An intervention model for breast feeding in Maharat Nakhon Ratchasima Hospital.

To promote breast feeding and/or prevent further decline of adverse infant feeding practices, we developed an integrated comprehensive breast feeding promotion program, and implemented it in Maharat Nakhon Ratchasima Hospital in 1987. The program provided sound knowledge and attitudes toward breast feeding to all mothers at the Antenatal Care Unit, delivery room, the Postnatal Care Unit, and the Outpatient Department. The program activities included early bonding, assistance with initiation of breast feeding, rooming-in, provision of a breast feeding corner in the special care unit, collecting breast milk for sick babies, a lactation clinic and home visits. The impact of the program was evaluated in 1992. Altogether 1,428 mothers were interviewed using structured questionnaires. The results were highly encouraging. A majority of the mothers were of low socioeconomic status, 60 percent of them worked outside the home, and 40 percent were housewives. Compared with baseline data reported in 1986, breast feeding in infants aged 0 to one month increased from 85 to 90 percent, and the practice in the nine- to 12-month old group increased from 39 to 47 percent. However, the acute drop of the practice from 90 percent at birth to 50 percent at the one- to two-month old stage observed was similar in the two studies. The main reasons given by mothers for prematurely stopping breast feeding were the mothers' working outside the home (46%), and insufficient milk (23%). Provision of breast feeding education, along with improved maternal nutrition, extension of maternity leave, and availability of nurseries at the work place, may sustain a longer period of breast feeding.

The role of parents and medical auxiliaries in oral rehydration in Thailand.

Parents and medical auxiliaries should participate in the oral rehydration programme to reduce diarrhoeal diseases mortality. Integration of this programme into the national health programme will require a system of education and training that can reach everyone involved in the delivery of health care. A pilot study carried out at a province in northeast of Thailand showed that only 0.6% of diarrhoeal cases had to be referred for treatment to the provincial hospital. The benefit of oral rehydration at periphery by local health officers could be appreciated by the reduction in admission of diarrhoeal cases to the provincial hospital and significant reduction of mortality rate. The role of parents and medical auxiliaries in practice and promotion of oral rehydration is the key to the success of control of diarrhoeal diseases in the context of primary health care.