الفهرس 
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Abstract
Breastfeeding has a major role to play in public health, promoting health in both short and long term for the baby and mother. It is an important preventive health behavior with implications for both infants and maternal health, and for health costs. Both global and Egyptian data show that breastfeeding indicators are not satisfactory and there are many problems which face mothers to breastfeed their infants which need to be studied aiming to find suitable solutions and recommendations which would help to reach satisfactory condition of breastfeeding with its major role in public health.
This study intended to study the problems of initiation and continuation of breastfeeding facing mothers attending breastfeeding support clinics in Alexandria, investigate breastfeeding practices and assess the knowledge of mothers concerning breastfeeding.
A cross sectional study was conducted on 200 mothers of infants aged 0-12 months with breastfeeding problems attending breastfeeding support clinics in three family health units in Alexandria. A predesigned interviewing questionnaire was constructed to collect the data required from mothers. It included the following; personal characteristics, obstetric history, infant’s data, breastfeeding experience, hospital practices, breastfeeding practices of the mother, knowledge about breastfeeding, barriers of initiation, barriers of continuation of breastfeeding and current visit data.
Data were collected and statistically analysed revealing the following results:
Total mothers who initiated breastfeeding after 24 hours of birth and those who didn’t initiate at all represented 45% which were considered the non initiation group, while the initiation group represented 55%.
Breastfeeding along with formula feeding was reported as the most common feeding practice for infants less than 6 months (31.5%), followed by formula feeding only (20.5%). About 38% of the mothers breastfed on demand, only 32.5% breastfed at night, about 90.5% reported home “rooming in” and finally 41.5% reported pacifier use. Two thirds of mothers (66%) fed colostrum after birth. Most of the studied infants (82.5%) received prelacteal feeds.
Almost three quarters of the studied mothers (73.5%) delivered through cesarean section (CS), most of the non initiation group (91.1%) delivered via CS. About 91.5% of the mothers delivered at medical health facilities either in governmental, private hospital or polyclinic. The entire non initiation group (100%) delivered at medical health facilities. Entire the sample of early delivery at the 7th month of pregnancy was reported under the non initiation group. Half of the infants (50%) suffered from medical problems. One third of the infants (33.5%) were admitted to neonatal intensive care unit (NICU).
The majority of mothers (89%) didn’t receive any advice of breastfeeding. Almost all of the mothers (98.5%) reported family as their sole source of information. The majority of mothers (70.5%) reported no help offered by the staff to start
breastfeeding. Most of the non initiation group (92.2%) received no help from medical staff to start breastfeeding. The highest percent of mothers (59.5%) reported no hospital “rooming in”.
About half of the mothers (46.5%) had a poor level of knowledge while only 5% had a good level of knowledge. The fair level of knowledge represented the highest percent of the sample (48.5%). All mothers with good level of knowledge showed initiation of breastfeeding within first 24 hours of birth. The highest percent within the non initiation group (65.6%) had just a fair level of knowledge.
The most common barriers of initiation from the mothers’ point of view are “medical problems of the baby or NICU admission” (50%), followed by “baby is not present with the mother at the same room after delivery” (49%), while (39%) was referred to “pain due to labor”.
The most common barrier of continuation of breastfeeding from the mothers’ point of view is ”baby’s ease and convenience with formula feeding” (72%). The second most common barrier is “pediatrician’s advice of introduction or depending on formula milk” (69%), followed by “perception of insufficient milk production” (65%) as the third most common barrier.
Using logistic regression for factors affecting initiation, CS is considered to be the main risk factor contributing to delay or failure of initiation of breastfeeding. A female who delivered by CS is considered to be 11.69 times more at risk of non initiation. The second most important risk factor (OR=4.6) is NICU admission. The third most important risk factor is the lack of help offered by staff to start breastfeeding (OR=3.175).
from the outcome of this study, the following can be concluded:
• Failure of proper initiation and maintenance of breastfeeding is a result of complex interrelationship between multiple factors, many of which are preventable.
• Less than half of the studied mothers initiated breastfeeding after 24 hours of birth or didn’t initiate at all.
• Late or not initiating breastfeeding at all is associated with cesarean delivery, NICU admission, no help offered by medical staff to start breastfeeding, medical problems of the newborn, no receiving breastfeeding advice and no hospital “rooming in”. These factors are arranged in a descending manner according to their effect on initiation of breastfeeding.
• The most common barriers of initiation from the mothers’ point of view are medical problems of the baby, no “rooming in” after delivery and pain due to labor.
• The most common barriers of continuation from the mothers’ point of view are baby’s ease and convenience with formula feeding, pediatrician’s advice of introduction or depending on formula milk and perception of insufficient milk production.
• There is a huge gap between the current infant feeding practices and the global recommendations for optimal infant feeding practices.
• Formula feeding alone, or in combination with breastfeeding are considered as the most common feeding practice for infants less than 6 months.
• Some breastfeeding practices are still unsatisfactory where the majority of infants received prelacteal feeds, less than half of the mothers are using pacifiers.
• Entire mothers who had good level of knowledge about breastfeeding belonged to the initiation group. Two thirds of the non initiation group had a fair level of knowledge where the remaining non initiation group had a poor level.
• Almost all of the mothers reported family as their sole source of information about breastfeeding which in turn leads to the unsatisfactory level of knowledge about breastfeeding which impact negatively on breastfeeding.
The main recommendations were as follows:
Governmental level:
• The promotion and support of breastfeeding should be emerged as a national public health priority and government should ensure the continuity of programs on breastfeeding through the establishment of long term plans.
• Regular reassessment of baby friendly hospitals according to application of the ten steps.
• Legislations to support the international code for breast milk substitutes and retribution to all violations of the code.
• Health education programs about breastfeeding through mass media should be directed not only to mothers, but also to all family members.
Community level:
• Enhancing the role of community support through extension of non governmental committees for promoting and supporting breastfeeding.
• Increasing the community awareness about breastfeeding aiming at more insurance for the rights of private working mothers to practice breastfeeding.
Health facilities level:
• Raising the level of education of mothers regarding proper infant feeding practice during antenatal period, the immediate postnatal period and during visits to well-baby clinic with stressing on the definition and importance of exclusive breastfeeding, breastfeeding benefits and how to manage breastfeeding problems.
• All maternity care providers at different health facilities should receive an externally evaluated structured program in order to develop the knowledge, skill and attitudes to implement breastfeeding policy and to support breastfeeding mothers. Periodic refreshing training should be also done.
• Encourage formation of mother support groups, breastfeeding clinics and ensure the availability of breastfeeding consultants in pediatric and maternity hospitals and all facilities providing maternity and child care services to support lactating mothers.
• Restrict performing caesarian section only to the cases of obstetrical or medical indications as it has a negative impact of breast feeding.
• The separation of a woman and her baby within the first hour of the birth for routine postnatal procedures should be avoided.