BACKGROUND Few studies have examined the independent effect of delivery method and timing of breastfeeding initiation on the prevalence of breastfeeding. The objectives of this study were to examine the effect of method of delivery and timing of breastfeeding initiation on the prevalence of breastfeeding at 1 and 3 months after delivery using a national sample from Taiwan. METHODS The study population of 2,064 women who gave birth to infants without congenital anomalies at hospitals in Taiwan from June through October 2003, inclusively, participated in a postal questionnaire survey. RESULTS Multivariate ordinal logistic regression analysis showed that women with cesarean delivery had a lower odds of breastfeeding at 1 and 3 months after delivery. Women with assisted vaginal delivery had lower odds of breastfeeding at 3 months after delivery compared with women with unassisted vaginal delivery. Initiation of breastfeeding within 30 minutes of delivery was associated with higher odds of breastfeeding at 1 and 3 months after delivery. Women who did not initiate breastfeeding during hospital stay but breastfed at 1 month after delivery had lower odds of breastfeeding at 3 months after delivery. CONCLUSIONS The findings suggest the importance of conservative use of operative obstetrical intervention due to its negative impact on breastfeeding. Health professionals need to support mothers who have experienced cesarean and assisted vaginal delivery to increase their breastfeeding. Hospital staff should improve practice with respect to early initiation of breastfeeding.

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

The promotion of breastfeeding has been established as a global public health issue. Despite this global agenda, breastfeeding initiation and duration rates remain low in many countries. The lack of provision of adequate support to the breastfeeding mother is an important contributory factor to shorter duration of breastfeeding. Health professionals and voluntary breastfeeding supporters are in a prime position to work collaboratively to provide comprehensive support to the breastfeeding mother. However, a comparative evaluation of the breastfeeding support skills of voluntary breastfeeding supporters and health professionals has never been conducted. This study aimed to assess the breastfeeding support skills of midwives and Breastfeeding Network (BfN) supporters. Breastfeeding support skills were assessed using a between-subjects design conducted with 15 midwives and 15 BfN supporters in the north-west of England. Support skills were measured using the prevalidated Breastfeeding Support Skills Tool (BeSST), a questionnaire and video tool. Total scores on the BeSST were significantly higher in the BfN group (mean = 42.5 +/- 6.4 SD) than in the midwife group (mean = 30.7 +/- 8.2 SD)[t (26.5)= 4.4, P < 0.0001]. The BfN group has the breastfeeding support skills necessary to provide adequate assistance for breastfeeding mothers. An interagency and interdisciplinary collaborative model is crucial to developing a coherent and cohesive approach to the support infrastructure for breastfeeding women.

OBJECTIVES The objective of this study was to examine the association between number of Baby Friendly hospital practices (based on World Health Organization/United Nations Children's Fund Ten Steps to successful breastfeeding) experienced by mothers and breastfeeding initiation during hospital stay, breastfeeding at 1 month and breastfeeding at 3 months after delivery. METHODS The study population consisted of mothers who gave birth to infants without congenital anomalies at hospitals in Taiwan from June to October of 2003, inclusively. A total of 2079 mothers participated in the postal questionnaire survey. RESULTS Only 1% of women reported experiencing all 10-step practices, while 5.7% of women did not report experiencing any Baby Friendly practices. Mothers who delivered at certified Baby Friendly hospitals experienced more 10-step practices. The level of breastfeeding increased as the number of 10-step practices experienced increased at all three time points when confounders were controlled in the model. CONCLUSIONS This study found a dose-response relationship between number of 10-step practices experienced and breastfeeding. However, very few women in Taiwan reported experiencing all 10 steps. Our findings highlight the need for greater attention to implement the 10 steps.

BACKGROUND To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. METHODS As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. RESULTS Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. CONCLUSION Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.

AIM: The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling. METHOD: An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding. RESULTS: By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor. CONCLUSION: This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling.

The purpose of this study was to evaluate the implementation of a change to the breastfeeding policy in seven hospitals in accordance with the 'Ten Steps to Successful Breastfeeding' issued by the World Health Organization and the United Nations Children's Fund and to assess the impact of hospital practices on breastfeeding. A 3-year quasi-experimental pre-post test design was conducted in 12 hospitals. The subjects were composed of 4614 lactating women in both experimental and control groups. The research instruments included the Baby-Friendly hospital Initiative training programs and questionnaires on breastfeeding duration, knowledge, attitude, and demographic data. Breastfeeding rates (including exclusive breastfeeding, mixed breastfeeding, and overall breastfeeding rates) of the experimental and control groups were measured and compared at four different times, during the hospital stay and at 2 weeks, 1 and 2 months postpartum. The results indicated that the exclusive and overall breastfeeding rates of the experimental group were higher than those of the control group (p < 0.001); moreover, the breastfeeding rates generally exhibited an increasing trend year by year ((p < 0.001). The results also showed that the experimental group scored higher in breastfeeding knowledge than the control group as did positive attitudes toward breastfeeding (t > 1.96, p < 0.05) with scores increasing year by year. The results also showed that higher scores reflected better knowledge in breastfeeding, and, in turn, a longer duration of breastfeeding.

BACKGROUND The increasing number of motorcyclists in Nigeria has led to a rise in poor road safety practices leading to increased rate of accidents. This study was conducted to implement and evaluate the effect of safety education on riding habits of motorcyclists in Uyo, Nigeria. METHODS The intervention study was conducted among commercial motorcyclists in Uyo with controls from another town in Akwa Ibom State. Baseline information was collected from both groups on their riding habits. Motorcyclists in Uyo were educated on appropriate road safety practices. Data was collected from both groups three months later and analysed using the Statistical Package for Social Sciences version 11. RESULTS A total of 200 respondents participated in the study, 100 per group. At 3 months post-intervention, those riding when tired reduced in the intervention group from 69% at baseline to 42%(p<0.05), while in the control group it increased from 74% to 79%. Furthermore, those who rested during riding hours increased from 30% at baseline to 93%(p<0.05) in the intervention group, while it reduced from 40% to 36% in the control group. Those riding within speed limit in the intervention group increased from 37.5% at baseline to 56.6%(p <0.05), while in the control group, it remained the same. Use of psycho-active substances reduced in the intervention group, though the changes were not statistically significant at p<0.05. CONCLUSION Safety education improved many riding habits of motorcyclists in the intervention group. Road safety education is recommended for all motorcyclists to ensure safer road use.

OBJECTIVE This study presents the costs of injury from road crashes sustained by commercial motorcyclists in Oyo state, Nigeria. METHODS Across-sectional survey of 373 commercial motorcyclists selected using a multi-stage sampling technique was conducted. Information on injury costs for 44 (11.8%) of them who were reportedly involved in a road crash in the 12-month preceding the survey are presented. RESULTS The mean age of the 44 crash-involved motorcyclists was 33.6 +/- 9.1 years. Daily income ranged from N300.00 ($2.31)- N1, 500.00 ($11.54). Thirty-three (75.0%) of those involved in crashes sustained injuries and 7 (21.2%) of them were admitted. Common injuries sustained were bruises (75.8%), fractures (12.1%), cuts (6.1%) and burns (6.1%). Median number of days away from work was 14 (range: 1 - 150). Median number of days on admission was 60 (range 7 - 90). The median cost of treatment was N2, 000.00 ($15.38), range: N20.00 (about 16 cents)- N25, 000.00 ($192.31) and this was paid by the injured motorcyclist alone in about 47% of cases. Median productivity costs lost was N7, 000.00 ($53.85), range N300 ($2.31)- N72, 000.00 ($553.85). CONCLUSION The study showed that the costs of injuries were considerable. Efforts to prevent road crashes must be intensified to reduce the ensuing economic losses.

Objective: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. Materials and Methods: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. Results: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. Conclusion: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.

BACKGROUND: Visual challenges compromise mobility, increase dependency on family members and constitute a major health problem mainly seen by the primary care physicians among the elderly. However, there is little information on the pattern of visual problems of elderly patients attending the primary care clinics in Nigeria. OBJECTIVE: To describe the visual problems among elderly subjects in a hospital setting. METHODS: Five hundred consecutive patients (311 females and 189 males) aged 60 years and above were interviewed using a structured questionnaire based on the World Organization of Family Doctors (Wonca) format between September 2004 and April 2005. The main outcome measurements were sociodemographic characteristics, visual acuity and ocular problems. RESULTS: The main visual problems reported by the elderly were impaired vision 224 (44.8%) and abnormal sensations in the eyes 64 (12.8%). Cataract 198 (39.7%) was the commonest eye disorder diagnosed by the Family Physician, followed by pterygium 32 (6.4%). Assessment of binocular acuity revealed blindness in 109 (21.8%) and low-vision in 68 (13.6%). The prevalence of visual impairment increased significantly with age. CONCLUSION: Visual impairment is a common problem of the elderly people in the hospital setting, with cataract being the main cause. Efforts should be made to detect these conditions early and institute treatment promptly.

Migration has been associated with a higher risk of STI/HIV but few studies have assessed the sexual risk behaviour of migrant farm workers in Nigeria. An exploratory survey was conducted to assess the knowledge of HIV/AIDS and sexual risk behaviours of migrant farmers in Saki West Local Government Area, Oyo State, Nigeria. Questionnaires were used to obtain information on socio-demographic and occupational characteristics, knowledge of HIV/AIDS, sexual behaviours and history of STI symptoms. Overall 518 respondents were interviewed, slightly over half were aware of HIV/AIDS; awareness was significantly lower among the females, those aged 15-24 years and those with no formal education. Majority (80.7%) were sexually experienced, the mean age at sexual debut was 19.4 +/- 5.2 years and 18.4 +/- 4.2 years for males and females respectively. Sexual intercourse with multiple sexual partners in the past year was reported by 24.6%(males, 35.7%, versus females, 10.4%, p < 0.05). Recent sexual intercourse with a casual partner was reported by 9.1%(12.8% males versus 4.4% females). Only 18.2% used a condom during the last casual sexual contact. Level of awareness of HIV is unacceptably low and sexual risk behaviours are prevalent among these workers. Appropriate sexual health and HIV prevention interventions should be instituted.

HASH(0x27eb9700)

This descriptive cross-sectional survey was conducted among all the female traders in Sango market, Ibadan in, April 2003. The aim of the study was to identify the common health problems of women traders in Sango and their work conditions. The most commonly reported health problems were muscular and joint pains by 105 (37.4%), 95 (33.8%) had symptoms suggestive of malaria and 66 (23.5%) had chronic low back pain. The prevalence of muscular and joint pain was highest among respondents aged > 60yrs (p=0.023), and among those who spent eight to ten hours per day in the market (p=0.200). On examination 56 (19.9%) were hypertensive, 88 (31.3%) and 97 (16.7%) were overweight and obese respectively. The prevalence of hypertension was associated with increasing age and obesity (p=0.000). The common health problems among these female traders were muscular and joint pain, symptoms suggestive of malaria, chronic low back pain and hypertension. It is recommended that appropriate health interventions be instituted to address these problems.

The study reports a questionnaire based survey on mill operators in a large market in Ibadan, Southwest Nigeria. One hundred and twenty respondents, 65 males and 55 females aged between 18 and 65 years were interviewed and noise measurements were done at various work stations. Health problems reported by these workers include headaches 73%, backache 53% and respiratory symptoms such as cough 37% rhinitis 63% and wheezing 13%. Thirty four respondents (28%) reported a difficulty in hearing mostly due to tinnitus. Four complained of deafness. Twenty-three (19%) had raised blood pressure of 140/90Hg and above. In spite of the high levels of dust in the work environment only 15 (13%) of workers used a face cloth to cover their noses. Noise levels at the work stations ranged from 88-90dB from smaller machines and 101-105 dB for larger machines. None of the workers used hearing protection in any form. Health education of workers and the provision of low cost protective equipment may alleviate the suffering of these workers.

INTRODUCTION Upper urinary tract stones are relatively uncommon in Nigeria and they are most often seen in men in their 4th and 5th decades. There is however no recent report on this disease from our locality. This retrospective study was done to evaluate the pattern of presentation of upper tract urolithiasis in our institution. PATIENTS AND METHODS We reviewed all cases of renal stones referred to a single Consultant in a Teaching Hospital in Southwestern Nigeria over a two year period. RESULTS Twenty cases of renal calculi presented within the study period. All patients presented with sudden onset of loin or back pain, and the diagnosis was confirmed radiologically. The mean age of our patients was 27 years (age range 13-38 years), and the male to female ratio was 1.5: 1. Nineteen patients (95%) reported poor fluid intake (<1.5L/day), and 17/20 (85%) frequently total fasted totally (no water or food intake) for religious reasons. Serum calcium was normal in 15 of 16 patients (94%) and only marginally raised in the remaining patient. All patients were treated with a high fluid intake (3L/day) and analgesics, and 16 of the patients (80%) passed their stones spontaneously. The other four are currently pain free, one of whom is awaiting surgery. CONCLUSION This (uncommon) occurrence of upper tract urolithiasis in young adults in Ibadan may be related to chronic dehydration exacerbated by religious fasting. Further studies are required to explore this relationship,

This study was designed to determine the effectiveness of trabeculectomy on African patients. All patients who underwent trabeculectomy over a 10-year period, January 1987 to December 1996 were included in the study. Information extracted from their case notes sex, included age, type of glaucoma, number of years of glaucoma before surgery, eye involved, and visual acuity pre-operatively and post-operatively. Intraocular pressures at presentation, pre-operatively and post-operatively (2 days, 1 week, 3 months, 6 months, 12 months and last clinic visit) were also recorded. Other data collected included pre-operative antiglaucoma therapy, additional techniques at surgery, complications of surgery, presence of a filtering bleb and follow-up period post operatively. A success rate of 91.2% was obtained from 433 eyes operated upon. The most significant outcome was the presence of a filtering blob which had a better success rate than the absence of a bleb. High success rates were recorded in the age groups "> 60 years and 20-40 years", the lowest success rate was in the "less than 20 years of age". All the patients with developmental glaucoma had a successful outcome (100%) while only 50% of the secondary glaucoma were successful. Patients with open angle glaucoma had 92% success rate. Complications of surgery were mostly transient. It was concluded that the presence of a bleb was a good indication of the control of intraocular pressure and that early surgery gave a more successful outcome than late surgery.

INTRODUCTION In India, with the introduction of Accredited Social Health Activist (ASHA) workers under the National Rural Health Mission (NRHM) from 2005 to 2006, utilization of healthcare services at the peripheral level has improved. This study was conducted with the purpose of evaluating knowledge, attitudes and practices of ASHA workers in relation to child health. METHODS A cross-sectional study was conducted at Palghar Taluka in the Thane district of Maharashtra for a period of 3 months from January 2011 to March 2011, inclusive, with the study participants all being trained ASHA workers working in the various primary health centres of Palghar Taluka. A total of 150 ASHA workers were working in the area, of which four workers were untrained and thus excluded from the study. The study was conducted by the authors after receiving permission from the medical officer in charge of the primary health centres. Each of the ASHA workers was then contacted individually by the authors and had the study explained to them, after which they were interviewed face to face. Informed consent was taken from each of the study participants. A pre-tested semi-structured questionnaire was designed for ASHA workers regarding child health after thoroughly studying the ASHA Training Module 2, which was then translated into their local language (ie Marathi). RESULTS A total of 70 (47.9%) workers were from the under 25 years age group; 67 (45.9%) had received less than a secondary level education. A total of 67.1% of ASHA workers were not aware of the correct preventive measures for vitamin A deficiency. Twenty-nine (19.9%) of the ASHAs did not feel the need for referral for a child with diarrhoea who is unable to drink or breast feed. Similarly, in acute respiratory tract infections, 35 (23.9%) of ASHAs did not know to refer a child with fast breathing. Fifty-nine ASHAs (50.4%) considered a baby crying for more than 3 hours following immunization not worth referring to a first referral unit. The oral contraceptive pill was the most frequently advised temporary contraceptive measure for females in the reproductive age group (15-45 years). CONCLUSION Despite the training given to ASHAs, lacunae still exists in their knowledge regarding various aspects of child health morbidity. Monthly meetings can be used as a platform for the reinforcement of various aspects of child health. Periodical refresher training should be conducted for all of the recruited ASHA workers. In the future training sessions, more emphasis should be given to high risk cases requiring prompt referral.

This research was designed to assess nurses' perceptions, knowledge, attitudes and intentions in relation to nurse participation in Healthcare Ethics Committees (HECs). A convenience sample of 87 nurses from five Israeli hospitals completed a self-administered questionnaire, whose data were then analyzed by quantitative statistics. The main findings were that large percentages of nurses were totally ignorant of the existence and functioning of the HEC in their workplaces. Nurses in managerial roles were (a) much more knowledgeable on these matters than staff nurses and (b) regarded more positively the idea that nurses had an obligation to sit on such committees. Workplace role and rank in the organizational hierarchy had a stronger impact on nurse attitudes to HEC work than level of education. Overall, nurse willingness to sit on an HEC and to take special training in preparation for such a role were high.

Abstract Background: Early discontinuation of breastfeeding exposes babies to severe and fatal illnesses. The aim of this study was to identify the barriers to relactation among Egyptian women who had stopped breastfeeding and to test different interventions to support the mothers to relactate. Subjects and Methods: We conducted a prospective longitudinal cohort study of 200 mothers from Alexandria with babies less than 3 months of age who were not breastfeeding. They were exposed to three different types of educational models (problem solving, coaching, and cautioning) and followed up by phone calls over a period of 6 weeks. Results: Compliance with the protocol for relactation varied according to the educational model used. Only 10% succeeded in relactating. The most effective educational strategy was the problem solving (45%) and the coaching (50%). The least effective was the cautioning approach (5%). Determinants of relactation included mother's education level (100%), cup feeding with no nipples or soothers (70%), and the husband's involvement (70%). Conclusions: We conclude that the choice of appropriate educational models is key to encouraging mothers to return to breastfeeding. This study strongly supports Step Ten of the Baby Friendly Hospital Initiative.

UNLABELLED ABSTRACT: BACKGROUND The practice of exclusive breastfeeding is still low despite the associated benefits. Improving the uptake and appropriating the benefits will require an understanding of breastfeeding as an embodied experience within a social context. This study investigates breastfeeding practices and experiences of nursing mothers and the roles of grandmothers, as well as the work-related constraints affecting nurses in providing quality support for breastfeeding mothers in Southwest Nigeria. METHODS Using a concurrent mixed method approach, a structured questionnaire was administered to 200 breastfeeding mothers. In-depth interviews were also held with breastfeeding mothers (11), nurses (10) and a focus group discussion session with grandmothers. RESULTS Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. Only a small proportion (19%) of the nursing mothers practiced exclusive breastfeeding. The survey showed the major constraints to exclusive breastfeeding to be: the perception that babies continued to be hungry after breastfeeding (29%); maternal health problems (26%); fear of babies becoming addicted to breast milk (26%); pressure from mother-in-law (25%); pains in the breast (25%); and the need to return to work (24%). In addition, the qualitative findings showed that significant others played dual roles with consequences on breastfeeding practices. The desire to practice exclusive breastfeeding was often compromised shortly after child delivery. Poor feeding, inadequate support from husband and conflicting positions from the significant others were dominant constraints. The nurses decried the effects of their workload on providing quality supports for nursing mothers. CONCLUSION Breastfeeding mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. Thus, scaling up of exclusive breastfeeding among mothers requires concerted efforts at the macro, meso and micro levels of the Nigerian society.

The Ministry of Health in Iraq is undertaking a systematic programme to integrate mental health into primary care in order to increase population access to mental health care. This paper reports the evaluation of the delivery of a ten day interactive training programme to 20% of primary care centres across Iraq. The multistage evaluation included a pre- and post-test questionnaire to assess knowledge, attitudes and practice in health workers drawn from 143 health centres, a course evaluation questionnaire and, in a random sample of 41 clinics, direct observation of health workers skills and exit interviews of patients, comparing health workers who had received the training programme with those from the same clinics who had not received the training. Three hundred andseventeen health workersparticipated in the training, which achieved an improvement in test scores from 42.3% to 59%. Trained health workers were observed by research psychiatrists to have a higher level of excellent skills than the untrained health workers, and patient exit interviews also reported better skills in the trained rather than untrained health workers. The two week course has thus been able to achieve significant change, not only in knowledge, but also in subsequent demonstration of trained practitioners practical skills in the workplace. Furthermore, it has been possible to implement the course and the evaluation despite a complex conflict situation.

OBJECTIVE To determine the knowledge, attitudes, and practices of obstetric care providers (OCPs) in Bugesera District, Rwanda, crucial to the delivery of safe motherhood services. METHODS A quantitative descriptive survey in Kinyarwanda targeting all OCPs in the district was implemented in November 2010 to determine demographic characteristics, safe motherhood knowledge, obstetric practices, and attitudes toward additional training. RESULTS The study captured 87% of OCPs, of whom 137 of 168 (82%) were A2 level nurses. Most expressed a need to improve their knowledge (60.6%) and skills confidence (72.2%) in safe motherhood. The mean percentage of correct answers of 50 questions assessing overall knowledge was 46.4%; sections on normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest. Fundal pressure during vaginal delivery was practiced by 60.8%, and only 15.9% of providers practiced active management of the third stage of labor for all deliveries. Providers supported additional training, and 89.3% expressed willingness to participate in a 2-day workshop even if it were their day off. CONCLUSION The study has identified a need to improve safe motherhood knowledge and practices of OCPs in the Bugesera District of Rwanda. OCPs support additional training as an intervention to reduce maternal mortality.

While the benefits of breastfeeding are well established, few Scottish women exclusively breastfeed, as recommended nationally and internationally. Breastfeeding peer support can help mothers to breastfeed for longer, but the training peer supporters receive is variable and few studies have measured the effectiveness of peer supporter training. This study aimed to compare mothers' attitudes towards and knowledge of breastfeeding before and after undertaking Breastfeeding Network (BfN) peer supporter training. This study used a quasi-experimental design to investigate levels of breastfeeding knowledge and attitudes in 28 women, immediately before and after the BfN peer supporter (Helper) training programme. Data were collected using the Infant Feeding Questionnaire. Mothers had high baseline scores for attitude (88.8%) and knowledge (76.4%). After training 78% of mothers improved their attitude scores. The mean difference in attitude scores was 4.9%, which was statistically significant (t = 4.44, P < 0.001). Ninety-six per cent of mothers had increased their knowledge scores. The mean difference in knowledge scores was 10.4%, which was statistically significant (t = 6.25, P < 0.001). This study provides evidence that the BfN's accredited peer support training can improve both breastfeeding knowledge and attitudes of breastfeeding mothers. Peer supporters who have undertaken this training are therefore suitably qualified to provide mothers with the support and information required to make informed choices in breastfeeding and to contribute to effective support and promotion of breastfeeding as suggested in the National Institute for Health and Clinical Excellence guideline on maternal and infant nutrition (PH11) and Scottish Government's Maternal and Infant Nutrition: A Framework for Action (2011).

AIMS To describe the experiences of Turkish women regarding traditional breastfeeding practices. BACKGROUND Breastfeeding is a popular practice in Turkey. Nevertheless, the rate of exclusive breastfeeding in the first six months of life is quite low. Merely about 16% of infants aged between 2-3 months are exclusively breastfed, whereas those fed with supplementary foods are 78%. In the light of this data, we argue that traditional breastfeeding practices may be the underlying reason for low rate of breastfeeding. Significant as it is, however, this subject matter has largely been overlooked in the literature in Turkey. DESIGN A descriptive, qualitative study based on in-depth interviews, with a purposive sample of 24 mothers of four to- 24-month-old babies. METHODS The background information of the mothers was obtained from the Mother and Child Health and Family Planning Centre that offers specific services for mothers. Mothers were visited at home and data were gathered through semistructured and in-depth, audio-taped interviews. The collected data were analysed using the content analysis method. RESULTS Three themes emerged from the participants' descriptions of their breastfeeding experiences:(1) influence of the older family members,(2) influence of social learning and (3) influence of the religion. CONCLUSION This study concluded that traditional breastfeeding practices are still prevalent among mothers, regardless of their age and level of education. Breastfeeding behaviour of mothers was mostly shaped by various cultural social and religious influences imposed on them by their family, close social network and religious community. RELEVANCE TO CLINICAL PRACTICE Nurses can encourage mothers for exclusive breastfeeding by means of individual- and social-based training programmes, which they will prepare in view of traditional breastfeeding practices.

BACKGROUND The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. METHODS The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. RESULTS Three main themes were identified:'Belief and Commitment';'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. CONCLUSION Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation.

AIM To evaluate the effects of Baby Friendly Initiative (BFI) community training on breastfeeding rates, staff and mothers in a large Primary Care Trust (PCT). BACKGROUND UK Government policy promotes the adoption and implementation of the World Health Organization/United Nations Children's Fund BFI as the best evidence to raise breastfeeding initiation and prevalence. METHODS A total of 141 health visitors and nursery nurses were trained on mandatory three-day BFI courses during 2008; 137 staff (100 health visitors, 37 nursery nurses) took part in the evaluation. Breastfeeding attitudes, knowledge and staff confidence in helping mothers to breastfeed were measured using a validated Breastfeeding Questionnaire and a self-efficacy tool at three time points before and after training. FINDINGS Breastfeeding rates at eight weeks increased significantly, and a baby born in 2009 was 1.57 times more likely to be breastfed than one born in 2006. Statistically significant improvements in staff breastfeeding attitudes, knowledge and self-efficacy were seen after attending the course, in addition to increases in the appropriate management of breastfeeding problems.Process evaluation interviews with 43 health visitors, nursery nurses and managers explored views of the training and changes in practice. The response to the course was overwhelmingly positive and felt to be extremely worthwhile. It has led to renewed enthusiasm, improved the consistency of advice among team members and raised confidence levels of all staff who help mothers with breastfeeding. Health visitors felt confident about enabling nursery nurses to take a greater role in breastfeeding support. A small survey of mothers reported increases in exclusive breastfeeding and signs of increased breastfeeding self-efficacy. Making the training mandatory across the whole PCT has improved the consistency of breastfeeding advice and confidence of all health-care staff who help breastfeeding mothers.