Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

Effect of care intervention with a health education form for breastfeeding on breast distension,pain,and lactation in postpartum mothers

BACKGROUND Breastfeeding not only meets the nutritional needs of newborn growth and development but also promotes uterine contraction and discharge of lochia,which helps in maternal recovery.However,some mothers experience abnormal lactation and breast swelling due to a lack of breastfeeding knowledge,painful cesarean incisions,anesthesia,negative emotions,and other factors,resulting in a reduced breastfeeding rate,which adversely affects neonatal and maternal health.AIM To explore the effects of care intervention with a health education form for breastfeeding on breastfeeding-related conditions.METHODS In this study,207 mothers with postpartum breast pain and difficulty lactating were selected and divided into intervention and control groups using a random number table.Both groups of mothers were provided with basic nursing and related treatment measures after delivery.The intervention group additionally received care intervention with a health education form for breastfeeding.The scores of lactation volume,breast distension and pain,breastfeeding rate,breastfeeding self-efficacy,treatment effect,and complication rate of the two groups were compared.RESULTS After treatment,the breast pain score of the intervention group was significantly lower than that of the control group,while the lactation score,score of Breastfeeding Self-Efficacy Scale Short Form scale,parent-child communication score,maternal-infant interaction score,total score of maternal-infant communication,and breastfeeding rate of the intervention group were significantly higher than those of the control group.After intervention,the overall therapeutic effect of the intervention group was better than that of the control group,and the complication rate of the intervention group was lower than that of the control group.CONCLUSION Breastfeeding health education and nursing intervention combined with basic clinical treatment have good clinical effects in managing postpartum breast distension and pain and increasing lactation yield.

Exclusive breastfeeding greater than 50%, success of education in a university hospital in Bogotá: Case-control study

BACKGROUND Maintenance rates of exclusive breastfeeding(EBF)worldwide are low,thus,one of the objectives of the summary of policies on breastfeeding(BF)in world nutrition goals for 2025 are that at least 50%of infants under six months of age receive EBF that year.The Objective of this study is to document the rates of EBF in children born in San Ignacio University Hospital(HUSI)and identify factors associated with maintenance.AIM To document the percentages of EBF in those that were born at HUSI and identify factors associated to their maintenance.METHODS This is a study of cases and controls in an analytic,retrospective cohort that took children born alive between January 2016 and January 2019 at HUSI located in the city of Bogotá,Colombia.RESULTS Receiving information about BF at HUSI was able to maintain EBF up until 4 mo(OR=1.65;95%CI:1.02-2.66).The presence of gynecologic and obstetric comorbidities(OR=0.32;95%CI:0.12-0.83),having mastitis(OR=0.56;95%CI:0.33-0.94),and receiving information from mass media(OR=0.52;95%CI:0.31-0.84)are factors associated with not maintaining EBF.CONCLUSION Receiving education at a Women-and Child-Friendly Institution was the only significant factor to achieve EBF until 4 mo,with a frequency greater than the one reported in the country,which matches multiple studies where counseling and individualized support on BF achieve this purpose.Knowledge about BF and early detection of obstetric/gynecologic complications must be strengthened among the healthcare staff in charge of mothers during post-partum.Additionally,strategies must be promoted to continue BF such as creating milk banks with the objective of increasing BF rates even when mothers return to work.

Effect and Value of Quality Nursing Intervention in Breastfeeding after Cesarean Section among Primigravid Women

Objective:To analyze the effect of using quality nursing care for primigravid women undergoing cesarean delivery.Methods:A total of 80 cases of primigravid women undergoing cesarean section from June 2022 to June 2023 were randomly selected.They were divided into two groups:Group A(40 cases)received routine care and Group B(40 cases)received quality care.The division was done using a computerized randomization method.The effects of the nursing care received in the two groups were compared.Conclusion:Quality nursing care for primigravid women undergoing cesarean section can enhance breastfeeding rates,alleviate maternal anxiety,improve feeding practices,and enhance breastfeeding self-efficacy.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

Factors influencing self-efficacy in breastfeeding support among public health nurses in Japan

This study investigated self-efficacy in breastfeeding support among public health nurses (PHNs) working at maternal and child health (MCH) services in Japanese municipalities, and its related factors such as education, working experience, breastfeeding experience, and postgraduate/continuous education. Directors of the MCH divisions were requested to select one PHN to answer the self-report questionnaires sent. The questionnaires were collected from October 2010 to January 2011. Of the 1750 questionnaires sent, 831 were returned (response rate: 47.5%);102 were excluded from analysis because of missing data (valid response rate: 41.7%). After adjusting the weights of PHN sampling and collection rates by prefecture and population size, Model 1 of the multiple regression analysis showed that the self-efficacy in breastfeeding support was significantly higher in large/urban municipalities (β = 0.13) and in the Kanto district. Model 2 revealed that self-efficacy was significantly associated with working experience (β = 0.13) and breastfeeding experience (β = 0.22) but not with educational background. Model 3 showed that self-efficacy was significantly associated with postgraduate education (β = 0.14) and continuous education (β = 0.12). This suggested that PHNs’ self-efficacy increased through self-enrichment. It is necessary to create training opportunities about breastfeeding support for PHNs—especially those working in remote and/or small municipalities— and to provide them with new and important information.

Association of Breastfeeding Duration with Body Composition in Children Aged 3–5 Years

Objective This study aimed to assess the relationship between the body composition of children aged 3–5 years and breastfeeding status and duration.Methods The study was conducted using data from the National Nutrition and Health Systematic Survey for children 0–17 years of age in China(CNHSC),a nationwide cross-sectional study.Breastfeeding information and potential confounders were collected using standardized questionnaires administered through face-to-face interviews.The body composition of preschool children was measured using bioelectrical impedance analysis.A multivariate linear regression model was used to assess the relationship between breastfeeding duration and body composition after adjusting for potential confounders.Results In total,2,008 participants were included in the study.Of these,89.2%were ever breastfed and the median duration of breastfeeding was 12 months(IQR 7–15 months).Among children aged 3 years,the height-for-age Z-score(HAZ)for the ever breastfed group was lower than that for never breastfed group(0.12 vs.0.42,P=0.043).In addition,the weight-for-age Z-score(WAZ)of the ever breastfed group was lower than that of the never breastfed group(0.31 vs.0.65,P=0.026),and the WAZ was lower in children aged 4 years who breastfed between 12 and 23 months than in those who never breastfed.Compared to the formula-fed children,the fat-free mass of breastfed infants was higher for children aged 3 years(12.84 kg vs.12.52 kg,P=0.015)and lower for those aged 4 years(14.31 kg vs.14.64 kg,P=0.048),but no difference was detected for children aged 5 years(16.40 kg vs.16.42 kg,P=0.910)after adjusting for potential confounders.No significant difference was detected in the weight-for-height Z-score(WHZ),body mass index(BMI)-for-age Z-score(BAZ),fat-free mass index,and body fat indicators in the ever breastfed and never breastfed groups and among various breastfeeding duration groups for children aged 3–5 years.Conclusion No obvious associations were detected between breastfeeding duration,BMI,and fat mass indicators.Future prospective studies should explore the relationship between breastfeeding status and fat-free mass.

Determinants of Breastfeeding Practices among Working Mothers in Solwezi District of Zambia

Background: As one of the strategies to reduce infant morbidity and mortality, the World Health Organization recommends early initiation of exclusive breastfeeding and timely introduction of complementary feeding with continued breastfeeding for up to two years or beyond. Although breastfeeding is a natural process, it is influenced by different socio-cultural factors, habits, standards, and behaviours. Rapid industrialization and changes in lifestyle have seen increasing numbers of women in the labour force, and associated poor Exclusive Breastfeeding practices among working mothers. The aim of this study was to identify the determinants of breastfeeding practices among working mothers in Solwezi District of Zambia. Methods: This was a cross-sectional comparative survey comparing determinants of breastfeeding practices among working mothers aged 15 - 49 years in urban and rural areas of Solwezi District. The study was carried out in the Under-five Clinics at Solwezi, Kimasala and Mushitala Urban Clinics, as well as St. Francis, Kapijimpanga and Kisalala Rural Health Centers. Eighty-seven participants were successfully recruited using convenience sampling. A researcher-assisted questionnaire was used to collect data. Data analysis was done using SPSS version 27.0. Descriptive statistical analysis was done using numerical measures such as measures of central tendency and dispersion. The Pearson Chi Square test, correlation and linear regression analysis were performed to test association between the variables at the 0.05 level of significance. Are you assessing exclusive breastfeeding alone or what? Results: The mean age of respondents was 27.44 years (SD = 6.042 years) and the majority of the respondents were married (71.3%, n = 62). Forty-three percent of the respondents were self-employed while the rest were in formal government or private sector employment. Overall, 97.7% of the respondents had heard of exclusive breastfeeding, with health facilities being the most frequent source of information (64.4%). Attitude towards exclusive breastfeeding was generally positive. Fifty-eight percent of respondents exclusively breastfed while the rest were on mixed feeding. Seventy-one percent of respondents reported that their workplaces did not have breastfeeding facilities at work. Only 11.5% of the respondents reported having cultural beliefs restricting breastfeeding. Statistically significant associations were obtained from cross-tabulation analysis between respondent’s occupation and baby feeding type (p 0.001);workload and feeding type (0.024);as well as knowledge of EBF and feeding type (p 0.001). Conclusion: Majority of the respondents demonstrated good knowledge and positive attitude towards exclusive breastfeeding. This study recommends sensitization campaigns in communities to raise awareness about the importance of breastfeeding, and foster behaviour change that promotes breastfeeding.

Enhancing the role of nurses in breastfeeding preterm infants

The provision of breast milk and breastfeeding is recommended for preterm infants.Multidisciplinary cooperation is required to promote breastfeeding.Nurses play impor tant roles in breastfeeding preterm infants.First,nurses are strong advocates to help families be aware of the significance of breastfeeding.Second,nurses are educators providing technical and emotional support to pregnant and lying-in women.Third,nurses are coordinators in a multidisciplinary team.Nurses’unawareness of the impor tance of breastfeeding,knowledge deficit,and unsupportive lactation policy are barriers to breastfeeding promotion for preterm infants.It is therefore suggested that hospital administrators provide appropriate breastfeeding policies,set up posts,and ensure nurses’responsibilities in breastfeeding.Additionally,tailored training should be strengthened to improve nurses’knowledge and skills and thereby enable them to fully exer t their roles in the breastfeeding promotion of preterm infants.

Infertility,pregnancy and breastfeeding in kidney transplantation recipients:Key issues

Chronic kidney disease(CKD),especially in advanced stages,is an important cause of infertility.In CKD patients,infertility has been linked to multiple factors.The pathophysiology of infertility related to CKD is complex and forked.Correction of modifiable factors can improve fertility in both genders.In males as well as females,successful kidney transplantation offers good chances of restoration of reproductive function.In female renal allograft recipients,recovery of reproductive functions in the post-transplant period will manifest as restoration of normal menses and ovulation.Owing to this improvement,there is a significant risk of unplanned pregnancy,hence the need to discuss methods of contraception before transplantation.In kidney transplant recipients,different contraceptive options for pregnancy planning,have been used.The selection of one contraception over another is based on preference and tolerability.Pregnancy,in renal transplanted females,is associated with physiologic changes that occur in pregnant women with native kidneys.Immunosuppressive medications during pregnancy,in a recipient with a single functioning kidney,expose the mother and fetus to unwanted complications.Some immunosuppressive drugs are contraindicated during pregnancy.Immunosuppressive medications should be discussed with renal transplant recipients who are planning to breastfeed their babies.In addition to antirejection drugs,other medications should be managed accordingly,whenever pregnancy is planned.

Research Progress on Self-Efficacy Level of Patients with Type 2 Diabetes Mellitus and Its Influencing Factors

Self-efficacy plays an important role in the management of type 2 diabetes mellitus (T2DM) patients, and it runs through the whole process of diabetes treatment, which is conducive to controlling and delaying the occurrence and development of complications, as well as improving the quality of life of patients. This paper mainly describes the concept of self-efficacy, the current situation of self-efficacy of diabetic patients at home and abroad, the functional aspects and their influencing factors, so as to take relevant measures on how to improve self-efficacy. It aims to provide a theoretical basis for the development of self-efficacy interventions for patients with type 2 diabetes mellitus.

The Impact of Simulation Education on Self-Efficacy in Pre-Registration Nursing Students

This literature review primarily aims to explore and synthesise the previous studies in simulation education research conducted over the past five years related to the effects of simulation training on the self-efficacy of undergraduate pre-registration nursing students. The second aim of this study is to explore additional outcome variables that were examined in the previous studies. Five electronic databases were searched systematically. These databases were MEDLINE, CINAHL Plus, Scopus, Embase and PsycINFO. The PICO model was employed to identify the search terms, with a thesaurus being used to provide synonyms. Reference lists of relevant articles were examined and hand searches of journals were also undertaken. The quality of each study was assessed using the Simulation Research Rubric (SRR). A total of 11 studies were included. All studies explored the impact of simulation education on undergraduate pre-registration nursing. Six studies explored nursing students’ competence and performance and two papers examined their critical thinking. Problem solving, learning motivation, communication skills and knowledge acquisition were examined once. The majority of studies indicated that simulation training has a positive impact on pre-registration nursing students’ self-efficacy and other outcome variables. Furthermore, the study results indicate that simulation training is more dependable than traditional training, and students were extremely satisfied with the simulation training. However, most of the studies included in this review had several gaps, including study design, sample size and dissimilarities between the scales used. Further research with large samples, reliable and valid instruments, and outcomes measures (such as critical thinking and transferability of skills) is required to provide better insight into the effectiveness of simulation in undergraduate nursing education. .

Examining the Interplay between Trait Mindfulness and Thriving at Work among Teachers in Western China:The Mediating Role of General Self-Efficacy

This study explores the nuanced relationship between trait mindfulness and thriving at work among educators in Western China,emphasizing the mediating role of general self-efficacy.Employing a sample of 378 primary and secondary school teachers,this research utilizes the Five Facet Mindfulness Questionnaire(FFMQ),Thriving at Work Scale(TWS),and the General Self-Efficacy Scale(GSES)to conduct a thorough investigation.The findings indicate a significant positive correlation between trait mindfulness and thriving at work,between trait mindfulness and general self-efficacy,and between general self-efficacy and thriving at work.Additionally,trait mindfulness was found to have a positive predictive effect on both thriving at work and general self-efficacy,with general self-efficacy also showing a positive predictive effect on thriving at work.Importantly,general self-efficacy was identified as playing a partial mediating role in the relationship between trait mindfulness and thriving at work.These results underscore the importance of cultivating mindfulness and self-efficacy among teachers to enhance their enthusiasm for work,suggesting potential pathways for professional development and well-being in the educational sector.

Translation and psychometric validation of the Korean version of the academic nurse self-efficacy scale for Korean bachelor-level nursing students

Objective:This study aimed to translate the Academic Nurse Self-Efficacy scale(ANSE),assess its appropriateness for use in Korean nursing students,and evaluate the Korean Version of the Academic Nurse Self-Efficacy scale’s(K-ANSE)validity and reliability.Methods:The data of 444 nursing college students at 10 universities across the country were collected from November 1,2020 to June 8,2021.The K-ANSE was analyzed utilizing SPSS 25.0 and AMOS 25.0 programs.The K-ANSE’s content validity,construct validity,convergent/discriminant validity,criterion-related validity,and reliability were evaluated.Results:Internal emotion management,auto-regulatory behavior,external emotion management,and sociality were established.The Cronbach’sαfor the overall scale was 0.87,and that of the 4 subscales ranged from 0.70 to 0.89.Conclusions:The Korean version of the ANSE seems to be a valid and reliable instrument to measure Korean bachelor-level nursing students.

Breastfeeding and chronic HBV infection: Clinical and social implications

Mother-to-child transmission of hepatitis B virus (HBV) is among the most important causes of chronic HBV infection and is the commonest mode of transmission worldwide. Currently, the presence of HBsAg, HBeAg and HBV DNA in breast milk is confirmed. Several studies have reported that breastfeeding carries no additional risk that might lead to vertical transmission. Beyond some limitations, the surveys have not demonstrated any differences in HBV transmission rate regarding feeding practices in early childhood. Promotion of breastfeeding is substantial, especially for low-income individuals and regions with uncertain, unfeasible, and unsafe water supplies. Lactoferrin, minimal inflammation or activation within the infant gut during exclusive breastfeeding, and nonspecific biological molecules in the milk are identified as major factors of breast-milk defense. This review discusses preemptive antiviral therapy during pregnancy and lactation. Long-term follow up of breast-milk HBV concentrations and correlation with serum viral load; nucleos(t)ide analogue concentrations in breast milk in HBV-positive mothers in the setting of chronic HBV infection; safety of antiviral therapy during pregnancy and lactation; and the difference in viral load in the milk in exclusive or non-exclusive breastfeeding are still open questions. The paper reviews the current data and outlines the course of further investigation into this often underestimated issue.

Possible ameliorative effect of breastfeeding and the uptake of human colostrum against coeliac disease in autistic rats

AIM: To examine the possible ameliorative effect of breastfeeding and the uptake of human colostrum against coeliac disease in autistic rats. METHODS: Female rats were fed a standard diet and received a single intraperitoneal injection of 600 mg/kg sodium valproate on day 12.5 after conception. In study 1, neonatal rats were randomly subjected to blood tests to investigate autism. In study 2, the 1st group was fed by the mother after an injection of interferon-γ (IFN-γ) and administration of gliadin. The pups in the 2nd group were prevented from accessing maternal milk, injected IFN-γ, administered gliadin, and hand-fed human colostrum. The normal littermates fed by the table mothers were injected with physiological saline and served as normal controls in this study.RESULTS: The protein concentration was higher in group 2 than in group 1 in the duodenum (161.6 ± 9 and 135.4 ± 7 mg/g of tissue, respectively, P < 0.01). A significant increase (P < 0.001) in body weight was detected in human colostrum-treated pups on post natal day (PND) 7 and 21 vs suckling pups in group 1. A delay in eye opening was noticed in the treated rats in group 1 on PND 13 compared with the control group and group 2. Administration of a single intraperitoneal injection of 600 mg/kg sodium valproate on day 12.5 after conception resulted in significantly reduced calcium and vitamin D levels in study 1 compared with the control groups (P < 0.001). However, human colostrum uptake inhibited increases in the level of transglutaminase antibody in autistic pups with coeliac disease. CONCLUSION: The effects of early-life nutrition and human colostrum on the functional maturation of the duodenal villi in autistic rats with coeliac disease that might limit or prevent the coeliac risk with autism.

Factors affecting breastfeeding duration in Greece:What is important?

AIM:To investigate factors associated with breastfeeding duration(BD) in a sample of mothers living in Greece.METHODS:Four hundred and twenty-eight mothers(438 infants) were initially recruited in a tertiary University Hospital.Monthly telephone interviews(1665in total) using a structured questionnaire(one for each infant) were conducted until the sixth postpartum month.Cox regression analysis was used to assess factors influencing any BD.RESULTS:Any breastfeeding rates in the first,third,and sixth month of the infant's life reached 87.5%,57.0%and 38.75%,respectively.In the multivariate analysis,maternal smoking in the lactation period[hazard-ratio(HR) = 4.20]and psychological status(HR = 1.72),and the introduction of a pacifier(HR =2.08),were inversely associated,while higher maternal education(HR_(university/college vs primary/high school) = 0.53,HR_(master's vs primary/high school) = 0.20),and being an immigrant(HR = 0.35) were positively associated with BD.CONCLUSION:Public health interventions should focus on campaigns against smoking during lactation,target women of lower educational status,and endorse the delayed introduction of pacifiers.

Teaching New Mothers about Infant Feeding Cues May Increase Breastfeeding Duration

The objective of this pilot study was to compare two different methods of educating prenatal women regarding breast-feeding. Comparisons were made between traditional and innovative methods to determine which was more effective in increasing breastfeeding duration. Over a 32 month period, 197 prenatal women were assigned to either a control (C, n = 139) or an experimental (E, n = 51) group. The C group received standard breastfeeding education, while the E group received standard education in addition to information about infant hunger cues. Cox Regression and Kap-lan- Meier analysis were performed. Estimated mean number of weeks for C and E groups to continue breastfeeding was 14.3 + 17.4 weeks and 18.5 + 17.1 weeks, respectively. At 26 weeks, duration of breastfeeding approached significance (chi square = 2.907, df = 1, p = 0.088), indicating probability of continuing to breastfeed was about 28% better for those in E group when compared to C group. Duration of breastfeeding may increase when prenatal women are taught to identify infant behavior such as hunger cues.

Breastfeeding and risk of parasitic infection-a review

Breastfeeding,as exclusive nutrition in the first six months of life,is a necessary nutritional requisite in infants.Except for very few maternal diseases that contraindicate breastfeeding,some of which still controversial,breastfeeding mothers must continue exclusive and sustained lactation to provide maximum overall benefits through breastfeeding.Parasitic infections is a global disease and children remain a significant proportion of the affected population.The complex and mandatory life cycles of some parasites,particularly the helminths may partly explain their geographical distribution.The world-wide prevalence of parasitic infections as well as the largely asymptomatic nature of most infections,make many of these infections to likely remain under-recognized.Breast milk,the prime infant nutrition must be recognized to be more than a rare vehicle of parasite transmission,but also a general and focused immune defensive tool against some important parasites.The possibility and influence of small quantities of parasite antigens in breast milk have not been adequately explored.It is believed that useful immunological responses both direct and indirect in breast milk that occur due to the presence of parasite antigens,must be further studied in the light of both immediate and long term benefits.Within this context,and prompted by a spectrum of existing uncertainties,researched and hypothetical roles of parasites and associated immunological responses in the lactating mammary gland are proposed and reviewed.

Practice environment related barriers to exclusive breastfeeding among HIV-positive mothers in Blantyre, Malawi

Rates of exclusive breastfeeding in Malawi remain low despite the acknowledged benefits of exclusive breastfeeding for the infant’s wellbeing and the prevention of mother-to-child transmission of HIV. Creating an environment supportive of exclusive breastfeeding is critical to increase the rate of exclusive breastfeeding among HIV-positive mothers. However, little is known on factors that influence the environment within which HIV-positive mothers in Malawi practise exclusive breastfeeding. Therefore, the exploratory qualitative study on which this article is based was conducted at the Chatinkha maternity unit of Queen Elizabeth Central Hospital in Malawi from April 16, 2009 to May 8, 2009 to explore perceived practice environment related barriers to exclusive breastfeeding among HIV-positive mothers. Data were obtained through indepth interviews with 16 purposively selected breastfeeding HIV-positive mothers between 18 and 35 years old and two focus group discussions with women of unknown HIV status. Semi-structured interview and focus group guides were utilised. Content analysis of data was done. Five main themes emerged regarding factors that may influence the environment within which exclusive breastfeeding was practised: 1) availability of resources;2) societal norms and cultural practices;3) mother-baby proximity;4) health workers’ attitudes and 5) disclosure of the mothers’ HIV status. A multi-sectoral approach to promote exclusive breastfeeding is suggested. This?should include community involvement because it is in the community where breastfeeding norms and cultural practices associated with breast-feeding are propagated.