Breastfeeding in the first hour of life in Brazilian private hospitals participating in a quality-of-care improvement project.

BACKGROUND: The Baby-Friendly Hospital Initiative's Step 4 recommends: "support mothers to start breastfeeding as soon as possible after birth", thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the "Adequate Childbirth Project", a quality-of-care improvement project, and to analyze determinants of this outcome. METHODS: Secondary analysis of data collected by the cross-sectional evaluative "Healthy Birth Study", conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns' severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. RESULTS: The prevalence of breastfeeding in the first hour of life was 58% (CI 95% 56.6-59.5%). Lower maternal education (aOR 0.643; CI 95% 0.528-0.782), lower economic status (aOR 0.687; CI 95% 0.504-0.935), cesarean section delivery (ORa 0.649; CI 95% 0.529-0.797), preterm birth (aOR 0.660; CI 95% 0.460-0.948) and non-rooming-in at birth (aOR 0.669; CI 95% 0.559-0.800) were negatively associated with the outcome. Receiving information during prenatal care about the importance of breastfeeding at birth (aOR 2.585; CI 95% 2.102-3.179), being target of the quality-of-care improvement project (aOR 1.273; CI 95% 1.065-1.522), skin-to-skin contact at birth (aOR 2.127; CI 95% 1.791-2.525) and female newborn (aOR 1.194; CI 95% 1.008-1.415) were factors positively associated with the outcome. CONCLUSIONS: The private maternities participating in the Healthy Birth Study showed a good prevalence of breastfeeding in the first hour of life, according to WHO parameters. Prenatal guidance on breastfeeding at birth, being target of the quality-of-care improvement project and skin-to-skin contact at birth contributed to breastfeeding in the first hour of life.

Ovicidal effect of essential oils of Lippia alba, Lippia sidoides and Lippia gracilis on the acanthocephalan Neoechinorhynchus buttnerae (Eoacanthocephala: Neoechinorhynchidae).

Acanthocephalosis in tambaqui Colossoma macropomum culture is a limiting factor for the production of the species, being the most recurrent, which makes it necessary to develop strategies to control parasitosis even in the early stages of parasite development. This study aimed to elucidate the morphological characteristics of eggs of the acanthocephalan Neoechinorhynchus buttnerae and the ovicidal effect of the essential oils of Lippia alba, Lippia sidoides, and Lippia gracilis. The parasites were collected from hosts naturally infected with N. buttnerae, and the eggs obtained from the female 'parasites' abdominal cavity were added to 12-well plates containing the essential oils at different dilutions. After the eggs (N = 300) were separated and measured (length and width) with the aid of an optical microscope coupled to a digital program, the viability of the treated eggs was monitored 24 h after treatments, L. gracilis essential oil was 100% effective at the highest concentration, whereas L. sidoides essential oil showed over 50% efficacy at 2 mg/ml, reaching 100% efficacy at all higher concentrations. Lippia. alba essential oil did not show satisfactory efficacy in preventing N. buttnerae egg hatching.

Distribution of the acanthocephalan Neoechinorhynchus buttnerae and semiquantitative analysis of histopathological damage in the intestine of tambaqui (Colossoma macropomum).

In this paper, we have described for the first time a semiquantitative method to evaluate histopathological damage, taking the degree of Neoechinorhynchus buttnerae attachment to the intestinal wall of the tambaqui (Colossoma macropomum), an important species in Brazilian aquaculture, into account. Twelve specimens of tambaqui were collected from a fish farm. Their bowels were removed and divided into seven morphologically distinct portions according to density and distribution of the parasite studies. Fragments from each fraction were histologically processed and analyzed. There was a clear preference on the part of N. buttnerae for the intermediate regions of the intestinal tube, where the highest densities were recorded. The intensity of damage to the host, estimated by calculating the Histopathological Alteration Index (HAI), showed severe and irreversible changes only where the parasite had its proboscis penetrated into the intestine wall.

Morphological and histochemical changes associated with massive infection by Neoechinorhynchus buttnerae (Acanthocephala: Neoechinorhynchidae) in the farmed freshwater fish Colossoma macropomum Cuvier, 1818 from the Amazon State, Brazil.

The study describes the morphological changes associated with parasitism by the intestinal acanthocephalan Neoechinorhynchus buttnerae in tambaqui juveniles Colossoma macropomum farmed in an excavated nursery, in Manaus (Amazon) in September 2013. After fish biometrics, analysis of macroscopic changes in morphology and counting of parasites, bowel fragments were fixed and submitted to histological and histochemical processing. All fish analyzed had acanthocephalans in the intestine; intestinal loops were milky white in color, with the presence of nodules with heavy parasitism. The changes in tissues that form the intestine varied according to the arrangement of the parasites: either free in the intestinal lumen or fixed by the proboscis on the organ wall. In the first case, the changes found were flaking, abrasion, compression, hypertrophy of goblet cells and disappearance of the villi on the mucosa, leukocytic cell infiltration in the submucosa, and muscle layer thickening. In the second case, in addition to these, other changes were observed as metaplasia in muscle tissue with its replacement by a loose connective tissue with severe leukocytic infiltration, edema in blood vessels, and necrotic foci. The histochemical analysis revealed that positive Alcian Blue mucosal cells (pH 2.5) were more expressive in parasitized intestines than in intestines not parasitized by N. buttnerae.

The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study.

BACKGROUND: Breastfeeding in the first hour after birth is important for the success of breastfeeding and in reducing neonatal mortality. Government policies are being developed in this direction, highlighting the accreditation of hospitals in the Baby-Friendly Hospital (BFH) initiative. The aim of this study was to analyze the association between delivery in a BFH (main exposure), compared to non BFH, and timely initiation of breastfeeding (outcome). METHODS: Data came from the "Birth in Brazil" survey, a nationwide hospital-based study of postpartum women and their newborns, coordinated by the Oswaldo Cruz Foundation. A sample of 22,035 mothers/babies was analyzed through a hierarchical theoretical model on three levels, and all analyzes considered the complex sample design. Odds ratios were obtained by logistic regression, with a 99 % CI. RESULTS: Among all births, 40 % occurred in hospitals accredited or in accreditation process for the BFHI and 52 % of women underwent caesarean section. In the final model, at the distal level, mothers less than 35 years old, and those who lived in the North Region, had a higher chance of timely initiation of breastfeeding. At the intermediate level, prenatal care in the public sector and advice on breastfeeding during pregnancy were directly associated with the outcome. At the proximal level, being born in a Baby-Friendly Hospital and vaginal delivery increased the chance of timely initiation of breastfeeding, while prematurity and low birth weight reduced the chance of the outcome. CONCLUSIONS: The chance of being breastfed in the first hour after birth in Baby-Friendly hospitals was twice as high as at non-accredited hospitals, which shows the importance of this initiative for timely initiation of breastfeeding.

Baby-Friendly Hospital Initiative and exclusive breastfeeding during hospital stay.

OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (outcome) and to analyze the association between delivery in a Baby-Friendly Hospital (BFH) and the outcome. The hypothesis is that accreditation to this program improves exclusive breastfeeding during maternity hospital stay. Exclusive breastfeeding is essential in reducing neonatal morbidity and mortality. METHODS: This study is based on secondary data collected by the "Birth in Brazil: National Survey into Labour and Birth", a population-based study, conducted with 21,086 postpartum women, from February 1, 2011, to October 31, 2012, in 266 hospitals from all five Brazilian regions. Face-to-face interviews were conducted mostly within the first 24 hours after birth, regarding individual and gestational characteristics, prenatal care, delivery, newborn's characteristics, and breastfeeding at birth. A theoretical model was created, allocating the exposure variables in three levels based on their proximity to the outcome. This hierarchical conceptual model was applied to perform a multiple logistic regression (with 95%CI and p < 0.05). RESULTS: In this study, 76.0% of the babies were exclusively breastfed from birth until the interview. Babies born in public (AOR = 1.73; 95%CI: 1.10-2.87), mixed (AOR = 2.48; 95%CI: 1.35-4.53) and private (AOR = 5.54; 95%CI: 2.38-12.45) BFHs were more likely to be exclusively breastfed during maternity hospital stay than those born in non-BFHs, as well as those born by vaginal birth (AOR = 2.16; 95%CI: 1.79-2.61), with adolescent mothers (AOR = 1.83; 95%CI: 1.47-2.26) or adults up to 34 years old (AOR =1 .31; 95%CI: 1.13-1.52), primiparous women (AOR = 1.51; 95%CI: 1.34-1.70), and mothers living in the Northern region of Brazil (AOR = 1.99; 95%CI: 1.14-3.49). CONCLUSIONS: The Baby-Friendly Hospital Initiative promotes exclusive breastfeeding during hospital stay regarding individual and hospital differences.

Harassment of health professionals by the infant food industry at scientific events.

OBJECTIVE: To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events. METHODS: Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals' knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL - Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession. RESULTS: We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%). CONCLUSION: The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships.

Violations in the marketing of milks and complementary foods that compete with breastfeeding in Rio de Janeiro City, Brazil.

OBJECTIVE: To analyze if milk and complementary foods are being sold under the Brazilian Code of Marketing of Infant and Toddler's Food, Teats, Pacifiers and Baby Bottles (NBCAL), Law 11265/2006 of breastfeeding protection. METHODS: Epidemiological survey that analyzed the marketing practices of pharmacies, supermarkets, and department stores in the Southern region of the city of Rio de Janeiro, Brazil, by direct observation. RESULTS: Among the 349 stores in Rio de Janeiro's South Region, 339 traded milk and complementary foods and, among them, 60.8% were not complying with NBCAL. Infractions to NBCAL were more common for the selling of milk (58.6%) than complementary foods (22.8%). The most recurrent promotion strategy infringing NBCAL was discount pricing without the Ministry of Health disclaimer. CONCLUSIONS: Most retail stores infringe NBCAL in the commercialization of milk and complementary foods in the city of Rio de Janeiro, Brazil, a violation of the right to information that may impact mothers' choice regarding their child's feeding.

Factors associated with infant formula supplementation in Brazilian hospitals: a cross-sectional study.

OBJECTIVE: To analyze the factors associated with infant formula supplementation in newborns referred to rooming-in in Brazilian hospitals. METHOD: Cross-sectional study with data from 14,531 postpartum women and newborns obtained from the "Birth in Brazil" survey, conducted in 2011-2012. The analysis used a logistic regression model with a hierarchical approach. RESULTS: In total, 21.2% newborns received infant formula during hospital stay. After adjustment, the following factors were associated with the use of infant formula: maternal age ≥ 35 years (OR = 1.51; IC95%:1.30-1.75), prenatal care in a private service (OR = 2,22; IC:1.72-2.85)/public and private service (OR = 1.67; IC:1.24-2.23), cesarean delivery (OR = 1.83; IC:1.41-2.38), multiple pregnancy (OR = 3.786; IC:2.02-7.06), non-breastfeeding in the delivery room (OR = 1.780; IC:1.43-2.21), birth in a private hospital (OR = 1.695; IC:1.02-2.79), prematurity (OR = 1.656; IC:1.32-2.06) and extremes of birth weight (< 2.500 g: OR = 2.084; IC: 1.585-2.741/ ≥4,000g: OR = 1.672; IC:1.31-2.11). Teenage age (OR = 0.651; IC:0.55-0.76), low maternal education (OR = 0.579; IC:0.43-0.77), multiparity (OR = 0.588; IC:0.510-0.678), and lower economic class (OR = 0.565; IC:0.41-0.76) significantly reduced the probability of using infant formula. CONCLUSIONS: Of the associated factors, the authors highlight cesarean delivery and non-breastfeeding in the delivery room, showing that it is necessary to strengthen policies that encourage good practices during childbirth care in order to promote exclusive breastfeeding and protect mothers and newborns from all social classes against the misuse of infant formula.

Methodology and indicators for NBCAL monitoring in stores and health services: a multicenter study (Multi-NBCAL). / Metodologia e indicadores para monitoramento da NBCAL em estabelecimentos comerciais e serviços de saúde: estudo multicêntrico (Multi-NBCAL).

The Brazilian Code of Marketing of Infant and Toddlers Food, Nipples, Pacifiers and Baby Bottles (NBCAL), in force in Brazil since 1988, is still systematically violated, exposing mothers and family members to illegal marketing of products that compete with breastfeeding. This study aimed to describe a multicenter study methodology and propose standardized indicators for NBCAL monitoring. This is a Multicenter Study for NBCAL Compliance Assessment (Multi-NBCAL) conducted in seven Brazilian cities: Rio de Janeiro, São Paulo, Ouro Preto (Minas Gerais State), Florianópolis (Santa Catarina State), Brasília (Federal District), João Pessoa (Paraíba State), and Belém (Pará State). Assessment tools were adapted from NetCode/WHO and IBFAN Brazil (International Baby Food Action Network) to conduct two evaluations: (1) evaluation of NBCAL compliance in stores, and NBCAL knowledge and practices of store managers; (2) evaluation of the interaction between the baby food industry and health professionals and post-partum mothers in maternity hospitals. Five indicators were developed to assess NBCAL compliance in stores; seven indicators to assess the knowledge and practices of store managers; five indicators to assess the provision of incentives to maternity hospitals, health professionals, and mothers by sectors; and five indicators to assess NBCAL knowledge and practices of health professionals. The NBCAL assessment methodology with the proposal of standardized indicators allows comparability of studies about this theme. Using these indicators in periodic national or regional investigation can help monitor the level of NBCAL implementation in Brazil.

A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), vigente no Brasil desde 1988, ainda é sistematicamente infringida, expondo mães e familiares ao marketing ilegal de produtos que competem com o aleitamento materno. O objetivo foi descrever metodologia de estudo multicêntrico e propor indicadores padronizados para monitoramento da NBCAL. Estudo Multicêntrico para Monitoramento da NBCAL (Multi-NBCAL) conduzido em sete cidades brasileiras: Rio de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasília (Distrito Federal); João Pessoa (Paraíba) e Belém (Pará). Instrumentos de avaliação foram adaptados do NetCode/WHO e da IBFAN Brasil (Rede Internacional em Defesa do Direito de Amamentar) para condução de dois inquéritos: (1) avaliação do cumprimento da NBCAL em estabelecimentos comerciais e das práticas e conhecimento dos seus gerentes sobre a NBCAL; (2) avaliação em maternidades da interação da indústria de alimentos infantis com profissionais de saúde e mães. Foram elaborados cinco indicadores para avaliação do cumprimento da NBCAL em estabelecimentos comerciais; sete indicadores para avaliar conhecimentos e práticas dos seus responsáveis; cinco indicadores para avaliar a oferta de incentivos a maternidades, profissionais de saúde e mães pelas indústrias e cinco indicadores para avaliar conhecimento e práticas de profissionais de saúde quanto à NBCAL. A metodologia de avaliação da NBCAL, com a proposta de indicadores padronizados, permite a comparabilidade de estudos sobre o tema. A utilização desses indicadores em inquéritos periódicos, nacionais ou regionais, pode contribuir para monitorar o grau de implementação da NBCAL no Brasil.

La Norma Brasileña de Comercialización de Alimentos para Lactantes y Niños en la Primera Infancia, Tetillas, Chupetes y Biberones (NBCAL), vigente en Brasil desde 1988, todavía es sistemáticamente infringida, exponiendo a madres y familiares al marketing ilegal de productos que compiten con la lactancia materna. El objetivo fue describir la metodología de estudio multicéntrico y proponer indicadores estandarizados para el monitoreo de la NBCAL. Estudio Multicéntrico para Monitoreo de la NBCAL (Multi-NBCAL) llevado a cabo en siete (7) ciudades brasileñas: Río de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasilia (Distrito Federal); João Pessoa (Paraíba) y Belém (Pará). Se adaptaron instrumentos de evaluación del NetCode/OMS y de la IBFAN Brasil (Red Internacional de Acción por la Alimentación Infantil)para la realización de dos encuestas: (1) evaluación del cumplimiento de la NBCAL en establecimientos comerciales y de las prácticas y conocimiento de sus gerentes sobre la NBCAL; (2) evaluación en maternidades de la interacción de la industria de alimentos infantiles con profesionales de salud y madres. Se elaboraron cinco indicadores para la evaluación del cumplimiento de la NBCAL en establecimientos comerciales; siete indicadores para evaluar conocimientos y prácticas de sus responsables; cinco indicadores para evaluar la oferta de incentivos a maternidades, profesionales de salud y madres por las industrias y cinco indicadores para evaluar el conocimiento y prácticas de profesionales de salud, respecto a la NBCAL. La metodología de evaluación de la NBCAL, con la propuesta de indicadores estandarizados, permite la comparabilidad de estudios sobre el tema. La utilización de estos indicadores en encuestas periódicas, nacionales o regionales, puede contribuir a monitorear el grado de implementación de la NBCAL en Brasil.

[Assessment of the impact of the NGO Refazer on medical care for children at social risk]. / Avaliação de impacto da ONG Refazer no tratamento médico de crianças em risco social.

OBJECTIVE: Assess the impact of activities by the nongovernmental organization Refazer in support of medical care for children at social risk. METHODS: A longitudinal study was conducted of 77 patients from Rio de Janeiro in treatment at the Fernandes Figueira Institute and supported by Refazer. The assessment period was two years, one before and the other during the intervention period while being supported by the NGO. The percentage of hospitalizations, average length of stay, severity of the illness, use of technology, number of outpatient consultations, and clinical conditions involved were compared. RESULTS: The indicators linked with the hospitalizations revealed changes during the intervention period. There was a reduction in the average time and percentage of hospitalization. The most common pathologies were congenital malformations, chromosomal anomalies, and diseases of the nervous system. These diseases and HIV/AIDS were more prevalent in children that remained hospitalized even after receiving support from the NGO. CONCLUSIONS: Analysis of the indicators showed that the outcomes are adequate to the NGO's mission and that the population helped benefits from participation in the social support network. Although it cannot be stated that the benefits found are due exclusively to the activities of the NGO, a simple and easy-to-use evaluation of adequacy was developed that NGOs themselves can use, representing progress toward the institutional use of evaluations by NGOs working in health.

Breastmilk Substitutes Marketing Violations and Associated Factors in Rio de Janeiro, Brazil.

BACKGROUND: Aiming to protect breastfeeding, the World Health Organization released the International Code of Marketing of Breastmilk Substitutes in 1981, which was adopted by the vast majority of the 118 member countries, including Brazil. The Brazilian Code regulates the marketing of infant formulas, baby bottles, teats, pacifiers, milk, and processed complementary food. RESEARCH AIMS: (1) To determine if retail stores had violated the Brazilian Code and (2) to analyze factors associated with these violations. METHODS: This cross-sectional study included all drugstores, supermarkets, and department stores in the Southern Zone of Rio de Janeiro City, Brazil. Trained health professionals observed retail stores for marketed products and violations of the Brazilian Code and then interviewed their managers. Factors associated with the retail stores violating the Brazilian Code (outcome) were analyzed, employing a logistic regression model with 95% Confidence Interval. RESULTS: Of the retail stores (N = 349) evaluated, 62.8% violated the Brazilian Code, ranging from 1 to 37 violations per retail store. The most common promotion strategies were price discounts and special displays. Retail stores being part of a chain store (aOR = 4.59) and their manager receiving visits from industry business representatives (aOR = 2.14) were associated with the presence of violations. CONCLUSIONS: The prevalence of Brazilian Code violations was high, especially in chain stores. The association between regular visits by industry representatives and violations suggests an indirect influence of manufacturers on the promotion of human milk substitutes. We recommend strengthening compliance with the Brazilian Code through calling on governmental surveillance agencies and civil society mobilization.

Sustainability of the Breastfeeding-Friendly Primary Care Initiative: a cross-sectional study.

OBJECTIVES: to assess the sustainability of the Breastfeeding-Friendly Primary Care Initiative by analyzing compliance with the Ten Steps in accredited units; and association with maternal satisfaction and exclusive breastfeeding. METHODS: a cross-sectional study conducted in 2016. An assessment of compliance, conducted by interviews with health professionals, pregnant women, and mothers. An association between compliance and satisfaction, analyzed by Spearman>s correlation test; and association between contextual/individual characteristics and exclusive breastfeeding, by the multilevel Poisson regression. RESULTS: compliance was 5.4-10 points and satisfaction was 36.8%-100%. Prevalence of exclusive breastfeeding was 56.7%. There was a correlation between compliance and satisfaction. Higher education, prenatal orientation, hospital discharge on exclusive breastfeeding, attendance in mixed units, and female gender of the child were associated with higher prevalence of exclusive breastfeeding; on the other hand, increasing age and pacifier use were associated with lower prevalence. CONCLUSIONS: the Initiative proved to be sustainable; compliance with the Ten Steps was high and was reflected in maternal satisfaction.

Digestive tube of an herbivorous fish (Rhytiodus microlepis) from the Amazonian floodplain lakes: A morphological and histochemical study.

This study describes the morphology and histochemistry of the digestive tube of the herbivorous fish Rhytiodus microlepis, which is commonly found in the Amazonian floodplain lakes, Brazil. Thirty-eight fish were used in this study. The digestive tube was measured and dissected for anatomical description, and stained with (i) haematoxylin and eosin, for histological analyses; (ii) periodic acid-Schiff, for detected neutral mucins; and (iii) Alcian Blue (AB) pH 1.0 and 2.5 for acid and sulphated acid mucins. The oesophagus, with its secretory cells and taste buds, is adapted for lubrication of vegetable matter, resistance to friction and reception of stimuli. The stomach is U-shaped and rich in gastric glands, particularly in cardiac and fundic regions, which are adapted to receive large amounts of food, and promotes the digestion. The intestine comprises more than 70% of the digestive tube. All portions of the intestine, except the rectum, have the same pattern of mucosal folds, and the goblet cells reacted positively to all histochemical methods (PAS, AB 1.0 and 2.5), while rodlet cells reacted only to periodic acid-Schiff (PAS) staining. Neutral mucins and sulphated acid mucins predominated in the anterior portion of the intestine and a high concentration of carboxylated acid mucosubstances were present in the other portions. The rectum showed a strong reaction to all histochemical methods. The muscular layer of the intestine consists of three layers, which showed features presumably related to the rigid nature of the food. A simple squamous epithelium constitutes the serous layer over the entire length of the tube.

[Impact assessment of an educational intervention in pharmacies that use commercial promotion of products competing with maternal breastfeeding]. / Avaliação do impacto de intervenção educativa em farmácias com promoção comercial de produtos que competem com o aleitamento materno.

The Brazilian Code of Marketing of Infant and Toddlers Food, Nipples, Pacifiers, and Baby Bottles (Federal Law n. 11,265/2006) aims to control the abusive marketing of products that compete with breastfeeding. The objective was to assess the impact of an educational intervention on compliance with this law by pharmacies. A randomized intervention study was conducted in 155 pharmacies that were infringing the law in the Southern Zone of Rio de Janeiro, Brazil. The pharmacies' commercial practices were assessed before and after the intervention with the pharmacist and manager, compared to the control group. The interval between the intervention and the second assessment was one month. McNemar test was used to measure changes in the number of pharmacies infringing the law before and after the intervention. Wilcoxon test was used to compare variation in the number of violations in each group. A month after the intervention, there was a 16.1% reduction (n = 25) in the number of pharmacies committing violations. There was a decrease from 18.7% to 12.9% in products whose commercial promotion is banned by the law (p = 0.093) and from 92.9% to 80.5% in milk products (p = 0.001), but among processed complementary food there was an increase from 28.5% to 42.3% of pharmacies with illegal promotions (p = 0.006). The intervention group with the pharmacists showed a statistically significant reduction in violations related to discount prices (p = 0.022) and special displays (p = 0.002). The educational intervention reduced the number of pharmacies that infringed the law, mainly when the intervention involved the pharmacist.

A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (Lei Federal nº 11.265/2006) visa controlar o marketing abusivo de produtos que competem com o aleitamento materno. O objetivo foi avaliar o impacto de uma intervenção educativa sobre o cumprimento da Lei em farmácias. Pesquisa de intervenção randomizada conduzida em 155 farmácias que infringiam a Lei na Zona Sul do Rio de Janeiro, Brasil. A prática comercial das farmácias foi avaliada antes e depois da intervenção com o farmacêutico e com o gerente, comparados ao grupo controle. O intervalo entre a intervenção e a segunda avaliação foi de um mês. Para aferir as mudanças no quantitativo de farmácias com infração à Lei, antes e depois da intervenção, foi utilizado o teste de McNemar. O teste de Wilcoxon foi usado para comparar a variação no número de infrações em cada grupo de alocação. Um mês após a intervenção houve redução de 16,1% (n = 25) no total de farmácias com infração. Houve redução de 18,7% para 12,9% em produtos cuja promoção comercial é proibida (p = 0,093) e de 92,9% para 80,5% nos produtos lácteos (p = 0,001), mas entre alimentos de transição houve aumento de 28,5% para 42,3% de farmácias com promoção ilegal (p = 0,006). O grupo intervenção com farmacêutico apresentou redução estatisticamente significativa nas infrações relacionadas a descontos de preço (p = 0,022) e a exposições especiais (p = 0,002). A intervenção educativa reduziu a quantidade de farmácias que infringia essa Lei, principalmente quando esta intervenção foi realizada com o farmacêutico.

La Norma Brasileña de Comercialización de Alimentos para Lactantes y Niños de la Primera Infancia, Tetillas, Chupetes y Biberones (Ley Federal nº 11.265/2006) tiene como finalidad controlar el márketing abusivo de productos que compiten con la lactancia materna. El objetivo fue evaluar el impacto de una intervención educativa sobre el cumplimiento de la ley en farmacias. Se realizó una investigación de intervención aleatoria, llevada a cabo en 155 farmacias que infringían la ley en la zona sur de Río de Janeiro, Brasil. La práctica comercial de las farmacias fue evaluada antes y después de la intervención con el farmacéutico y con el gerente, comparadas con el grupo de control. El intervalo entre la intervención y la segunda evaluación fue de un mes. Para evaluar los cambios en lo cuantitativo de farmacias con infracción a la ley, antes y después de la intervención, se utilizó el test de McNemar. El test de Wilcoxon se utilizó para comparar la variación en el número de infracciones en cada grupo de asignación. Tras un mes de la intervención hubo una reducción de un 16,1% (n = 25) en el total de farmacias con infracción. Hubo una reducción desde un 18,7% a un 12,9% en productos cuya promoción comercial está prohibida (p = 0,093) y de un 92,9% a un 80,5% en productos lácteos (p = 0,001). Sin embargo, entre alimentos de transición hubo un aumento de un 28,5% a un 42,3% de farmacias con promoción ilegal (p = 0,006). El grupo de intervención con el farmacéutico presentó una reducción estadísticamente significativa en las infracciones relacionadas con descuentos de precio (p = 0,022) y respecto a exposiciones especiales (p = 0,002). La intervención educativa redujo la cantidad de farmacias que infringía esta ley, principalmente cuando la intervención educativa se realizó con el farmacéutico.

Social support modifies the association between pre-pregnancy body mass index and breastfeeding initiation in Brazil.

BACKGROUND: Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association. DESIGN: National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses. RESULTS: Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI. CONCLUSIONS: Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation.

Illegal commercial promotion of products competing with breastfeeding.

OBJECTIVE: To assess if the commercialization of infant formulas, baby bottles, bottle nipples, pacifiers and nipple protectors is performed in compliance with the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância e de Produtos de Puericultura Correlatos (NBCAL - Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related products). The commercial promotion of these products is prohibited by the Law 11,265. METHOD: Cross-sectional study conducted in 2017 through a census of all pharmacies, supermarkets and department stores that sold products covered by NBCAL in the South Zone of Rio de Janeiro. Health professionals trained at NBCAL used structured electronic form for direct observation of establishments and for interviews with their managers. We created indicators to evaluate commercial practices and performed descriptive analyses. RESULTS: A total of 352 commercial establishments were evaluated: 240 pharmacies, 88 supermarkets and 24 department stores, of which 88% sold products whose promotion is prohibited by NBCAL. Illegal commercial promotions were found in 20.3% of the establishments that sold the products we investigated: 52 pharmacies (21.9%), four supermarkets (7.5%) and seven department stores (33.3%). The most frequent commercial promotion strategies were discounts (13.2%) and special exposures (9.3%). The products with the highest prevalence of infractions of NBCAL were infant formulas (16.0%). We interviewed 309 managers of commercial establishments; 50.8% reported unfamiliarity with the law. More than three-quarters of the managers reported having been visited at the establishments by commercial representatives of companies that produce infant formulas. CONCLUSION: More than a fifth of commercial establishments promoted infant formulas, baby bottles and nipples, although this practice has been banned in Brazil for thirty years. We think it is necessary to train those managers. Government agencies must monitor commercial establishments in order to inhibit strategies of persuasion and induction to sales of these products, ensuring mothers' autonomy in the decision on the feeding of their children.

Professional who attended childbirth and breastfeeding in the first hour of life.

OBJECTIVES: To investigate the association between the professionals who attended vaginal delivery and breastfeeding in the first hour of life. METHODS: This is a cross-sectional study with data from the Nascer no Brasil (Born in Brazil) survey, conducted in the 2011-2012 period. Data from 8,466 puerperae were analyzed using a logistic regression model with a hierarchical approach. RESULTS: The proportion of mothers who breastfed at birth was higher in deliveries attended by nurses (70%). A nurse-assisted delivery was 64% more likely to breastfeed in the first hour of life. Other factors associated with the outcome: residing in the North; age less than 35 years; multiparity; prenatal guidance on breastfeeding in the first hour of life; birth at Baby-Friendly Hospital; companion at birth; and female newborn. CONCLUSIONS: Obstetrician nurse/nurse-assisted delivery was a significant independent factor associated with breastfeeding in the first hour of life, suggesting the importance of strengthening the role of the obstetrician nurse.