الفهرس 
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Abstract
This study was carried-out in Netma health unit at Kom Hamada district, which is one of the districts of Al Beheira Governorate. The aim was to study the effect of breastfeeding education, continued support and mothers’ counseling on initiation and continuation of exclusive breastfeeding. Approval for the study was taken from the ethical committee of Faculty of Medicine, Tanta University. Approval of the health authorities in Behira Governorate was obtained to conduct the study. Verbal consent was taken from mothers to participate in the study. All data were considered confidential and were used only for scientific research purposes. The sample included 176 mothers and their infants who were divided into two groups (control group and intervention group). The control group got only routine follow up while each mother in the intervention group got at least 16 phone calls, one home visit, 9 educational sessions and 2 arranged meeting with her at NHU. The child age ranged from 1-150 days of both groups. More than half of both groups were females. The majority of children in both groups were (first born child) in the family. In both groups about half of infants aged less than one month at time of recruitment (57.9% of the intervention group and 50% of the control group). The number of family members in more than half of both groups was less than 5 people. Most of the studied mothers in both groups were educated; the majority had secondary education (54.5% in the intervention group, 57.0% in the control group).Most of the studied mothers were not employed (house wives) 97.5% and 93.0% of the intervention group and the control group respectively. Working mothers in both groups work at the morning for six hours, only 50% of them had official locational vacation. More than half of fathers (52.0%) of both groups had secondary education. The majority of the studied fathers were farmers (54.5% of the intervention group and 47.0% of the control group). About 75% of both groups have sufficient income level. All mothers of the two studied groups used health care services during pregnancy. 88% of intervention group vs. 90% of the control group started antennal care at 1st trimester. Most of mothers started breastfeeding within 1-2 hours after delivery. The frequency of breastfeeding times per day was 6-16 in the intervention group vs. 8-16 in the control group. The majority of mothers of both groups had cesarean delivery (93% of the intervention group and 89% of the control group). 94% of the intervention group and 96.5% of the control group delivered in hospitals. There was non-significant difference between the two studied groups as regard feeding practices of previous family children. But the percentage of exclusive breastfeeding increase with increasing child order in the family in both groups. In the intervention group the majority of infants (85.3%) were breastfed for 5-6 months (overall mean = 5.53 ± 1.25) while in the control group only 45.6% of infants were breastfed exclusively for 5-6 months with mean (overall mean = 4.65 ± 1.38). The majority of infants (46.5%) in the intervention group were followed up for 5-6 months. While only (18.1%) of infants in the control group were followed up for 5-6 months. In the intervention group the majority (80%) of infants aged less than one month continued EBF under supervision for 5-6 months compared to 36.3% of the control group. Only 61% of mothers in the control group were satisfied with exclusive breastfeeding vs. 90% of mothers in the intervention group. Only 5% of mothers of the intervention group had difficulties during breastfeeding vs. 57% of mothers in the control group. About third of mothers in control group misunderstand definition of exclusive breastfeeding, and 26%of them suffered from inadequate milk. As regards health status of infants, 13.5% of the intervention group suffered from diarrhea compared to 18% in the control group. The number of episodes was lower in the intervention group (mean 1.17±.96) compared to mean (1.55 ± 0.89) in the control group. 61% of the intervention group suffered from respiratory infection compared to 68% in the control group. The number of episodes was lower in the intervention group (mean 1.71 ± 0.72) compared to mean (1.9 ± 0.73) in the control group. 88% of the intervention group suffered from fever compared to 93% in the control group. The number of episodes was lower in the intervention group (mean 2.22 ± 0.79) compared to mean (2.42 ± 0.86) in the control group. As regard progression in nutritional status: In the intervention group the nutritional status of 13.6% of infants improved, 16.6% of them improved after follow up for 2-3 months and 41.6% after follow up for 5-6 months. 3.4% of infant’s nutritional status deteriorated. In the control group 5.6% of infant’s nutritional status improved during period of exclusive breastfeeding, 50% of them were followed for 5-6 months. And 12.5% of infant’s nutritional status deteriorated, 44.5% of them were followed for 3-4 months only. In the intervention group 1.1% of infant’s nutritional status according to weight measures deteriorated compared to 0% in the control group, and according to length measures 3.4% of infant in the intervention group improved compared to 0% in the control group and 1.1% deteriorated in both groups by the end of the study. According to head circumference measures, the nutritional status improved in 3.4% in the intervention group compared to 1.1% in the control group and 7.9% deteriorated in the intervention group compared to 0% in control group. Nutritional status according to BMI improved in 9.1% of infants of the intervention group compared to 6.8% in the control group and deteriorated in 4.5% in the intervention group compared to 10.2% of the control group. So we can conclude that: - Skilled breastfeeding counseling as part of comprehensive breastfeeding policies and programs in health facilities can increase the duration of exclusive breastfeeding up to six months. - The ongoing individualized support and counseling can solve most of the problems that face mothers during breastfeeding. - Compared with face to face visits, the regular ongoing phone calls can effectively reduce economic costs for improvement of breastfeeding practices and minimization of medical and nutritional problems. - Exclusive breastfeeding for six months is associated with lower number of diarrheal episodes and decreased sufferings from ARI and fever of any other reason. - Mother’s high educational level positively affects duration of exclusive breastfeeding. - Restricting the official lactation vacation for only 4 months and for only three pregnancies prevents most of working mothers to exclusively breastfeed their infants for the recommended six months. - Exclusive breastfeeding does not significantly affect infant’s weight or length, but without doubt, can improve nutritional status of malnourished infants. - Using more than one anthropometric measure is preferred to make detection of any physical developmental abnormality easier. The study recommended that: - Maternal and child health administrations (MOHP) should put emphasis on training family physicians working at rural and urban health units to give pregnant and lactating women regular educational sessions on breastfeeding as a routine. - Breastfeeding women should be offered regular follow up through phone calls by family physicians working in the nearest health units to their homes. - Follow up of lactating mothers should continue for at least six months. - The Ministry of Health and Population in Egypt (MOHP) should make it mandatory for family physicians working at rural and urban health units to monitor, at least monthly, all infants‘ anthropometric measurements during the first six months of life to early detect any developmental abnormalities. - The government should reconsider the duration of the official lactation vacation (four months) given to women working in governmental institutions and increase it to six months to encourage them to freely breastfeed their infants during that period.