Chapter1_4+breastfeeding+thesis

Chapter 1

UNIVERSITY OF SANTO TOMAS - FACULTY OF MEDICINE & SURGERY 1

CHAPTER IINTRODUCTION

BACKGROUND OF THE STUDYBreast milk

Breast milk is the natural food for full-term infants and is the appropriate milk for the 1st year of life. It is always available at the proper temperature and requires no preparation time.Human milk contains bacterial and viral antibodies, including relatively high concentrations of secretory immunoglobulin A, that prevent microorganisms from adhering to the intestinal mucosa. It also contains substances that inhibit the growth of many common viruses as well as specific antibodies that are thought to provide local gastrointestinal immunity against organisms entering the body via this route. Breast milk contains all the nutrients that an infant needs in the first 6 months of life, including fat, carbohydrates, proteins, vitamins, minerals and water. It is easily digested and efficiently used. Breast milk also contains bioactive factors that augment the infants immature immune system, providing protection against infection, and other factors that help digestion and absorption of nutrients.

Macrophages in human milk may synthesize complement, lysozyme, and lactoferrin. In addition, breast milk contains lactoferrin, an iron-binding whey protein that is normally approximately saturated with iron and has an inhibitory effect on the growth of Escherichia coli in the intestine. Human milk also contains bile salt-stimulated lipase, which kills Giardia lamblia and Entamoeba histolytica.

Breastfeeding

Breastfeeding plays a particularly important role in child survival in developing countries: it contributes to the child's immunologic defense system, and increases its resistance to disease. Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. According to WHO, in 2006 an estimated 9.5 million children died before their fifth birthday, and two thirds of these deaths occurred in the first year of life. Under-nutrition is associated with at least 35% of child deaths. It is also a major disabler preventing children who survive from reaching their full developmental potential. Around 32% of children less than 5 years of age in developing countries are stunted and 10% are wasted. It is estimated that sub-optimal breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in 1.4 million deaths and 10% of the disease burden in children younger than 5 years.

The first two years of life provide a critical window of opportunity for ensuring childrens appropriate growth and development through optimal feeding. Based on evidence of the effectiveness of interventions, achievement of universal coverage of optimal breastfeeding could prevent 13% of deaths occurring in children less than 5 years of age globally, while appropriate complementary feeding practices would result in an additional 6% reduction in less than five mortality.

In 2002, the World Health Organization and UNICEF adopted the Global Strategy for infant and young child feeding. The strategy was developed to revitalize world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and survival of infants and young children.

WHO and UNICEFs a global recommendation for optimal infant feeding includes exclusive breastfeeding for 6 months (180 days) and nutritionally adequate and safe complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond.Poor breastfeeding and complementary feeding practices are widespread. Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6 months of life, the majority receiving some other food or fluid in the early months. Complementary foods are often introduced too early or too late and are often nutritionally inadequate and unsafe.

Breastfeeding confers short-term and long-term benefits on both child and mother, including helping to protect children against a variety of acute and chronic disorders. The long-term disadvantages of not breastfeeding are increasingly recognized as important.Diarrhea and pneumonia are more common and more severe in children who are artificially fed, and are responsible for many of these deaths. Artificially-fed children have an increased risk of long term diseases with an immunological basis, including asthma and other atopic conditions, type 1 diabetes, celiac disease, ulcerative colitis and Crohns disease. Artificial feeding is also associated with a greater risk of childhood leukemia.

Several studies suggest that obesity in later childhood and adolescence is less common among breastfed children, and that there is a dose response effect, with a longer duration of breastfeeding associated with a lower risk. The effect may be less clear in populations where some children are undernourished. Regarding intelligence, a meta-analysis of 20 studies showed scores of cognitive function on average 3.2 points higher among children who were breastfed compared with those who were formula fed. The difference was greater (by 5.18 points) among those children who were born with low birth weight. Increased duration of breastfeeding has been associated with greater intelligence in late childhood and adulthood, which may affect the individuals ability to contribute to society.For the mother, breastfeeding also has both short- and long-term benefits. The risk of postpartum hemorrhage may be reduced by breastfeeding immediately after delivery, and there is increasing evidence that the risk of breast and ovarian cancer is less among women who breastfed. Exclusive breastfeeding can also delay the return of fertility, and accelerate recovery of pre-pregnancy weight. Mothers who breastfeed exclusively and frequently have less than a 2% risk of becoming pregnant in the first 6 months postpartum, provided that they still have amenorrhea.

Health workers do not always have the opportunity to ensure that mothers successfully establish breastfeeding. Mothers may give birth at home, or they may be discharged from a maternity facility within a day or so after delivery. Difficulties may arise in the first few weeks with breastfeeding, and later on when complementary foods are needed. Families and friends are usually a mothers main source of advice about feeding her children, but this advice is sometimes fraught by misconceptions.The propensity to breastfeed is not only of importance with regard to the beneficial effects on the individual, but is also of concern as an indicator of health behaviour related to social conditions.

Internationally, studies on weaning of term infants suggest that mothers who have lower education wean earlier than those with higher education. Various studies have found that socially disadvantaged mothers start breastfeeding less often and also breastfeed for a shorter period. At the start of their lives, children from socially disadvantaged families may already run a higher risk of several diseases.Breastfeeding behavior can be predicted by attitudes, perceived control, and social support, including social norms, peer influence, and intergenerational factors (elements of the theory of planned behavior).Factors associated with breastfeeding include hospital practices and maternal sociodemographic characteristics, as well as biomedical, environmental-support, and psychosocial factors. The decline in the initiation and duration of breastfeeding is an inevitable consequence of the modernization process. In a broad sense, modernization entails a rapid abandonment of traditional approaches to childrearing, and the adoption of modern practices, including the use of modern health services and the use of supplementary foods for infants, in favor of breastfeeding or prolonged lactation. Urbanization is usually associated with lower incidence and a shorter duration of breastfeeding. The adoption of bottle-feeding in the urban areas is widespread both because it is considered to be more modern, sophisticated and convenient (especially if the mother works outside the home), and because there are fewer breastfeeding role models for urban women to emulate. In the rural environment, however, breastfeeding calls for little change in lifestyle. The presence of additional family members in the household, in particular mothers-in-law, provides positive support for breastfeeding practices, encouraging mothers to breastfeed for a longer period of time. In line with this, mothers and families need support to initiate and sustain appropriate infant and young child feeding practices.

Health care professionals can play a critical role in providing that support, through influencing decisions about feeding practices among mothers and families. Therefore, it is critical for health professionals to have basic knowledge and skills to give appropriate advice, counsel and help solve feeding difficulties, and know when and where to refer a mother who experiences more complex feeding problems.STATEMENT OF THE PROBLEM

This study on the Determination of the Different Demographic Profile that can contribute to the cessation of breastfeeding mothers among their infants before 1 year of age in the University of Santo Tomas Hospital-Out Patient Department for the month of January to February 2011 seeks to answer the following questions:

1. Why do women stop breastfeeding their infants before 1 year of age ?

2. What are the different demographic factors that can lead to the cessation of breastfeeding of mothers to their infants before 1 year of age in the University of Santo Tomas Hospital-Out Patient Department for the month of January to February 2011?

SIGNIFICANCE OF THE STUDY

Breastfeeding has distinct advantages which benefit the infant and the mother, including the hospital and the country that adopt its practice. It is the first preventive health measure that can be given to the child at birth. It also enhances mother-infant relationship. Furthermore, the practice of breastfeeding could save the country valuable foreign exchange that may otherwise be used for milk importation. However there are factors that affect the practice of breastfeeding and the use of breast milk especially in developing countries where influences due to urbanization are significant. It is therefore important to determine the causes of cessation breastfeeding (Determination of the Different Demographic Profile that can contribute to the cessation of breastfeeding mothers among their infants before 1 year of age in the University of Santo Tomas Hospital-Out Patient Department for the month of January to February 2011) in which it can be useful for designing breastfeeding interventions that address issues most likely to affect mothers of infants at various ages. It can be used by doctors and lactation consultants to help mothers overcome breastfeeding barriers. It can also be useful to health officials when attempting to design targeted interventions to prolong breastfeeding by focusing on the issues that constitute the most important barriers to breastfeeding among mothers of infants of various ages.SCOPE AND LIMITATION

This study will only cover the determination of the different demographic factors that can lead to the cessation of breastfeeding of mothers to their infants before 1 year of age in the University of Santo Tomas Hospital-Out Patient Department for the month of January to February 2011.OBJECTIVES OF THE STUDYThe study aims to determine the different demographic factors that can lead to the cessation of breastfeeding of mothers to their infants before 1 year of age in the University of Santo Tomas Hospital-Out Patient Department for the month of January to February 2011.

CHAPTER II

Review of Related Literature

Breast milk and breastfeeding nowadays are among the most advocated natural products and practice worldwide since both of them have beneficial effects to the infant and to the mother. However, there are a lot of factors that contribute to poor consumption and poor practice of breast milk and breastfeeding respectively.

According to UNICEF the importance of Breastfeeding includes: a. Breastfeeding saves lives. The risk of death for infants who are not breastfed is 10-times greater in the first 3-4 months of life than those babies who are exclusively breastfed. Over 6 million infant lives are saved each year by breastfeeding, b. Breastfeeding is ideal and perfect food for infants. It fulfills the infants total nutritional requirement through 4-6 months of age, c. Breastfeeding prevents diarrhea, d. Breastfeeding confers immunity. Colostrums is the childs first immunization. It protects the infants from bacterial and viral pathogens, e. Breastfeeding is an effective family planning. Exclusive breastfeeding will provide almost total protection from pregnancy during the first 6 months when amenorrhea is present, f. Breastfeeding protects mothers health. Aside from child spacing, it significantly lowers the mothers risk of breast and ovarian cancer and reduces the chances of fatal post partum hemorrhage, g. Breastfeeding saves money, h. Breastfeeding promotes bonding. It is during this hour that he feels, smells and has visual image of each member becomes mutually imprinted and bonding occurs (DOH, Manila 1994).

In the study by Lianto, they determined the extent of current knowledge/ information of mothers about breastfeeding, defined the varied roles of health personnel in the art of promoting the art of successful initiatives and maintenance of breastfeeding. To improve the breastfeeding practice among mothers and thereby enhancing child survival, information is needed to determine the adequacy of maternal knowledge and practice regarding lactation. Results of the study showed that the women chose breastfed babies because breast milk is economical and protects their babies from infections. Friends and relative have greater impact than health workers do in influencing mothers to breastfeed. Maternal knowledge and information regarding advantages of breastfeeding, establishment and maintenance of lactation, care of nipples and breasts, and proper diet are inadequate. Several misconception and beliefs regarding breastfeeding have been recognized (Lianto, 1995).

On the other hand, Tantuco conducted a survey over a four-month period at Cardinal Santos Medical Center (CSMC) in an attempt to look at the present picture of breastfeeding and weaning practices among urban mothers with children 6 months t 3 years of age. Incidence of breastfeeding among these women was 91%. Maternal employment appeared to be a major obstacle to successful breastfeeding. Bottle-feeding seems to be the most common if not the only option to most working mothers (Tantuco, 1999).

The study of Florentino was conducted for six weeks. Most of the subjects were housewives who had either 1-2 children and had college degrees and these respondents caged me from economically advantaged group. Cases showed significant post test in many aspects of their knowledge and attitudes regarding breastfeeding although their practices were unchanged. This showed that participation of health personnel proving adequate information helps improve general knowledge and attitudes with regards to breastfeeding since efforts have to be doubled in promoting and supporting the practices and maintenance of breastfeeding through informational campaign, health education and provisions of adequate local and national dissemination (Florentino, 1995).

According to World Health Organization (WHO) statistics, everyday, between 3,000 to 4,000 die from diarrhea and acute respiratory infections because the ability to feed them adequately has been taken away from their mothers. Thousands more succumb to their illness and malnutrition. Every week, a quarter of million children die in the developing world. In the Philippines, about 100,000 infants die each year. Many more live on with ill health and poor growth.

To encourage breastfeeding from the time of childbirth, to prevent difficulties from arising and to overcome difficulties should they occur, mothers need appropriate management and skilled help. Support and counseling should be available routinely during antenatal care, to prepare mothers; at the time of birth to help them initiate breastfeeding; and in the postnatal period to ensure that breastfeeding is fully established. Mothers and other caregivers who are not able to breastfeed need counselling and support for alternative methods of infant feeding.

The Baby-friendly Hospital Initiative (BFHI) was launched in 1992 with the aim of transforming maternity facilities to provide this standard of care. Without the BFHI, practices often undermine breastfeeding, with damaging consequences for infant health. Support of BreastfeedingMothers need continuing support to maintain exclusive and continued breastfeeding, to implement other methods of infant feeding when breastfeeding is not possible, and to establish adequate complementary feeding when the child is 6 months of age and older. If a child becomes ill, the mother may require skilled support from a health worker to continue feeding her child. This support can be provided by trained personnel in the community, and in various other settings, such as a primary care facility or a paediatric department in a hospital.

There should be no missed opportunities for supporting feeding in any contact that a mother and child have with the health system, whether it involves doctors, midwives, nurses or community health workers. Lay or peer counselors who have the skills and knowledge to support optimal infant and young child feeding can also contribute to improved feeding practices. Collectively, all these providers should ensure a continuum of care from pregnancy through the postnatal period into early childhood. When they help a mother, they should also talk to other family members, showing respect for their ideas, and helping them to understand advice on optimal feeding. In addition, they can share information and create awareness about the importance of appropriate infant and young child feeding through other channels, for example, by involving school children or extension workers from other sectors. This multi-pronged approach to promoting and supporting infant and young child feeding has been shown to be effective in many settings.Infant and young child feeding counseling is the process by which a health worker can support mothers and babies to implement good feeding practices and help them overcome difficulties. Details of infant and young child feeding counseling depend on the childs age and the mothers circumstances. Generally, a health worker should use good communication and support skills, assess the situation, manage problems and reinforce good practices and follow-up.According to Republic Act No. 10028, Expanded Breastfeeding Promotion Act of 2009 , an act expanding the promotion of brestfeeding, amending for the purpose of Republic Act No. 7600, otherwise known as An act providing incentives to all government and private health institutions with rooming-in and breastfeeding practices and for other purposes. The State adopts rooming-in as a national policy to encourage, protect and support the practice of breastfeeding. It shall create an environment where basic physical, emotional, and psychological needs of mothers and infants are fulfilled through the practice of rooming-in and breastfeeding. The State shall likewise protect working women by providing safe and healthful working conditions, taking into account their maternal functions, and such facilities and opportunities that will enhance their welfare and enable them to realize their full potential in the service of the nation. This is consistent with international treaties and conventions to which the Philippines is a signatory such as the Convention on the Elimination of Discrimination Against Women (CEDAW), which emphasizes provision of necessary supporting social services to enable parents to combine family obligations with work responsibilities. The State shall promote and encourage breastfeeding and provide the specific measures that would present opportunities for mothers to continue expressing their milk and/or breastfeeding their infant or young child.

On Chapter IV, Section 13 of the Republic Act No. 10028, Continuing Education, Re-education and Training of Health Workers and Health Institutions. It stated that the Department of Health with the assistance of other government agencies, professional and nongovernmental organizations shall conduct continuing information, education, re-education, and training programs for physicians, nurses, midwives, nutritionist-dietitians, community health workers and traditional birth attendants (TBAs) and other health worker on current and updated lactation management.During the prenatal, perinatal and postnatal consultations and/or confinements of the mothers or pregnant women in a health institution and the health worker to immediately and continuously teach, train and support the women on current and updated lactation management and infant care, through participatory strategies such as organization of mothers' clubs and breastfeeding support groups and to distribute written information materials on such matters free of charge.

The Department of Health is mandated to develop and provide breastfeeding programs for working mothers whose employees are encouraged to avail of it as part of their human resource development programs.

To equip women of reproductive age with accurate information on maternal nutrition and proper nourishment in preparation for successful and sustainable breastfeeding, the Department of Health is likewise mandated to produce and make available relevant information and programs which should be disseminated to all city, municipal and barangay health centers.

Employers are also highly encouraged to develop breastfeeding or lactation support programs which main functions are to assess the needs of lactating employees with adequate information regarding lactation management in the form of brochures, pamphlets and other educational materials.Exclusive BreastfeedingExclusive breastfeeding until the age of 4 months followed by partial breastfeeding was associated with a significant reduction of respiratory and gastrointestinal infectious diseases in infants. Exclusive breastfeeding until the age of 6 months tended to be more protective than exclusive breastfeeding until the age of 4 months and partially thereafter (Duijts, Liesbeth et.al., 2010). Factors that causes cessation of breastfeedingIn a study by Flaking, et. al., which provides the first population based data on the association between socio-economic status (SES) (which includes, level of education and employment) and breastfeeding duration up to 1 year in mothers of preterm and term infants, it showed that all SES factors showed a strong association with breastfeeding up to 6 months of infants postnatal age. On the other hand, preterm infants are breastfed for a shorter time compared with term infants, despite the known health benefits of breastfeeding in the preterm infants. This study also suggested that strategies like increased opportunities for being together in privacy, individualized care routines, psychological support and empowering attitudes, may entail feelings of trust and pride and less symptomatic response to the experienced situation of having a preterm infant as well as being beneficial for longer breastfeeding duration. The findings in the study also call for substantial improvements in the pre- and post-natal care of mothers exposed to low SES and of mothers of preterm infants. Such improvements include better allocations and prioritizations of resources to meet the needs in these more vulnerable mothers and infants (Flaking, Rene et.al.).In a study by van Rossem, Lennie et.al., it was found out that socially disadvantaged mothers are less likely to start breastfeeding and to continue it for 2 months. In addition to this, lifestyle-related and birth characteristics are important modifying factors in the association between educational level and breastfeeding. It was suggested that interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women. Also in this study, maternal education was used as an indicator of socioeconomic status, because it reflects not only material resources but also noneconomic characteristics such as general and health-related knowledge, which in turn influence health behavior, and problem-solving skills (Van Rossem, et.al., 2009). One of the key determinants of the decline in breastfeeding in the Philippines is the increasing level of education among women, a factor which plays a role in the adoption of modern ideas, and which usually leads to the abandonment of traditional practices regarding child care. This shift in the balance of family relations can manifest itself in the abandonment of traditional sources of influence, namely extended family members, which can often result in breastfeeding of a shorter duration. The transition from traditional to modern societies has prompted a move away from breastfeeding of long duration, particularly among younger generations of women. On the other hand, increasing maternal age and high parity can also lead to breastfeeding of a shorter duration. Higher parity leads to shorter birth intervals and hence shorter times available for breastfeeding (Abada, Teresa et.al., 2002).CHAPTER 3

RESEARCH METHODOLOGY

MATERIALS AND METHODS:

Concept Map

MaterialsA set of questionnaires that was translated in Filipino by a professional translator were given to women who had previously stopped breastfeeding . The sample questionnaire can be found in the Appendix.Procedure

Women that were present in the Univeristy of Santo Tomas- Out Patient Division who had a history of breastfeeding and stopped breastfeeding were asked to participate in this study. Verbal consent were asked before proceeding to answer the questionnaire .

CHAPTER 4

Results and Discussion

presentation of data

Table 1.This table shows the percentage of educational attainement women who stopped breastfeeding.Educational Attainment

FrequencyPercent

Elementary717.5

High School1845

College1127.5

Vocational410

Total40100

Table 2. This table shows the number of children of women who stopped breastfeeding. No. of Children

FrequencyPercent

11435.90

22051.28

4512.82

Total39100.00

Table3. This table shows the number of months of breastfeeding their infants.

No. of Months of Breast Feeding

MonthsFrequencyPercent

11127.5

21025

3922.5

412.5

512.5

637.5

712.5

825

1225

Total40100

Table4. This table shows the lactational factors of women who stopped breastfeedingLactation Factors

FactorsFrequencyPercent

None of the above2460

My baby had trouble sucking or latching on410

My breasts were overfull or engorged12.5

Breast feeding was too painful820

Combination37.5

Total40100

Table5. This table shows the psychosocial factors of women who stopped breastfeedingPsychosocial Factors


None of the above717.5

Breastfeeding was too tiring12.5

I have too many household chores1332.5

I wanted/needed someone to feed my baby922.5

Someone else wanted to feed the baby12.5

Combination922.5

Total40100

Table6. This table shows the nutritional factors of women who stopped breastfeeding.Nutritional Factors



Breastfeed alone did not satisfy my baby1230

I had trouble getting the milk flow to start12.5

I did not have enough milk12.5

Combination37.5

Total40100

Table7. This table shows the lifestyle factors of women who stopped breastfeeding.Lifestyle Factors



I wanted my body back to myself12.5

Total40100

Table8. This table shows the lifestyle factors of women who stopped breastfeeding.Lifestyle Factors



My baby became sick and could not breastfeed37.5

I was sick or need to take medicines12.5

I became pregnant or wanted to become pregnant again25

Total40100

Table9. This table shows the milk pumping factors of women who stopped breastfeeding.Milk Pumping Factors



I could not or did not want to pump or breast feed at work1230

Total40100

Table10. This table shows the infants factors of women who stopped breastfeeding.Infants Factors



My baby lost interest or began to wean him/herself410

Total40100

Table11. This table shows the civil status factors of women who stopped breastfeeding.Civil Status Factors


Married2767.5

Single1332.5

Total40100

Table12. This table shows the age of women who stopped breastfeeding.Respondents' Age

NMinimumMaximumMean

40205929.6

Analysis of Variance

Ho: The mean Rf values of the solvent systems are not significantly different from each other. (The type of solvent system (DCM fraction) does not affect the mean Rf value)

Ha: At least one pair of the mean Rf values of the different solvent systems is significantly different from each other. (The type of solvent system significantly affects the mean Rf value)

Alpha = 0.05

Decision rule: Reject Ho if F >= F crit = 3.106 or if P-value |t|

1 vs 2-0.05010.017-2.940.0123

1 vs 30.02010.0171.180.2621*

1 vs 40.05010.0172.940.0123

1 vs 5-0.1210.017-6.86< 0.0001

1 vs 6-0.2610.017-15.10< 0.0001

2 vs 30.07010.0174.120.0014

2 vs 40.10010.0175.88< 0.0001

2 vs 5-0.06710.017-3.920.0020

2 vs 6-0.2110.017-12.16< 0.0001

3 vs 40.03010.0171.770.1030

3 vs 5-0.1410.017-8.04< 0.0001

3 vs 6-0.2810.017-16.28< 0.0001

4 vs 5-0.1710.017-9.81< 0.0001

4 vs 6-0.3110.017-18.04< 0.0001

5 vs 6-0.1410.017-8.24< 0.0001

Values of "Prob > |t|" less than 0.0500 indicate the difference in the two treatment means

is significant.

Values of "Prob > |t|" greater than 0.1000 indicate the difference in the two treatment means is not significant.

The starred value indicates a pair of means that are not significantly different. The only pair of means that do not differ significantly is 1 and 3. This tells us that the DCM fraction that has the closest Rf value results to CHCl3:CH3OH:H2O (18:8:1) is CH3OH:H2O (17:9:1). The following graph shows the result:General discussion

Based on the data obtained on Potassium Ferricyanide- Ferric Chloride, the three batches of Ipomoea muricata extracts contain Phenols, Tannins and Flavonoids due to the positive result which is the formation of blue spots.

Based on Dragendorffs spray test, all three batches of Ipomoea muricata extracts contain alkaloids due to the formation of orange spots immediately after spraying.

Based on the Vanillin-Sulfuric acid test, all three batches of Ipomoea muricata conatin triterpenes and sterols due to the formation of blue-violet spots.

The negative result on UV 366 means that I. muricata does not exhibit the property of fluorescence (Wagner and Bladt, 1996)BIBLIOGRAPHYAbada, Teresa S.J. et.al., Determinants of breastfeeding in the Philippines: a survival Analysis. Social Science and Medicine. Canada. 2001

Duijts, Liesbeth et.al., Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy. Journal of the American Pediatrics 2010;126. 2010 Flacking, Rene e et.al., Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. European Journal of Public Health, Vol. 17, No. 6, 579584. 2007Florentino, AC., Improving Breastfeeding Practices Through Active Interaction by a Physician., Makati Medical Center, NCR, 1995

Fourteenth Congress Third Regular Session. REPUBLIC ACT No. 10028. 2009

Li, Ruowei et.al., Why Mothers Stop Breastfeeding: Mothers Self-reported Reasons for Stopping During the First Year. American Academy of Pediatrics. 2008

Lianto, Emma M., A survey on Breastfeeding Practice Through Active Intervention by a Physician, Makati Medical Center, 1995

Tantuco, Panasagen S.G., Breastfeeding and Weaning pRactices Among the Urban Mothers in the 90s, NCR Manila, 1999

The Prevalence and Duration of Breastfeeding: A Critical Review of Available Information, Geneva: World Health Organization, Discussion of Family Health

van Rossem, Lenie. Are Starting and Continuing Breastfeeding Related to Educational Background? The Generation R Study. American Academy of Pediatrics. 2009

WHO, Infant and young child feeding Model Chapter for textbooks for medical students and allied health professionals. France. 2009

APPENDICESAPPENDIX A

SAMPLE SURVEY QUESTIONNAIRE

Magandang umaga,

Kami po ay mga mag-aaral ng Medisina na kasalukuyang nasa ika-apat na taon sa Unibersidad ng Santo Tomas. Kami po ay nananaliksik tungkol sa estatistika ng mga babaeng tumigil sa pagpapasuso ng kanilang mga sanggol gamit ang gatas ng ina. Ang questionnaire po na ito ay makakatulong ng malaki sa aming isinasagawang pag-aaral. Pakisagutan lang po ng tama ang mga tanong na nakasulat sa baba. Makakaasa po kayong magiging konpidensyal ang mga impormasyon na inyong binahagi. Maraming salamat po.Mga Tanong Ukol sa PagsisiyasatPetsa:___________________

I. Pangunahing Kaalaman

Pangalan:_____________________________________________________________________________Edad:_________________________________________________________________________________Petsa ng Kapanganakan:_________________________________________________________________Tirahan:______________________________________________________________________________Katayuang Pambayan (Estado Sibil):________________________________________________________Kabansaan:____________________________________________________________________________Pinakamataas na Nakamit sa Pag-aaral: ( ) Mababang Paaralan ( ) Mataas na Paaralan ( ) Pamantasan ( ) Kursong BokasyonalBilang ng Anak: ( ) Unang Panganganak ( ) Pangalawang Beses nang Nagbuntis (__Bilang ng anak__) ( ) Limang beses o higit pang Nagbuntis (__Bilang ng anak__)

II. Pananaliksik Ukol sa Pagpapasuso ng Sanggol Gamit ang Gatas ng Ina

a. Nagawa mo na bang magpasuso ng iyong sanggol gamit ang sarili mong gatas (bilang isang ina)? ( ) Oo ( ) HindiKung Oo, ilang buwan (o taon) na ang iyong anak nang huminto ka nang pasusohin siya ng sarili mong gatas? ______ buwan/ taong gulang(maaaring magpatuloy sa ikatlong katanungan)

Kung Hindi, maaaring magpatuloy sa ikatlong katanungan.

III. Bakit hindi mo pinasuso ang iyong anak ng sarili mong gatas o bakit mo na naihinto ang pagpapasuso mo sa iyong anak gamit ang sarili mong gatas?

Salik sa Pagpapagatas:( ) May problema ang aking anak sa pagsipsip( ) Nagsusugat o pumuputok ang aking utong( ) Hindi litaw o natabunan ang aking utong( ) Nalalinan o may impeksiyon ang aking utong( ) Sobrang maggatas ang aking suso( ) Masyadong masakit ang magpasuso

Salik sa Kaisipang-Panlipunan:( ) Nakakapagod ang magpagatas gamit ang sariling suso( ) Hindi maginhawa ang magpagatas gamit ang sariling suso( ) Masyado akong maraming gawaing-pambahay( ) Gusto o kailangan kong may ibang mag-alaga/ magpasuso (gamit ang bote) sa aking anak( ) May ibang gustong mag-alaga/ magpasuso (gamit ang bote) sa aking anak( ) Ayaw kong magpasuso (gamit ang sarili kong suso) sa harap ng madla

Salik sa Pagkain (Nutrisyon):( ) Hindi sumasapat ang pagpapasuso ko lamang para sa aking anak( ) Sa tingin ko hindi nagtatamo ng tamang timbang ang aking anak( ) May isang kawani ng kalusugan ang nakapagsabing hindi nagtatamo ng tamang timbang ang aking anak( ) Nahihirapan akong simulang palabasin ang gatas mula sa aking dibdib( ) Wala akong sapat na gatas sa katawan para sa aking sanggol

Salik sa Paraan ng Pamumuhay( ) Ayaw kong magpasuso gamit ang sarili kong gatas( ) Gusto kong kumuha ng diyetang pampapayat( ) Gusto kong bumalik sa dati kong diyeta( ) Gusto kong manigarilyo ulit( ) Gusto kong ibalik ang aking katawan sa aking sarili (gawin ang gustong gawin nang hindi inaalala ang kalusugan ng aking anak).

Salik sa Kalusugan:( ) Nagkasakit ang aking sanggol at hindi siya makasuso mula sa sarili kong gatas( ) Nagkasakit ako at kinailangan kong uminom ng mga gamot( ) Wala ako sa piling ng aking anak sa ilang personal na kadahilanan maliban sa hanap-buhay.( ) Nabuntis ako agad o ginusto kong mabuntis muli

Salik sa Pagbomba ng Gatas:( ) Hindi ko kaya o ayaw kong magbomba ng suso o magpasuso gamit ang sarili kong gatas sa oras ng trabaho( ) Ang pagbubomba ng suso ay hindi ganoon kalaki ang pakinabang para pagsumikapan ito

Salik sa Pag-awat sa Pagsuso sa Ina:( ) Nag-umpisa nang mangagat ang aking anak( ) Nawalan ng gana ang aking anak at nag-umpisa nang iwalay ang sarili sa pagsuso mula sa aking dibdib( ) Malaki at may gulang na ang aking anak

Iba pang dahilan: _____________________________________________________________________________________________________________________________________________________________________________________________________

Salamat sa iyong partisipasyon sa aming pananaliksik!

APPENDIX B

CURRICULUM VITAEContact Information

Name:

Krista Anne B. Esmael

Address:

Ilagan Street, Poblacion West, Santa Ignacia, Tarlac

Telephone:

(02) 7429861

Cellphone:

09223659033

Email:

[email protected]

Personal Information

Date of Birth:

December 20,1986

Place of Birth:

Camiling, Tarlac

Citizenship:

Filipino

Visa Status:

Permanent Resident

Gender:

Female

EducationHigh School

Tarlac College of Agriculture-Laboratory High School (1999-2003)

University

University of Santo Tomas (2003-2007) BS Pharmacy

February- May 2006 Intern, UP- PGH

Graduate School University of Santo Tomas (2007-2011) Doctor of Medicine

Publication

Thesis Paper: Thin Layer Chromatography: Solvent System Development of the Crude Extract from the Dried Seeds of Ipomoea muricata (Linn.) Jacq. (Convolvulaceae)Interests

Sports, movies, music

Affiliations:USTFMS Table Tennis Team

Christian Youth in Action, Tarlac Chapter

Contact Information

Name:

Krista Anne B. Esmael

Address:

Ilagan Street, Poblacion West, Santa Ignacia, Tarlac

Telephone:

(02) 7429861

Cellphone:

09223659033

Email:

[email protected]

Personal Information

Date of Birth:

December 20,1986

Place of Birth:

Camiling, Tarlac

Citizenship:

Filipino

Visa Status:

Permanent Resident

Gender:

Female


Tarlac College of Agriculture-Laboratory High School (1999-2003)

University

University of Santo Tomas (2003-2007) BS Pharmacy

February- May 2006 Intern, UP- PGH


Publication

Thesis Paper: Thin Layer Chromatography: Solvent System Development of the Crude Extract from the Dried Seeds of Ipomoea muricata (Linn.) Jacq. (Convolvulaceae)Interests

Sports, movies, music

Affiliations:USTFMS Table Tennis Team

Christian Youth in Action, Tarlac Chapter

Contact Information

Name:

Harry M. Gabuat

Address:

Zone 2, Brgy. Ayudante, Candon City, Ilocos Sur

Telephone:

(02) 743 0598

Cellphone:

0933 5243538

Email:

[email protected] Information

Date of Birth:

August 29, 1986

Place of Birth:

Bangar, La Union

Citizenship:

Filipino

Visa Status:

Permanent Resident

Gender:

Male


Saint Joseph Institute (1999-2003)

University

University of Santo Tomas (2003-2007) BS Biology


Publication

Thesis Paper: Effect of Gonadotropin on... I forgot the title! Kaloka! to follow

Interests

Sports, video games, movies, computers_____________________________________________________________________

Free and informed consent; questionnare

demographic profile

Target Population(women who stopped breastfeeding before infants 1 year of age)

Documents

Chapter1_4+breastfeeding+thesis