Trends of breastfeeding indicators in Brazil from 1996 to 2019 and the gaps to achieve the WHO/UNICEF 2030 targets

Exclusive breastfeeding modifies the association between maternal education and child development: a cross-sectional study nested in a cohort

OBJECTIVE

Low maternal education is a risk factor for early childhood development (ECD), while exclusive breastfeeding (EBF) is a protective factor. This study examined the association between maternal education and ECD outcomes such as cognitive, language, and motor domains and whether EBF modifies this association in Brazil.

METHODS

This cross-sectional study analyzed data from a non-probabilistic sample of 12-month-old infants born during the COVID-19. Moderation analyses using the Mann-Whitney test examined the effect of EBF at 6 months (effect modifier) on the relationship between Bayley-III cognitive, language, and motor scores as well as Bayley Global Score (BGS) (outcomes) and maternal education (independent variable). The effect size (r) from the sensitivity analysis of the effect modifier was estimated.

RESULTS

A total of 269 full-term infants were evaluated. Higher maternal education was associated with better cognitive, language, and BGS (p < 0.00). EBF was associated with higher cognitive (p < 0.01), language (p < 0.02), and BGS (p < 0.00). EBF modified the effect of low maternal education (<10 years; and 10-12 years) on cognitive score and BGS. Among mothers with >10 years of education, a large effect size of EBF was observed on the BGS (r = 0.51), and a medium effect size was noted in the cognitive domain (r = 0.38).

CONCLUSION

Higher maternal education is associated with better scores on Bayley-III domains, and EBF can modify the effect of lower maternal education on ECD in Brazil. This is the first study to identify EBF as a mechanism to protect ECD in adverse conditions such as low maternal education.

Trend and Burden of Suboptimal Breastfeeding in Children Under Five Years of Age in 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021

Background/Objectives: Breastfeeding is a cost-effective early child health intervention that has been identified as a protective factor against adverse child health outcomes. However, as estimated by previous epidemiological studies, the prevalence of breastfeeding in most countries around the world is below the recommended levels established by the World Health Organization. This study aims to assess the changes in suboptimal breastfeeding mortality, disability-adjusted life years (DALYs), and years lost to disabilities (YLDs) on a global, regional, and national level from 1990 to 2021. Methods: Data regarding suboptimal breastfeeding in children under 5 years of age from 1990 to 2021 were extracted from the Global Health Data Exchange query tool. Data from 204 countries and territories countries were classified into 5 regions based on the sociodemographic index (SDI) and 21 Global Burden of Disease (GBD) regions according to geographical contiguity. The average annual percentage change (AAPC) was calculated to assess changes in the trends of suboptimal breastfeeding DALYs, YLDs, and mortality in the past 30 years. Results: Countries with high-middle (AAPC = -0.94, 95% CI = -0.95 to -0.93) SDI scores had the greatest degree of improvement in both suboptimal breastfeeding mortality from 28,043.47 to 1128.24 and disease burden from 43,202.94 to 4428.47, while countries with high (AAPC = -0.83, 95% CI = -0.86 to -0.81) and low SDI (AAPC = -0.63, 95% CI = -0.71 to -0.55) scores showed the least improvement from 16,775.75 to 5930.56 and 49,522.23 to 32,881.08, respectively. Conclusions: Significant global improvements in suboptimal breastfeeding mortality and morbidity have occurred in the last 30 years. However, the extent of improvement differs significantly across nations, while some countries also showed no improvements or increased suboptimal breastfeeding mortality and disease burden. Nation-specific policies that account for cultural practices and economic conditions are required to target vulnerable mothers that are unable to achieve optimal breastfeeding.

Low-level laser therapy for nipple trauma and pain during breastfeeding: systematic review and meta-analysis

Objective

This study aimed to investigate the effect of low-level laser therapy (LLLT) on nipple trauma and pain during breastfeeding through a systematic review with a meta-analysis of selected studies.

Source of the data

A thorough search was conducted on March 22, 2022, using the databases PubMed, SciELO, LILACS, PEDro, CINAHL, EMBASE, ScienceDirect, Scopus, Google Scholar, MEDLINE, the Cochrane Library, Clinical Trials, Web of Science, TRIP, DARE, and ProQuest. The search terms included various combinations of low-level laser therapy, nipple pain, nipple trauma, and breastfeeding.

Studies selection

Out of 107 articles identified, only three controlled and randomized clinical trials was included. The extracted data encompassed breast and trauma characteristics, treatment types, outcomes (pain and healing process), evaluation tools, LLLT usage, laser brand, and parameters.

Data collection

Data extraction was performed using RAYYAN for systematic reviews. The risk of bias in the studies was evaluated.

Data synthesis

Pain was measured using the visual analog scale (VAS). The included studies did not use validated tools for assessing physical conditions. All studies employed LLLT with a 660-nm wavelength, though there were variations in equipment power, energy dose, and application methods. The meta-analysis revealed an average difference of -0.60 points (95% CI: -1.52 to 0.31) in the VAS pain scores between the LLLT and control groups. No heterogeneity was observed among the studies (I2=0%), indicating no significant difference in pain relief between LLLT (red light) and control groups.

Conclusion

LLLT may offer a promising option for managing breastfeeding-related complications, though further research is required.

Knowledge, attitudes and practices of primary care professionals about the food guide for children up to 2 years old: a cross-sectional study, Botucatu, São Paulo, Brazil, 2023

OBJECTIVE

To investigate knowledge, attitudes and practices of primary health care professionals regarding breastfeeding and complementary feeding, in accordance with the recommendations of the food guide for Brazilian children up to 2 years old.

METHODS

This is a descriptive study undertaken from October to December 2023, with a self-administered online questionnaire, aimed at physicians, nurses and community health agents in primary health care in Botucatu, São Paulo, Brazil. We performed descriptive analysis and used Pearson's chi-squared test to analyze association between professional categories and their knowledge, attitudes and practices in relation to the content of the food guide.

RESULTS

74 professionals participated, including 37 community health agents, 19 nurses and 18 physician. Half the professionals had low knowledge about the content of the guide, getting less than half the answers right, in particular those related to complementary foods, for which 57 professionals got less than half of them right. Physicians and nurses were the professionals who believed they were more qualified to provide information related to the content of the guide, when compared to community health agents (p-value<0.001). Regarding practices, 18 professionals stated they sometimes provide guidance on breastfeeding, 24 reported never doing breastfeeding assessments during consultations and home visits and 22 provided guidance on introduction of complementary feeding.

CONCLUSION

Knowledge of physician, nurses and community health workers was deficient regarding the content of the guide. Attitudes and practices regarding the content were also compromised.

Patterns of complementary feeding introduction and associated factors in a cohort of Brazilian infants

BACKGROUND

Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants.

METHODS

Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction.

RESULTS

Three distinct patterns were identified and named according to their main characteristics: Pattern 1 - "Low Infant Formula and Timely CF Introduction"; Pattern 2 - "High Infant Formula and Early CF Introduction"; and Pattern 3 - "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10-1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53-0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13-2.01) or > 34 years (PR = 1.42; 95% CI = 1.04-1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01-1.80).

CONCLUSIONS

We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Nipple shield use in the maternity ward increases risk of exclusive breastfeeding interruption in the first six months of infant's life

OBJECTIVE

The objective of this study was to investigate the association between use of silicone nipple shields in the maternity ward and exclusive breastfeeding interruption in the first 6 months of the infant's life.

DESIGN

Cohort study.

SETTING

Interviews were conducted personally at the mother's home at 1 and 6 months postpartum and by telephone at 2 and 4 months.

PARTICIPANTS

287 mother-infant dyads.

METHODS

Lactating mothers were randomly selected at two maternity wards (one public, one private) in Porto Alegre, Brazil. Data were analyzed using Kaplan-Meier survival curves and Cox multivariate regression. The outcome of interest was exclusive breastfeeding interruption before 6 months of the infant's life.

FINDINGS

Nipple shields were used by 6.2 % of the women in the public maternity ward and by 25.8 % of those in the private setting. Median duration of exclusive breastfeeding was 11 days (95 %CI 0.0-36.9) among women who used the accessory vs. 89 days (95 %CI 60.8-117.2) among those who did not. Nipple shield use in the maternity ward was associated with exclusive breastfeeding interruption before 6 months of infant's life (adjusted risk ratio = 1.47; 95 %CI 1.01-2.15). The risk was higher in the first months of breastfeeding, ranging from 2.0 to 1.47 in the first and sixth months, respectively.

CONCLUSIONS

The use of silicone nipple shields in the maternity ward increased the risk of exclusive breastfeeding interruption before 6 months of the infant's life, especially in the first months. These findings suggest caution in recommending this accessory to new mothers.

Women's Satisfaction with Breastfeeding and Risk of Exclusive Breastfeeding Interruption

This prospective cohort study was conducted to evaluate the association between women's satisfaction with breastfeeding at 1 month post-partum and the risk of exclusive breastfeeding (EBF) interruption before 6 months. 287 mother-infant dyads randomly selected from two maternity hospitals were followed from birth to 24 months of infant's age. Women's satisfaction with breastfeeding was assessed using the Maternal Breastfeeding Evaluation Scale (MBFES) at 1 month. The association between women's satisfaction with breastfeeding and risk of EBF interruption before 6 months was estimated using Cox proportional hazards model. Kaplan-Meier survival curves for EBF were compared between women with lower satisfaction with breastfeeding (MBFES score < median 124) and those with higher satisfaction (MBFES score ≥ 124). Median EBF duration in women with higher satisfaction was 120 days (95%CI 109-131), vs. 26 days (95%CI 19-33) in less satisfied women. Each additional point on MBFES promoted a reduction of 2.0% in the risk of EBF interruption. Among women with satisfaction scores < 124, the risk of EBF interruption was 86% higher when compared with those ≥ 124 (adjusted hazard ratio 1.86; 95%CI 1.41-2.46). Lower maternal satisfaction with breastfeeding in the first month post-partum is associated with a higher risk of EBF interruption before 6 months.