الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Breastfeeding is crucial for sustaining health and wellbeing of children. Breastfeeding is a way of providing ideal food for the healthy growth and development of infants and has a unique biological and emotional influence on the health of both mother and child.. It has been estimated that optimal breastfeeding of children under two years of age has the potential to prevent 1.4 million deaths in under five children in the developing world annually.
In Egypt, Breastfeeding practices are not always optimal; children born at home were twice as likely to have been breastfed within an hour of delivery as children born in a health facility (48 percent and 24 percent, respectively).Moreover, 6 in 10 children were reported to have received a pre lacteal feed after birth. Furthermore, only 4 in 10 children under 6 months of age were being exclusively breastfed, and around 3 in 10 children under 6 months were being bottle fed.
The World Health Organization (WHO) strongly recommends EBF for the first six months of life. At six months, other foods should complement breastfeeding, with breastfeeding continuing for up to two years and beyond. In addition, breastfeeding should begin within an hour of birth; offered to the infant “on demand,” and as often as the child wants day and night; bottles or pacifiers should be avoided.
A few women breastfeed easily from the first day and never have a problem, but many meet challenges. Most women need encouragement and skilled support to continue to breastfeed successfully. There is clear evidence for the effectiveness of professional support on the duration of breastfeeding. It is necessary to determine the level of knowledge among health workers in the healthcare system. It is also necessary to assess the attitude and practices of such health workers towards breastfeeding. This would help proper mobilization and training of the healthcare delivery system to respond to the concerns and growing need for proper infant and young child feeding practices.
The current study aimed to assess the knowledge, attitude and practice of all physicians allocated for providing maternal and child health care in the Family Health Centers in Alexandria regarding breastfeeding motivation. In order to accomplish these aims, a descriptive cross sectional approach was adopted and included all available physicians providing maternal and child health care services working at all the Family Health Centers (FHC) in East health District; Smoha FHC, san Stefano FHC, Elseuf FHC, Danna FHC, Hagar el Nawateya, Abies 2 and Bakose FHC in Alexandria and agreed to participate in the study from February 2015 throughout July 2015.
All physicians in the studied FHC were subjected to predesigned questionnaire to obtain information about socio-demographic characteristics (age, sex, qualification, personal experience of breast feeding for female physicians), attendance of breast feeding training and main source of knowledge about breastfeeding. Moreover, it obtained information to assess knowledge, attitude and practice of physicians regarding breastfeeding motivation.
In the present study, according to sex, 98% of physicians in the current study were females and 2.0% were males. Moreover, as regards age,31.5% of the physicians were <30 years old,40.5% were between 30-50 years old, and 28.0% were >50 years old. In addition, as regards physicians qualification, 32.0% of physicians obtained bachelor degree, 24.5% obtained diploma, 28.5% obtained master degree and 15.0% obtained Egyptian fellowship board of family medicine. Furthermore, 62.0% had personal breastfeeding experience and 55.0% of physicians attended training about breastfeeding. As regards main source of knowledge, 41.0% of the participants reported personal experience of breastfeeding19.0% reported undergraduate training and 33.0% reported general practice experience as a main source of knowledge about breastfeeding.
As regards physicians’ knowledge about breastfeeding, 9.0% of physicians achieved an excellent score of knowledge about breastfeeding (>85%), 19.0% achieved very good (75-<85%), 26.5% achieved a good score (65-<75%), 21.0% of physicians achieved average (60-<65%), and 24.5% achieved poor score of knowledge (<60%). The percent score of knowledge of physicians about breastfeeding in the current study ranged from (45.0 – 95.0). The mean percent score of knowledge about breastfeed was (66.38 ± 11.65%).
Moreover, physiology and nutritional value of breastfeeding, about 81.5% of physicians knew that prolactin reflex is important reflex for breast milk production and 77.5% knew that letdown reflex is important for milk ejection. In addition, 70% of physicians, 75.5% knew that colostrum secreted during first 3-5 days after labor, 76.0% knew that colostrum has low content of carbohydrates compared to mature milk and 71% knew that lactoferrin is the principal protein in human milk. Moreover, more than 90% of physicians knew that iron content in human milk is sufficient for infant during first 6 month, lactation decreases the risk of ovarian and breast cancer and that 2 years is the appropriate duration of breastfeeding.
Furthermore, about 85% of physicians knew that there is unrestricted duration of each feed, initiation of skin to skin contact between mother and baby should be immediately, and that breastfeeding should be on demand, breastfeeding returns the body to pre pregnancy weight. Moreover, about 63% of physicians knew that lactoferrin, lysosomes and bifidus factor are immunological factors in the breastmilk. Furthermore, more than 53% knew that Lactoferrin important for inhibition of growth of staphylococcus and E coli, IgA is the principal immunoglobulins in human milk, and that nose touching the breast isn’t one of signs of effective latch.
On the other hand, only 39.0% and 27% of physicians knew importance of bifidus factor in growth of intestinal mucosa and knew that galactosaemia is one of the absolute contraindications of breastfeeding. Moreover, only 20.5% knew that having confidence to deal with breastfeeding problems not one of the ten steps of successful breastfeeding.
In the current study, female physicians had significantly higher mean percent score of knowledge about breastfeeding compared with male physicians. Moreover, physicians aged between (30-50) years old had significantly higher mean percent score compared with physicians aged (<30) years old and physicians aged (>50) years old. Furthermore, physicians achieved master degree had significantly higher mean percent score of knowledge about breastfeeding than physicians achieved bachelor degree. Moreover, physicians achieved Egyptian fellowship board of family medicine had significantly higher mean percent score than physicians achieved bachelor degree.
In addition, physicians who reported personal experience of breastfeeding had significantly higher mean percent score of knowledge about breastfeeding than physicians without personal experience of breastfeeding. Finally, trained physicians had significantly higher mean percent score of knowledge about breastfeeding than the mean percent score of knowledge about breastfeeding of untrained physicians.
As regards physicians’ attitude towards breastfeeding promotion, about 97.5% of physicians had positive attitude (≥60%) and 2.5% had neutral attitude (40-<60%).The percent score of attitude of physicians towards breastfeeding ranged from (56.8-100.0).The mean percent score was 92.1±7.8%.
in the current study, all the physicians agreed that breastfeeding is a part of primary health care physicians role, the benefits of breastfeeding overweigh any difficulties mother may encountered, and that exclusive breastfeeding is the most beneficial form of infant feeding for the first 6 month of life. Moreover, 98.5% of physicians agreed that the presence of written policy in health care services and control of formula milk marketing help in breastfeeding promotion.
Furthermore, 99.5% of physicians disagreed to stop breastfeeding during jaundice. Moreover, about 95% of physicians disagreed to prescribe milk formula and medications freely to any lactating woman. Additionally, 97% disagreed with that first feed should be water or glucose to test gut patency. In addition, about 96.0% disagreed with stopping breastfeeding during pregnancy. Furthermore, 87.5 of physicians disagreed that formula feeding is preferable to working mothers.
In the current study, there was no statistical significant difference in the mean percent score of attitude towards breastfeeding between males and females. On the other hand, physicians aged <30 old had significantly lower mean percent score of attitude towards breastfeeding compared with physicians aged 30-50 and physicians 50 years old. Moreover, physicians achieved bachelor degree had significantly lower mean percent score of attitude compared with physicians achieved diploma, master and Egyptian fellowship board of family medicine.
In addition, physicians who reported personal experience of breastfeeding had significantly higher mean percent score of attitude towards breastfeeding compared with physicians without personal experience of breastfeeding. Furthermore, trained physicians had significantly higher mean percent score of attitude towards breastfeeding compared with the mean percent score of untrained physicians. Finally, Physicians who reported personal experience in breastfeeding as a main source of knowledge had significantly higher mean percent score of attitude compared with physicians who reported undergraduate training as a main source of knowledge .
As regards physicians’ practice of breastfeeding promotion, In the present study, 12.0% of physicians achieved an excellent level (>85%), 15.5 % achieved very good (75-<85%), 19.0% achieved good (65-<75%.), 22.0% of physicians achieved average(60-<65%) and 31.5 % of physicians achieved poor level of practice (<60%). The percent score of practice of physicians about breastfeeding in the current study ranged from (0.9– 100.0). The mean percent score was 65.28 ± 18.22%.
in the current study, about 88.0% of physicians advised to continue breastfeeding during child gastroenteritis. Moreover, 80.5% of physicians helped mothers about correct positioning and attachment. Additionally, about 65.0% of physicians considered antenatal care the most effective period of providing information about breastfeeding to mothers, treated non protractile nipple by massage and drawing up nipple by the thump and the opposite finger, treated breast engorgement by hand expression of breast and frequent suckling and advised to continue breastfeeding during unilateral mastitis.
Furthermore, more than 60.0%of physicians advised to give expressed breast milk to preterm and cleft palate infant and advised application of hind milk after each feed to treat painful cracked nipple. On the other hand only 47.5% and 50.5% of physicians advised mother to continue breast feeding in case of inadequate milk secretion and considered proper positioning and attachment prevent cracked nipple.
In the current study, female physicians had statistically higher mean percent score of practice regarding breastfeeding promotion compared with male physicians. According to age, physicians aged <30 old had significantly lower mean percent score of practice regarding breastfeeding compared with physicians aged 30-50 and physicians 50 years old. Moreover, physicians achieved bachelor degree had significantly lower mean percent score of practice regarding breastfeeding promotion compared with physicians achieved diploma, master and Egyptian fellowship board of family medicine and additionally, physicians who reported personal experience of breastfeeding had significantly higher mean percent score of practice regarding breastfeeding promotion compared with physicians without personal experience of breastfeeding.
Moreover, trained physicians had significantly higher mean percent score of practice about breastfeeding compared with mean percent score of untrained physicians. Furthermore, Physicians who reported personal undergraduate training about breastfeeding as a main source of knowledge had significantly lower mean percent score of practice compared with physicians who reported personal experience of breastfeeding and general practice as a main source of knowledge.
In the current study, there was a significant positive weak correlation between knowledge percent score and practice percent (r=0.25, p=0.00).Moreover, There was a significant positive weak correlation between knowledge percent score and attitude percent score (r=0.23,p=0.00).Additionally, there was significant positive weak correlation between practice percent score and attitude percent score (r=0.25,p=0.00).