การวิเคราะห์ข้อมูล data analysis•perceived benefits of feeding...
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Researchers
Krisda Jitrakbumrung Chatdanai Thanarungsimund
Aksornanong Tangthong
5th Medical students Faculty of Medicine, Naresuan University
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“Breastfeeding is the healthiest way to feed the babies”
http://birthbootcamp.com/wp-content/uploads/2012/11/breastfeeding-photo.jpg
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What are the consequences of long-term formula feeding?
http://www.slate.com/blogs/expecting_better.html
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Increase risk of respiratory tract infections and gastrointestinal tract infections
http://khebert.blogspot.com/2011_09_01_archive.html
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Malnutrition
http://www.trust.org/slideshow/?id=ad97eede-e596-4ddd-9a92-d266d4efa607
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Never or less than 6-month breastfeeding increase risk of ALL, HL
http://www.cancer.org/cancer/cancerinchildren/
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Breastfeeding rates currently do not reflect this recommendation
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Questions ???
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Questions ???
• Who have an influence on decision making about infant feeding? • What are differences in Thai culture affecting infant feeding? • Why the mothers who have good knowledge in breastfeeding
didn’t succeed exclusive breastfeeding? • Previously maternal breastfeeding experience is important for
successfully exclusive breastfeeding, isn’t it? • Can the psychological stress reduce quantity of breast milk? • Medical staffs can support exclusively breastfeeding, can’t them?
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Problems and barriers to exclusive breastfeeding in
the first 6 months postpartum
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Design
• A grounded theory qualitative research
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Methods • A total of 21 mothers were purposively selected from
– well-baby clinic
– pediatric clinic
– lactation clinic
at Naresuan University Hospital who came to the clinic between 14-24 January 2014
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Methods • Data were collected through
– in-depth interviews
– non-participant observation
– field note taking
– analyzed by using content analysis
– data verification
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Main findings
http://planning.croydon.gov.uk/DocOnline/69962_3.pdf
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1. Familial, social, and cultural influences
http://www.matichon.co.th/online/2013/06/13717214081371721629l.jpg
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2. Maternal barriers
http://board.postjung.com/data/694/694598-topic-ix-12.jpg
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3. Infant barriers
http://www.momypedia.com/file_manager/mmpd/wiki_0_1/59_3.jpg
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4. Medical staff barriers
http://www.munjeed.com/image_news/2013-05-16/image_165201380223.jpg
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http://www.matichon.co.th/online/2013/06/13717214081371721629l.jpg
1. Familial, social, and cultural influences
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• giving other food or drink other than breastfeeding – Family members' opinion have an influence on maternal
decision making about infant feeding.
–Many reasons to support their suggestion such as • Higher vitamin
• Rapid infant growth
• Previous child care experience
• More satiety
• Time for relaxation
1. Familial, social, and cultural influences
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• giving other food or drink other than breastfeeding – The relatives’ reasons for giving water to the infant such as
• Making cornea more transparent
(บทสัมภาษณ์: ช่วยท าใหน้ัยน์ตาใส)
• Preventing infant from jaundice
• Washing the babies’ mouth
• Breast milk cannot substitute of water
• Previous child care experience
1. Familial, social, and cultural influences
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• perceived benefits of feeding formula – The relatives’ reasons for giving infant formula such as
• Inadequate milk supply
• Breast milk becomes low quality while infant gradually grows
• Expressed breast milk and method of their storage aren’t reliable, It becomes low quality.
• Infant formulas have higher nutrient
• Previous child care experience
1. Familial, social, and cultural influences
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• perceived benefits of feeding formula
“เค้า(ทวด)คิดว่านมผงอ่ะดีกว่าอยู่แล้ว นมเราแช่ตู้เย็นมันก็เสีย ท าให้เด็กท้องเสีย คิดว่ามันไม่มีประโยชน์ พี่เก็บสต๊อกไว้ เค้า(ทวด)ก็เอาทิ้งหมดเลย แม่สามีด้วยอะไรด้วย เอา(นมแม่ที่บีบเก็บ)ไปหมดเลย จนพี่ก็ต้องเอานม(แม่)ไปไว้บ้านแม่พี่ แล้วก็แอบเอามาให้กินด้วยคู่กับนมผสม”
มารดา 32 ปี บุตรคนที ่1 รบัราชการ/พนกังานรฐัวสิาหกจิ
1. Familial, social, and cultural influences
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http://board.postjung.com/data/694/694598-topic-ix-12.jpg
2. Maternal barriers
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2. Maternal barriers • Perception of inadequate milk supply
• Unable to maintain sufficient breast milk for 6 months
• Need to return to work
• Sore nipple
• Problems with latch
• Psychological stress
• Using certain medications during lactation
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2. Maternal barriers • Perception of inadequate milk supply and unable
to maintain sufficient breast milk for 6 months
“พี(่คนรู้จักของมารดา)ก็ไม่มีนมเหมือนกัน นี่ก็เลี้ยงนมกระป๋องมาตั้งแต่เกิดเหมือนกัน เนี่ยซน เรา(มารดา)ก็เบาใจไดร้ะดับนึงหน่ะ ว่ามัน(การเลี้ยงลูกด้วยนมผสม)ก็คงได้ในระดับนึง ไม่ถึงกับแย่หรอก”
มารดา 41 ปี บุตรคนที่ 1 นักธุรกิจ/เจ้าของกิจการ
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2. Maternal barriers • Mothers need to return to work and unable to
express breast milk for infant
“อาจจะด้วยสถานที่ด้วย เวลาด้วยมันไม่พร้อมตอนไปท างาน บางทีเราต้องไปแช่ตู้เย็น ที่ท างานเราอาจไม่มีตู้เย็นให้แช่ แล้วก็เกรงใจเจ้านายด้วย หัวหน้างานด้วยอะไรด้วย แล้วก็อาจจะต้องใช้นมขวดนั่นแหละ เพราะเราไม่มีเวลา”
มารดา 34 ปี บุตรคนที่ 2 แม่บ้าน
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2. Maternal barriers • Problems with latch of infant or maternal nipple
“เป็นคนที่มีหัวนมสั้น น้องก็จะดูดไม่ได้ น้องจะงับไม่ถึง ก็เริ่มถอดใจ ว่าลูกจะกินได้ไหม แต่พี่ก็พยายามบังคับเขาต้องดูด เขาก็ดูด แล้วพี่ก็มีปัญหาว่าหัวนมมันแตก แล้วทีนี้เจ็บพี่ก็เลยเลิกให้เขาดูดจากอกพ่ี”
มารดา 27 ปี บุตรคนที่ 2 รับราชการ/พนักงานรัฐวิสาหกิจ
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http://www.momypedia.com/file_manager/mmpd/wiki_0_1/59_3.jpg
3. Infant barriers
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• maternal concern of infant growth
• refusal to breastfeed
• jaundice from not-enough breastfeeding
3. Infant barriers
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Maternal concern of infant growth
• compared infant’s weight or height with formula-fed infants
https://edc2.healthtap.com/ht-staging/user_answer/reference_image/2114/large/Height.jpeg?1386670392
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refusal to breastfeed
– inadequate milk supply of any causes solved by bottle-feeding with a pacifier, leading infant always need a pacifier.
http://www.bebelu.ro/wp-content/uploads/2013/09/gty_pacifier_mi_130503_wblog.jpg
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Jaundice from not-enough breastfeeding
• Suggestion from former belief
• Excessive concern can cause negative attitudes towards breastfeeding
http://www.newborn-baby-care.com/wp-content/uploads/2014/02/Baby_Under_Phototherapy.jpg
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4. Medical staff barriers
http://www.munjeed.com/image_news/2013-05-16/image_165201380223.jpg
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4. Medical staff barriers • giving in-hospital formula supplementation
• incorrect and insufficient information about breastfeeding
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4. Medical staff barriers • giving in-hospital formula supplementation
– One mother concern was that giving in-hospital formula supplementation may cause failure in exclusive breastfeeding
• incorrect and insufficient information about breastfeeding – Some medical staffs suggest other food supplementation for infant
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Conclusion and recommendations
• Parents, family members, and child care workers must perceive the risks of using an infant formula instead of breastfeeding.
• Medical staffs should support initiation and continuation of breastfeeding until the day of hospital discharge.
• The hospital guidelines for the use of supplementary feedings are needed to be revised.
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Advisors
Daranee Sirichaisutdhikorn, M.D
Department of Obstetrics and Gynecology
Faculty of Medicine, Naresuan University
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Advisors
Col. Tawesak Nopkesorn, M.D
Department of Community Medicine,
Faculty of Medicine, Naresuan University
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Full paper Contact us: [email protected]
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THANKS YOU FOR YOUR ATTENTION