La regulación basada en desempeño: estrategia para incrementar las tasas de lactancia materna / Performance based regulation: a strategy to increase breastfeeding rates

Resumen: La disminución de la tasa de lactancia materna en México es un problema de salud pública. En este artículo discutimos un enfoque regulatorio -Regulación Basada en Desempeño- y su aplicación para mejorar las tasas de lactancia materna. Este enfoque obliga a la industria a asumir su responsabilidad por la falta de lactancia materna y sus consecuencias. Se considera una estrategia factible de ser aplicada al caso, ya que el mercado de sucedáneos tiene una estructura oligopólica, donde es relativamente fácil fijar la contribución de cada participante del mercado en el problema; incide en un grupo poblacional definido; tiene un objetivo regulatorio que puede ser fácilmente evaluado, y se pueden definir las sanciones bajo criterios objetivos. Para su aplicación se recomienda: modificar la política pública, crear convenios de concertación con la industria, establecer sanciones disuasorias, fortalecer los mecanismos de supervisión y alinear lo anterior al Código Internacional de Comercialización de Sucedáneos.

Abstract: The decreasing breastfeeding rate in México is of public health concern. In this paper we discus an innovative regulatory approach -Performance Based Regulation- and its application to improve breastfeeding rates. This approach, forces industry to take responsibility for the lack of breastfeeding and its consequences. Failure to comply with this targets results in financial penalties. Applying performance based regulation as a strategy to improve breastfeeding is feasible because: the breastmilk substitutes market is an oligopoly, hence it is easy to identify the contribution of each market participant; the regulation's target population is clearly defined; it has a clear regulatory standard which can be easily evaluated, and sanctions to infringement can be defined under objective parameters. Recommendations: modify public policy, celebrate concertation agreements with the industry, create persuasive sanctions, strengthen enforcement activities and coordinate every action with the International Code of Marketing of Breast-milk Substitutes.

Uso indiscriminado de sucedaneos de la leche materna en Bolivia y su impacto en la economía familiar / Indiscriminate use of breast milk substitutes and its impact on the Bolivian family economy

OBJETIVO: Estimar el presupuesto mensual que las familias destinan a la lactancia artificial de infantes en Bolivia analizando algunos factores sociales y epidemiológicos relacionados a la lactancia materna. MATERIAL Y MÉTODOS: Se realizaron encuestas a madres asistentes a consulta pediátrica del Hospital del Niño Dr. Ovidio Aliaga Uria, hospital universitario de tercer nivel de la ciudad de La Paz, que incluyeron sólo a madres que daban de lactar a bebés menores de un año (infantes), investigando el tipo de lactancia, el uso de fórmulas; estimando el costo de cada una de las diversas fórmulas utilizadas, calculando el volumen requerido, y el presupuesto mensual estimado, necesario para invertirlo exclusivamente para leche artificial. RESULTADOS: En el grupo estudio de infantes entre 0 a 6 meses de edad se comprobó que solo18% de infantes recibe lactancia exclusiva, 58% recibe lactancia mixta y 24% usa fórmulas de manera exclusiva. En el grupo de 6 a 12 meses de edad reciben lactancia exclusiva 8%, lactancia mixta 63% y lactancia en base a formula 29%. Los primeros 6 meses se utiliza un promedio de 30 latas de leche de formula implicando un gasto de entre Bs.5.530 bs (USD 801.-) si se compra en farmacias o supermercados y Bs. 5,202 (USD 754.) si se compra en mercado libre informal. En cuanto al uso de números de empaque o latas en los siguientes meses el número total es de 36 latas, implicando un costo de Bs. 6,936 (USD 1.005.-), si se compra exclusivamente en farmacias y 6,660 bs en mercado libre.

OBJECTIVE: To estimate proportion of the monthly family budget allocated for artificial feeding of infants and discuss the social and some epidemiological factors related to breastfeeding. METHODS: An operative survey has been conducted interviewing mothers attending out patients pediatric Unit of Dr. Ovidio Aliaga Uria Children's Hospital, which included only interviews to mothers breastfeeding just infants under one year, searching data about type of feeding, preferences of formula; cost of each of the different formulas , volume of formula recommended to use monthly budget. RESULTS: in the group of 0-6 months of age 18% of mothers offer exclusive breastfeeding, while mixed feeding is preferred by 58% and 24% use exclusively just formula. In the group of babies of 6 to 12 months 8% receive breast milk, while , 63% offer mixed breastfeeding and formulas, and just formulas in offer to 29%. The first 6 months an average of 30 cans are consumed, involving an estimate expenditure of Bs. 5.530.- (USD 801.-) and Bs. 5.202 (USD 754.-) in the next 6 months, depending on the formula brand, infant age, type of feeding bottle used

Perfil bioquímico sérico de bezerros de origem leiteira aleitados com dietas líquidas alternativas / Serum biochemistry profile of dairy calves fed with alternative liquid diets

O perfil metabólico é utilizado como monitoramento rotineiro para o diagnóstico de transtornos metabólicos, deficiências nutricionais e como preventivo de transtornos subclínicos, além da pesquisa de problemas de saúde e de desempenho de um rebanho. Neste contexto, o objetivo do presente trabalho foi avaliar a influência de diferentes dietas líquidas contendo soro de queijo e colostro sobre os perfis dos metabólitos séricos de bezerros durante a fase de aleitamento. Foram utilizados 24 bezerros mestiços provenientes de rebanhos leiteiros da região, distribuídos em delineamento inteiramente casualizado com três tratamentos e oito repetições: LI = Leite integral (controle); LS = 50% Leite integral + 50% de Soro de queijo in natura; SC = 70% de Soro de queijo in natura + 30% Colostro. Semanalmente foram coletadas amostras de sangue por punção jugular externa, no período da manhã, antes do fornecimento da dieta líquida e duas horas após a ingestão desta. As concentrações dos parâmetros séricos avaliados diferiram entre os tratamentos, porém sem comprometer o desempenho dos animais. Desse modo, a utilização de soro de queijo associado ao colostro apresenta-se como forma viável de redução de custos com aleitamento de bezerros, visto que possíveis déficits causados pelas diferenças nutricionais das dietas líquidas são supridos pelos alimentos sólidos, não afetando os perfis dos metabólitos séricos relacionados ao status protéico e energético.(AU)

Metabolic profile is used as routine monitoring for the diagnosis of metabolic disorders, nutritional deficiencies, and as a preventive of subclinical disorders, in addition to research health issues and performance of a herd. In this context, the aim of this study was to evaluate the influence of different liquid diets containing whey cheese and colostrum on the serum biochemistry profile of calves. Twenty-four crossbred calves from dairy herds in the region, distributed in a completely randomized design with three treatments and eight replicates: LI = Whole milk (control); LS = 50% Whole milk + 50% cheese whey in nature; SC = 70% of cheese whey in natura + 30% Colostrum. Weekly blood samples by jugular puncture were collected in the morning, before the supply of liquid diet and two hours after eating this. The serum concentrations of the evaluated parameters differ between treatments, but without compromising animal performance. Thus, the use of whey associated with colostrum presents itself as a viable cost reduction with feeding calves, since possible nutritional deficits caused by differences in liquid diets are supplied by solid food form, not affecting the profiles of the metabolites related to serum protein and energy status.(AU)

Factores que influyen en el abandono precoz de la lactancia materna / Factors that influence in the precocious abandonment of the maternal nursing

Introducción: la lactancia materna constituye el modo de alimentación que ha garantizado la supervivencia de la especie humana, y proporciona ventajas que son conocidas. Objetivo: identificar factores sociopsicológicos que influyen en el abandono de la lactancia materna exclusiva antes de los primeros seis meses de vida del niño. Métodos: investigación descriptiva, retrospectiva y de corte transversal a través de una encuesta aplicada a las madres de 64 lactantes de hasta seis meses de edad, pertenecientes al área de salud policlínico Dr. Tomás Romay, municipio Artemisa, provincia Artemisa, entre septiembre de 2011 y abril de 2012. Resultados: la mitad de las madres abandonó la lactancia materna exclusiva antes de los 6 meses, así como hubo una asociación entre su abandono y la aparición de enfermedades en los lactantes. Conclusiones: la única alimentación necesaria con múltiples ventajas para el niño antes de los 6 meses es la lactancia materna exclusiva(AU)

Introduction: the maternal nursing constitutes the feeding way that has guaranteed the survival of the human species and it provides advantages that are known. Objective: identifying factors social and psychological that influence in the abandonment of the nursing maternal sole right before the first six months of the boy's life. Methods: a descriptive, retrospective investigation, of traverse court in the period of September of 2011 to April of 2012 through a survey applied the mothers of 64 newborn of up to six months of age, belonging to the area of health policlínico Dr. Tomás Romay, municipality Artemisa, county Artemisa. The universe was conformed by 92 newborn of the advice popular New Allotment and Laundryman belonging to this area of health. The selection of the sample was carried out intentional in which 64 newborn was selected of up to six months of age. To carry out this investigation one kept in mind the basic principles of the ethics. The information was obtained through the history clinics and cards of the studied newborn as well as a survey that was carried out in an anonymous way. Results: half of the mothers he/she abandoned the nursing maternal sole right before the 6 months, as well as an association existed between its abandonment and the appearance of illnesses in the newborn, concluding that the only necessary feeding with multiple advantages for the boy before the 6 months is the nursing maternal sole right. Conclusions: the only necessary food with multiple benefits for the child before 6 months is exclusive breastfeeding(AU)

Factores que influyen en el abandono precoz de la lactancia materna / Factors that influence in the precocious abandonment of the maternal nursing

Introducción: la lactancia materna constituye el modo de alimentación que ha garantizado la supervivencia de la especie humana, y proporciona ventajas que son conocidas. Objetivo: identificar factores sociopsicológicos que influyen en el abandono de la lactancia materna exclusiva antes de los primeros seis meses de vida del niño. Métodos: investigación descriptiva, retrospectiva y de corte transversal a través de una encuesta aplicada a las madres de 64 lactantes de hasta seis meses de edad, pertenecientes al área de salud policlínico Dr. Tomás Romay, municipio Artemisa, provincia Artemisa, entre septiembre de 2011 y abril de 2012. Resultados: la mitad de las madres abandonó la lactancia materna exclusiva antes de los 6 meses, así como hubo una asociación entre su abandono y la aparición de enfermedades en los lactantes. Conclusiones: la única alimentación necesaria con múltiples ventajas para el niño antes de los 6 meses es la lactancia materna exclusiva(AU)

Introduction: the maternal nursing constitutes the feeding way that has guaranteed the survival of the human species and it provides advantages that are known. Objective: identifying factors social and psychological that influence in the abandonment of the nursing maternal sole right before the first six months of the boy's life. Methods: a descriptive, retrospective investigation, of traverse court in the period of September of 2011 to April of 2012 through a survey applied the mothers of 64 newborn of up to six months of age, belonging to the area of health policlínico Dr. Tomás Romay, municipality Artemisa, county Artemisa. The universe was conformed by 92 newborn of the advice popular New Allotment and Laundryman belonging to this area of health. The selection of the sample was carried out intentional in which 64 newborn was selected of up to six months of age. To carry out this investigation one kept in mind the basic principles of the ethics. The information was obtained through the history clinics and cards of the studied newborn as well as a survey that was carried out in an anonymous way. Results: half of the mothers he/she abandoned the nursing maternal sole right before the 6 months, as well as an association existed between its abandonment and the appearance of illnesses in the newborn, concluding that the only necessary feeding with multiple advantages for the boy before the 6 months is the nursing maternal sole right. Conclusions: the only necessary food with multiple benefits for the child before 6 months is exclusive breastfeeding(AU)

Energy contribution from non-breastmilk items in low-income Guatemalan infants in their sixth month of life / Contribución de energía de fuentes diferentes a la leche materna en infantes de seis meses de edad de bajos recursos en Guatemala

Objective. To examine the nature and energy contribution of complementary feeding in breastfed infants in their sixth month of life, and the prevalence of the use of bottles as a delivery method. Materials and methods. We recruited 156 breastfeeding infants at a health clinic in metropolitan Quetzaltenango, Guatemala. A previous-day recall was performed. Results. Sixty nine mothers (44%) reported offering items other than breastmilk. The median contribution of energy from complementary foods among infants with mixed feeding (n=66) was 197 kcal/day (interquartile range [IQR] 49-353). The median energy contribution of formula or cow's milk among consumers (n=39) was 212 kcal/day (IQR 84-394). Bottles were used on the previous day by 55 (80%) of the 69 mothers not offering exclusive breastfeeding. Conclusions. Premature introduction of non-breastmilk items is commonly practiced in feeding Guatemalan infants. Adherence to the internationally recognized guidelines for early infant feeding should be an intervention priority for this population.

Objetivos. Examinar la naturaleza y contribución energética de la alimentación complementaria en infantes lactantes en el sexto mes de vida y la prevalencia del uso de biberones como método de alimentación. Material y métodos. Se seleccionaron 156 infantes lactantes en un centro de salud en la ciudad de Quetzaltenango, Guatemala. Se solicitó una rememoración de la alimentación del día anterior. Resultados. Sesenta y nueve madres (44%) reportaron dar alimentos adicionales a la leche materna. La mediana de contribución energética de alimentos complementarios en infantes con alimentación mixta (n=66) fue 197 kcal/día (rango intercuartil [RIC] 43-353). La mediana de contribución energética de leche de vaca entre consumidores (n=39) fue 212 kcal/día (RIC 84-394). De 69 madres que ofrecían alimentación mixta, 55 (80%) proporcionaron biberones. Conclusiones. Las madres guatemaltecas practican comúnmente la introducción prematura de la alimentación complementaria. La adhesión a las guías internacionalmente reconocidas para alimentación de infantes debe ser una prioridad de intervención en esta población.

Perfil bioquímico sérico de bezerros de origem leiteira aleitados com dietas líquidas alternativas

Abstract: Metabolic profile is used as routine monitoring for the diagnosis of metabolic disorders, nutritional deficiencies, and as a preventive of subclinical disorders, in addition to research health issues and performance of a herd. In this context, the aim of this study was to evaluate the influence of different liquid diets containing whey cheese and colostrum on the serum biochemistry profile of calves. Twenty-four crossbred calves from dairy herds in the region, distributed in a completely randomized design with three treatments and eight replicates: LI = Whole milk (control); LS = 50% Whole milk + 50% cheese whey in nature; SC = 70% of cheese whey in natura + 30% Colostrum. Weekly blood samples by jugular puncture were collected in the morning, before the supply of liquid diet and two hours after eating this. The serum concentrations of the evaluated parameters differ between treatments, but without compromising animal performance. Thus, the use of whey associated with colostrum presents itself as a viable cost reduction with feeding calves, since possible nutritional deficits caused by differences in liquid diets are supplied by solid food form, not affecting the profiles of the metabolites related to serum protein and energy status.

Resumo: O perfil metabólico é utilizado como monitoramento rotineiro para o diagnóstico de transtornos metabólicos, deficiências nutricionais e como preventivo de transtornos subclínicos, além da pesquisa de problemas de saúde e de desempenho de um rebanho. Neste contexto, o objetivo do presente trabalho foi avaliar a influência de diferentes dietas líquidas contendo soro de queijo e colostro sobre os perfis dos metabólitos séricos de bezerros durante a fase de aleitamento. Foram utilizados 24 bezerros mestiços provenientes de rebanhos leiteiros da região, distribuídos em delineamento inteiramente casualizado com três tratamentos e oito repetições: LI = Leite integral (controle); LS = 50% Leite integral + 50% de Soro de queijo in natura; SC = 70% de Soro de queijo in natura + 30% Colostro. Semanalmente foram coletadas amostras de sangue por punção jugular externa, no período da manhã, antes do fornecimento da dieta líquida e duas horas após a ingestão desta. As concentrações dos parâmetros séricos avaliados diferiram entre os tratamentos, porém sem comprometer o desempenho dos animais. Desse modo, a utilização de soro de queijo associado ao colostro apresenta-se como forma viável de redução de custos com aleitamento de bezerros, visto que possíveis déficits causados pelas diferenças nutricionais das dietas líquidas são supridos pelos alimentos sólidos, não afetando os perfis dos metabólitos séricos relacionados ao status protéico e energético.