Factors associated with exclusive breastfeeding in " Near Miss " neonates in Brazil.

Objective: To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. Methods: This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Results: Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Conclusion: Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

Factors associated with neonatal near miss in Brazil.

OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

Factors associated with exclusive breastfeeding in "Near Miss" neonates in Brazil

Abstract Objective To assess the association between sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in near miss neonates in maternity hospitals. Methods This is a prospective cohort of live births from the survey "To be born in Brazil" conducted between 2011 and 2012. The weighted number of newborns who met the neonatal near miss criteria was 832. Exclusive breastfeeding at hospital discharge and 45 days after delivery were dependent variables of the study. The sociodemographic and perinatal factors of the puerperal women and hospital practices to encourage breastfeeding were independent variables. The data were analyzed with Poisson regression and set with p value<0.05. Is exclusive breastfeeding in neonatal near misses associated with factors related to sociodemographic conditions, maternal characteristics and the organization of health services? Results Data from 498 women and their children were analyzed. Mothers with incomplete primary education were more likely (36%) to have exclusive breastfeeding (RR: 1.36; 95% CI: 1.06-1.74) at discharge. Women who did not offer the breast to the newborn in the joint accommodation (65%) were less likely to be breastfeeding exclusively (RR: 0.65; 95% CI: 0.56-0.75) at discharge. Variables that increased the probability of exclusive breastfeeding after 45 days of delivery were primiparity (RR: 1.36; 95% CI: 1.08-1.69) and having the newborn in the delivery room (RR: 1.90; 95% CI: 1.12-3.24). Conclusion Exclusive breastfeeding in neonatal near misses was associated with maternal characteristics and important hospital practices, such as being breastfed in the joint accommodation and the newborn being in the mother's lap in the delivery room.

Factors associated with neonatal near miss in Brazil / Fatores associados ao near miss neonatal no Brasil

ABSTRACT OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.

RESUMO OBJETIVO: Este estudo avalia a associação entre fatores sociodemográficos, características maternas, organização dos serviços de saúde e near miss neonatal em maternidades públicas e privadas do Brasil. MÉTODOS: Trata-se de uma coorte prospectiva de nascidos vivos da pesquisa Nascer no Brasil, realizada entre 2011 e 2012. As variáveis foram estabelecidas a partir da literatura e organizadas em três níveis: distal, intermediário e proximal. A avaliação foi realizada a partir dos resultados das análises bivariadas e de seus respectivos valores-p, com nível de significância < 0,20, pelo teste de Wald. Para a análise multivariada, foram inseridas as variáveis contidas no nível distal, conservadas no modelo quando significativas (p < 0,05). O mesmo foi feito no ajuste dos níveis intermediário e proximal. RESULTADOS: No nível distal, nenhuma variável apresentou associação significativa com o desfecho. No nível intermediário, idade da mãe maior ou igual a 35 anos (risco relativo - RR = 1,32; IC95% 1,04-1,66), parto cesáreo (RR = 1,34; IC95% 1,07-1,67), uso de fumo (RR = 1,48; IC95% 1,04-2,10), síndrome hipertensiva gestacional (RR = 2,29; IC95% 1,98-3,14), diabetes pré-gestacional (RR = 2,63; IC95% 1,36-5,05) e gestação gemelar (RR = 2,98; IC95% 1,90-4,68) foram variáveis associadas ao desfecho. No nível proximal, o pré-natal não adequado (RR = 1,71; IC95% 1,36-2,16) e a localização do hospital/maternidade na capital (RR = 1,89; IC95% 1,40-2,55) foram associados ao near miss neonatal. CONCLUSÃO: Os resultados mostram que o near miss neonatal foi influenciado pelas variáveis da organização dos serviços de saúde e pelas características maternas.

Near miss neonatal no Brasil: fatores associados e repercussões no aleitamento materno exclusivo / Neonatal near miss in Brazil: associated factors and repercussions on exclusive breastfeeding

Os objetivos do presente estudo foram avaliar os fatores associados ao near miss neonatal no Brasil e à prática do aleitamento materno exclusivo na alta e após 45 a 90 dias do parto nesse grupo de crianças. A presente pesquisa faz parte do estudo, de âmbito nacional e de base hospitalar, intitulado "Nascer no Brasil": Inquérito Nacional sobre Parto e Nascimento, conduzida entre fevereiro de 2011 a outubro de 2012, cuja amostra de recém-nascidos se constituiu de 832 casos de near miss neonatal. Para a obtenção dos dados foram aplicados questionários às puérperas, transcritos os dados dos prontuários e realizadas entrevistas telefônicas entre 45 a 90 dias após o parto. Os resultados estão apresentados sob o formato de dois artigos. O primeiro manuscrito analisou, a partir de um modelo hieraquizado, os fatores sociodemográficos, maternos e relativos à organização dos serviços de saúde associados ao near miss neonatal. Verificou-se que o near miss neonatal foi associado às determinadas características maternas (idade maior que 35 anos, parto cesáreo, ser fumante, ter síndrome hipertensiva gestacional, diabetes mellitus pré-gestacional e gestação gemelar) e aos aspectos relacionados à organização dos serviços (inadequação do pré-natal e realização de parto na capital). O segundo artigo investigou a associação de fatores sociodemográficos, perinatais e as práticas hospitalares de incentivo ao aleitamento materno exclusivo em near miss neonatal. Verificou-se que 70,5% dos recém-nascidos tiveram alta em aleitamento exclusivo e apenas 40% continuaram sendo amamentados exclusivamente após 45 a 90 dias do parto. O aleitamento materno exclusivo foi associado à primiparidade, baixa escolaridade, a mãe ter seu recém-nascido no colo na sala de parto e ser amamentado no alojamento conjunto. Assim, o near miss neonatal foi associado às características passíveis de intervenção no pré-natal como o uso habitual de fumo e à prestação de serviços e de cuidados. E ainda, foi verificado que o aleitamento materno exclusivo entre os casos de near miss neonatal foi associado aos fatores sociodemográficos (baixa escolaridade) e perinatais (primiparidade) como também a realização de importantes práticas hospitalares (recém-nascido ficar no colo da mãe na sala de parto e ser amamentado no alojamento conjunto). Portanto, é de extrema importância enfatizar a necessidade de realização do pré-natal para identificar as gestantes que necessitam de atenção mais especializada, com acompanhamento oportuno durante a gravidez, o parto e o pós-parto para a prevenção de condições perinatais que ameaçam a vida.

The objectives of the present study were to evaluate the factors associated with neonatal near miss in Brazil and the practice of exclusive breastfeeding at discharge and 45 to 90 days after delivery in this group of children. This research is part of the study, nationwide and with a hospital base, entitled National Survey on Childbirth and Birth: "Being born in Brazil", conducted between February 2011 and October 2012, whose sample of newborns consisted of 832 cases neonatal near miss. For information on the data, questionnaires were given to the mothers, the data from the medical records were transcribed and telephone calls were reported between 45 and 90 days after delivery. The results obtained in the format of two articles. The first analyzed, based on a hierarchical model, the sociodemographic, maternal and relative factors in the organization of health services associated with neonatal near miss. It was found that neonatal near miss was associated with maternal characteristics (age over 35, cesarean delivery, being a smoker, having gestational hypertensive syndromes, gestational diabetes mellitus and twin pregnancy) and aspects related to the organization of prenatal and maternal services delivery in the capital. The second article investigated the association of sociodemographic and perinatal factors and hospital practices to encourage exclusive breastfeeding in neonatal near miss. It was found that 70.5% of newborns were discharged on exclusive breastfeeding and only 40% of these continued to be breastfed exclusively after 45 to 90 days of delivery. Exclusive breastfeeding was associated with primiparity, low education, the mother having her newborn on her lap in the delivery room and being breastfed in the room together. Thus, neonatal near miss was associated with characteristics that could be prenatal intervention, such as the usual use of tobacco and related to the provision of services and care. Furthermore, it was found that exclusive breastfeeding among neonatal near miss cases was associated with maternal, sociodemographic (low education) and perinatal (primiparity) characteristics, but also with important hospital practices (newborns staying on the mother's lap in the delivery room and be breastfed in the room together). Therefore, it is extremely important to emphasize the need for prenatal care to identify pregnant women who need more specialized care, with timely monitoring during pregnancy, childbirth and postpartum to prevent life threatening perinatal conditions.

Insegurança alimentar em povos de terreiros / Food insecurity in people of terreiros

INTRODUÇÃO: O conceito de segurança alimentar é compreendido como a realização do direito de todos ao acesso regular e permanente a alimentos de qualidade em quantidade suficiente, sem afetar outras necessidades essenciais. OBJETIVO: Estimar a prevalência de insegurança alimentar intrafamiliar em povos de terreiros e verificar a associação com indicadores socioeconômicos. MÉTODOS: Estudo transversal que investigou a situação de insegurança alimentar em povos de terreiros de Teresina, Piauí, cuja amostra foi constituída por 137 casas ativas no período de agosto de 2011 a julho de 2012. Foram instrumentos de coleta de dados a Escala Brasileira de Insegurança Alimentar e um questionário sociodemográfico aplicados ao pai/mãe de santo, após consentirem formalmente sua participação na pesquisa. Para análise das variáveis e da insegurança alimentar, foi utilizado o teste χ2. RESULTADOS: A insegurança alimentar esteve presente em 79,6% dos domicílios, sendo 29,9% de insegurança alimentar leve, 33,6% na forma moderada e 16,1% na grave. Nos domicílios com menores de 18 anos, a prevalência de insegurança alimentar grave foi maior (22,7%) se comparada aos domicílios que possuíam moradores com 18 anos ou mais (14,7%). As variáveis independentes como rendimento mensal e tipo de moradia apresentaram associação inversamente significante à insegurança alimentar. CONCLUSÃO: Os resultados expressam a gravidade da situação de insegurança alimentar em povos de terreiro em Teresina, indicam a violação do direito humano à alimentação adequada vivenciada por esse grupo e reforçam a necessidade do poder público agir mais efetivamente com ações de proteção social junto a esses povos.

INTRODUCTION: The concept of food security is understood as the realization of everyone’s right to regular and permanent access to quality food in sufficient quantity, without affecting other essential needs. OBJECTIVE: To estimate the prevalence of intrafamily food insecurity in people of terreiros and verify the association with socioeconomic indicators. METHODS: Cross-sectional study that investigated the food insecurity of people in terrains in Teresina, Piauí, Brazil. The sample consisted of 137 active houses from August 2011 to July 2012. The Brazilian Food Insecurity Scale and the sociodemographic questionnaire were the instruments of data collection applied to pai/mãe de santo, after formally consent to their participation in the research. To analyze variables and food insecurity, the χ2 test was used. RESULTS: Food insecurity was present in 79.6% of households, with 29.9% in mild food insecurity, 33.6% in moderate and 16.1% in severe. In households with children under 18 years of age, the prevalence of severe food insecurity was higher (22.7%) than in households with residents who were 18 years old or older (14.7%). Independent variables such as monthly income and housing type showed significant association with food insecurity. CONCLUSION: The results express the severity of food insecurity of people in the terrains of Teresina, Piauí, Brazil, indicating a violation of the human right to adequate food experience in this group and reinforcing the necessity for public authorities to act more effectively with social protection actions for these people.

A iniciativa hospital amigo da criança sob a ótica dos atores sociais que a vivenciam em Teresina, Piauí / The baby-friendly hospital initiative as perceived by the social actors who experience it in Teresina, Piauí, Brazil

OBJETIVO: Analisar os reflexos da Iniciativa Hospital Amigo da Criança nos atores sociais que a vivenciam. MÉTODOS: Estudo qualitativo. Utilizaram-se entrevistas semiestruturadas, com auxílio de um roteiro temático, junto a vinte mulheres e dez profissionais de saúde em cinco hospitais amigos da criança em Teresina (PI). Para a análise dos dados foi utilizada a técnica de análise de conteúdo do tipo temática. RESULTADOS: A análise das falas levou à construção de dois eixos de discussão: um relacionado à tríade de sustentação da Iniciativa - promoção, proteção e apoio; e o outro a seu próprio modus operandi, os quais permitiram evidenciar dificuldades na implementação das normas e rotinas da Iniciativa Hospital Amigo da Criança desenvolvidas nas instituições. CONCLUSÃO: Os resultados revelaram a necessidade de ajustes para melhorar a resolutividade do programa, com ênfase para: adoção de uma nova matriz ensino-aprendizagem pautada na educação reflexiva e na adoção dos referenciais da pedagogia da problematização; fortalecimento das redes de apoio à mulher; investimentos na melhoria do acolhimento, tornando a relação cliente-profissional mais respeitosa e definição de um processo de monitoramento contínuo que permita a adoção de medidas corretivas sempre que se fizer necessário.

OBJECTIVE: This study analyzed the way the Baby-Friendly Hospital Initiative is perceived by the social actors involved in it. METHODS: This qualitative study administered semi-structured interviews aided by a thematic guide to twenty female patients and ten health professionals from five Baby-Friendly Hospitals in Teresina (PI), in Northeast Brazil. Thematic content analysis was used to analyze the data. RESULTS: Analysis of the testimonials led to two axes of discussion: one related to the foundation triad of the initiative - promotion, protection and support; and the other related to its own modus operandi, highlighting the difficulties for implementing the BFHI norms and practices carried out in these institutions. CONCLUSION: The results showed that adjustments are necessary to improve the effectiveness of the program, with special emphasis to: adoption of a new teaching-learning matrix based on reflexive education; adoption of references from the pedagogy of questioning; strengthening of women's support networks; investments for improving the receptiveness, thus creating a more respectful relationship between customers and professionals; and the establishment of a continuous monitoring system that allows the implementation of corrective measures whenever necessary.

Perfil microbiológico do leite materno do Banco da Maternidade Evangelina Rosa, Teresina (Piauí) / Microbiological profile of Maternal milk of Maternidade Evangelina Rosa, Teresina(Piauí)

Amostras de leite materno do banco da Maternidade Evangelina Rosa, localizada em Teresina,Pi(Rrasil) foram analisadas quanto a qualidade microbiológica. As amostras de leite cru apresentaram média de 5,7 x 10 (elevada a quinta potência)UFC,mL na contagem de aeróbicos mesófilos e 6,0 x 10 (elevada a segunda potência) UFC/mL na contagem de psicrotróficos. Oito amostras (32 por cento) tiveram valores de 10 (elevada a quinta potência > 300 x 10 UFC/mL para contagem de Staphylococcus aureus. Na enumeraçäo de coliformes totais e fecais os valores obtidos foram de <0,3 a 3 240 NMP/mL. O leite parteurizado apresentou média de 1,0 x 10 (elevada a segunda potência) UFC/mL para contagem de aeróbicos mesófilos. Nenhuma das amostras apresentou coliformes totais, fecais e S.aureus. A pasteurizaçäo é de vital importância para manutençäo da qualidade higiênico-sanitária em bancos de leite humano.