Breastfeeding and early weaning practices in northeast Brazil: a longitudinal study.

OBJECTIVES: To describe breastfeeding practices from 0 to 12 months of age in 4 small towns that are representative of urban northeast Brazil and to identify factors associated with introduction of other milk in the first month of life. METHODS: From January to August 1998, 364 mothers were interviewed at delivery to ascertain antenatal care; delivery room practices; and their intentions regarding breastfeeding, pacifiers, and introduction of water, teas, and other milk. Their perceptions of home support and the advantages of breastfeeding also were assessed. Thereafter, daily information about feeding practices was collected at twice-weekly home visits. When other milk was started, a second interview was conducted to ascertain initial and current breastfeeding problems and use of a pacifier. Reasons for starting other milk were investigated using 5-point Likert scales. RESULTS: Mothers were positive toward breastfeeding, and 99% breastfed their new infant. Few intended to breastfeed exclusively, and in the first week 80% gave water/tea and 56% used a pacifier. The median duration of exclusive breastfeeding was 0 days, and the median age for starting other milk was 24 days. The median duration of breastfeeding was 65 days for mothers who started other milk within 1 month and 165 days for other mothers. After adjustment for confounding variables, the main factors associated with introduction of other milk within 1 month were pacifier use in the first week (odds ratio [OR], 4.01; 95% confidence interval [CI]: 2.07-7.78), intention to start other milk in the first month (OR, 3.79; 95% CI: 1.74-8.24), giving water/tea in the first week (OR, 3.07; 95% CI: 1.56-6.03), and leaving the maternity ward before breastfeeding was started (OR, 2.59; 95% CI: 1.34-5.04). CONCLUSION: Although breastfeeding is common in this community, it rarely is exclusive and takes place for a relatively short duration. Identification of risk factors for early introduction of other milk offers potential avenues for future intervention, including improvement of breastfeeding support in antenatal and maternity services.

[Intestinal parasite infections and schistosomiasis in a poor urban area, in townships of the sugar cane belt and in villages of the semi-arid area of North-East Brazil]. / Parasitoses intestinales et schistosomose en milieu urbain, en région semi-aride du Nord-Est du Brésil.

We determined the prevalence of intestinal parasite infections between 1993 and 1998 in the populations of a poor quarter of Recife (Pernambuco), in two townships in the sugar cane belt and in three villages of the semi-arid area far from the coast. Intestinal schistosomiasis was present in the sugar-growing area but was not observed in the populations inland that use dams to provide irrigation and fishing. Ascaris was very common in the city and the sugar cane belt and large numbers of hookworms were observed, especially in the sugar-growing area. These nematodes were very rare in the semi-arid area. This distribution probably results from both climatic conditions and human behavior. The high frequency of Amoeba cysts demonstrates that the peasants, farmers and fisherman living in these areas have poor hygiene practices. There are probably many, complex relationships between education, income, lifestyle and intestinal parasite infections.

[Infant mortality rate and social disparity at Recife, the metropolis of the North-East of Brazil]. / Taux de mortalité infantile et disparités sociales à Recife, métropole du Nord-Est du Brésil.

We analyzed differences in infant mortality between areas of Recife, a city in the North East of Brazil, analyzing the relationship between living conditions and the risk of death. We compared infant mortality coefficients for 1995 with indicators of living conditions and collected data for the 770 infant deaths and the 27,965 live births. Neighborhoods were ranked according to the quality of living conditions and were grouped into four clusters. The infant, neonatal and postneonatal mortality coefficients were 27.53, 18.84 and 8.69 per 1,000 live births respectively. Lower quality living conditions were associated with higher coefficients. The main causes of infant deaths were perinatal disorders, the coefficient of which was 14.95 per 1,000 live births, followed by congenital malformations, gastroenteritis and bronchopneumonia. With the exception of congenital malformations, the coefficients of all these causes of death increased as living conditions worsened. These inequalities are generally obscured by the presentation of means for the city as a whole.

[Experimental anatomo-pathologic study in the myocardium of animals with arterial hypertension caused via a nitric oxide synthesis blocker]. / Estudo anátomo-patológico experimental em miocárdio de animais submetidos a hipertensão arterial via bloqueador da síntese do óxido nítrico.

INTRODUCTION: Cardiac hypertrophy and reactive (including perivascular) and reparative fibrosis in L-NAME model are similar to that of hypertensive and cardiomyopathic patients. THE AIM: To qualitatively evaluate the reactive (including perivascular) and reparative fibrosis, on days 21 and 35, occurring in hearts submitted to the L-NAME model, using special staining. MATERIAL AND METHODS: We utilized 33 normotensive Wistar rats. L-NAME was administered orally--in a concentration of 75 mg x 100 ml-1 in drinking water. Six rats were submitted during 21 days and an other 15 rats during 35 days. The arterial pressure was obtained on days 12, 20 and 34 using hydraulic plethysmography. On days 21 and 35 during the experiment the animals were anesthetized and submitted to cardiotomy. The hearts were fixed in Bouin fixative during 48 hours and processed using routine methods, emblocked in paraplast and cut in slices 4 to 7 microns thick. The special staining utilized were: Gomori's trichrome (aniline blue) or Masson trichrome, picro-sirius red-polarization, alcian blue technique (pH 0.5 and pH 2.5), periodic acid-Schiff technique (with and without amylases) and Weigert's resorcinol fuchsin solution (with and without oxon). RESULTS: Our results demonstrated an increase in the arterial pressure in animals submitted to the model. On day 21 of submission we observed modest to extensive infarct areas in the right and left ventricular myocardium. On day 35 the wide reparative areas were from old infarct areas. In some cases at day 35 the lesions reached the totality of the right ventricle in several histological slices. The right ventricle was much more affected than the left one. In both groups perivascular fibrosis was observed, nevertheless, on day 21 it was very reduced. DISCUSSION: The degree of direct influence of NO or hypertension produced by NO on hypertension and cardiac lesions during L-NAME model is discussed nowadays. Nevertheless, the fact is that NO deficit has great influence in several cases of cardiac lesions occurring in hypertension and also in cardiomyopathies.

[Hemoglobin "S" positive newborn detected by cord blood and its characteristics] / Características de recém-nascidos portadores de hemoglobina.

OBJECTIVE: To evaluate the prevalence of hemoglobin "S" (Hb "S") in babies born at the Instituto Materno Infantil de Pernambuco (IMIP) and its occurrence according to sex, birth weight and Apgar score. METHODS: We carried out a cross-sectional descriptive study of all babies born in the IMIP from October 1996 to March 1997. We used alkaline electrophoresis to analyze cord blood samples (1,988). Data for other variables were collected from medical reports. EPI-Info 6.0 was used to analyze the data.RESULTS: We found 105 (5.3%) newborns with Hb "S": 102 (5.1%.) as sickle cell trait (Hb "FAS"), and 3 (0.2%) as sickle cell disease (Hb "SC"). No cases of homozygosis were found. Newborns with and without Hb "S" did not differ in relation to sex, birth weight and Apgar score. CONCLUSIONS: We suggest the implementation of neonatal screening for hemoglobinopathies for all the newborns in Recife, Brazil, with further follow up focusing on genetic counseling for suspected and positive cases.

The antecedents of adolescent pregnancy in a Brazilian squatter community.

A case-control study among first time pregnant adolescent girls in a squatter community in Recife, Brazil, showed that 46 per cent had already dropped out of school (P less than 0.001) and had a job at the time of their pregnancy (P less than 0.001; RR 5.5). Two-thirds came from single-parent households (P less than 0.001; RR 2.8) with weak supervision at home. There was some indication of modelling effect, in that more pregnant adolescents had mothers who became pregnant before the age of 15, or close family members who were adolescent mothers, but the difference was not statistically significant. By contrast, the peer group effect was significant (P less than 0.05; RR 1.9). More amongst the pregnant adolescents had commenced menarche before age 13, and twice as many compared to controls had started regular dating before that age (P less than 0.05; RR 2.3). There was a striking lack of knowledge concerning menarche, conception and contraception. The implications of the findings for school and health services in squatter communities are discussed. Four main antecedents on the path to parenthood when the adolescent can benefit from counseling are identified.