Tendência temporal da amamentação na cidade do Rio de Janeiro: 1996-2006

Time trends in the prevalence of breastfeeding among schoolchildren from public and private schools in Florianópolis, Southern Brazil: From 2002 to 2013

OBJECTIVE

To describe breastfeeding trends from 2002 to 2012/2013, and to investigate whether breastfeeding practices differ between mothers of children in public and private schools.

METHODS

Data were obtained from three school-based cross-sectional studies conducted with 7 to 10 years old children. The total sample was 7264 individuals. Data related to breastfeeding were analyzed descriptively and compared using the chi-square test for heterogeneity or trend.

RESULTS

In the 10-year period was observed a decrease in the total percentage of schoolchildren who were not breastfed (12.9%-10.5%) and an increase in the percentage of schoolchildren breastfed for >12 months (23.9%-36.7%). In public schools, the increase of breastfeeding for >12 months was independent of maternal age and years of schooling. In private schools, the increase was observed for schoolchildren born to older mothers and to more educated mothers, although the highest percentage was observed for schoolchildren born to less educated mothers.

CONCLUSIONS

The results confirm the complexity of determining breastfeeding behaviors, and understanding these dynamics is fundamental to develop and improve programs and actions aimed at encouraging, supporting, and protecting breastfeeding. However, strategies developed in Brazil during the first decade of the 21st century should explain the increase of proportion of breastfed children for more than 12 months, and the concomitant decrease of never breastfeed children in the city of Florianopolis (Southern Brazil).

[Training of health professionals in breastfeeding and its association with knowledge, skills and practices]

A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0.723), but with better practices (aPR = 1.183). Nursing staff reported better practices than physicians (aPR = 0.808) and other categories (aPR = 0.658). The study concludes that training contributes to improved breastfeeding knowledge, skills and practices that are essential for maternal and child care.

Complementary feeding patterns in the first year of life in the city of Rio de Janeiro, Brazil: time trends from 1998 to 2008

This study aimed to analyze time trends in complementary feeding practices among children under one year of age in the city of Rio de Janeiro, Brazil, from 1998 to 2008. Based on comparable questions on food consumption in five surveys conducted in representative randomized samples of children in 1998 (n=3,762), 2000 (n=3,670), 2003 (n=4,305), 2006 (n=3,686), and 2008 (n=2,621), 16 complementary feeding indicators were constructed. The percentage frequency of all indicators was estimated for each year of the study. Linear trend analyses were also conducted by means of multivariate regression models. All indicators of early complementary feeding decreased from 1998 to 2008. In the 6-11.9 month age group, there was a significant downward trend in the proportion of children receiving food with adequate consistency for their age, consumption of iron-rich foods, and overall adequacy of the diet. A significant upward trend in fruit consumption was observed. There was a decrease in the early complementary feeding, and generally a worsening of complementary feeding practices in children aged 6-11.9 months in Rio de Janeiro during the period studied.

Association between the use of a baby's bottle and pacifier and the absence of breastfeeding in the second six months of life

Introduction: The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use.Objective: Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life.Methods: Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model.Results: 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006).Conclusions: The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies.

Fatores associados ao aleitamento materno nas diferentes Regiões do Brasil

Objetivos: identificar os fatores que determinam o aleitamento materno nas diferentes regiões do país. Métodos: os dados fazem parte da Pesquisa de Orçamento Familiar de 2002-2003 realizada no Brasil. A amostra foi de 2958 crianças de zero a um ano, representativas da população nacional. Um modelo de regressão linear (GLM) com família binomial e ligação logarítmica foi criado para cada região, com um intervalo de confiança de 90%. Resultados: o aumento do número de moradores no domicilio é o principal fator negativo para a amamentação em todas as regiões do Brasil. Foram considerados como fatores desfavoráveis, no conjunto da amostra: mães com idade avançada, ter quatro ou mais moradores no domicílio, maior renda, maior escolaridade materna e uso de creche. Os fatores favoráveis foram: ter dois ou mais filhos menores de cinco anos em casa e mães de cor preta ou parda. Conclusões: as regiões que apresentaram um número maior de fatores desfavoráveis ao aleitamento materno foram Sudeste e Sul, sendo que o maior número de moradores no domicílio foi a pior situação para a efetivação da amamentação nas regiões do Brasil.

Degree of compliance with the ten steps of the Breastfeeding Friendly Primary Care Initiative and its association with the prevalence of exclusive breastfeeding

OBJECTIVE

To analyze the association between the degree of compliance with the ten steps of the Breastfeeding-Friendly Primary Care Initiative (BFPCI) and the prevalence of exclusive breastfeeding (EBF) in infants younger than six months in the city of Rio de Janeiro.

METHODS

This was a cross-sectional study conducted in a representative sample of 56 primary health care units of this municipality. The assessment of compliance with the ten steps of the BFPCI was carried out by interviewing health care professionals, pregnant women, and mothers; the generated performance scores were classified into tertiles. To obtain the outcome, i.e., the EBF, a data collection questionnaire was applied to mothers of children younger than six months who were followed up at these units in November of 2007. Prevalence ratios were obtained for the EBF using Poisson regression with robust variance.

RESULTS

The prevalence of EBF was 47.6%. In the multivariate analysis, the upper tertile of performance showed a 34% higher prevalence of EBF (PR=1.34, 95% CI: 1.24 to 1.44) and the second tertile was 17% higher (PR=1.17, 95% CI: 1.08 to 1.27) than the first tertile. Mothers who did not work outside home had a 75% higher prevalence of EBF (PR=1.75, 95% CI: 1.53 to 2.01); assistance in a basic health unit, as opposed to a family health unit, implied a 10% higher prevalence (PR=1.10, 95% CI: 1.03 to 1.19). The prevalence of EBF decreased 1% for each day of the infant's life (PR=0.993, 95% CI: 0.992 to 0.993).

CONCLUSION

Given the contribution of BFPCI to the practice of EBF, a greater investment in the expansion and sustainability of this initiative is recommended, as well as its association with other strategies to promote, protect, and support breastfeeding.

Indoor air quality and sources in schools and related health effects

Good indoor air quality in schools is important to provide a safe, healthy, productive, and comfortable environment for students, teachers, and other school staff. However, existing studies demonstrated that various air pollutants are found in classrooms, sometimes at elevated concentrations. Data also indicated that poor air quality may impact children's health, in particular respiratory health, attendance, and academic performance. Nevertheless, it should be noted that there are other adverse health effects that are less documented. Few data exist for teachers and other adults that work in schools. Allergic individuals seem to be at a higher risk for adverse respiratory health consequences. Air quality improvement represents an important measure for prevention of adverse health consequences in children and adults in schools.

Effects of vitamin C and E intake on peak expiratory flow rate of asthmatic children exposed to atmospheric particulate matter

One hundred eighty-four asthmatic children were selected from 8 schools in Tainan City (high PM(10) [particulate matter with aerodynamic diameter <10 μm] exposure) and Hualien County (low PM(10) exposure) in Taiwan, and completed records of dietary consumption, daily peak expiratory flow rate (PEFR), and daily respiratory symptoms for 1 week. The higher prevalence of PEFR less than 80% predicted was found in children of high-exposure district than of low-exposure one, as well as in subjects with high intake of vitamin E than those who took less vitamin E. Furthermore, the risk of declining PEFR appeared to significantly decrease for subjects with both high intake of vitamins C and E and residing in area of low PM(10) levels as compared with those with low intake of vitamins C and E and residing in high-exposure area. The beneficiary effect of vitamin C and E intake on PEFR improvement for asthmatic children with low air pollution is suggested.

Reappraising the relationship between maternal age and postpartum depression according to the evolutionary theory: Empirical evidence from a survey in primary health services

BACKGROUND

Postpartum depression (PPD) is a widespread worldwide phenomenon, but its etiology remains unclear. This study reappraised how evolutionary theory could explain PPD as an adaptation through investigating the relationship between maternal age and PPD, and if this relationship is modified according to the number of children at home.

METHODS

A cross-sectional study carried out in five primary health care units included 811 participants randomly selected among mothers of children up to five postpartum months in Rio de Janeiro, Brazil. Postpartum depression was defined by scores above 11 on Edinburgh Postnatal Depression Scale (EPDS), and statistical analysis was based on multivariate logistic regression models.

RESULTS

One hundred and ninety-seven (24.3%, CI 95% 21.3-27.2) participants were classified as PPD positives. Maternal age was significantly associated to PPD (OR=0.96, p-value=0.019) independently of socioeconomic and reproductive characteristics, conjugal status or substance consumption by the couple. Thus, for each additional year, a reduction of 4% in the chance of developing PPD could be anticipated, effect which was not modified by the number of children at home (p-value=0.602).

LIMITATIONS

Information on social support was not included in this analysis since its relationship with maternal mental health would be better evaluated in a prospective fashion.

CONCLUSIONS

These findings suggest that adaptive mechanisms shaped through human generations persist contributing to the development of PPD in contemporary societies. According to this evolutionary approach, as maternal age advances the reproductive potential diminishes and, consequently, mothers are less prone to develop PPD and reduce investment in new offspring.

Avaliação da implantação da iniciativa hospital amigo da criança no Rio de Janeiro, Brasil

OBJETIVOS: avaliar a implantação da Iniciativa Hospital Amigo da Criança no Rio de Janeiro. MÉTODOS: pesquisa avaliativa realizada em 2009, com sete hospitais credenciados (HAC) e oito não (HNC), do SUS. Avaliação de estrutura (Passos 1 e 2) realizada por observação e entrevista a 215 profissionais. Avaliações de processo (Passos 3 a 10) e resultado compreenderam entrevista em amostra representativa de 461 gestantes, 687 mães em alojamento conjunto e 148 mães com recém-nascido em unidade neonatal. O grau de implantação foi avaliado segundo o cumprimento de cada passo e de parâmetros compreendidos nestes passos. A correlação entre grau de implantação e desfechos foi analisada por meio de regressão linear: aleitamento materno (AM) na primeira hora, AM exclusivo (AME) e satisfação das mulheres com o apoio recebido. RESULTADOS: os graus de implantação variaram de 9 a 5 passos (90,6% a 70,1% dos parâmetros) cumpridos nos HAC e de 5 a 1 passo (76,1% a 43,9% dos parâmetros) nos HNC. Foi encontrada correlação linear significativa entre o grau de implantação, expresso em passos e parâmetros, respectivamente, e o AM na primeira hora (r=0,78 e r=0,74), o AME (r=0,72 e r=0,69), e a satisfação (r=0,69 e r=0,73). CONCLUSÕES: ambas as formas de avaliação mostraram-se consistentes com os resultados. Os HAC apresentaram um desempenho superior aos HNC, sendo necessário um investimento na sustentabilidade desta iniciativa.

Tempo de aleitamento materno exclusivo em recém-nascidos prematuros e a termo

OBJETIVOS: determinar o tempo de aleitamento materno exclusivo de recém nascidos prematuros e observar se estes apresentam um índice de aleitamento materno exclusivo diferente do apresentado pelo município de Maceió, na I e II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e no Distrito Federal. Além de comparar o tempo de aleitamento materno e aleitamento materno exclusivo de recém nascidos prematuros e a termo e verificar as causas do desmame precoce e suas consequências. MÉTODO: trata-se de uma investigação de campo, de caráter exploratório e longitudinal da prevalência do aleitamento materno exclusivo de recém nascidos prematuro e à termo. RESULTADOS: o percentual de aleitamento materno e de aleitamento materno exclusivo de prematuros aos 6 meses. Houve diferença significante para a variável peso ao nascimento. Dentre as causas do desmame precoce, os fatores educacionais seguidos dos fatores culturais apareceram em maior porcentagem. Como consequência do desmame precoce a prática de hábitos orais ocorreu em 98,1% das crianças. CONCLUSÃO: as crianças prematuras permaneceram mais tempo em aleitamento materno e em aleitamento materno exclusivo que as nascidas a termo. Os fatores educacionais e culturais foram as principais causas do desmame precoce e sua consequência foi o uso de chupeta e mamadeira.

[Factors associated with exclusive breastfeeding: the role of primary health care]

The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (PR = 1.20; 95% CI: 1.05-1.36); schooling (PR = 1.19; 95% CI: 1.05-1.35); marital status (married or in common-law marriage) (PR = 1.72; 95% IC:1.02-2.90); previous breastfeeding (PR = 1.27; 95% CI: 1.08-1,49); exclusive breastfeeding at the time of hospital discharge (PR = 2.01; 95% CI: 1.20-3.36); group support for the mother (PR = 1.14; 95% CI: 1.01-1.28); and orientation on breastfeeding (PR = 1.20; 95% CI: 1.08-1.33). Prevalence of exclusive breastfeeding decreased 17% per month in the infant's life. Support groups and orientation by primary health care for breastfeeding were associated with increased exclusive breastfeeding prevalence.

Nascer em Hospital Amigo da Criança no Rio de Janeiro, Brasil: um fator de proteção ao aleitamento materno?

Este artigo pretende avaliar o papel da Iniciativa Hospital Amigo da Criança (IHAC) na duração do aleitamento materno exclusivo (AME). Trata-se de estudo transversal, com população constituída de 811 mães de crianças menores de cinco meses de idade, selecionadas aleatoriamente em cinco unidades básicas de saúde (UBS) no Município do Rio de Janeiro, Brasil. A exposição de interesse central foi o local de nascimento da criança: Hospital Amigo da Criança (HAC), em vias de receber a titulação (EVHAC) e sem a titulação. Optou-se pelo modelo de análise de sobrevida log-log complementar, que recompõe a experiência longitudinal da coorte, caracterizando abordagem do tipo current status. Mesmo após o controle por variáveis sociodemográficas, relativas ao estilo de vida e aos aspectos psicossociais maternos, à utilização dos serviços de saúde, idade e saúde da criança, houve maior duração do AME em crianças nascidas em HAC e EVHAC. Os resultados sugerem a efetividade da IHAC na manutenção de AME nos primeiros meses de vida, reforçando a necessidade de ampliar sua cobertura para todo o território nacional.

Postpartum depression according to time frames and sub-groups: a survey in primary health care settings in Rio de Janeiro, Brazil

This study aimed at estimating the prevalence of postpartum depression (PPD) according to postpartum periods and sub-groups in public primary health care settings in Rio de Janeiro, Brazil. A cross-sectional survey was carried out in five primary health care units and included 811 participants randomly selected among mothers of children up to five postpartum months. Women were classified as depressed and given scores on Edinburgh Postnatal Depression Scale (EPDS) above 11. The overall estimate of PPD was 24.3% (95% CI, 21.4-27.4). However, estimates were not homogeneous during the first 5 months postpartum (p value = 0.002). There was a peak of depressive symptoms around 3 months postpartum, when 128 women (37.5%, 95% CI, 29.1-46.5) disclosed scores above 11 on EPDS. Regarding the magnitude of PPD according to some maternal and partners' characteristics, it was consistently higher among women with low schooling, without a steady partner, and whose partners misused alcohol or used illicit drugs. The prevalence of PPD among women attending primary health care units in Rio de Janeiro seems to be higher than general estimates of 10-15%, especially among mothers with low schooling and that receive little (if any) support from partners. Also, the "burden" of PPD may be even higher around 3 months postpartum. These results are particularly relevant for public health policies. Evaluation of maternal mental health should be extended at least until 3 to 4 months postpartum, and mothers presenting a high-risk profile deserve special attention.

Factors associated with breastfeeding in the first hour of life

OBJECTIVE

To identify factors associated with breastfeeding in the first hour of life (Step 4 of the Baby-Friendly Hospital Initiative).

METHODS

A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect--at maternity hospital level--Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance.

RESULTS

Only 16% of the mothers breastfed in the first hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically significant.

CONCLUSIONS

At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals.