Assistência pré-natal e amamentação exclusiva na atenção primária à saúde em um município do Sudoeste da Bahia / Prenatal care and exclusive breastfeeding in primary health care in a municipality in the Southwest of Bahia

Introdução: o aleitamento materno exclusivo deve ser promovido e fortalecido em todas as esferas públicas, especialmente na Atenção Primária à Saúde (APS), que tem o pré-natal como elemento importante para assistência e acompanhamento da mulher durante a gestação. Objetivo: identificar a associação entre assistência pré-natal e amamentação exclusiva em crianças menores de seis meses acompanhadas na APS em um município do Sudoeste da Bahia. Metodologia: estudo transversal, envolvendo 75 mães/crianças de zero a seis meses cadastradas no programa de Crescimento e Desenvolvimento do serviço de saúde do município de Jequié, Bahia, no período de março a agosto de 2018. Empregou-se o Teste de Qui-Quadrado de Pearson, para avaliar associação entre variáveis da assistência pré-natal e amamentação exclusiva. Resultados: a prevalência de aleitamento materno exclusivo registrado neste estudo foi de 36%.Observou-se que,mães com mais de seis consultas de pré-natal durante a gestação apresentaram maior prevalência de amamentação exclusiva (55,2%; p=0,019). A variável orientações sobre amamentação exclusiva no pré-natal não foi estatisticamente associada ao desfecho (0,457), porém descritivamente identificou-se que as mães que tiveram orientações durante o pré-natal apresentaram tendência de amamentar exclusivamente (56,7%; p= 0,457). Conclusão: a assistência pré-natal pode ser considerada elemento protetor na prática da amamentação exclusiva, e por isso a promoção e apoio ao aleitamento materno deve ser fortalecida na APS.

Introduction: exclusive breastfeeding should be promoted and strengthened in all public spheres, especially in Primary Health Care (PHC), which has prenatal care as an important element for the assistance and monitoring of women during pregnancy. Objective:to identify the link between prenatal care and exclusive breastfeeding in children younger than six months followed up in the PHC in a municipality in the Southwest of Bahia. Methodology: cross-sectional study, with 75 mothers/children aged zero to six months enrolled in the Growth and Development program of the health service in the municipality of Jequié, Bahia, from March to August 2018. Pearson's Chi-Square Test was used to assess the association between prenatal care variables and exclusive breastfeeding. Results: the prevalence of exclusive breastfeeding recorded in this study was 36%. It was observed that mothers with more than six prenatal consultations during pregnancy had a higher prevalence of exclusive breastfeeding (55.2%; p=0.019). The variable guidance on exclusive breastfeeding during prenatal care was not statistically associated with the outcome (0.457), however it was descriptively identified that mothers who received guidance during prenatal care tended to breastfeed exclusively (56.7%; p= 0.457 ). Conclusion:prenatal care can be considered a protective element in the practice of exclusive breastfeeding, and therefore the promotion and support of breastfeeding should be strengthened in PHC.

Situación Nutricional de embarazadas y lactantes haitianos atendidos en el CESFAM "Los Castaños" de la comuna de La Florida, Región Metropolitana, Chile

En Chile, al 31 de diciembre del 2020 un 12,5% de los extranjeros eran de nacionalidad haitiana. Se desconoce el estado nutricional (EN) en embarazadas y lactantes; así como también la prevalencia de lactancia materna exclusiva (LME) de la población haitiana en Chile. Los objetivos de este trabajo fueron comparar: (i) el EN de embarazadas haitianas y chilenas, (ii) el EN de lactantes y (iii) la duración de la LME en hijos de madres haitianas y chilenas. Para esto se analizó la base de datos de la población haitiana y chilena atendidos entre los años 2016-2019 en el Centro de Salud Familiar (CESFAM) "Los Castaños" ubicado en la comuna de La Florida. En la etapa pre-gestacional, las embarazadas haitianas presentaron mayor prevalencia de bajo peso en comparación a embarazadas chilenas (p= 0,0003), mientras que al término del embarazo presentaron una mayor prevalencia de estado nutricional normal (p= 0,0001) y menor prevalencia de obesidad (p= 0,0001). Respecto al estado nutricional de los lactantes, sólo se observaron diferencias en el primer mes de vida, donde un 82% de los lactantes haitianos tenían un EN normopeso en comparación al 24% en los lactantes chilenos (p= 0,0001). No se observaron diferencias significativas en la prevalencia de LME hasta los 6 meses entre lactantes haitianos y chilenos (35,3% vs 30%, respectivamente). Es importante mencionar que ninguno de los dos grupos de lactantes cumplió con la meta establecida por la Organización Mundial de la Salud (OMS) que propone LME en los primeros seis meses de vida hasta al menos 50%. En conclusión, se evidencian diferencias en el EN de las embarazadas y lactantes de ambos países, mientras que la prevalencia de LME en ambos grupos fue similar.

In Chile, until December 31st, 2020, 12.5% of foreign residents were from Haiti. The nutritional status (NS) in pregnant women and infants is unknown; as well as the prevalence of exclusive breastfeeding (EBF) of the Haitian population residing in Chile. This study aimed to compare: (i) the NS of Haitian and Chilean pregnant women, (ii) the NS of infants, and (iii) the duration of EBF in children of Haitian and Chilean mothers. We analyzed the database of the Haitian and Chilean population attended between the years 2016-2019 at the Primary Care Health Center (CESFAM) "Los Castaños" located in the commune of La Florida. During the pregestational stage, the Haitian pregnant women had a higher prevalence of low weight compared to the Chilean pregnant women (p= 0,0003), whereas, at the end of the pregnancy, they had a higher prevalence of normal nutritional status (p= 0,0001) and a lower prevalence of obesity and a tendency at the end of pregnancy. Whereas at the end of the pregnancy, Chilean women had a higher prevalence of obesity. Regarding the nutritional status of the infants, differences were only observed in the first month of life, where 82% of Haitian infants had a normal weight compared to 24% of Chilean infants (p= 0.0001). No significant differences were observed in the prevalence of EBF up to 6 months between Haitian and Chilean infants (35.3% vs. 30%, respectively). It is important to mention that neither of the two groups of infants met the goal established by the World Health Organization (WHO) that proposes EBF for the first six months of life up to at least 50%. In conclusion, there are differences in the NE of pregnant and lactating women in both countries, while the prevalence of EBF in both groups was similar.

Prácticas de lactancia materna y morbilidad del lactante

La lactancia materna (LM), es la opción más segura para garantizar buena salud y crecimiento de los niños pequeños. Se realizó un estudio observacional descriptivo, retrospectivo, en un consejo popular urbano, perteneciente al Policlínico Docente "Jimmy Hirzel", municipio Bayamo, provincia Granma, período enero 2018 - diciembre 2020, con el objetivo de determinar la relación entre prácticas de lactancia materna y la morbilidad del lactante. La muestra incluyó 231 niños de 12 meses de edad, y sus madres, que cumplieron criterios de selección. Variables estudiadas: en la madre (prácticas de lactancia materna exclusiva y causas del abandono de la misma); y en el niño (morbilidad durante el primer año de vida). Las medidas de resumen empleadas fueron, de la estadística descriptiva, los números absolutos y porcientos y de la estadística inferencial, la prueba de Chi cuadrado con nivel de significación del 5%. Como resultados relevantes, el 45% de las madres ofreció a sus hijos lactancia materna exclusiva (LME) por seis meses, siendo la hipogalactia la causa principal del abandono de la misma (60/126); el 44.8% de los niños que recibió LME enfermó durante el primer año de vida, y el 90.5% de los que no la recibió. Las infecciones respiratorias agudas constituyeron la primera causa de morbilidad, afectando más a niños sin LME (76.2%). Se concluyó que las prácticas de lactancia materna se asociaron significativamente a la morbilidad del lactante (p˂0.05).

SUMMARY Breastfeeding (BF) is the safest option to ensure good health and growth for young children. A retrospective, descriptive observational study was carried out in an urban popular council, belonging to the Jimmy Hinzel polyclinic, Bayamo municipality, Granma province, period January 2018-December 2020, with the aim of determining the relationship between breastfeeding practices and infant morbidity. The sample included 231 12-month-old children and their mothers who met selection criteria. Variables studied: in the mother (exclusive breastfeeding practices and causes of abandonment); and in the child (morbidity during the first year of life). The summary measures used were, from descriptive statistics, absolute numbers and percentages and from inferential statistics, the Chi-square test with a significance level of 5%. As relevant results, 45% of mothers offered their children exclusive breastfeeding (SCI) for six months, with hypogalactia being the main cause of abandonment (60/126); 44.8% of children who received SCI became ill during the first year of life, and 90.5% of those who did not. Acute respiratory infections were the leading cause of morbidity, affecting more children without SCI (76.2%). It was concluded that breastfeeding practices were significantly associated with infant morbidity (p˂0.05).

O aleitamento materno (AM) é a opção mais segura para garantir boa saúde e crescimento para crianças pequenas. Foi realizado um estudo observacional retrospectivo, descritivo, em um conselho popular urbano, pertencente à policlínica Jimmy Hinzel, município de Bayamo, província de Granma, no período de janeiro de 2018 a dezembro de 2020, com o objetivo de determinar a relação entre as práticas de aleitamento materno e a morbidade infantil. A amostra incluiu 231 crianças de 12 meses de idade e suas mães que atenderam aos critérios de seleção. Variáveis estudadas: na mãe (práticas de aleitamento materno exclusivo e causas de abandono); e na criança (morbidade no primeiro ano de vida). As medidas-resumo utilizadas foram, a partir da estatística descritiva, números absolutos e percentuais e da estatística inferencial, o teste Qui-quadrado com nível de significância de 5%. Como resultados relevantes, 45% das mães ofereceram aos filhos aleitamento materno exclusivo (LM) por seis meses, sendo a hipogalactia a principal causa de abandono (60/126); 44,8% das crianças que receberam LM adoeceram no primeiro ano de vida e 90,5% das que não receberam. As infecções respiratórias agudas foram a principal causa de morbidade, acometendo mais crianças sem LM (76,2%). Concluiu-se que a prática do aleitamento materno associou-se significativamente à morbidade infantil (p˂0,05).

Breastfeeding practices and head circumference in young children: a systematic review

ABSTRACT OBJECTIVE To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required.

Impact of a Mobile Health Intervention to Support Exclusive Breastfeeding: A Scoping Review

@#Nowadays, mobile health (mHealth) intervention has become a popular and convenient strategy to support exclusive breastfeeding (EBF). However, the effectiveness of the mHealth intervention on this topic is still ambiguous. Thus, a scoping review was done to map the available evidence and identify the impact of mHealth interventions to support EBF. A scoping review of English academic journals was conducted using four electronic databases (Scopus, EBSCOHost, Google Scholar, and Science Direct) from 2016 to 2021. Only 23 articles were eligible. The sample size ranged from 50 to 1,568 participants, aged 18 and above. About 60% of the reviewed articles showed that mHealth interventions had a significant impact on EBF. The intervention group that received the mHealth tools had longer and higher EBF rates and duration compared to the control group. Other articles did not find a significant mHealth intervention impact towards EBF; however, it increased breastfeeding efficacy, mother’s knowledge and the child’s body weight.

Transcultural adaptation of a scale for exclusive breastfeeding to be used in Brazil

SUMMARY OBJECTIVE: The aim of this study was to perform a cross-cultural adaptation of the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding for use in a Brazilian-Portuguese context. METHODS: The cross-cultural adaptation process involved the translation from original English into Brazilian Portuguese by two qualified and independent translators. Both translations were synthesized into a single version that was back-translated into English. An expert committee was created to assess linguistic equivalences, formulating a pre-final version that was tested on ten nursing women attending a maternity hospital. To assess its psychometric properties, a cross-sectional study was carried out. The population consisted of 99 nursing women from a reference maternity hospital in southern Brazil. The scale's stability and internal consistency were measured through Cronbach's alpha. The Pearson's correlation coefficient and the intraclass correlation coefficient between two applications were assessed to ascertain the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br scale's reliability. The construct validity was evaluated through exploratory factorial analysis. RESULTS: The Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br showed a general Cronbach's alpha of 0.849. The test-retest analysis showed a Pearson's correlation coefficient of 0.483 and intraclass correlation coefficient of 0.645. The exploratory factorial analysis showed two domains among the nine items of the Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br: the functional domain, including six items, and the cognitive domain, including three items, explaining 59.77% of the variance. CONCLUSION: The Breastfeeding Self-Efficacy Scale in Exclusive Breastfeeding-Br was considered adequate for the cultural context and reliable and valid for Brazilian nursing women.

Impact of breastfeeding on respiratory and gastrointestinal infections in infants of Muslim mothers of Kolkata, India

Background: Breast milk contains some proteins whose functions are not nutritive but anti-infective, which prevents infants from infections. Objective: The objective of the present study was to evaluate an association between the occurrence of diarrhea and respiratory tract infection (RTI) and breastfeeding among infants of Muslim mothers in Kolkata. Materials and Methods: An observational cross-sectional community-based study was conducted among mother–infant pairs of a total of 540 numbers in Muslim-dominated urban slums of Kolkata. The study period was from November 1, 2017, to October 31, 2018. Results: The findings indicated that 82.22% of breastfed infants had no diarrhea, and the absence of RTI was observed in 69.81%. It was also noted that both episodes of diarrhea and RTI in infants become less when the duration of breastfeeding increases. The study also significantly (P < 0.001 and P = 0.03) revealed that the occurrence of diarrhea and RTI was found to have lower incidence in colostrum-fed babies. Out of 391 colostrum- fed babies, about 85.42% had no diarrhea, and the absence of RTI was noticed in 72.12%. In conclusion, breast milk gives protection to babies against diarrheal diseases and RTI. It is the most appropriate food for infants. Conclusions: It is concluded that the prevention of RTI and diarrhea in infants, exclusive breastfeeding (EBF), early initiation of breastfeeding, and avoidance of bottle feeding should be the best practice to be recommended. To explore appropriate intervention strategies for reinforcing early initiation and continuation of EBF from birth to 6 months of life.

Impacto del abandono de la lactancia materna exclusiva sobre la salud de los lactantes / Impact of exclusive breastfeeding withdrawal on the health of babies

Introducción: El abandono de la lactancia materna es uno de los problemas que enfrenta el Sistema Nacional de Salud en Cuba por las consecuencias desfavorables que representa para la salud de los lactantes. Objetivo: Identificar la relación entre el abandono de la lactancia materna exclusiva y las afectaciones en la salud de los lactantes. Material y Métodos: Se realizó un estudio descriptivo, retrospectivo de corte transversal, en 105 lactantes del Policlínico Aleida Fernández Chardiet nacidos en 2019, cuyas madres dejaron de utilizar la lactancia materna exclusiva antes del sexto mes. Las variables utilizadas fueron edad materna, tiempo de duración de la lactancia materna exclusiva, las enfermedades más frecuentes diagnosticadas en el niño y la necesidad de ingresos hospitalarios. Se aplicó la prueba no paramétrica de independencia Chi Cuadrado para demostrar la relación entre variables. Resultados: Predominó el abandono de la lactancia materna exclusiva antes de los 3 meses y no se encontró relación estadísticamente significativa entre esta y las afecciones más frecuentes de los lactantes (las IRA en 40 por ciento y las EDA en 23,8 por ciento). El 55,2 por ciento necesitó ingreso hospitalario antes del sexto mes y la relación con el abandono precoz de la lactancia materna exclusiva fue estadísticamente significativa. Conclusiones: El abandono precoz de la lactancia materna exclusiva afecta la salud de los lactantes y aunque las afecciones no tuvieron una relación estadísticamente significativa con aquella sí tienen una elevada frecuencia en estos niños de tan corta edad(AU)

Introduction: Breastfeeding withdrawal is one of the challenges faced by the Cuban National Health System due to its adverse consequences on the health of babies. Objective: To identify the relationship between exclusive breastfeeding withdrawal and health disorders in babies. Material and Methods: A descriptive, retrospective, cross-sectional study was carried out on 105 breastfed babies from "Aleida Fernández Chardiet" Policlinic who were born in 2019 and were precociously weaned from exclusive breastfeeding before the sixth month. The variables used were: maternal age, duration of exclusive breastfeeding, most frequent diseases diagnosed in the child, and need for hospital admission. The chi-squared non-parametric independence test was used to show the relationship among variables. Results: Exclusive breastfeeding withdrawal before the third month was predominant (71, 4 percent); the most frequent diseases diagnosed were respiratory diseases and diarrheas (40 percent and 23,8 percent, respectively); about half the babies required hospital admission (55,2 percent) before the sixth month; the relationship with early withdrawal of breastfeeding was statistically significant. Conclusions: Early withdrawal of breastfeeding has negative effects on the health of babies. Although the illnesses did not have a statistically significant relationship with it, a high frequency of their incidence was found in such young babies(AU)

Associação da adesão das regiões do brasil à rede cegonha com a mortalidade materna e outros indicadores de saúde / Association of adhesion to the cegonha network in brazil with maternal mortality and other health indicators / Asociación de adhesión a la redcegonha en brasil con mortalidad materna y otros indicadores de salud

Introdução:As taxas de morbimortalidade materna, no Brasil, são evidenciadas pelo processo de trabalho intervencionista e por desigualdades socioculturais entre as regiões do país.Objetivo:Avaliar a adesão das regiões do Brasil à Rede Cegonha associada à mortalidade materna e aos indicadores de aleitamento materno exclusivo e cobertura da Atenção Básica.Metodologia:Trata-se de um estudo ecológico, do tipo transversal, onde foram analisados o comportamento da adesão à Rede cegonha, entre os anos de 2012 e 2017, associado a indicadores de saúde materna. Resultados:Percebeu-se que a adesão à Rede Cegonha coincidiu com o aumento da cobertura da atenção básica nas regiões do Brasil. Houve associação da adesão ao programa com a diminuição da mortalidade materna com o passar dos anos, com destaque para as regiões Sul e Sudeste do país. Ainda, a distribuição de coeficiente de aleitamento materno exclusivo revelou-se em crescimento em todas as regiões, com dados discrepantes na região sul. Conclusões:Observam-se os impactos da Rede Cegonha no Brasil dentro do recorte temporal estabelecido, expressos pela diminuição dos índices de mortalidade e melhoria dos indicadores de saúde, apesar das limitações institucionais e culturais encontradas (AU).

Introduction: Maternal morbidity and mortality rates in Brazil are evidenced by the interventionist work process and by sociocultural inequalities between the regions of the country. Objective:To evaluate the adhesion of regions of Brazil to rede cegonha associated with maternal mortality and indicators of exclusive breastfeeding and coverage of Primary Care. Methodology: This is an ecological, cross-sectional study, which analyzed the behavior of adhesion to the Stork Network between 2012 and 2017, associated with maternal health indicators. Results: It was noticed that the adhesion to Stork Network coincided with the increase in the coverage of Primary Care in the regions of Brazil. There was an association between adherence to the program and a decrease in maternal mortality over the years, especially in the South and Southeast regions of the country. Furthermore, the distribution of the coefficient of exclusive breastfeeding was growing in all regions, with discrepant data in the southern region. Conclusions: The impacts of Rede Cegonha in Brazil are observed within the established time frame, expressed by the decrease in mortality rates and improvement in health indicators, despite the institutional and cultural limitations found (AU).

Introducción: Las tasas de morbilidad y mortalidad materna en Brasil se evidencian por el proceso de trabajo intervencionista y por las desigualdades socioculturales entre las regiones del país. Objetivo: Evaluar la adhesión de las regiones de Brasil a la Rede Cegonha asociada a la mortalidad materna e indicadores de lactancia materna exclusiva y cobertura de Atención Primaria.Metodología: Se trata de un estudio ecológico, transversal, que analizó el comportamiento de incorporación a la Red Cigüeña entre 2012 y 2017, asociado a indicadores de salud materna.Resultados: Se notó que la adhesión a Rede Cegonha coincidió con el aumento de la cobertura de atención primaria en las regiones de Brasil. Hubo una asociación entre la adherencia al programa y una disminución de la mortalidad materna a lo largo de los años, especialmente en las regiones Sur y Sudeste del país. Además, la distribución del coeficiente de lactancia materna exclusiva estaba creciendo en todas las regiones, con datos discrepantes en la región sur.Conclusiones: Los impactos de la Rede Cegonha en Brasil se observan dentro del marco temporal establecido, expresados por la disminución de las tasas de mortalidad y la mejora de los indicadores de salud, a pesar de las limitaciones institucionales y culturales encontradas (AU).

Prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life

Abstract Objective: To investigate the prevalence and factors associated with no intention to exclusively breastfeed for the first 6 months of life in a sample of women in the first 24 h postpartum during the hospital stay. Methods: Cross-sectional study with data from screening phase of a birth cohort. The proportion of mothers who did not intend to breastfeed exclusively for 6 months (primary outcome) derived from a negative response to the question "Would you be willing to try to breastfeed exclusively for the first 6 months?", in an interview conducted by previously trained interviewers. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals were obtained by Poisson regression with robust variance. Results: A total of 2964 postpartum women were interviewed. The overall prevalence of mothers who did not intend to breastfeed exclusively for 6 months was 17.8% (16.4-19.1%). After adjusting for maternal age and type of pregnancy (singleton or multiple), no intention to exclusively breastfeed was higher in mothers with a monthly household income < 3 minimum wages (PR, 1.64; 1.35-1.98) and in those who intended to smoke 4-7 days/week after delivery (PR, 1.42; 1.11-1.83). The presence of significant newborn morbidity (PR, 0.32; 0.19-0.54) and intention to breastfeed up to 12 months (PR, 0.46; 0.38-0.55) had a protective effect against not intending to breastfeed exclusively for 6 months. Conclusions: Approximately 1 in every 5 mothers did not intend to breastfeed exclusively for 6 months. Strategies aimed at promoting exclusive breastfeeding should focus attention on mothers from lower economic strata and smokers.

Infant feeding knowledge and practice among HIVpositive mothers attending HIV treatment centres in Lagos

Background: Twenty five to forty percent of children will be infected with HIV in the absence of any form of intervention which is Prevention of Mother to Child Transmission (PMTCT). Objectives: This study determined the infant feeding knowledge and practices among HIV positive mothers attending HIV treatment centers in Lagos. Methods: A descriptive crosssectional design was used for the study. A multistage sampling technique was used to select / recruit 290 HIV positive mothers with babies between the ages of 2weeks to 18months, attending PMTCT services into the study Pre-tested interviewer administered structured questionnaire was used to collect data and analysis was done using Epi-info software. Chi-square and Fischer exact tests were used to determine association between the dependent and independent variables. The pvalue was set at 0.05. Results: Majority of the respondents (58.9%) were within the age range of 31 ­ 40 years and about half had a secondary school level of education. Exclusive formula feeding (40.3%) and exclusive breast feeding (42.4%) were feeding options known by the majority of the respondents. More than half (55.5%) of the mothers had a good knowledge of infant feeding options. Exclusive breastfeeding (EBF) was practiced by majority (55.5%) of the respondents, 21.4% practiced exclusive formula feeding (EFF) while only 6% practiced mixed feeding (MF). Knowledge of infant feeding options and the attitude towards exclusive breast feeding being enough in the first 6 months of life were associated with infant feeding options practiced; those with good knowledge of infant feeding options did not practice MF (9.7%) (p = 0.013). Conclusion: knowledge of infant feeding options was good and poor knowledge was associated with exclusive formula feeding. Majority practiced EBF. Educational programmes targeted at improving the knowledge of HIV and infant feeding options as well as strengthening of counseling sessions at PMTCT clinic would help reduce the risk of HIV transmission to the child.

Effectiveness of Intervention Methods on Exclusive Breastfeeding among Antenatal and Postnatal Mothers: A Systematic Review

@#Introduction: The universal truth surrounding the benefits of exclusive breastfeeding has seldom been disputed. However, the success of exclusive breastfeeding has not been guaranteed despite the availability of numerous interventions. The objective of this study is to review the effectiveness of various breastfeeding promotion education delivery methods in promoting exclusive breastfeeding. Design: A systematic search of leading databases was conducted for scholarly peer-reviewed randomized trials published between January 2014 and May 2019. Data sources: Eight articles were identified as relevant, all were published in English and assessed exclusive breastfeeding. Review Methods: Articles were analyzed for overall quality of evidence using the PEDro Scale. Results: A significant increase in the duration of exclusive breastfeeding was found in seven of the eight studies, with three interventions using combination verbal and written delivery methods and four interventions delivered verbally. Conclusion: Verbal delivery method was the most effective method and many studies use combination method of verbal and written to achieve the objective of their studies.

Determinants of the introduction of early complementary feeding before and after the third month of life: a multinomial analysis

The introduction of early complementary feeding (ECF) is determined by different factors depending on when it occurs. The objective of this study was to analyze factors associated with the introduction of ECF in two different moments of the infant's life: from zero to three and from four to five months of age. A cohort with 3,306 dyads studied in the BRISA survey in São Luis/MA in 2010 was used. Questionnaires were applied at birth and at follow-up when the infants were 15 to 36 months of age of women with more than 20 weeks of gestational age, residing in this municipality. A multivariate model of multinomial logistic regression was used to verify associations between independent variables and ECF at 0 to 3 months and at 4 to 5 months of age. A hierarchical analysis model was used to select variables for confounding adjustment. Variables with a P-value <0.05 were considered significant. For ECF introduced between 0-3 months, the variables "use of pacifier", "maternal paid activity", "smoking", and "postpartum pregnancy" were identified as risk factors. The variables "use of pacifier" and "maternal paid activity" remained associated as a risk for ECF introduced from 4-5 months. The variable 'mother without partner' (RR=1.26 and P=0.04) represented a risk factor for ECF only for the 4-5 months period. Although each period presented specific risk factors, the use of pacifier and maternal professional activity were associated in the two periods studied, indicating their importance for the introduction of ECF.

Results of a study on breastfeeding practices / Монголын Анагаах Ухаан

Background@#Breastfeeding is the ideal food source for all newborns globally. Proper feeding of infants and young children promotes optimal growth and development, especially in the critical window from birth to 2 years of age. Exclusive breastfeeding for 6 months and continued breastfeeding for the first 2 years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe.@*Objective@#To assess the indicators of infant feeding practices among 0- 23 months old children.@*Materials and Methods@#The NNS V was implemented in 21 aimags (provinces) in 4 economic regions (Central, Eastern, Khangai, Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [1]. The infant and young child feeding indicators assessed in the NNS V were based on the mother’s or caretaker’s report of breastfeeding and consumption of foods and fluids by the child during the day or night prior to being interviewed.@*Results@#83.7% of children under 2 years started breastfeeding within 1 hour of birth and though almost all children were ever breastfed (97.9%), a slightly higher percentage of girls were ever breastfed overall and within 1 hour of birth. Children 0-5 months were categorized according to whether they were exclusively breastfed or predominantly breastfed, with the former only allowing vitamins, mineral supplements, and medicine and the latter also including plain water and non-milk liquids. Among children 0-5 months of age, 58.3% were exclusively breastfed and 65.3% were predominantly breastfed, having received other liquids or foods in addition to breast milk. The prevalence of exclusive breastfeeding was lowest in the 4th wealth index quintile (46.5%) and wealthiest quintile (54.0%) households.@*Conclusions@#Exclusive breastfeeding and early initiation of breastfeeding practices are unacceptably low in Mongolia; 20% of newborns are not breastfed within 1 hour of birth and more than 40% of infants under 6 months of age are not exclusively breastfed and therefore, not receiving optimum nutritional and immunity benefits from breast milk. Strengthening IYCF counselling in all regions and wealth quintiles to support women to practice optimal breastfeeding, along with counselling and awareness of timely and adequate complementary feeding for children under 2 years of age, should be a top priority for public health and as it is a key strategy to reduce malnutrition in children.

Qualidade da assistência ao parto e sua relação com a duração do aleitamento materno exclusivo entre mulheres usuárias do Sistema Único de Saúde no município de Ribeirão Preto/SP / Quality of childbirth care and its relationship with the duration of exclusive breastfeeding among women users of the Unified Health System in the city of Ribeirão Preto / SP

O aleitamento materno exclusivo é a mais sábia estratégia natural de vínculo, afeto, proteção e nutrição para a criança é recomendado pela Organização Mundial da Saúde até o sexto mês de vida da criança. Realizou-se um estudo longitudinal prospectivo, observacional, analítico e quantitativo que avaliou a assistência perinatal em uma maternidade de risco comum de um município do interior paulista, à luz das Boas Práticas de Atenção ao Parto e Nascimento. Utilizou-se o escore de Bologna, que combina as cinco práticas recomendadas pela OMS, a soma dessas cinco avaliações representa a qualidade da assistência, escore varia de 0 a 5, e no grupo estudado o escore médio foi de 3,1 segundo os dados coletados das 104 participantes do estudo. Na aplicação do escore de Bologna, os resultados encontrados sobre a qualidade avaliada mostraram que quanto mais próximo de 5, melhor a qualidade. A associação foi estatisticamente significativa (p<0.05) para o profissional enfermeiro na assistência perinatal e a condição de consumo de leite materno exclusivo nos 30 dias pós parto, das 78 mulheres entrevistadas, 62 delas tinham sido atendidas por enfermeiras, sendo que 100% destas consideravam o leite materno o único alimento oferecido a criança, comparado as 18 mulheres que não tiveram assistência da enfermeira, (14) 87,5% dessas mulheres responderam que consideravam o leite materno como único alimento oferecido. Os resultados indicam que a maternidade atingir padrões de qualidade condizentes com um modelo de atendimento viável recomendado pela OMS. Demonstrou-se também que o parto atendido pelo profissional enfermeiro, determinou que houvesse maiores escores de qualidade na assistência e que aumentassem o tempo de aleitamento materno exclusivo

Exclusive breastfeeding is the wisest natural strategy of bonding, affection, protection and nutrition for the child and is recommended by the World Health Organization until the child's sixth month of life. A prospective, observational, analytical and quantitative longitudinal study was carried out, and that evaluated perinatal care in a maternity hospital of common risk in a municipality in the interior of São Paulo, in the light of Good Practices in Childbirth and Birth Care. The Bologna score was used, which combines the five practices recommended by the WHO, the sum of these five assessments represents the quality of care, the score ranges from 0 to 5, and in the studied group the average score was 3.1 according to the data collected from the 104 study participants. When applying the Bologna Score, the results found on the quality assessed were closer to 5, the better quality. The association was statistically significant (p <0.05) for the professional nurse in perinatal care and the condition of exclusive breast milk consumption in the 30 days postpartum, of the 78 women interviewed, 62 of them had been attended by nurses, 100% of whom they considered breast milk as the only food offered to the child, compared to the 18 women who did not have assistance from the nurse, (14) 87.5% of these women answered that they considered breast milk as the only food offered. The results indicate that motherhood reaches quality standards consistent with a viable care model recommended by WHO. It was also shown that the delivery attended by the professional nurse, determined that there were higher scores on quality of care and that they increase the time of exclusive breastfeeding

Diseño y validación de los instrumentos cuantitativo y cualitativo 0-6 lme para determinar los factores de riesgo de la interrupción de la lactancia materna exclusiva / Design and validation of the quantitative and qualitative instruments 0-6 lme to determine the risk factors of the interruption of exclusive breastfeeding

La lactancia materna exclusiva (LME) ha sido considerada una práctica saludable, ya que contribuye con nutrientes esenciales para la salud y crecimiento del niño. Desde esta perspectiva se considera necesario disponer de instrumentos de medición como herramientas para el levantamiento de información sobre problemáticas de salud. Por consiguiente, para garantizar la calidad del instrumento, es indispensable que éste sea sometido a un proceso de validación por juicio de expertos. Objetivo: Validar los instrumentos cuantitativo y cualitativo 0-6 LME para establecer los factores de riesgo que determinan la interrupción de la lactancia materna exclusiva. Método: La metodología empleada tuvo un enfoque mixto (cuantitativo.- cualitativo) de corte transversal, exploratorio, descriptivo y de campo. El enfoque cualitativo es fenomenológico e interpretativo. El instrumento cuantitativo se diseñó con respuestas dicotómicas y polinómicas y el instrumento cualitativo fue diseñado con preguntas abiertas para realizar la entrevista a profundidad o saturación. Como responsables de la validación de los instrumentos estuvieron 2 PhD, 1 especialista y 2 investigadores. Resultados: La validación por parte de los expertos determinó para el criterio de pertinencia 93,18 puntos, para el criterio validez 93,07 puntos y para el criterio coherencia 92,67. Del mismo modo fueron obtenidos los resultados para el instrumento cualitativo, el criterio validez 95,73 puntos, para el criterio pertinencia 95,73 y para coherencia 95,73 puntos. Conclusión: se establece que los instrumentos son considerados confiables de acuerdo al juicio de los expertos, por lo tanto, fueron validados y servirán como aporte para obtener los datos requeridos en la investigación científica(AU)

Exclusive breastfeeding (EBF) has been considered a healthy practice, since it contributes essential nutrients for the health and growth of the child. From this perspective, it considered necessary to have measurement instruments as tools for gathering information on health problems. Therefore, to guarantee the quality of the instrument, it is essential to submit these instruments to an expert validation process based on expert judgment. Objective: To validate the quantitative and qualitative instruments 0-6 LME to establish the risk factors that determine the interruption of exclusive breastfeeding. Method: The methodology used had a mixed approach (quantitative-qualitative) of cross-sectional, exploratory, descriptive and field sections. The qualitative approach is phenomenological and interpretive. The quantitative instrument was designed with dichotomous and polynomial responses and the qualitative instrument was designed with open questions to carry out the interview in depth or saturation. Responsible for the validation of the instruments were 2 PhD, 1 specialist and 2 researchers. Results: The validation by the experts determined for the relevance criterion 93.18 points, for the validity criterion 93.07 points and for the coherence criterion 92.67. In the same way, the results obtained for the qualitative instrument, the validity criterion 95.73 points, for the relevance criterion 95.73 and for coherence 95.73 points. Conclusion: it established that the instruments are considered reliable according to the judgment of the experts; therefore, they were validated and will serve as a contribution to obtain the data required in scientific research(AU)

Caracterización de la Lactancia Materna Exclusiva en menores de 6 Meses. Enero-Marzo. 2019 / Characterization of Exclusive Breastfeeding in children under 6 months. January March. 2019 / Caracterização do Aleitamento Materno Exclusivo em menores de 6 meses. Janeiro Março. 2019

RESUMEN Introducción: la lactancia materna ha sido la forma de alimentación más segura para el ser humano en toda su historia. Objetivo: caracterizar el comportamiento de la lactancia materna exclusiva en los niños menores de 6 meses en el Servicio de Gastro del Hospital Pediátrico Docente General Luis Ángel Milanés Tamayo, en el periodo Enero-Marzo de 2019. Métodos: el diseño fue descriptivo, observacional y trasversal. El universo estuvo constituido por 393 niños que ingresaron en este periodo y la muestra después de aplicados los criterios de inclusión y exclusión quedó conformada por 227 niños. El procesamiento de los datos se realizó mediante el programa EPIDAT versión 3.1, como procesador de texto, el programa Microsoft Word versión 6.0. Resultados: la edad que más predominó en estos niños ingresados en el servicio de Gastro fueron los de 0 a 3 meses (72,2%), la edad materna de los niños ingresados en el servicio de Gastro que abandonaron la LME predominando las de 20 a 30 años con (58,1%), el sexo que predominó en estos niños fue el masculino con 121 (53,3%), La procedencia urbana fue la que predomino en los niños que abandonaron la LME, con 146(63,4%) y el nivel de escolaridad que predominó fue el nivel universitario (58,1%). Conclusiones: la edad del niño de 0-3 meses, edad materna de 21 a 30 años, el sexo masculino, la procedencia urbana, con nivel de escolaridad universitario, fueron los factores que incidieron en el abandono de la lactancia materna exclusiva.

ABSTRACT Introduction: breastfeeding has been the safest form of feeding for human beings throughout its history. Objective: to characterize the behavior of exclusive breastfeeding in children under 6 months of age in the Gastro Service of the Luis Ángel Milanés Tamayo General Teaching Pediatric Hospital, in the period January-March 2019. Methods: the design was descriptive, observational and transversal. The universe consisted of 393 children who were admitted in this period and the sample after applying the inclusion and exclusion criteria was made up of 227 children. The data processing was performed using the EPIDAT version 3.1 program, as a word processor, the Microsoft Word version 6.0 program. Results: the age that most prevailed in these children admitted to the Gastro service were those from 0 to 3 months (72.2%), the maternal age of the children admitted to the Gastro service who left the EBF, predominantly those of 20 at 30 years with (58.1%), the sex that predominated in these children was the male with 121 (53.3%), The urban origin was the one that predominated in the children who abandoned the EBF, with 146 (63, 4%) and the level of education that predominated was the university level (58.1%). Conclusions: the child's age from 0-3 months, maternal age from 21 to 30 years, the male sex, the urban origin, with a university education level, were the factors that influenced the abandonment of exclusive breastfeeding.

RESUMO Introdução: a amamentação tem sido a forma mais segura de alimentação do ser humano ao longo de sua história. Objetivo: caracterizar o comportamento do aleitamento materno exclusivo em menores de 6 meses de idade no Gastro Service do Hospital Geral Pediátrico Luis Ángel Milanés Tamayo, no período de janeiro a março de 2019. Métodos: o desenho foi descritivo, observacional e transversal. O universo foi constituído por 393 crianças internadas nesse período e a amostra após aplicação dos critérios de inclusão e exclusão foi composta por 227 crianças. O processamento dos dados foi realizado no programa EPIDAT versão 3.1, como processador de texto, o programa Microsoft Word versão 6.0. Resultados: a idade que mais prevaleceu nessas crianças internadas no Gastro foi a de 0 a 3 meses (72,2%), idade materna das crianças internadas no Gastro que saíram do AME, predominantemente as de 20 anos. aos 30 anos com (58,1%), o sexo que predominou nessas crianças foi o masculino com 121 (53,3%), A origem urbana foi a que predominou nas crianças que abandonaram o AME, com 146 (63, 4%) e o nível de escolaridade que predominou foi o ensino superior (58,1%). Conclusões: a idade da criança de 0 a 3 meses, a idade materna de 21 a 30 anos, o sexo masculino, a origem urbana, com nível de escolaridade universitária, foram os fatores que influenciaram o abandono do aleitamento materno exclusivo.

Effect of peer counselling on exclusive breastfeeding among mothers attending child welfare clinic in two selected general hospitals in Lagos state, Nigeria

Background: Inadequate nutrition and poor feeding practices of newborn and infants has turn out to be a major public health concern that has negatively affected the lives of many children and as led to the cause of various forms of deficiencies, also the leading cause of death of most children between 1-5years of age. This study determined the effect of peer counselling on exclusive breastfeeding among mothers attending child welfare clinic in two selected general hospitals in Lagos State, Nigeria.Methods: This study adopted a two group pre-test post-test quasi experimental design. Total enumeration was used to select one hundred and seventy-four (174) participants that participated in the study. Data was collected using a self-developed questionnaire while four research questions were tested using descriptive statistics.Results: Findings indicated that the pre-intervention knowledge mean score of participants on the knowledge of exclusive breastfeeding in the control group was 15.43±4.98 (48.2%) and 14.69±5.16 (45.9%) in the experimental group with a mean difference of 0.74. The post-intervention knowledge mean score of participants on the exclusive breastfeeding in the control group was 15.58±4.83 (48.7%) and 28.97±8.31 (90.5%) in the experimental group with a mean difference of 13.39. Conclusions: The present study demonstrated a significant improvement in the exclusive breastfeeding rate among mothers due to peer counselling exposure, and the interventions have been effective in increasing knowledge and practice of breastfeeding among mothers. It was recommended that knowledge of peer counselling will influence knowledge, practice and behaviours on exclusive breastfeeding rate among mothers.

Knowledge, attitudes and practices of breast feeding among lactating mothers in a tertiary care hospital in Dakshina Kannada district: a cross sectional survey

Background: Breastfeeding plays a crucial role in the general health and wellbeing of infants. However, this fact has been made to look inconsequential due to various misconceptions and lack of adequate knowledge among lactating mothers. The aim of this study was to assess the knowledge, attitudes and practices of breastfeeding among postnatal women in Dakshinakannada district of Karnataka, India. The objective was to educate them and encourage breastfeeding.Methods: This study is a cross-sectional survey conducted during a period of 2 months from November to January 2019 among 80 postnatal mothers regarding their KAP of breastfeeding. A questionnaire was designed from FAO guidelines for assessing nutrition-related knowledge, attitudes and practices manual and The Iowa Infant Feeding Attitudes. The data was collected by a single interviewer, collaborated into a 3-point Likert scale and analyzed using descriptive statistics.Results: The study shows that 81.25% of the mothers had good knowledge regarding breastfeeding, but the alarming finding was that 46.6% of them had a neutral attitude towards it.Conclusions: The study showed that there is significant possibility for enhancing breastfeeding practices among lactating mothers by simple provision of supportive prenatal and postnatal counselling. The role played by healthcare workers in this context would be very imperative to accomplish millennium development goals of reducing infant mortality.

Factores maternos asociados a prácticas alimentarias con lactancia materna exclusiva / Maternal factors associated with feeding practices with exclusive breastfeeding / Fatores maternos associados às práticas alimentares com aleitamento materno exclusivo

RESUMEN El abandono precoz de lactancia materna es una problemática de interés mundial. Con el objetivo de determinar la asociación entre factores maternos y duración de la lactancia materna exclusiva (LME) se realizó un estudio observacional, analítico, de cohorte, en niños de seis meses de edad y sus madres, que habitan en el área del policlínico Jimmy Hirzel, municipio Bayamo, provincia Granma, durante el periodo enero-diciembre del 2018. Integraron la muestra 140 niños y sus madres, seleccionados por criterios de inclusión y exclusión. Se exploraron variables maternas: edad, escolaridad, ocupación, paridad, procedencia, conocimientos sobre lactancia materna y prácticas alimentarias con lactancia materna exclusiva. Se utilizaron métodos teóricos, empíricos y estadísticos. Como resultados relevantes, al caracterizar la muestra destacaron las madres de 20 a 34 años de edad (75,7%), nivel de escolaridad preuniversitario (37,1 %), trabajadoras (40,7%), con un solo hijo (66,4%), de procedencia rural (70,7%), con conocimientos adecuados sobre lactancia materna (63,6%). El 65 % ofreció a sus hijos LME por seis meses, la causa principal del abandono del amamantamiento exclusivo fue la hipogalactia materna (59%). Los factores maternos que se asociaron al abandono de la práctica antes de los seis meses fueron: edad (madres adolescentes o añosas 0,0165), menor nivel de escolaridad (0,0373), primiparidad (p= 0,009) y bajo nivel de conocimiento sobre lactancia materna (0,0001).

ABSTRACT The early abandonment of breastfeeding is a problem of global interest. In order to determine the association between maternal factors and duration of exclusive breastfeeding (SCI), an observational, analytical, cohort study was conducted in six-month-old children and their mothers, who live in the Jimmy Hirzel polyclinic area, Bayamo municipality, Granma province, during the period January-December 2018. The sample comprised 140 children and their mothers, selected by inclusion and exclusion criteria. Maternal variables were explored: age, schooling, occupation, parity, origin, knowledge about breastfeeding and exclusive breastfeeding feeding practices. Theoretical, empirical and statistical methods were used. As relevant results, when characterizing the sample, mothers from 20 to 34 years old (75.7%), pre-university level of education (37.1%), workers (40.7%) stood out. , with a single child (66.4%), of rural origin (70.7%), with adequate knowledge of breastfeeding (63.6%). 65% offered their children SCI for six months, the main cause of abandoning exclusive breastfeeding was maternal hypogalactia (59%). The maternal factors that were associated with abandoning the practice before six months were: age (adolescent or elderly mothers 0.0165), lower level of education (0.0373), primiparity (p = 0.009) and low level of knowledge about breastfeeding maternal (0.0001).

RESUMO O abandono precoce da amamentação é um problema de interesse global. Para determinar a associação entre fatores maternos e duração do aleitamento materno exclusivo (LM), foi realizado um estudo observacional, analítico e de coorte em crianças de seis meses e suas mães, residentes na área policlínica de Jimmy Hirzel. , Município de Bayamo, província de Granma, no período de janeiro a dezembro de 2018. A amostra foi composta por 140 crianças e suas mães, selecionadas por critérios de inclusão e exclusão. As variáveis ​​maternas foram exploradas: idade, escolaridade, ocupação, paridade, procedência, conhecimento sobre aleitamento materno e práticas de aleitamento materno exclusivo. Foram utilizados métodos teóricos, empíricos e estatísticos. Como resultados relevantes, ao caracterizar a amostra, destacaram-se mães entre 20 e 34 anos (75,7%), nível de ensino pré-universitário (37,1%), trabalhadoras (40,7%). , com um filho solteiro (66,4%), de origem rural (70,7%), com conhecimento adequado sobre aleitamento materno (63,6%). 65% ofereceram SCI aos filhos por seis meses, a principal causa do abandono do aleitamento materno exclusivo foi a hipogalactia materna (59%). Os fatores maternos associados ao abandono da prática antes dos seis meses foram: idade (mães adolescentes ou idosas 0,0165), menor escolaridade (0,0373), primiparidade (p = 0,009) e baixo nível de conhecimento sobre aleitamento materno materna (0,0001).