the mean households in communities with high VCHW intensity. The association between selected nutrition behavior outcomes and the program was evaluated using three approaches: (i) an examination of the association between cluster change in the outcomes and community intensity of Volunteer Community Health Workers (VCHWs); (ii) examination of the association be-tween individual-level outcomes and community intensity of VCHWs; and (iii) examination of the association between the outcomes behaviors and household exposure to VCHWs. We found plausible evidence that CBN scale up was associated with greater dietary di-versity and more women eating the same or more in pregnancy. We also found that living in a higher VCHW intensity community or having exposure to VCHWs was associated with more women receiving IFA in pregnancy, but that this association was not modified by the survey round. We did not find consistent evidence that that the increases in VCHW intensity or expo-sure were associated with improvements in colostrum, hand washing, or minimum meal frequency. These results imply that community-based programs of this intensity can bring about change in nutrition behaviors linked to improved nutrition. / 1 / Lisa Saldanha

INTRODUCTION/BACKGROUND UNICEF introduced a community infant and young child feeding (cIYCF) training and counselling package in 2010, which was implemented in Zimbabwe for community counsellors (CCs) in rural districts. The training package is generic for programming and capacity development on community-based IYCF counselling skills. The implementation includes a set of 15 pre/post-test questions on different aspects of IYCF practices. No analysis of the training pre- and post-tests for the package has been documented in literature. The main aim of the research was therefore to analyse training records on the training in Zimbabwe and identify specific IYCF practices that might require additional attention. The mini-dissertation presents recommendations for the Ministry of Health and Child Care/Welfare Zimbabwe for possible follow up. METHODS The study used a quasi-experimental design. We retrieved pre- and post-test training records on the 15 questions from 19 districts where training had been conducted from the Zimbabwe National Nutrition Department of the Ministry of Health and Child Care/Welfare. Fifteen districts were included for the educational material case-study experience presented in manuscript 1, while 13 districts satisfied the inclusion criteria for the in-depth analysis in manuscript 2. SPSS (version 17.1) was used to do a t-test mean comparison of the proportions of CCs giving correct responses before and after training. ANOVA was used to compare changes in proportions of correct responses from pre- to post-training by district and province. Post hoc analysis was done to determine where differences lay. A p value of < 0.05 was accepted for statistical significance. Graphical trends of proportions of CCs giving correct responses pre- and post-training for individual questions by district were generated and presented in manuscript 2. RESULTS The training package is valuable in taking IYCF training to community level. In manuscript 1, a total of 966 CCs evaluated the training. Ninety-one per cent of CCs evaluated all the training components on average as good, while 0.2% evaluated them as unsatisfactory. In manuscript 2, we used 88% of the retrieved data for analysis. ANOVA results of the percentage change in CCs giving correct responses pre- to post-test by district were not significant (p>.05) for all the questions except question 8 on milk production and the baby’s suckling stimulus. The mean comparison t-test of proportions (pre- and post-test) was significant for all 15 questions (p<.05). Three different trends were observed in the proportions of CCs giving correct responses to different questions. CONCLUSION Our results demonstrate the value of analysing the records of the pre- and post-training test training package to inform follow-up on aspects needing additional attention. The different trends in proportions of CCs giving correct responses have implications for the knowledge base on specific IYCF practices in the communities served by the CCs. We recommend analysis of similar training records where such training is planned or has taken place to inform the implementation process. For Zimbabwe we recommend follow-up of the CCs with training to address the issues raised in our findings. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

INTRODUCTION/BACKGROUND UNICEF introduced a community infant and young child feeding (cIYCF) training and counselling package in 2010, which was implemented in Zimbabwe for community counsellors (CCs) in rural districts. The training package is generic for programming and capacity development on community-based IYCF counselling skills. The implementation includes a set of 15 pre/post-test questions on different aspects of IYCF practices. No analysis of the training pre- and post-tests for the package has been documented in literature. The main aim of the research was therefore to analyse training records on the training in Zimbabwe and identify specific IYCF practices that might require additional attention. The mini-dissertation presents recommendations for the Ministry of Health and Child Care/Welfare Zimbabwe for possible follow up. METHODS The study used a quasi-experimental design. We retrieved pre- and post-test training records on the 15 questions from 19 districts where training had been conducted from the Zimbabwe National Nutrition Department of the Ministry of Health and Child Care/Welfare. Fifteen districts were included for the educational material case-study experience presented in manuscript 1, while 13 districts satisfied the inclusion criteria for the in-depth analysis in manuscript 2. SPSS (version 17.1) was used to do a t-test mean comparison of the proportions of CCs giving correct responses before and after training. ANOVA was used to compare changes in proportions of correct responses from pre- to post-training by district and province. Post hoc analysis was done to determine where differences lay. A p value of < 0.05 was accepted for statistical significance. Graphical trends of proportions of CCs giving correct responses pre- and post-training for individual questions by district were generated and presented in manuscript 2. RESULTS The training package is valuable in taking IYCF training to community level. In manuscript 1, a total of 966 CCs evaluated the training. Ninety-one per cent of CCs evaluated all the training components on average as good, while 0.2% evaluated them as unsatisfactory. In manuscript 2, we used 88% of the retrieved data for analysis. ANOVA results of the percentage change in CCs giving correct responses pre- to post-test by district were not significant (p>.05) for all the questions except question 8 on milk production and the baby’s suckling stimulus. The mean comparison t-test of proportions (pre- and post-test) was significant for all 15 questions (p<.05). Three different trends were observed in the proportions of CCs giving correct responses to different questions. CONCLUSION Our results demonstrate the value of analysing the records of the pre- and post-training test training package to inform follow-up on aspects needing additional attention. The different trends in proportions of CCs giving correct responses have implications for the knowledge base on specific IYCF practices in the communities served by the CCs. We recommend analysis of similar training records where such training is planned or has taken place to inform the implementation process. For Zimbabwe we recommend follow-up of the CCs with training to address the issues raised in our findings. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Postpartum depression can be defined as a major depressive disorder which usually occurs during the postpartum period within one month or more after giving birth. Literature shows that 35 to 47 per cent of South African women have been diagnosed with major depressive disorder during pregnancy and the postpartum period. Studies stated that the challenges in the South African context regarding the postpartum period includes detachment from care and lack of a support system. Emotions are typically present in the context of relationships, in this case a mother and child relationship. However, research on early childhood has emphasised that the impact of the first five years of a child’s life on his/her social and emotional development is crucial, since children must learn to communicate with emotional language. The role of the mother in a young child’s emotional development is crucial, as the mother models certain behaviour to be imitated by the infant. A phenomenological and multiple case studies research design were followed throughout this qualitative research study. As the aim of the study was to provide information and guidelines for mothers who suffer from postpartum depression, the sample selection focused on participants (mothers) who had experienced postpartum depression and who, in retrospect, could give information about their experience and their perceptions of the effect this syndrome had on the emotional development of their children. Three mothers who were diagnosed with postpartum depression were the participants of this study. In order to get rich in-depth data, they were each interviewed and had to compile a narrative describing their experience with postpartum depression and the effect it had on their child’s emotional development. The three case studies provided a unique insight into the effect of postpartum depression on a young child’s emotional development according to the mother’s experience of postpartum depression. The empirical part of the study revealed that postpartum depression has a severe effect on a child’s emotional regulation and that support was an integral part in overcoming depression. / Dissertation (MEd)--University of Pretoria, 2017. / Early Childhood Education / MEd / Unrestricted

The young child’s experiences of living with cancer are crucial to providing evidence based care. The overall aim of this thesis was to explore and describe experiences of health and functioning in the everyday life of young children with cancer, over a three year period from diagnosis, to provide insights and suggestions to improve evidence based care. The first and second papers in the series of four for this thesis used a qualitative content analysis to describe the child’s experiences shortly after diagnosis and six and 12 months later. The third paper used mixed methods to identify a comprehensive set of ICF-CY codes describing everyday health and functioning in the life of the young child with cancer. The fourth paper used the identified comprehensive set of ICF-CY codes to follow changes in everyday health and functioning over the study’s entire three year period from diagnosis. Entry into the health-illness transition was characterised by trauma and isolation. Health and functioning in everyday life was utterly changed and physical difficulties were at their peak. The passage through transition was characterised by an active striving on the part of the child to make a normal everyday life of the cancer experience. Difficulties affecting health and functioning in everyday life decreased and changed during the trajectory, though feelings of loneliness prevailed. A new period of stability in the child’s post treatment life was seen from two years after diagnosis and onwards, with (re)-entry to preschool/school and other social activities. However, an increase in difficulties with personal interactions with others and access to, and support from healthcare professionals was seen. Variances were seen within individual children’s’ trajectories. In summary it can be stated that the everyday life of young children with cancer changes over time and health care services are not always in phase with these changes. Young children living with cancer want to be participatory in their care and to have access to their parents as protectors. They need access to and ongoing contact with peers and preschool. Although physical difficulties in living an everyday life with cancer reduce over time, new difficulties emerge as the child post cancer treatment re-enters society. A structured follow-up throughout the cancer trajectory and not just during active treatment is necessary. A child-centered philosophy of care would guide the child towards attainment of health and well-being. Both the child’s own perspective and a child’s perspective as described by adults caring for them should be seen on a continuum, rather than as opposites. This view could help ensure that young children become visible and are listened to as valuable contributors to care planning. Knowledge of health-illness transition can be useful in illustrating everyday health and functioning through long term illness trajectories.

The young child’s experiences of living with cancer are crucial to providing evidence based care. The overall aim of this thesis was to explore and describe experiences of health and functioning in the everyday life of young children with cancer, over a three year period from diagnosis, to provide insights and suggestions to improve evidence based care. The first and second papers in the series of four for this thesis used a qualitative content analysis to describe the child’s experiences shortly after diagnosis and six and 12 months later. The third paper used mixed methods to identify a comprehensive set of ICF-CY codes describing everyday health and functioning in the life of the young child with cancer. The fourth paper used the identified comprehensive set of ICF-CY codes to follow changes in everyday health and functioning over the study’s entire three year period from diagnosis. Entry into the health-illness transition was characterised by trauma and isolation. Health and functioning in everyday life was utterly changed and physical difficulties were at their peak. The passage through transition was characterised by an active striving on the part of the child to make a normal everyday life of the cancer experience. Difficulties affecting health and functioning in everyday life decreased and changed during the trajectory, though feelings of loneliness prevailed. A new period of stability in the child’s post treatment life was seen from two years after diagnosis and onwards, with (re)-entry to preschool/school and other social activities. However, an increase in difficulties with personal interactions with others and access to, and support from healthcare professionals was seen. Variances were seen within individual children’s’ trajectories. In summary it can be stated that the everyday life of young children with cancer changes over time and health care services are not always in phase with these changes. Young children living with cancer want to be participatory in their care and to have access to their parents as protectors. They need access to and ongoing contact with peers and preschool. Although physical difficulties in living an everyday life with cancer reduce over time, new difficulties emerge as the child post cancer treatment re-enters society. A structured follow-up throughout the cancer trajectory and not just during active treatment is necessary. A child-centered philosophy of care would guide the child towards attainment of health and well-being. Both the child’s own perspective and a child’s perspective as described by adults caring for them should be seen on a continuum, rather than as opposites. This view could help ensure that young children become visible and are listened to as valuable contributors to care planning. Knowledge of health-illness transition can be useful in illustrating everyday health and functioning through long term illness trajectories.

Introduction: Adequate nutrition knowledge, positive attitudes and perceptions, and good practices of parents on infant and young child feeding (IYCF), among others, are essential for the optimal growth of children. Hence, the involvement of both parents in IYCF is essential. Aim: To explore and describe the involvement of both biological parents and caregivers in IYCF in Mzimba-north district, Malawi by assessing their nutrition knowledge, attitudes, perceptions and practices, and identifying the factors that affected their involvement. Study design: A cross sectional descriptive study employing quantitative and qualitative research methodologies. Setting: Five agriculture extension planning areas in Mzimba-north district, Malawi. Sampling technique: Stratified random sampling in the quantitative domain and purposive sampling in the qualitative domain. Sample: Quantitative domain: Households [mothers (n = 154) and fathers (n = 127)] with children aged zero to 24 months and caregivers (n = 4) where the biological parents were absent. Qualitative domain: A different sample of fathers (n = 41), mothers (n = 53) and local leaders (n = 3). Methodology: Quantitative domain: Participants were stratified into three groups based on the age of their children, i.e. <six months, six to 12 and >12 to 24 months. Data were collected using modified FAO nutrition knowledge, attitudes and practices (KAP) questionnaires. Data were analysed using Stata version 14.0 and Microsoft Excel 2013 version. The Chi-square, Fisher’s exact and McNemar's tests were used to compare the nutrition KAP between males and females. Testing was done at 0.05 significance level. Qualitative domain: Eleven focus group discussions (FGDs): five with males and six with females, and three in-depth interviews with three local leaders were conducted using three interview guides (one for each group). Creswell’s method of data analysis was used to identify themes and sub-themes. Ethical approval was obtained from the Ethics Committee, Faculty of Natural and Agricultural Sciences, University of Pretoria (Ref no EC151204-26) and the Ministry of Agriculture, Mzuzu Agriculture Development Division, Malawi. Results: Quantitative domain: More than half of the participants knew the recommended IYCF practices. More than 80% of the participants showed positive attitudes on the appropriate IYCF practices. No significant differences were observed between the male and female participants’ mean knowledge scores and their responses on the attitude statements (P > 0.05). All participants with children <six months reported having their children breastfed both during the previous day and night. Half of the children <six months were exclusively breastfed. Poor food diversity with low consumption of animal foods was observed for children aged six to 24 months. The majority of the participants reported to have given their children food from only two food groups out of seven food groups. Qualitative domain: The participants identified the roles of mothers, fathers and local leaders in IYCF; mothers had direct roles while fathers and local leaders had supporting roles. The roles and influence of grandmothers on IYCF were also discussed. The participants identified the motivating factors and the factors limiting parental involvement in IYCF, and made recommendations on improving parental involvement in IYCF. Conclusion: Findings from the qualitative study were in support of quantitative study findings. Both parents were involved in IYCF. However, mothers had direct roles while fathers had supporting roles. Good nutrition knowledge, positive attitudes and perceptions, and poor practices on IYCF were reported. Recommendations: Participants in the FGDs made recommendations on improving parental involvement in IYCF. Recommendations are also made for future research and the implementation of IYCF practices in Mzimba-north district, Malawi. / Dissertation (MSc)--University of Pretoria, 2017. / Food Science / MSc / Unrestricted

Omsorgsfull, välkommen beröring har funnits vara avgörande för barns tillväxt och utveckling. Samspel mellan pedagoger och barn ses som det viktigaste för barns utveckling och lärande i förskolan. I flera förekommande diskurser inom förskolan i Sverige värderas emellertid fysisk distans mellan barn och pedagoger. Dit hör diskursen om det kompetenta barnet som kan mycket mer än de vuxna tror; diskursen om att barn måste tränas i självständighet av vuxna samt No touch-diskursen, vars syfte sägs vara att skydda barnen från sexuella övergrepp. Syftet med denna undersökning är att undersöka hur samspel mellan barn och pedagoger i form av beröring kan komma till uttryck i förskolans vardag. Den övergripande forskningsfrågan handlar om hur beröringsklimatet är på de undersökta förskolorna.En observationsstudie med mixed methods genomfördes på tre småbarnsavdelningar på olika förskolor i en sydsvensk stad, med sammanlagt 29 barn och 15 pedagoger. De teoretiska begrepp som användes vid analysen kommer från anknytningsteori, intersubjektivitetsteori, Educare-modellen och omsorgsetik.Resultatet visade att pedagoger framför allt initierade beröring av barnen i samband med den praktiska fysiska omsorgen med på- och avklädning av ytterkläder samt barnens hygien samt vid förflyttningar. De initierade beröring av barnen i socialt och kommunikativt syfte; i lek, för att påkalla uppmärksamhet samt för att skapa lugn. Vid några tillfällen uppstod situationer när beröring uteblev men möjligen hade ökat barnens fokus om det förekommit. Pedagogerna initierade även beröring i känslomässigt påfrestande situationer, som när barn grät, vid överlämningen från föräldrarna samt i samband med att barnen lades till vila och vaknade efter vilan. Pedagogerna, med undantag för en pedagog, initierade beröring i situationer när de hade en för observatören uppenbar anledning. Barnen å sin sida initierade beröring som till större del handlade om sökande av emotionell bekräftelse. Barnen kunde röra vid pedagogen med en hand eller fot när de var tillräckligt nära eller luta sig mot eller klamra sig intill pedagogen när de befann sig i pedagogens famn eller knä. Olika pedagoger förhöll sig olika inbjudande till beröring.Barnen vidrörde påfallande ofta pedagogernas ben eller fötter, även om pedagogen satt på golvet och hela kroppen var inom räckhåll. Barnen behövde beröring för att återfå jämvikt när de grät. Försök till avledning misslyckades och pedagogerna övergick till att trösta med beröring. I några fall vände sig barnen till en annan pedagog för att få tröst. De barn sin fick mest beröring fanns bland de som såg yngst ut. Dock fick inte alla de yngsta barnen mycket beröring. Några barn förhöll sig mer passiva och då uteblev beröring. Detta blev ytterligare betonat utomhus, där ytorna var större och bemanningen lägre på två av förskolorna. När ingen pedagog fanns till hands hände det att barn vände sig till en främmande vuxen (observatören) eller till äldre barn.Beröringsklimatet kan beskrivas som vänligt och tillåtande, men inom vissa gränser. Barnen fick beröring av pedagogerna i situationer som kan tänkas vara emotionellt krävande som när de grät eller skulle somna eller vakna, men de fick sällan beröring för dess egen skull. För barnens del innebar det att de till stor del hölls ansvariga för att de skulle få beröring i annat än den praktiska omsorgen. En enda pedagog bjöd in till beröring och fysisk kontakt utan att det fanns någon uppenbar anledning, och hen blev också oftare berörd av barn än andra pedagoger. Kompetensdiskursen och den kvardröjande självständighetsdiskursen kan ge vid hand att det är ”duktigt” att avstå från beröring.Ser man relaterande som barns främsta utvecklingsuppgift kan barns sökande efter beröring av pedagogerna kan räknas in i ett vidgat kompetensbegrepp. Kulturella och diskursiva föreställningar om att även små barn ska vara självständiga och fysiskt separerade från föräldrarna och andra omsorgsgivare kan försvåra barns anpassning till förskolan. Föreliggande undersökning ger inte stöd för idén att fysisk närhet blir en (dålig) vana som pedagoger aktivt måste träna bort.Omsorg i form av fysisk och känslomässig närhet har ett eget värde som behöver lyftas och kläs i ord. Eftersom långvarig fysisk kontakt mellan barn och pedagoger framför allt ägde rum när pedagogen satt ner behövs också soffor och andra sittmöbler såväl inomhus som utomhus på förskolorna.Pedagogers och barns beröring av varandra är ett ämne som är angeläget att utforska vidare. Är den diskrepans mellan pedagogers och barns syfte med att initiera beröring generell? Beröring har visats vara avstressande. Blir barn som får rika tillfällen till beröring med pedagogerna mindre stressade än barn med större fysisk distans till pedagogerna? Även pedagogernas förhållningssätt till beröring, och huruvida utbildning eller andra parametrar påverkar om och hur pedagoger berör barnen kan vara föremål för framtida forskning. / Caring, human touch has been found to be crucial for young children’s growth and development. However, in several discourses regarding Swedish preschools value is placed on physical distance between children and caregivers. The aim of this investigation is to increase knowledge about how physical care of young children might be expressed in Swedish preschools, by observing physical interaction between teachers and children. The dominant research question is: What is the touch climate between teachers and young children in Swedish preschools like? An observational study was conducted of 3 preschool groups constituted by 29 children ages 1-2, and 15 teachers. Data was analyzed using mixed methods with several theoretical concepts including care ethics, the Educare framework, attachment theory and inter-subjectivity theory.The results showed that teachers initiated physical contact primarily through their roles as physical caregivers (i.e. in satisfying the children’s physical needs such as helping to put on clothes, toilet training, help with mobility). Touch was also used while teaching and playing, but to a lesser extent, and seemingly not necessarily in a self conscious way, by the teachers. Physical contact also occurred during social interactions between caregivers and children. Of the contact initiated by the teachers, 20% was “emotional”, or comfort giving touch, i.e., touch not related to the execution of other specific duties such as diaper changing or helping to put on clothes. In contrast, 76% of the touch initiated by the children was “emotional”, or comfort seeking. The children strikingly often touched the teachers’ hips, legs and feet. The children initiated physical contact more frequently with teachers who were more receptive and open to physical contact. The youngest children tended to receive the most physical contact. However, children who were vague in the cues used to communicate a desire for physical contact tended to receive less attention in this regard. This was more pronounced during outdoor activities. When a child began to cry, they would eventually be comforted. Attempts to divert the child’s attention tended to fail. Some children experienced extended periods of contact, some as long as 15- 27 minutes, when they were being put to sleep. Older preschool children would sometimes care for the younger children when no teachers were immediately available. There was a discrepancy between the kind of physical contact the teachers offered the children, and the kind of contact the children sought. When children are seen as subjects that actively relate to fellow humans, a greater emphasis on the emotional component of child care is required. The children’s touching of the lower parts of the teachers’ bodies may indicate a slight feeling of distance. Whereas the teachers offered contact mostly in the conduct of practical circumstances, the children sought emotional support. Thus, the children were, to some extent, responsible for physical contact.Touching the children gently, while respecting the childrens’ integrity, can be seen as a means to unite caring and teaching within the Educare framework.

Thesis (MPH.) -- University of Limpopo, 2015 / Background: The revised Infant and Young Child Feeding Policy (IYCFP) 2013 encourages HIV-positive mothers to also exclusively breastfeed for six months, and to continue breastfeeding for a year with introduction of appropriate complementary feeding, while their children receive antiretroviral treatment. The aim of this study was to determine knowledge and practices of the Primary Health Care Workers (PHCWs) related to the implementation of the revised IYCFP 2013 in the Blouberg Municipality of Capricorn District, Limpopo Province. Methods: A quantitative descriptive study was conducted on 103 PHCWs. The questionnaire was closed ended. The questionnaire was developed based on the contents of the revised IYCFP 2013. A simple random sampling technique was used to sample nurses irrespective of the category. Data were analyzed through SPSS Software v23.0. Results: Most participants were females (91.3%), category were Professional Nurses (44.7%), aged between 31 and 40 years (44.7%) and also mostly worked for >10 years (56.3%). The results revealed that 97.1% of the participants have good knowledge about infant and young child feeding, 68% of participants were not trained on the revised IYCFP 2013, resulting to only 32% of participants having a good practice of this policy. Also 44.7% of the participants reported that they were not aware if clinics had a copy of this policy. The results further revealed that 92.2% of the participants reported that clinics still receive, keep and issue infant formula to HIV positive mothers, which maybe the reason the dieticians still receive requests for Infant Formulas to be delivered to HIV-positive mothers. Conclusion: There is a need for monitoring and evaluation to ensure availability and vi implementation of the revised IYCFP 2013; and also the need for in-service training on this policy in order to improve the capacity to implement the revised IYCFP 2013. Key Concepts Revised IYCFP 2013; knowledge; practice; implementation; PHCWs; infant and young child feeding.

Infant and young child feeding (IYCF) has a lifelong influence on health and is critically important during emergencies. Policies and guidance are designed to support IYCF in emergencies (IYCF-E), but are seldom fully implemented. Lebanon has a long history of national emergencies and is currently hosting 1.2 million Syrian refugees. Lebanese infant feeding practices are sub-optimal overall. To respond adequately in emergencies, there is a need to understand how best to address the nutritional needs of vulnerable infants and young children. This single-case study with three-level embedded units of analysis examines policies and programmes on IYCF-E in Lebanon. The study utilised a desk review comprising existing policies and guidance at all levels; a survey questionnaire targeting non-governmental organisations (n=54) (organisational level); semi-structured interviews with 12 stakeholders (central level), and focus groups with health care providers (n=8) and mothers (n=8) (service provision level). Descriptive analyses were used for survey data and thematic analysis for qualitative data. Existing policies were based on international guidance. However, despite notable efforts, these have not been fully implemented, disseminated or enforced at all levels. Policies were not part of a national strategy and IYCF-E was not integrated within national emergency preparedness plans. Programmes at each level lacked the necessary services to support mothers, notably an absence of counselling and support and a reliance on support from international organisations. Barriers include the lack of awareness and prioritisation of recommended IYCF practices and policies, gaps in human and financial resources, operational challenges and the influence of the infant formula industry which have combined to hinder the advancement of adequate IYCF policies and practices. Opportunities include the need to establish, organise, prioritise, and implement IYCF plans that are integrated within health and emergency plans, and disseminated. Any initiative needs to be evaluated and documented through rigorous implementation research.