Breastfeeding patterns and factors associated with early weaning in the Western Amazon.

OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

Breastfeeding patterns and factors associated with early weaning in the Western Amazon / Padrões de amamentação e fatores associados ao desmame precoce na Amazônia ocidental

ABSTRACT OBJECTIVE: To characterize breastfeeding patterns in the first six months of life and factors associated with early weaning in a birth-cohort in Rio Branco, state of Acre. METHODS: This is a prospective study with all babies born between April and June 2015. The mothers were interviewed soon after birth and between 6 and 15 months postpartum. At hospital discharge, breastfeeding was defined as exclusively (EBF), and breastfeeding (BF). In the follow-up, breastfeeding patterns were exclusive breastfeeding (EBF), predominant breastfeeding (PBF), and breastfeeding (BF). The interruption of breastfeeding in the first six months was classified as early weaning. The Kaplan Meier method (log-rank: 95%) was used to estimate the conditional probability of change in breastfeeding pattern, and early weaning risk. Crude and adjusted proportional Cox regression models, and their respective 95% confidence intervals (95%CI), were used to analyze the factors associated with early weaning. RESULTS: The study included 833 infants in EBF (95.4%) and BF (4.6%) at hospital discharge. During the first six months of life, the infant likely discharged in EBF remaining in EBF, becoming PBF, and BF, were respectively 16.4%, 32.3%, and 56.5%. The weaning likely at six months was statistically higher for infants discharged in BF (47.4%) when compared with those discharged in EBF (26%). Factors associated with early weaning were BF at hospital discharge (HR = 1.82; 95%CI 1.06-3.11), no mother cross-breastfeeding (HR = 2.50; 95%CI 1.59-3.94), pacifier use (HR = 6.23; 95%CI 4.52-8.60), less than six months of breastfeeding intention (HR = 1.93; 95%CI 1.25-2.98), lack of breastfeeding in the first hour of life (HR = 1.45; 95%CI 1.10-1.92), and pregnancy alcohol consumption (HR = 1.88; 95%CI 1.34-2.90). CONCLUSION: Compared to infants in EBF, those in BF at hospital discharge were more likely to wean. Public health efforts should prioritize EBF at hospital discharge, promote breastfeeding in the first hour of life, and prevent alcohol consumption risks during pregnancy, cross-breastfeeding and pacifier use.

RESUMO OBJETIVO: Caracterizar os padrões de amamentação nos primeiros seis meses de vida e fatores associados ao desmame precoce numa coorte de nascidos vivos em Rio Branco, Acre. MÉTODOS: Estudo prospectivo com nascidos vivos entre abril e junho de 2015. As entrevistas com as mães ocorreram logo após o nascimento e entre 6 e 15 meses pós-parto. Na alta hospitalar, o aleitamento foi definido em exclusivo (AME) e materno (AM). No seguimento, os padrões de amamentação foram AME, aleitamento materno predominante (AMP) e AM. A interrupção da amamentação nos primeiros seis meses foi classificada como desmame precoce. Utilizou-se o método de Kaplan Meier (log-rank: 95%) para estimar a probabilidade condicional de mudança no padrão de amamentação e risco de desmame. Os fatores associados ao desmame e seus intervalos de confiança de 95% (IC95%) foram analisados pela regressão proporcional de Cox bruta e ajustada. RESULTADOS: Participaram do estudo 833 lactentes que na alta hospitalar estavam em AME (95,4%) e AM (4,6%). A probabilidade do lactente em AME na alta hospitalar permanecer em AME, ou se tornar AMP ou AM, aos seis meses, foi de 16,4%, 32,3% e 56,5% respectivamente. A probabilidade de desmame aos seis meses foi estaticamente maior para lactentes em AM na alta hospitalar (47,4%) em comparação com aqueles em AME (26%). Mostraram-se associados ao desmame precoce: o AM na alta hospitalar (HR = 1,82; IC95% 1,06-3,11), ausência de amamentação cruzada praticada pela mãe (HR = 2,50; IC95% 1,59-3,94), usar chupeta (HR = 6,23; IC95% 4,52-8,60), pretender amamentar por menos de seis meses (HR = 1,93; IC95% 1,25-2,98), não amamentar na primeira hora de vida (HR = 1,45; IC95% 1,10-1,92) e consumir álcool na gestação (HR = 1,88; IC95% 1,34-2,90). CONCLUSÃO: Comparados aos lactentes em AME, aqueles em AM, na alta hospitalar, apresentaram maior probabilidade de desmame. Esforços em saúde pública devem priorizar o AME na alta hospitalar, promover amamentação na primeira hora de vida e orientar sobre os riscos do consumo de álcool na gestação, amamentação cruzada e uso de chupeta.

Causas de óbitos em hospital de ensino da Amazônia Ocidental brasileira / Causas de fallecimiento en hospital universitario de la Amazonía Occidental brasileña / Causes of death in a teaching hospital of the Brazilian western Amazon

Resumo Objetivo Identificar o perfil epidemiológico dos pacientes que evoluíram para óbito, caracterizar essas mortes segundo variáveis sociodemográficas e clínicas e analisar a relação entre a causa básica e a causa imediata do óbito em um hospital de ensino. Métodos Estudo quantitativo, transversal retrospectivo, com componentes descritivos, utilizando como principal fonte de dados os atestados de óbitos do Sistema de Informações do Sistema Único de Saúde e das declarações de óbitos ocorridos em 2016 da instituição pesquisada. Resultados Dos 634 óbitos, a maioria dos pacientes era do sexo masculino (56,9%), sendo 70% de afrodescendentes, observou-se que quase metade (48,8%) tinha 65 anos ou mais de idade, acometeu 50,7% dos homens acima dos 66 anos e 53,8% das mulheres com menos de 66 anos. As principais causas imediatas de morte foram associadas às neoplasias (45,4%) e às doenças infecciosas e parasitárias (28,9%). Quanto as declarações de óbitos, existe uma subnotificação nas causas consequenciais 2 e 3, de 12,6% e 49,9%, respectivamente. Conclusão A ocorrência de doenças infecciosas e parasitárias, os sinais/sintomas e exames clínicos/laboratoriais alterados, exerceram impacto importante como causa imediata dos óbitos analisados. Destaca-se que os óbitos por neoplasias se mantiveram constantes em todas as categorias (causa imediata, causa consequencial 2, causa consequência 3, causa básica).

Resumen Objetivo Identificar el perfil epidemiológico de los pacientes que fallecieron, caracterizar esas muertes de acuerdo con variables sociodemográficas y clínicas y analizar la relación entre la causa básica y la causa directa del fallecimiento en un hospital universitario. Métodos Estudio cuantitativo, transversal retrospectivo, con componentes descriptivos, utilizando como principal fuente de datos los certificados de defunción del Sistema de Información del Sistema Único de Salud y las declaraciones de las defunciones ocurridas en 2016 en la institución estudiada. Resultados De los 634 fallecimientos, la mayoría de los pacientes era de sexo masculino (56,9 %), el 70 % era afrodescendiente. Se observó que casi la mitad (48,8 %) tenía 65 años o más, el 50,7 % de los hombres tenía más de 66 años y el 53,8 % de las mujeres, menos de 66 años. Las principales causas directas de muerte se asociaron con neoplasias (45,4 %) y enfermedades infecciosas y parasitarias (28,9 %). Respecto a las declaraciones de defunción, existe una subnotificación en la causa antecedente 2 del 12,6 % y en la 3 del 49,9 %. Conclusión Los casos de enfermedades infecciosas y parasitarias, los signos/síntomas y estudios clínicos/de laboratorio alterados ejercieron un importante impacto como causa directa de los fallecimientos analizados. Se observa que los fallecimientos por neoplasias se mantuvieron constantes en todas las categorías (causa directa, causa antecedente 2, causa antecedente 3, causa básica).

Abstract Objectives To identify the epidemiological profile of patients who died, to characterize these deaths according to sociodemographic and clinical variables and to analyze the relation between the underlying cause and immediate cause of death in a teaching hospital. Methods Quantitative cross-sectional study, with descriptive components, using as the main source of data the death certificates of the Information System of the Brazilian Unified Health System and the death declarations that occurred in 2016 in the institution studied. Results Of the 634 deaths, most of the patients were male (56.9%), being 70% Afro-descendants; it was observed that almost half (48.8%) were 65 years of age or older; it affected 50.7% of men over 66 years and 53.8% of women under 66 years. The main immediate causes of death were associated with neoplasms (45.4%) and infectious and parasitic diseases (28.9%). Regarding death declarations, there is an underreporting in consequential causes 2 and 3, of 12.6% and 49.9%, respectively. Conclusion The occurrence of infectious and parasitic diseases, the signs/symptoms and altered clinical/laboratory tests had an important impact as immediate cause of the analyzed deaths. It is noteworthy that deaths from neoplasms remained constant in all categories (immediate cause, consequential cause 2, consequential cause 3, and underlying cause).

Infant mortality trend in the city of Rio Branco, AC, 1999 to 2015.

OBJECTIVE: Analyze the trend of infant mortality in Rio Branco, state of Acre, from 1999 to 2015. METHODS: An ecological observational study of a time series, in which data from deaths from the Information System on Mortality and Births of the Information System on Live Births were used. The annual percentage change was estimated using the Joinpoint software. RESULTS: The infant mortality rate decreased from 26.99 in 1999 to 14.50 in 2015 per 1,000 live births, with an annual percentage change of -4.37 (95%CI -5.4- -3.4). When stratified by age components, the neonatal period presented an annual percentage change of -4.73 (95%CI -5.7- -3.7), and the post-neonatal period was -3.7 (95%CI -5.4- -2.0). Avoidability, avoidable causes and poorly defined causes showed a downward trend throughout the period and causes not clearly preventable showed an upward trend until 2008. The group of causes that contributed most to the infant deaths during the period studied was perinatal diseases, followed by malformations, infectious and parasitic diseases, and respiratory diseases. CONCLUSIONS: Despite the decreasing trend in infant mortality rates in the capital compared to developed countries, it is relatively high.

Infant mortality trend in the city of Rio Branco, AC, 1999 to 2015 / Tendência da mortalidade infantil no município de Rio Branco, AC, 1999 a 2015

ABSTRACT OBJECTIVE Analyze the trend of infant mortality in Rio Branco, state of Acre, from 1999 to 2015. METHODS An ecological observational study of a time series, in which data from deaths from the Information System on Mortality and Births of the Information System on Live Births were used. The annual percentage change was estimated using the Joinpoint software. RESULTS The infant mortality rate decreased from 26.99 in 1999 to 14.50 in 2015 per 1,000 live births, with an annual percentage change of -4.37 (95%CI -5.4- -3.4). When stratified by age components, the neonatal period presented an annual percentage change of -4.73 (95%CI -5.7- -3.7), and the post-neonatal period was -3.7 (95%CI -5.4- -2.0). Avoidability, avoidable causes and poorly defined causes showed a downward trend throughout the period and causes not clearly preventable showed an upward trend until 2008. The group of causes that contributed most to the infant deaths during the period studied was perinatal diseases, followed by malformations, infectious and parasitic diseases, and respiratory diseases. CONCLUSIONS Despite the decreasing trend in infant mortality rates in the capital compared to developed countries, it is relatively high.

RESUMO OBJETIVO Analisar a tendência da mortalidade infantil em Rio Branco, AC, de 1999 a 2015. MÉTODOS Estudo observacional ecológico de série temporal, em que foram utilizados dados de óbitos do Sistema de Informações sobre Mortalidade e Nascimentos do Sistema de Informações sobre Nascidos Vivos. Estimou-se a variação percentual anual por meio do software Joinpoint. RESULTADOS A taxa de mortalidade infantil reduziu de 26,99, em 1999, para 14,50, em 2015, por 1.000 nascidos vivos, com variação percentual anual de -4,37 (IC95% -5,4- -3,4). Quando estratificada por componentes etários, o neonatal apresentou variação percentual anual de -4,73 (IC95% -5,7- -3,7), e o pós-neonatal de -3,7 (IC95% -5,4- -2,0). A evitabilidade, as causas evitáveis e as causas mal definidas apresentaram tendência descendente em todo o período e as causas não claramente evitáveis apresentaram tendência ascendente até 2008. O grupo de causas que mais contribuiu para os óbitos infantis no período estudado foi o das afecções perinatais, seguido pelo das malformações, das doenças infecciosas e parasitárias, e do grupo das doenças respiratórias. CONCLUSÕES Apesar da tendência decrescente da taxa de mortalidade infantil na capital, quando comparada à de países desenvolvidos, mostra-se relativamente elevada.

Utilização de medicamentos em gestantes no município de Rio Branco, Acre

O objetivo deste estudo foi analisar a utilização de medicamentos por mulheres,durante a gestação e o período de internação para o parto, no município de Rio Branco, Acre.Esta tese foi estruturada em forma de cinco artigos: Artigo 1 - Utilização de antianêmicos e diagnóstico laboratorial de anemia gestacional em Rio Branco, Acre, 2015; Artigo 2 -Utilização de anti-inflamatórios, analgésicos e antipiréticos em uma coorte de gestantes no município de Rio Branco, Acre, 2015; Artigo 3 - Perfil dos medicamentos administrados,especificamente da ocitocina, no período de internação para o parto no município de Rio Branco, Acre, 2015; Artigo 4 - Farmacocinética e mecanismos de teratogenicidade dos medicamentos na gestação: uma revisão narrativa da literatura; Artigo 5 - Anomalias congênitas em nascidos vivos em Rio Branco, Acre 2001 – 2013. Os três primeiros artigos fazem parte da investigação com um delineamento transversal com uma amostra representativa de 1190 gestantes residentes em área urbana e que se internaram para o parto nas duas únicas maternidades do município durante o período de estudo. A coleta de dados foi realizada de 06 de abril a 10 de julho de 2015 e se deu por entrevista, por consulta ao cartão de pré-natal e ao prontuário da parturiente. A variável de interesse foi o uso de medicamentos e as possíveis associações com as variáveis sociodemográficas, econômicas,características maternas e de assistência ao pré-natal e parto. Para análise dos dados foi utilizado o software SPSS 22.0. Este estudo foi devidamente submetido e aprovado pelo Comitê de Ética em Pesquisa da ENSP e da UFAC...

The objective of this study was to analyze the use of medications by women, duringgestation and the period of admission to labor, in the municipality of Rio Branco, Acre. Thisthesis was structured in the form of five articles: Article 1 - Use of antianemics and laboratorydiagnosis of gestational anemia in Rio Branco, Acre, 2015; Article 2 - Use of antiinflammatories,analgesics and antipyretics in a cohort of pregnant women in the municipalityof Rio Branco, Acre, 2015; Article 3 - Profile of medications administered, specificallyoxytocin, in the period of admission to labor in the municipality of Rio Branco, Acre, 2015;Article 4 - Pharmacokinetics and mechanisms of teratogenicity of drugs during pregnancy: anarrative review of the literature; Article 5 - Congenital anomalies in live births in RioBranco, Acre 2001 - 2013. The first three articles are part of the cross-sectional investigationwith a representative sample of 1190 pregnant women living in urban areas and who wereadmitted to labor in the only two maternity hospitals in the city during the study period. Thedata collection was performed from April 6 to July 10, 2015 and was given by interview, byconsulting the prenatal card and the woman's medical records. The variable of interest was theuse of medications and the possible associations with sociodemographic, economic variables,maternal characteristics and prenatal care and delivery. SPSS 22.0 software was used toanalyze the data. This study was duly submitted and approved by the Research EthicsCommittee of PHEP and UFAC...

[Factors associated with use of medication during first pregnancies in Rio Branco, Acre State, Brazil]. / Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil.

This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).

Fatores associados ao uso de medicamentos na gestação em primigestas no Município de Rio Branco, Acre, Brasil / Factors associated with use of medication during first pregnancies in Rio Branco, Acre State, Brazil / Factores asociados con el uso de fármacos en el embarazo de primigestas en Río Branco, Acre, Brasil

Estudo transversal, envolvendo 887 primigestas com o objetivo de analisar os fatores associados ao uso de medicamentos na gestação no Município de Rio Branco, Acre, Brasil. As informações tiveram como base uma entrevista e o cartão de pré-natal. Os medicamentos foram classificados de acordo com o Sistema Anatômico Terapêutico Químico (ATC), da Organização Mundial da Saúde, e com a categoria de risco do Food and Drug Administration (Estados Unidos). A média de idade foi 21 anos, a média do uso de medicamentos foi 2,42; os medicamentos mais consumidos foram os antianêmicos (47,5%), suplementos e vitaminas (18,7%), analgésicos (13,8%) e antibióticos (10,5%). Na categorização de risco, 69,3% pertenciam à categoria A; 22,3% à B; 7,6% à C e 0,8% à D. A chance de ter sido exposta à utilização de medicamentos de risco foi maior nas primigestas na unidade B (RC = 2,10; IC95%: 1,26-3,50), na faixa etária de 19 a 24 anos (RC = 2,79; IC95%: 1,58-4,93) e com prescrição médica (RC = 1,86; IC95%: 1,18-2,95). Os medicamentos essenciais foram menos utilizados entre as mulheres com maior renda familiar (RC = 0,63; IC95%: 0,42-0,96), e que realizaram o pré-natal na rede privada (RC = 0,53; IC95%: 0,38-0,74).

This cross-sectional study in a sample of 887 primigravidae in Rio Branco, Acre State, Brazil aimed to analyze factors associated with the use of medicines during the first pregnancy. Information was obtained from interviews and prenatal cards. Medicines were classified according to the Anatomical Therapeutic Chemical (ATC) Classification System of the World Health Organization and risk categories according to the U.S. Food and Drug Administration. Mean age was 21 years and mean number of medicines used was 2.42. The most frequently consumed medicines were antianemics (47.5%), supplements and vitamins (18.7%), analgesics (13.8%), and antibiotics (10.5%). In the risk categorization, 69.3% belonged to category A, 22.3% to B, 7.6% to C, and 0.8% to D. The odds of having used risky medicines were higher among primigravidae in unit B (OR = 2.10; 95%CI: 1.26-3.50), in the 19 to 24-year age bracket (OR = 2.79; 95%CI: 1.58-4.93), and in the presence of a medical prescription (OR = 1.86; 95%CI: 1.18-2.95). Essential drugs were less used by women with higher family income (OR = 0.63; 95%CI: 0.42-0.96) and those who had received private prenatal care (OR = 0.53; 95%CI: 0.38-0.74).

Estudio transversal con 887 primigestas para analizar los factores asociados al consumo de medicamentos durante el embarazo en Río Branco, Acre, Brasil. La información se basó en entrevistas y tarjeta prenatal. Los medicamentos se calificaron de acuerdo con el sistema anatómico terapéutico químico (ATC), de la Organización Mundial de la Salud y con la categoría de riesgo del Food and Drug Administration (Estados Unidos). La media de edad fue de 21 años; la media del uso de medicamentos fue de un 2,42; los medicamentos más consumidos fueron los antianémicos (47,5%), los suplementos y vitaminas (18,7%), analgésicos (13,8%) y antibióticos (10,5%). En la clasificación de riesgo, un 69,3% pertenecían a la categoría A; 22,3% a B; 7,6% a C y 0,8% a la D. La posibilidad de haber estado expuestas al riesgo en el consumo de medicamentos fue mayor en primigestas en la unidad B (OR = 2,10, IC95%: 1,26-3,50), con edades entre 19 y 24 años (OR = 2,79, IC95%: 1,58-4,93) y con prescripción (OR = 1,86, IC95%: 1,18-2,95). Los medicamentos esenciales fueron utilizados con menos frecuencia en las mujeres con mayores ingresos de los hogares (OR = 0,63, IC95%: 0,42-0,96) y que realizaron el cuidado prenatal en una red clínica privada (OR = 0,53, IC95%: 0,38- 0,74).