الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breastfeeding is the best way that contributes to provide perfect nourishment to the healthy development and improvement of babies and affects the wellbeing of both mother and child. Infant nutrition should be considered a public health issue and not only a life-style choice. Thus, health authorities encourage and support the initiation and sustaining of exclusive breastfeeding through providing expectant and new mothers with target and reliable guidance in such manner.
The present study was carried out with the principle aim of assessing breastfeeding service in family health centers in Alexandria, Egypt with the following specific objectives:
1. To evaluate resources (human and non-human) required for family health centres to
2. To assess knowledge and practices of family physicians and nurses about breastfeeding.
3. To assess knowledge and practices of mothers regarding breastfeeding.
The study was carried out inin family health centers in Alexandria Governorate, Egypt. A cross-sectional study was used for achieving the study objectives.
Four health districts out of eight districts in Alexandria was chosen randomly. from each district, two family health centers were randomly selected.
All family physicians and nurses working in family medicine clinics in the selected family health centers were included in the study.A sample of 445 females (220 pregnant women and 225 mothers of infant less than one year) was included in the study. Data were collected using the following:
1. An observational checklist to assess resourcesrequired for family health centres based on WHO/UNICEF Baby Friendly health centers.
2. A self-administered questionnaire to assess knowledge of family physicians about breastfeeding.
3. An observational checklist was designed to assess practices of family physicians about breastfeeding based on WHO/UNICEF Baby Friendly health centers.
4. A self-administered questionnaire to assess knowledge of nurses about breastfeeding.
5. An observational checklist was designed to assess practices of nurses about breastfeeding based on WHO/UNICEF Baby Friendly health centers.
6. An interview questionnaire to assess knowledge and practices of mothers about breastfeeding.
The study revealed the following main results:
1. All FHC/Us were familiar with WHO criteria of baby friendly centers with some variation in applying breastfeeding policy.
2. Most of FHC/Us had a written breastfeeding policy and (87.5%) of them had oriented clinical staff about the policy.
3. All the studied family health centers/units (100%) implemented the International Code of Marketing of breast milk substitutes (BMS). Non had any promotional material for BMS; neither visits by medical representative to promote BMS.
4. Most of the family physicians’ breastfeeding knowledge level ranged between fair to good with mean overall score of 26.02 ±7.55.
5. Nearly two thirds of the family physicians had partial practice level (50 – <75) with mean practice score level of 41.67 ±8.76.
6. More than two thirds (68.5%) of the family physicians had been trained on breastfeeding support which had a significant effect on the breastfeeding knowledge and practice of the family physicians who attended breastfeeding course.
7. There was no significant difference between physicians who attended IMCI course and who did not attend IMCI course regarding their knowledge or their overall practice.
8. There was a positive correlation between overall practice and knowledge of physicians regarding breastfeeding and this correlation was statistically significant.
9. There were positive correlations between years of experience of the physicians and their knowledge and overall practice, but these correlations were not statistically significant.
10. More than three quarters of the nurses had good knowledge regarding breastfeeding and none of them had poor knowledge with mean knowledge score of 23.92 ± 3.43.
11. Less than half of the nurses had good practice level regarding breastfeeding services with mean score of 23.62 ± 5.18.
12. There was a statistically significant positive correlation between knowledge of the nurses and their practice regarding breastfeeding.
13. There was a positive moderate linear correlation between knowledge and years of experience of the nurses while the correlation between their practice and years of experience was weak positive, both correlations were statistically significant.
14. Less than two thirds of the nurses had been trained on breastfeeding support and most of them had IMCI training.
15. There was a significant difference between nurses who had breastfeeding support training and those who did not have breastfeeding support training regarding their knowledge and practice.
16. The mean knowledge score of the mothers in the studied FHC/Us was 16.69 ± 3.16 with less than two thirds of them (62.7%) had a fair knowledge and 29.2% had good knowledge regarding breastfeeding.
17. The mean score of practice of the mothers was 17.23 ± 2.66 and less than two thirds of them (61.1%) had a good practice score regarding breastfeeding.
18. There was a positive weak correlation between knowledge and practice of the mothers and this correlation was statistically significant.
19. There was a significant difference between mothers who had health education about breastfeeding during antenatal visits and mother who had not health education regarding their knowledge or practice.
The main recommendations of the study are:
The study revealed the following main recommendations:
7.2.1. Recommendations to Ministry of Health and Population:
1. Reviewing and updating the BFHI standards
2. Establishing of breastfeeding intervention programs for promotion and support of breastfeeding.
3. Raising the orientation of medical and non-medical staff about breastfeeding policy through frequent seminars discussing ways to apply the ten steps of BFHI.
4. Increase number of breastfeeding consultant and health educators in FHC/Us.
5. Raising the awareness of the pregnant women about the benefits of breastfeeding. This could be doneusing health educational messages through the mass media and through the antenatal care visits.
6. Providing brochures and publications about breastfeeding importance and right practice in simple words to be understood by all mothers.
7. Continuous training courses for all health care workers (physicians and nurses) especial the fresh graduates who have little work experience.
7.2.2. Recommendations to health care providers:
1. Attendance of certified courses about breastfeeding with frequent updating of their knowledge.
2. Encourage mothers and provide the appropriate support regarding their decision about breastfeeding in the perinatal period
3. Evaluate mother’s knowledge and attitude towards breastfeeding during antenatal visits.
4. Counseling pregnant females about the importance of breastfeeding and training them on the practice of breastfeeding during the antenatal visits.
5. Building mother’s confidence by educating and supporting lactating mothers (especially primigravida) and stress on skin to skin contact.
6. Teaching mothers about the significance of EBF, the signs of effective breast feeding and infant satiety in every suitable occasion.
7. Correct misconceptions about breastfeeding (as the duration of EBF, avoiding prelacteal feeding, use of pacifiers or bottles and avoiding any fluids intake even water in the first 6 months)
8. Holding health education sessions for lactating mother’s family that will help the mother get full support and encouragement by her side.
9. Referring mother when indicated to breastfeeding consultant or support group.
7.2.3. Recommendations to the community:
1. Sharing breastfeeding knowledge among all mothers to enhance infant and maternal health.
2. Increase duration of exclusive breastfeeding to six months not four months as the most of mothers thought.
3. Raising awareness of the community about avoiding any fluids intake even water to the infant in the first six months without medical indication and importance of applying skin to skin contact technique as the study approved its benefit for both mother and infant.
4. The role of non-governmental organizations in holding awareness campaigns which discuss the role of father, mother’s mother and mother in law in supporting lactating mother and their great impact on mother’s decision and practice of breastfeeding.