Counselling on breastfeeding: assessing knowledge and skills

Reported are the results of a randomized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course ``Breastfeeding counselling: a training course''. The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo, Brazil...

Is overweight a risk factor for wheezing in pre-school children? A study in 14 Brazilian communities.

OBJECTIVE: To evaluate the association between overweight and wheezing in pre-school children in 14 small Brazilian communities. METHODS: Cross-sectional epidemiological study, conducted between 2001 and 2002. A sample of 3453 children under 5 years of age was taken from nine communities in the state of Bahia and five in the state of São Paulo. Data on housing, family and children were obtained by applying structured questionnaires in loco. Weight and height for each child were also measured. The association between wheezing and overweight was assessed by unconditional logistic multivariate regression models. RESULTS: Overweight children had a greater frequency of wheezing and an odds ratio of 2.57 (95% confidence interval 1.51-4.37) was estimated after controlling for several potential confounding variables. The magnitude of the risk was not affected by several different model specifications. CONCLUSION: Excess weight is associated with increased risk for wheezing in this population of children below 5 years of age.

[Breastfeeding in two Brazilian State capitals: a comparative analysis]. / Situação do aleitamento materno em duas capitais brasileiras: uma análise comparada.

This paper describes rapid assessment of infant feeding practices based on surveys conducted on National Immunization Day in the cities of Florianópolis and João Pessoa, Brazil. Two different infant feeding patterns emerge clearly in the data analysis. Most infants begin breastfeeding, but exclusive breastfeeding (EBF) from 0-4 months (46.3% in Florianópolis and 23.9% in João Pessoa) and timely complementary feeding rates (32.2% in Florianópolis and 24.8% in João Pessoa) are below recommended standards. EBF and breastfeeding duration medians were 53 and 238 days, respectively, in Florianópolis and 16.5 and 195 days, respectively, in João Pessoa. The results pointed to increasing breastfeeding rates and duration medians in Florianópolis as compared to João Pessoa. Use of these data could improve planning and monitoring of breastfeeding activities and infant nutrition policies.

Determinants of the breastfeeding pattern among working women in São Paulo.

The needs of breastfeeding women who work away from home differ from those of other women, particularly those who breastfeed exclusively. Sixty-nine factory workers were interviewed in São Paulo, both during pregnancy and when they returned to work. Median durations of exclusive (EBF), predominant (PBF), and any breastfeeding (BF) were found to be 10 days, 70 days, and 150 days, respectively. Despite having used the 4-month leave to which they were entitled, by 1 month, 86% of the respondents had given tea, 50% water, and 42% artificial baby milk. Only 2 women were still exclusively breastfeeding when they returned to work. Various personal characteristics were associated with longer duration of breastfeeding. Maternity ward routines were generally not supportive, but duration of PBF was longer where better support was received. Duration of EBF was longer among women with support for breastfeeding at work, and shorter for those working on weekends or doing shift work. Thus, women may have adjusted their feeding patterns based on whether or not they anticipated workplace support. Only weekend work and socioeconomic status were linked to shorter duration of breastfeeding. Stronger social and health care support for EBF may be needed before the full impact of workplace support can be usefully studied in Brazil.

Counselling on breastfeeding: assessing knowledge and skills.

Reported are the results of a randomized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course "Breastfeeding counselling: a training course". The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo, Brazil. Health workers from 60 health units were randomly assigned to be either participants (20) or controls (40), and their breastfeeding knowledge and skills were assessed before and immediately after the course, as well as 3 months later. Immediately after the course the participants' knowledge of breastfeeding had increased significantly compared to controls. Both their clinical and counselling skills also improved significantly. When assessed 3 months later, the scores remained high with only a small decrease. The implementation of the course was also evaluated. The methods used were participatory observation, key interviews and focus group discussion. In the 33 sessions of the course, the average score was 8.43 out of 10. Scores were highest for content and methodology of the theory sessions, and lowest for "use of time", "clinical management of lactation", and "discussion of clinical practice". "Breastfeeding counselling: a training course" therefore effectively increases health workers' knowledge and their clinical and counselling skills for the support of breastfeeding. The course can be conducted adequately using the material and methodology proposed, but could be more satisfactory if the time allocated to exercises and clinical practice sessions were increased.

PIP: This document presents a report which assesses the effectiveness of the WHO/UNICEF 40-hour course "Breastfeeding counseling: a training course" (BFC). The course was conducted in a maternity hospital which provides services to a low-income population in Sao Paulo, Brazil. The randomized controlled trial was composed of 60 health professionals divided into an "exposed" group (20) and a control group (40). The participants' breastfeeding knowledge and skills were assessed before, immediately after, and 3 months after the course. Results showed that the participants' knowledge of breastfeeding together with their clinical and counseling skills had markedly improved by the period immediately after the course. Three months after the course, their knowledge skills remained high with only a slight decrease. Participatory observation, key interviews and focus group discussions were used in evaluating the course implementation. The content and methodology of the theory sessions received the highest scores whereas "use of time", "clinical management of lactation", and "discussion of clinical practice" got the lowest scores. In general, BFC was effective in increasing the health workers' clinical and counseling skills for the support of breastfeeding. The course, however, does need to be improved with regard to the time allocated for exercises and clinical practice sessions.

[Assessment of the Breastfeeding Counselling Course WHO/UNICEF] / Avaliação do curso de aconselhamento em amamentação.

OBJECTIVES: To assess the implementation and the impact of the Breastfeeding Counselling Course WHO/UNICEF on knowledge and skills of health workers. METHODOLOGY: The implementation of the course was assessed by participant observation; the impact on participants was assessed with an experimental controlled study where 20 health workers were randomly allocated as course participants (Exposed Group-EG) and 40 as non participants (Control Group -CG). Impact on knowledge was verified with pre and post evaluations, with multiple choice questions; clinical and counselling skills were assessed through pre and post tests, observing participants in clinical consults with mother and baby pairs in rooming-in before and after the course. Kruskal-Wallis test of variance of means was used in analysis. RESULTS: In the post test of knowledge, the mean of the EG was 8.35 and that of the CG was 5.54 (p=0,0000). In clinical and counselling skills, the means of the EG were higher when compared with the CG in all items observed (p < 0,05). Some difficulties were found in breastfeeding history and in breastfeeding observation. Counselling skills were the most incorporated aspects. CONCLUSION: The course may be implemented as proposed; participants acquired counselling skills, but clinical management should be reinforced; participants shoud have continued support to put what they learned in practice.

[Possibilities and limitations of breast-feeding among formally employed women]. / Possibilidades e limitações da amamentação entre mulheres trabalhadoras formais.

INTRODUCTION: Studies carried out on breastfeeding and working women are difficult to compare. Breastfeeding practices among formally employed women in Brazil have not been much studied, despite important changes in public policies such as the extension of maternity leave to 120 days. OBJECTIVES: A description of breastfeeding patterns among women employed in factories and the constraints and opportunities involved in conciliating breastfeeding and work. MATERIAL AND METHOD: An exploratory study was carried out in 13 factories in S. Paulo city in 1994, where all women in the 3rd trimester of pregnancy were interviewed (76), and re-interviewed (69) when they went back to work (around 5,4 months after delivery). RESULTS: Breastfeeding initiation was found in 97% of women and the median duration was 150 days. The exclusive breastfeeding and predominant breastfeeding rates were, respectively, 10 and 70 days of median duration. Higher socio-economic status and nursery facilities and the existence of a place in which to extract and store the mother's milk at the workplace were factors associated with longer duration of breastfeeding. Other factors such as flex-time and work out of the production-line also showed a significant relation to longer duration of breastfeeding in the factories studied. CONCLUSION: Maternity leave is widely taken advantage of and highly beneficial for the majority of working women as regards breastfeeding, but other factors are important in maintaining lactation, such as circumstances which permit closer mother-child contact and/or the extraction of human milk during the working day.

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Capacitacion de profesionales de salud en lactancia natural y reformas institucionales subsiguientes / Breast-feeding training for health professionals and resultant institutional changes

Se evalua un curso de capacitacion sobre la lactancia natural al que asistieron varios profesionales de la salud en el Centro de Lactancia de Santos (CLS), Estado de Sao Paulo, Brasil, y se examina su efecto en la ejecucion de programas para la promocion de la lactancia natural en hospitales de maternidad. Ocho hospitales de este tipo se incluyeron en el estudio. De ellos, cuatro fueron asignados aleatoriamente al grupo experimental y enviaron a tres profesionales de salud a un curso de 18 dias en el CLS; las cuatro instituciones restantes formaron el grupo testigo. Para determinar en que grado se adheria cada hospital a las "Diez medidas para el exito de la lactancia materna" establecidas por la OMS y el UNICEF se calculo un puntaje antes del curso y otro seis meses despues de concluirlo. Las instituciones del grupo experimental tuvieron un mejor puntaje que las del grupo testigo. El curso del CLS fue eficiente porque permitio a los participantes promovieran la practica de la lactancia natural. Sin embargo, para ejecutar con exito los programas correspondientes, los profesionales de salud tambien tienen que aprender a aplicar los conocimientos adquiridos en el curso y lograr que todo el equipo del servicio de maternidad participe en las actividades correspondientes (AU)

Se publico en ingles en el Bull. WHO. Vol. 73(4), 1995

Breast-feeding training for health professionals and resultant institutional changes.

Assessed is a breast-feeding training course that was attended by health professionals at the Santos Lactation Center (SLC), Santos, São Paulo, Brazil, as well as its impact on the implementation of breast-feeding programmes in maternity hospitals. Eight maternity hospitals were studied--four were randomly allocated to the experimental group and sent three health professionals to attend an 18-day course at SLC; the remaining four institutions constituted the control group. The compliance of all eight hospitals with WHO/UNICEF's "Ten steps for successful breast-feeding" was determined using scores obtained before and 6 months after the training course. Institutions in the experimental group had an improved score, but those in the control group did not. The SLC training course was efficient since it enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programmes, health professionals require also to develop skills to apply the knowledge they acquire in the course, as well as to involve the whole maternity unit team in the activities.

PIP: A breast-feeding training course was assessed that was attended by health professionals at the Santos Lactation Center (SLC), Santos, Sao Paulo, Brazil, as well as its impact on the implementation of breast-feeding programs in maternity hospitals. Eight maternity hospitals were studied, 4 were randomly allocated to the experimental group with 3 health professionals to attend an 18-day course at SLC; the remaining 4 institutions constituted the control group. The course consisted of 45 units that covered theoretical and practical aspects of breast-feeding over a 133-hour period. The compliance of all 8 hospitals with the World Health Organization (WHO)/UNICEF's 10 steps for successful breast-feeding was determined using scores obtained before and 6 months after the training course. Individual interviews were held 6 months after the SLC course with directors in participating institutions, with administrative managers, and with professionals in charge of antenatal, nursery, and outpatient services. 16 focus group sessions were also held with 6-15 persons of the staff 6 months after the course. Pre- and postcourse test results showed that in general there was improvement in the students' knowledge on breast-feeding (the average number of correct answers were 20.27 precourse and 26.92 postcourse). Institutions in the experimental group had an improved score, but those in the control group did not. Changes were more particularly in relation to steps 2 (train all health care staff in skills necessary to implement this policy) and 10 (foster the establishment of breast-feeding support groups and refer mother to them upon discharge from hospital). Among graduate-level professionals interpersonal conflicts limited the possibilities for change. The SLC training course enabled the participants to promote breast-feeding practices. However, in order to succeed in implementing breast-feeding programs, health professionals also have to apply the knowledge they acquire in the course as well as involve the whole maternity unit team in the activities.