BACKGROUND: Exclusive breastfeeding for six months is one of the measures with highest impact on ... more BACKGROUND: Exclusive breastfeeding for six months is one of the measures with highest impact on prevention of child deaths. The determinants of breastfeeding practices are complex and differ between populations. This study aimed to identify factors associated with the prevalence of exclusive breastfeeding in a suburban area in Angola. DESIGN AND SETTING: Population-based cross-sectional study in the municipality of Cacuaco, Luanda. METHODS: A random sample of children under two years of age and their mothers was included. Prevalence ratios (PR) were estimated using Poisson regression based on a hierarchical model. RESULTS: 749 children and their mothers were surveyed, including 274 children under six months. The prevalence of exclusive breastfeeding among children under six months was 51.5% (95% confidence interval, CI, 46.3-56.6%). Four variables were positively associated with exclusive breastfeeding at ages of under six months: number of prenatal visits (PR 1.11 for each visit after the first one; 95% CI 1.04-1.18), maternal occupation (other occupations versus self-employed) (PR 1.54; 95% CI 1.05-2.26), younger child age (PR 0.77 for each month; 95% CI 0.71-0.84) and female child (PR 1.34; 95% CI 1.02-1.76). CONCLUSIONS: Our findings showed that the prevalence of exclusive breastfeeding at six months was satisfactory, according to international recommendations. Factors associated with exclusive breastfeeding practices that had never been surveyed before in Angola were identified through this study. These data are particularly relevant in the context of high infant mortality and may be useful in planning actions aimed at improving child health through promotion of exclusive breastfeeding, in Angola and other countries.
Background Due to the multiple health benefits of breastfeeding, it is essential to identify fact... more Background Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. Methods This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) an...
The importance of breastfeeding in low-income and middle-income countries is well recognised, but... more The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not fi nd associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 82...
This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and heal... more This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants’ first months of life on ultraprocessed food (UPF) consumption at 4–7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child’s age of 4–7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final a...
This study aimed to evaluate the association between a set of pro‐breastfeeding practices in faci... more This study aimed to evaluate the association between a set of pro‐breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross‐sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin‐to‐skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming‐in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro‐breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the a...
To perform the construct validity and the internal consistency of the Maternal Breastfeeding Eval... more To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved...
To assess the impact of an intervention for teenage mothers with the involvement of maternal gran... more To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this g...
OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first y... more OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Step...
Objective: Synthesize the information about the factors associated with maintenance of breastfeed... more Objective: Synthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more. Data source: A systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors. Summary of data: 1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%). Conclusions: The maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.
To assess the prevalence and factors associated with the occurrence of cracked nipples in the fir... more To assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum. This was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics). The prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4-34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3...
BMI-forage and height-forage were similar in the intervention and control groups, as was the prev... more BMI-forage and height-forage were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. Conclusion Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.
A promoção do aleitamento materno deve ser vista como uma ação prioritária para a melhoria da saú... more A promoção do aleitamento materno deve ser vista como uma ação prioritária para a melhoria da saúde e da qualidade de vida das crianças e de suas famílias. As estratégias de promoção da amamentação devem variar de acordo com a população, sua cultura, seus hábitos, suas crenças, sua posição sócio-econômica, entre outras características. No entanto, de fundamental importância em qualquer estratégia, é a conscientização da importância do aleitamento materno. Essa revisão procura contribuir para essa conscientização entre os profissionais de saúde, mostrando as evidências epidemiológicas da importância do leite materno para a saúde da criança e da mãe. São enfatizados o impacto da amamentação na mortalidade, na morbidade, no estado nutricional das crianças e no espaçamento entre os nascimentos. Num segundo momento, são discutidas algumas atividades promotoras do aleitamento materno, com ênfase nos programas educativos (educação dos profissionais de saúde, das gestantes, das puérperas e da população em geral). Mudanças nas rotinas hospitalares, comunicação de massa, normas para comercialização de alimentos para lactentes, proteção da mãe que trabalha e ações de base comunitária são também abordadas.
Objective: To present an up-to-date review about practical aspects in the promotion and managemen... more Objective: To present an up-to-date review about practical aspects in the promotion and management of breast-feeding Methods: Relevant materials from scientific journals, technical books, and publications of international organizations were reviewed. Results: Nowadays there is a recommendation of exclusive breast-feeding for about 6 months and maintenance of breastfeeding with complementary food up to 2 years or more. Despite the abundant scientific evidences about the superiority of breast-feeding over other blinds of milk, the number of women who breast-feed their infants in accordance with the recommendations is still low. Health care providers can improve this scenario, promoting breast-feeding and helping breast-feeding mothers to overcome obstacles to the successful breast-feeding. In order to perform this task, appropriate knowledge and skills in the management of different stages of lactation are needed. Prenatal care, orientation and help in the establishment of lactation, careful evaluation of breast-feeding technique and adequate interventions when problems related to breastfeeding happen are some of the tasks that health professionals who work with mothers and babies should be familiar with. This article discusses some important topics for the clinical practice of breastfeeding. Conclusion: Breast-feeding is the ideal way of feeding an infant, and in many cases it is facilitated by health professionals through an adequate clinical practice.
To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breas... more To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breastfeeding in the Brazilian Capitals and the Federal District and to analyze their evolution from 1999 to 2008. A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence ...
A cross-sectional study was conducted in children younger than 1 year old who participated in the... more A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. Results: We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41% (95%CI 39.7-42.4), while the prevalence of BF in children aged 9 to 12 months was 58.7% (95%CI 56.8-60.7). There was an increase of 30.7 days in the median duration of exclusive BF and 45.7 days in the median of BF. Conclusion: There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.
Objective: To evaluate the association between the consumption of unhealthy foods in children und... more Objective: To evaluate the association between the consumption of unhealthy foods in children under one year and the education level of the mothers, data obtained from participants of the II Survey on the prevalence of breastfeeding in the Brazilian capitals and the Federal District in 2008 was analyzed. Methods: During the second stage of the campaign for multi-vaccination, a questionnaire on food consumption in the last 24 hours was given to mothers or guardians of children under one year old. We analyzed the consumption of unhealthy foods according to age group, maternal education, region of residence and breastfeeding status. The state capitals and the Federal District were grouped according to the five macro-regions of the country (North, Northeast, Southeast, South and West). Processed juice, soda, coffee, cookies/salted snacks and sugar and/or honey were defined as unhealthy foods. Prevalence ratios (RP) for the association between the consumption of unhealthy foods and maternal education were estimated using Poisson regression models. Results: The study included 34,366 children. The consumption of sweet foods started early and was predominant until the age of six months; after this age, the consumption of biscuits and/or snacks became more prevalent. The consumption of these foods also differs in relation to the macro-region of residence. Consumption of unhealthy foods was higher among mothers with lower education levels. Conclusions: The consumption of unhealthy foods by Brazilian children under one year old was high, indicating a need for developing effective strategies to combat the consumption of unhealthy foods in Brazilian children as a way of preventing obesity and other future disorders.
O presente estudo teve por objetivo revisar as recomendações atuais sobre a alimentação complemen... more O presente estudo teve por objetivo revisar as recomendações atuais sobre a alimentação complementar de crianças menores de dois anos a partir da pesquisa em banco de dados - SciELO, MedLine e Lilacs - e de publicações da Organização Mundial da Saúde e do Ministério da Saúde. Utilizou-se o descritor desmame ou weaning e definiram-se os limites de crianças de 0 a 23 meses, período de publicação de 2002 a 2006 e idioma de redação em português, inglês e espanhol. Nos últimos anos acumularam-se evidências científicas sobre a importância da amamentação exclusiva nos primeiros seis meses, da alimentação complementar oportuna e da manutenção do aleitamento materno até os dois anos ou mais. A alimentação complementar adequada deve compreender alimentos ricos em energia, proteína e micronutrientes, sem contaminação, sem excesso de sal ou condimentos, em quantidade apropriada, fáceis de preparar, assegurando-se a consistência e a densidade energética adequadas. A família tem papel decisivo na...
Objective: To estimate the association between the implementation of the Brazilian Breastfeeding ... more Objective: To estimate the association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding in a medium-size city in southern Brazil. Methods: This was a cross-sectional study involving 405 children under 1 year who participated in the second phase of the multivaccination campaign in 2012. Children's consumption of food on the day before the interview was obtained through interviews with mothers or guardians. The manager and one health professional from every health facility that joined the Network were interviewed in order to investigate the process of implementation of this initiative. The association between prevalence of breastfeeding and exclusive breastfeeding and adherence to the Network implementation process was tested using Poisson regression with robust variance. Results: Multivariate analysis revealed that among the children assisted by health facilities who joined the Network and those attending services that did not adhere to this strategy, the prevalence of breastfeeding (74% and 70.4% among children under 1 year, respectively) and exclusive breastfeeding (43.3% and 38.1% among children under 6 months, respectively) did not differ significantly. Difficulties in implementing the Network, such as high turnover of professionals, not meeting the criteria for accreditation, and insufficient participation of tutors in the process were identified.
BACKGROUND: Exclusive breastfeeding for six months is one of the measures with highest impact on ... more BACKGROUND: Exclusive breastfeeding for six months is one of the measures with highest impact on prevention of child deaths. The determinants of breastfeeding practices are complex and differ between populations. This study aimed to identify factors associated with the prevalence of exclusive breastfeeding in a suburban area in Angola. DESIGN AND SETTING: Population-based cross-sectional study in the municipality of Cacuaco, Luanda. METHODS: A random sample of children under two years of age and their mothers was included. Prevalence ratios (PR) were estimated using Poisson regression based on a hierarchical model. RESULTS: 749 children and their mothers were surveyed, including 274 children under six months. The prevalence of exclusive breastfeeding among children under six months was 51.5% (95% confidence interval, CI, 46.3-56.6%). Four variables were positively associated with exclusive breastfeeding at ages of under six months: number of prenatal visits (PR 1.11 for each visit after the first one; 95% CI 1.04-1.18), maternal occupation (other occupations versus self-employed) (PR 1.54; 95% CI 1.05-2.26), younger child age (PR 0.77 for each month; 95% CI 0.71-0.84) and female child (PR 1.34; 95% CI 1.02-1.76). CONCLUSIONS: Our findings showed that the prevalence of exclusive breastfeeding at six months was satisfactory, according to international recommendations. Factors associated with exclusive breastfeeding practices that had never been surveyed before in Angola were identified through this study. These data are particularly relevant in the context of high infant mortality and may be useful in planning actions aimed at improving child health through promotion of exclusive breastfeeding, in Angola and other countries.
Background Due to the multiple health benefits of breastfeeding, it is essential to identify fact... more Background Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. Methods This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) an...
The importance of breastfeeding in low-income and middle-income countries is well recognised, but... more The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not fi nd associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 82...
This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and heal... more This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants’ first months of life on ultraprocessed food (UPF) consumption at 4–7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child’s age of 4–7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final a...
This study aimed to evaluate the association between a set of pro‐breastfeeding practices in faci... more This study aimed to evaluate the association between a set of pro‐breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross‐sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin‐to‐skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming‐in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro‐breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the a...
To perform the construct validity and the internal consistency of the Maternal Breastfeeding Eval... more To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved...
To assess the impact of an intervention for teenage mothers with the involvement of maternal gran... more To assess the impact of an intervention for teenage mothers with the involvement of maternal grandmothers on the prevalence of pacifier use in the first six months of life. This randomized clinical trial involved 323 teenage mothers, allocated to four groups: intervention with teenagers only, intervention with teenagers and their mothers, and respective controls. Six breastfeeding counseling sessions, including the recommendation to avoid the use of a pacifier, were delivered at the maternity ward and subsequently at the teenagers' homes, at seven, 15, 30, 60, and 120 days postpartum. Data on infant feeding and pacifier use were collected monthly by interviewers blinded to group allocation. The impact of the intervention was measured by comparing survival curves for pacifier use in the first six months of life and mean time to pacifier introduction. The intervention had a significant impact on reducing pacifier use only in the group in which grandmothers were involved. In this g...
OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first y... more OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Step...
Objective: Synthesize the information about the factors associated with maintenance of breastfeed... more Objective: Synthesize the information about the factors associated with maintenance of breastfeeding for 12 months or more. Data source: A systematic review was conducted in the Pubmed/Medline, Scielo, and Lilacs databases, including articles published in Portuguese or English since 2004 on the factors associated with breastfeeding maintenance for at least 12 months; review articles and those with qualitative design were excluded. The factors were organized into four levels, according to the chronological proximity to the outcome: distal, distal intermediate, proximal intermediate, and proximal; nationality and place/area of residence were considered contextual factors. Summary of data: 1174 articles were identified, of which 19 were included in this review, comprising seven cohort studies and 12 cross-sectional studies. A total of 39 of the 75 assessed factors were associated with the outcome at least once. The factors with the highest percentages of associations with maintenance of breastfeeding for 12 months or more, considering the number of times they were tested were: children whose parents are the caregivers (100%), none type of maternal exposure to smoke (54%), children and/or parents are immigrants/foreigners (50%), live in urban areas (42.9%), older maternal age (40%), married women (37.5%), higher level of maternal education (31.3%), greater parity (30.8%), and lower income (30%). Conclusions: The maintenance of breastfeeding for 12 months or more is associated with multiple factors, emphasizing the contextual factors and those related to some maternal sociodemographic characteristics. Associations differ in effect and magnitude between the different populations studied.
To assess the prevalence and factors associated with the occurrence of cracked nipples in the fir... more To assess the prevalence and factors associated with the occurrence of cracked nipples in the first month postpartum. This was a cross-sectional study nested in a cohort of mothers living in Feira de Santana, state of Bahia, northeastern Brazil. Data from 1,243 mother-child dyads assessed both at the maternity ward and 30 days after delivery were analyzed. The association between cracked nipples as reported by mothers and their possible determinants was analyzed using Poisson regression in a model where the variables were hierarchically organized into four levels: distal (individual characteristics), distal intermediate (prenatal characteristics), proximal intermediate (delivery characteristics), and proximal (postnatal characteristics). The prevalence of cracked nipples was 32 % (95 % confidence interval [95 % CI] 29.4-34.7) in the first 30 days postpartum. The following factors showed significant association with the outcome: poor breastfeeding technique (prevalence ratio [PR] = 3...
BMI-forage and height-forage were similar in the intervention and control groups, as was the prev... more BMI-forage and height-forage were similar in the intervention and control groups, as was the prevalence of overweight (39% vs. 31% respectively; p=0.318). There were no significant between-group differences in dietary habits. Conclusion Although the intervention prolonged the duration of exclusive BF and delayed the onset of complementary feeding, it had no impact on growth or prevalence of overweight at age 4 to 7 years.
A promoção do aleitamento materno deve ser vista como uma ação prioritária para a melhoria da saú... more A promoção do aleitamento materno deve ser vista como uma ação prioritária para a melhoria da saúde e da qualidade de vida das crianças e de suas famílias. As estratégias de promoção da amamentação devem variar de acordo com a população, sua cultura, seus hábitos, suas crenças, sua posição sócio-econômica, entre outras características. No entanto, de fundamental importância em qualquer estratégia, é a conscientização da importância do aleitamento materno. Essa revisão procura contribuir para essa conscientização entre os profissionais de saúde, mostrando as evidências epidemiológicas da importância do leite materno para a saúde da criança e da mãe. São enfatizados o impacto da amamentação na mortalidade, na morbidade, no estado nutricional das crianças e no espaçamento entre os nascimentos. Num segundo momento, são discutidas algumas atividades promotoras do aleitamento materno, com ênfase nos programas educativos (educação dos profissionais de saúde, das gestantes, das puérperas e da população em geral). Mudanças nas rotinas hospitalares, comunicação de massa, normas para comercialização de alimentos para lactentes, proteção da mãe que trabalha e ações de base comunitária são também abordadas.
Objective: To present an up-to-date review about practical aspects in the promotion and managemen... more Objective: To present an up-to-date review about practical aspects in the promotion and management of breast-feeding Methods: Relevant materials from scientific journals, technical books, and publications of international organizations were reviewed. Results: Nowadays there is a recommendation of exclusive breast-feeding for about 6 months and maintenance of breastfeeding with complementary food up to 2 years or more. Despite the abundant scientific evidences about the superiority of breast-feeding over other blinds of milk, the number of women who breast-feed their infants in accordance with the recommendations is still low. Health care providers can improve this scenario, promoting breast-feeding and helping breast-feeding mothers to overcome obstacles to the successful breast-feeding. In order to perform this task, appropriate knowledge and skills in the management of different stages of lactation are needed. Prenatal care, orientation and help in the establishment of lactation, careful evaluation of breast-feeding technique and adequate interventions when problems related to breastfeeding happen are some of the tasks that health professionals who work with mothers and babies should be familiar with. This article discusses some important topics for the clinical practice of breastfeeding. Conclusion: Breast-feeding is the ideal way of feeding an infant, and in many cases it is facilitated by health professionals through an adequate clinical practice.
To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breas... more To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breastfeeding in the Brazilian Capitals and the Federal District and to analyze their evolution from 1999 to 2008. A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence ...
A cross-sectional study was conducted in children younger than 1 year old who participated in the... more A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. Results: We obtained data from 34,366 children. We found that 67.7% (95%CI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41% (95%CI 39.7-42.4), while the prevalence of BF in children aged 9 to 12 months was 58.7% (95%CI 56.8-60.7). There was an increase of 30.7 days in the median duration of exclusive BF and 45.7 days in the median of BF. Conclusion: There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.
Objective: To evaluate the association between the consumption of unhealthy foods in children und... more Objective: To evaluate the association between the consumption of unhealthy foods in children under one year and the education level of the mothers, data obtained from participants of the II Survey on the prevalence of breastfeeding in the Brazilian capitals and the Federal District in 2008 was analyzed. Methods: During the second stage of the campaign for multi-vaccination, a questionnaire on food consumption in the last 24 hours was given to mothers or guardians of children under one year old. We analyzed the consumption of unhealthy foods according to age group, maternal education, region of residence and breastfeeding status. The state capitals and the Federal District were grouped according to the five macro-regions of the country (North, Northeast, Southeast, South and West). Processed juice, soda, coffee, cookies/salted snacks and sugar and/or honey were defined as unhealthy foods. Prevalence ratios (RP) for the association between the consumption of unhealthy foods and maternal education were estimated using Poisson regression models. Results: The study included 34,366 children. The consumption of sweet foods started early and was predominant until the age of six months; after this age, the consumption of biscuits and/or snacks became more prevalent. The consumption of these foods also differs in relation to the macro-region of residence. Consumption of unhealthy foods was higher among mothers with lower education levels. Conclusions: The consumption of unhealthy foods by Brazilian children under one year old was high, indicating a need for developing effective strategies to combat the consumption of unhealthy foods in Brazilian children as a way of preventing obesity and other future disorders.
O presente estudo teve por objetivo revisar as recomendações atuais sobre a alimentação complemen... more O presente estudo teve por objetivo revisar as recomendações atuais sobre a alimentação complementar de crianças menores de dois anos a partir da pesquisa em banco de dados - SciELO, MedLine e Lilacs - e de publicações da Organização Mundial da Saúde e do Ministério da Saúde. Utilizou-se o descritor desmame ou weaning e definiram-se os limites de crianças de 0 a 23 meses, período de publicação de 2002 a 2006 e idioma de redação em português, inglês e espanhol. Nos últimos anos acumularam-se evidências científicas sobre a importância da amamentação exclusiva nos primeiros seis meses, da alimentação complementar oportuna e da manutenção do aleitamento materno até os dois anos ou mais. A alimentação complementar adequada deve compreender alimentos ricos em energia, proteína e micronutrientes, sem contaminação, sem excesso de sal ou condimentos, em quantidade apropriada, fáceis de preparar, assegurando-se a consistência e a densidade energética adequadas. A família tem papel decisivo na...
Objective: To estimate the association between the implementation of the Brazilian Breastfeeding ... more Objective: To estimate the association between the implementation of the Brazilian Breastfeeding Network and prevalence of breastfeeding in a medium-size city in southern Brazil. Methods: This was a cross-sectional study involving 405 children under 1 year who participated in the second phase of the multivaccination campaign in 2012. Children's consumption of food on the day before the interview was obtained through interviews with mothers or guardians. The manager and one health professional from every health facility that joined the Network were interviewed in order to investigate the process of implementation of this initiative. The association between prevalence of breastfeeding and exclusive breastfeeding and adherence to the Network implementation process was tested using Poisson regression with robust variance. Results: Multivariate analysis revealed that among the children assisted by health facilities who joined the Network and those attending services that did not adhere to this strategy, the prevalence of breastfeeding (74% and 70.4% among children under 1 year, respectively) and exclusive breastfeeding (43.3% and 38.1% among children under 6 months, respectively) did not differ significantly. Difficulties in implementing the Network, such as high turnover of professionals, not meeting the criteria for accreditation, and insufficient participation of tutors in the process were identified.
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Papers by Elsa Giugliani