Baby-Friendly Hospital Initiative and exclusive breastfeeding during hospital stay

OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (outcome) and to analyze the association between delivery in a Baby-Friendly Hospital (BFH) and the outcome. The hypothesis is that accreditation to this program improves exclusive breastfeeding during maternity hospital stay. Exclusive breastfeeding is essential in reducing neonatal morbidity and mortality. METHODS: This study is based on secondary data collected by the “Birth in Brazil: National Survey into Labour and Birth”, a population-based study, conducted with 21,086 postpartum women, from February 1, 2011, to October 31, 2012, in 266 hospitals from all five Brazilian regions. Face-to-face interviews were conducted mostly within the first 24 hours after birth, regarding individual and gestational characteristics, prenatal care, delivery, newborn’s characteristics, and breastfeeding at birth. A theoretical model was created, allocating the exposure variables in three levels based on their proximity to the outcome. This hierarchical conceptual model was applied to perform a multiple logistic regression (with 95%CI and p < 0.05). RESULTS: In this study, 76.0% of the babies were exclusively breastfed from birth until the interview. Babies born in public (AOR = 1.73; 95%CI: 1.10–2.87), mixed (AOR = 2.48; 95%CI: 1.35–4.53) and private (AOR = 5.54; 95%CI: 2.38–12.45) BFHs were more likely to be exclusively breastfed during maternity hospital stay than those born in non–BFHs, as well as those born by vaginal birth (AOR = 2.16; 95%CI: 1.79–2.61), with adolescent mothers (AOR = 1.83; 95%CI: 1.47–2.26) or adults up to 34 years old (AOR =1 .31; 95%CI: 1.13–1.52), primiparous women (AOR = 1.51; 95%CI: 1.34–1.70), and mothers living in the Northern region of Brazil (AOR = 1.99; 95%CI: 1.14–3.49). CONCLUSIONS: The Baby-Friendly Hospital Initiative promotes exclusive breastfeeding during hospital stay regarding individual and hospital differences

Aleitamento cruzado: prevalência e fatores associados

O aleitamento cruzado, prática na qual a criança é amamentada por nutriz que não a sua mãe, é culturalmente aceito no Brasil, embora contraindicado pelo Ministério da Saúde. Este trabalho teve por objetivo estimar a prevalência do aleitamento cruzado e analisar os fatores associados à prática. O primeiro artigo baseou-se em estudo transversal conduzido em 2013 mediante entrevista com amostra representativa de mães de crianças <1 ano (n=695) em nove unidades básicas do Rio de Janeiro/RJ. Razões de prevalência ajustadas foram obtidas por regressão de Poisson com variância robusta. O aleitamento cruzado foi praticado por 29,4% das mães. Associaram-se diretamente à prática: adolescência (RP=1,595), tabagismo (RP=1,396), consumo de bebida alcoólica (RP=1,613), regime inadequado de alimentação do bebê (RP=1,371) e a idade do bebê em meses (RP=1,066), enquanto o trabalho materno formal associou-se inversamente (RP=0,579). O segundo artigo baseou-se em estudo transversal aninhado a uma coorte de gestantes recrutadas entre 2008 e 2010 em cinco unidades públicas de saúde com atendimento pré-natal em duas cidades de médio porte do Estado do Rio de Janeiro: da região metropolitana - “RME” e da região serrana -“SER”. O aleitamento cruzado foi praticado por 43,4% das mães da RME e por 34,5% das mães da SER. O baixo nível socioeconômico associou-se diretamente à prática nas duas cidades. Na SER, adolescência e ter realizado menos de seis consultas pré-natais associaram-se diretamente ao aleitamento cruzado e ter escolaridade igual ou superior ao ensino fundamental completo, inversamente. Na RME, além do nível socioeconômico, apenas a multiparidade se associou (inversamente) ao desfecho. Conclui-se que o aleitamento cruzado teve prevalência relevante em diferentes cenários do Estado do Rio de Janeiro e foi mais praticado por populações mais vulneráveisCross-nursing, a practice in which a child is breastfed by a mother not her own, is culturally accepted in Brazil, although contraindicated by the Ministry of Health. This study aimed to estimate the prevalence and to analyze factors associated with cross-nursing. The first article was based on a cross-sectional study conducted in 2013 by means of interview with a representative sample of mothers of infants less than one year old (n=695) in nine primary health units in Rio de Janeiro City, Brazil. Adjusted prevalence ratios were obtained by Poisson regression with robust variance. Cross-nursing was practiced by 29.4% of the mothers. The following variables were directly associated with cross-nursing: adolescence (PR=1.595), smoking (PR=1.396), alcohol consumption (PR=1.613), inappropriate baby feeding habits (PR=1.371) and the infant's age in months (PR=1.066), while maternal formal employment was inversely associated with the practice (PR=0.579). The second article was based on a cross-sectional study nested in a cohort of pregnant women recruited between 2008 and 2010 in five public health units with prenatal care in two medium-sized cities of the state of Rio de Janeiro: in the metropolitan area - "RME" and in the mountain region - "SER". Cross-nursing was practiced by 43.4% of the mothers in RME and by 34.5% of the mothers in SER. Low socioeconomic status was directly associated with cross-nursing in both cities. In SER, adolescence and less than six prenatal visits were directly associated with cross-nursing, while finishing elementary school or higher was inversely associated with the practice. In RME, in addition to the socioeconomic status, only multiparity was (inversely) associated with the outcome. We conclude that cross-nursing had a relevant prevalence in different scenarios of Rio de Janeiro State and was more practiced by the most vulnerable populations110 f

Fatores associados ao aleitamento cruzado em duas cidades do Sudeste do Brasil

Resumo: O objetivo foi estimar a prevalência de aleitamento cruzado em duas cidades brasileiras e analisar os fatores associados à prática. Estudo transversal aninhado a uma coorte de gestantes recrutadas nas unidades públicas de saúde que ofereciam atendimento pré-natal em duas cidades de médio porte do Estado do Rio de Janeiro, Brasil: da Região Metropolitana e da Região Serrana, conduzido entre 2008 e 2010. O presente trabalho inclui todas as mulheres entrevistadas aos seis meses de vida de seus bebês. Razões de prevalência ajustadas foram obtidas por modelo de regressão de Poisson e as variáveis de exposição que alcançaram p ≤ 0,05 compuseram o modelo final. O aleitamento cruzado foi praticado por 43,4% das mães na região metropolitana e por 34,5% delas na Região Serrana. O baixo nível socioeconômico esteve associado ao aleitamento cruzado nas duas cidades. Além disso, na Região Serrana foram associados diretamente ao desfecho ser mãe adolescente, ter escolaridade igual ou inferior ao Ensino Fundamental completo e ter realizado menos de seis consultas pré-natais. Na Região Metropolitana, além do nível socioeconômico, apenas a multiparidade foi associada (inversamente) ao aleitamento cruzado. O aleitamento cruzado, embora contraindicado pelo Ministério da Saúde, apresentou alta prevalência entre as mães entrevistadas e foi mais praticado pelas populações mais vulneráveis

Social support modifies the association between pre-pregnancy body mass index and breastfeeding initiation in Brazil.

BACKGROUND:Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association. DESIGN:National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses. RESULTS:Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI. CONCLUSIONS:Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation