Factors associated with the maintenance of breastfeeding for 6, 12, and 24 months in adolescent mothers

Background: Previous studies have demonstrated that adolescent mothers present a higher risk of not breastfeeding or of early interruption of this practice. Considering the scarcity of studies investigating the determining factors of breastfeeding in adolescent mothers, and the absence of studies exploring the determining factors of breastfeeding maintenance for different periods of time in a single population of adolescent mothers, the aim of this research was to identify factors associated with breastfeeding maintenance for at least 6, 12, and 24 months in adolescent mothers. Methods: Data analysis from a randomised control trial involving adolescent mothers recruited at a university hospital in southern Brazil. Participants were followed through the first year of life of their infants and reassessed at 4-7 years. Factors associated with any breastfeeding for at least 6, 12, and 24 months were assessed using multivariate Poisson regression. Results: Data for 228, 237, and 207 mothers were available, respectively. Breastfeeding maintenance for at least 6, 12, and 24 months was observed in 68.4, 47.3, and 31.9% of the sample, respectively. Only one factor was associated with breastfeeding maintenance at all outcomes: infant not using a pacifier showed a higher probability of breastfeeding maintenance in the first 2 years. Maternal grandmother breastfeeding support and exclusive breastfeeding duration were associated with breastfeeding maintenance for 6 and 12 months. The other factors evaluated were associated with breastfeeding maintenance at only one of the time points assessed: 6 months, maternal skin color (black/brown); 12 months, female infant and partner breastfeeding support; and 24 months, older paternal age and multiparity. Conclusions: The present findings shed light upon barriers and facilitators of breastfeeding practices among adolescent mothers. In order to contribute to the challenge of increasing BF duration among adolescent mothers interventions aimed at boosting breastfeeding maintenance among this population should take into consideration the determining factors here identified. Additionally, breastfeeding education and support should be provided continuously as factors influencing these practices vary with time. Thus, support for adolescent mothers during the different stages of breastfeeding need to be tailored to have a positive impact on breastfeeding experience

Obesidade, práticas alimentares e conhecimentos de nutrição em escolares

OBJECTIVE: To evaluate the association between obesity and eating habits and nutritional knowledge among schoolchildren. METHODS: Weight and height were measured in 573 schoolchildren of public schools in two cities of State of Rio Grande do Sul, Southern Brazil. Obesity was defined as Body Mass Index above the 95th percentile based on the National Center for Health Statistics (NCHS) criteria. Eating habits and nutrition knowledge were evaluated using a self-administered questionnaire. Simple and adjusted logistic regression models were used to assess associations. RESULTS: Obesity among children was found to be associated with limited nutrition knowledge and unhealthy eating and habits. These children were five times more likely to be obese (OR=5.3;1.1-24.9). CONCLUSIONS: The level of knowledge affects the association between obesity and eating habits, and there's reason to suspect that children who have more nutrition knowledge report habits known to be healthier but not necessarily the ones they actually practice. Taking into account children's level of knowledge, unhealthy habits were strongly associated to obesity.OBJETIVO: Avaliar a associação da obesidade com as práticas alimentares e conhecimentos de nutrição em escolares. MÉTODOS: Peso e estatura foram medidos em 573 crianças de todas as escolas municipais de Dois Irmãos e Morro Reuter, RS. Obesidade foi definida como índice de massa corporal acima do percentil 95, tendo como referência os dados do National Center for Health Statistics. Práticas alimentares e conhecimentos em nutrição foram avaliados por questionário auto-aplicado aos escolares. Foi realizada análise de regressão logística simples e ajustada para verificar associações. RESULTADOS: A obesidade mostrou-se associada com menos conhecimento de nutrição e práticas alimentares menos saudáveis. Crianças com essas características apresentaram cinco vezes mais chances de serem obesas (OR=5,3;1,1-24,9). CONCLUSÕES: O nível de conhecimento modifica a relação entre obesidade e práticas alimentares, levantando a suspeita de que as crianças que sabem mais sobre nutrição relatam práticas sabidamente mais saudáveis e não necessariamente as praticadas. As práticas alimentares menos saudáveis, quando considerado o nível de conhecimento em nutrição dos escolares, foram fortemente associadas à obesidade

Practice of exclusive breastfeeding and its associated factors in a suburban area in Angola : a cross-sectional study

BACKGROUND: Exclusive breastfeeding for six months is one of the measures with highest impact on prevention of child deaths. The determinants of breastfeeding practices are complex and differ between populations. This study aimed to identify factors associated with the prevalence of exclusive breastfeeding in a suburban area in Angola. DESIGN AND SETTING: Population-based cross-sectional study in the municipality of Cacuaco, Luanda. METHODS: A random sample of children under two years of age and their mothers was included. Prevalence ratios (PR) were estimated using Poisson regression based on a hierarchical model. RESULTS: 749 children and their mothers were surveyed, including 274 children under six months. The prevalence of exclusive breastfeeding among children under six months was 51.5% (95% confidence interval, CI, 46.3-56.6%). Four variables were positively associated with exclusive breastfeeding at ages of under six months: number of prenatal visits (PR 1.11 for each visit after the first one; 95% CI 1.04-1.18), maternal occupation (other occupations versus self-employed) (PR 1.54; 95% CI 1.05-2.26), younger child age (PR 0.77 for each month; 95% CI 0.71-0.84) and female child (PR 1.34; 95% CI 1.02-1.76). CONCLUSIONS: Our findings showed that the prevalence of exclusive breastfeeding at six months was satisfactory, according to international recommendations. Factors associated with exclusive breastfeeding practices that had never been surveyed before in Angola were identified through this study. These data are particularly relevant in the context of high infant mortality and may be useful in planning actions aimed at improving child health through promotion of exclusive breastfeeding, in Angola and other countries

Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers

OBJETIVO Avaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos. MÉTODOS Ensaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t. RESULTADOS Houve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna. CONCLUSÕES Intervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida.OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test. RESULTS Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found. CONCLUSIONS Educational dietary intervention in the first four months of the child’s life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child’s life

Adherence to dietary recommendations for preschoolers : clinical trial with teenage mothers

OBJETIVO: Avaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos. MÉTODOS: Ensaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t. RESULTADOS: Houve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna. CONCLUSÕES: Intervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida

Amamentação está associada à diversidade alimentar infantil no Brasil

O objetivo foi descrever o padrão de consumo alimentar em crianças brasileiras entre 6 e 24 meses e verificar as diferenças entre crianças em aleitamento materno (AM) que consomem ou não outros tipos de leites não-humano (LNH), e aquelas não amamentadas (NAM). Foram usados dados da Pesquisa Nacional de Demografia e Saúde (2006). O consumo alimentar de 1455 crianças foi avaliado usando um questionário de frequência alimentar. Avaliou-se a presença de dieta saudável e diversificada. A associação entre AM e o consumo alimentar foi testado pela regressão de Poisson. Na entrevista, 15,8% das crianças estavam em AM sem consumo de LNH, 30,7% estavam em AM com consumo de LNH e 53% não estavam em AM. Mais da metade consumiam os alimentos recomendados, 78% consumiam alimentos ricos em açúcar, gordura e sal, e apenas 3,4% estavam em uma dieta saudável e diversificada. As crianças em AM que não consumiam LNH tinham quase cinco vezes mais chances de ter uma dieta saudável e diversificada e tinham 19% menos chance de consumir alimentos ricos em açúcar, gordura e sal, comparadas àquelas que também consumiam LNH e àquelas que não estavam em AM.The aim of this study was to describe food consumption patterns in Brazilian children aged 6-24 months and to assess differences between breastfed children who do not consume non-human milks, breastfed children who consume non-human milks, and non-breastfed children. This study used data from the Brazilian National Demographic and Health Survey (2006). The food consumption patterns of 1,455 children were assessed using a food frequency questionnaire. One indicator adopted in this study was the healthy diverse diet. The association between breastfeeding and food consumption was tested using multivariate Poisson regression. At the interview, 15.8% of the children were breastfed without consuming non-human milk, 30.7% consumed breast milk in conjunction with non-human milk, and 53% were not breastfed anymore. Over half consumed the recommended foods, 78% consumed foods rich in sugar, fat, and salt, and only 3.4% were on a healthy diverse diet. The breastfed children who did not consume non-human milks were almost five times more likely to be on a healthy diverse diet and were 19% less likely to consume foods rich in sugar, fat, and salt than the breastfed children who also consumed non-human milks and the non-breastfed children

Influence of pacifier use on the association between duration of breastfeeding and anterior open bite in primary dentition

Background: The literature is controversial with regard to the association between longer breastfeeding duration and lower prevalence of anterior open bite. Pacifier use may be involved in this controversy. Thus, the objective of the study was to assess the influence of pacifier use and its duration on the association between longer breastfeeding duration and lower prevalence of anterior open bite in children with primary dentition. Methods: This was a cross-sectional study nested in a cohort study involving 153 infants recruited at a maternity hospital in the municipality of Porto Alegre, southern Brazil. The study outcome (anterior open bite) was assessed when the children were between 3 and 5 years old. Data on breastfeeding and pacifier use were collected at 7, 30, 60, 120, and 180 days of life and on the date of the evaluation here described. Poisson regression with robust variance was used to analyze the association between the prevalence of anterior open bite and breastfeeding duration, expressed in months. Results: The univariate analysis showed a protective effect of breastfeeding against anterior open bite (prevalence ratio [PR] 0.96; 95% confidence interval [95%CI] 0.95–0.98). This effect remained significant after adjustment for pacifier use at any time between birth and the date of dental assessment (PR0.98; 95%CI; 0.96–0.99), i.e., there was a reduction of 2% in the prevalence of anterior open bite for each month of breastfeeding. However, this effect lost significance when pacifier use duration was included in the multivariate analysis (PR1.00; 95%CI; 0.99–1.01). Conclusions: Pacifier use duration influences the association between longer breastfeeding duration and lower prevalence of anterior open bite. It is likely that prolonged pacifier use reduces the magnitude of this association

Factors associated with women’s satisfaction with prenatal care in Porto Alegre, Rio Grande do Sul, Brazil

O objetivo deste artigo é identificar fatores associados à plena satisfação com a atenção pré-natal em serviços de saúde de Porto Alegre, Rio Grande do Sul. Estudo transversal, com 287 mulheres que realizaram pré-natal na capital gaúcha. As mulheres foram selecionadas aleatoriamente em duas maternidades de grande porte (pública e privada) e entrevistadas nos seus domicílios, cerca de 30 dias após o parto, entre janeiro e agosto de 2016. A satisfação foi aferida por meio de escala Likert (muito satisfeita a muito insatisfeita). Foram estimadas razões de prevalência (RP) por regressão de Poisson com estimação robusta da variância, utilizando modelo hierarquizado. Os fatores associados à plena satisfação foram: ingresso no ensino superior (RP=1,49; IC95%:1,08- 2,06); atendimento multiprofissional (RP=1,29; IC95%:1,00-1,66); recebimento de orientações sobre amamentação (RP=1,33; IC95%:1,05-1,68) e sobre local do parto (RP=1,56; IC95%:1,12- 2,17); e sentimento da mulher de estar à vontade para fazer perguntas e participar das decisões (RP=5,17; IC95%:1,79-14,96). Os achados sugerem que serviços de pré-natal que oferecem cuidado multiprofissional, que dão orientações, e que oportunizam às gestantes o sentimento de estar à vontade para questionar e decidir sobre seu cuidado, proporcionam maior satisfação.This article aims to identify factors associated with full satisfaction with prenatal care in health services in Porto Alegre (RS), Brazil. This is a cross-sectional study with 287 women that attended prenatal care in the state capital. Women were randomly selected at two large maternity hospitals (public and private) and interviewed at their homes around 30 days after delivery, from January to August 2016. Satisfaction was measured by a Likert scale (very satisfied to very unsatisfied). Prevalence ratios (PR) were estimated by Poisson regression with robust variance, using a hierarchical model. Factors associated with greater satisfaction were higher education (PR=1.49; 95% CI: 1.08-2.06); multiprofessional care (PR=1.29; 95% CI: 1.00-1.66); receiving information about breastfeeding (PR=1.33; 95% CI: 1.05-1.68) and place of delivery (PR=1.56; 95% CI: 1.12-2.17); and women feeling comfortable asking questions and participating in decisions (PR=5.17; 95% CI: 1.79-14.96). The findings suggest that prenatal care services that offer multiprofessional care, provide guidance, and make pregnant women feel comfortable asking and deciding about their care may generate greater satisfaction

Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression

Background: Postpartum depression is a common condition in the pregnancy and postpartum cycle. The development of this condition is multifactorial and can be influenced by previous traumas. This study sought to verify whether there is an association between having been exposed to mistreatment during childbirth and presenting symptoms suggestive of postpartum depression. Methods: This is a cross-sectional study, with the inclusion of 287 women without complications in childbirth, randomly selected from two maternity hospitals of Porto Alegre, southern Brazil, in 2016. Four weeks after delivery, the postpartum women answered a face-to-face interview about socioeconomic aspects, obstetric history, health history, and childbirth experience (practices and interventions applied) and completed the Edinburgh Postnatal Depression Scale (EPDS). From the perception of women regarding the practices performed in the context of childbirth care, a composite variable was created, using item response theory, to measure the level of mistreatment during childbirth. The items that made up this variable were: absence of a companion during delivery, feeling insecure and not welcome, lack of privacy, lack of skin-to-skin contact after delivery, not having understood the information shared with them, and not having felt comfortable to ask questions and make decisions about their care. To define symptoms suggestive of postpartum depression, reflecting on increased probability of this condition, the EPDS score was set at ≥ 8. Poisson Regression with robust variance estimation was used for modeling. Results: Women who experienced mistreatment during childbirth had a higher prevalence of symptoms suggestive of postpartum depression (PR 1.55 95% CI 1.07–2.25), as well as those with a history of mental health problems (PR 1.69 95% CI 1.16–2.47), while higher socioeconomic status (A and B) had an inverse association (PR 0.53 95% CI 0.33–0.83). Conclusions: Symptoms suggestive of postpartum depression seem to be more prevalent in women who have suffered mistreatment during childbirth, of low socioeconomic status, and with a history of mental health problems. Thus, qualifying care for women during pregnancy, childbirth and postpartum and reducing social inequalities are challenges to be faced in order to eliminate mistreatment during childbirth and reduce the occurrence of postpartum depression

Aconselhamento e testagem voluntária para o HIV durante a assistência pré-natal

OBJECTIVE: Voluntary HIV counseling and testing are provided to all Brazilian pregnant women with the purpose of reducing mother-to-child HIV transmission. The purpose of the study was to assess characteristics of HIV testing and identify factors associated with HIV counseling and testing. METHODS: A cross-sectional study was carried out comprising 1,658 mothers living in Porto Alegre, Brazil. Biological, reproductive and social variables were obtained from mothers by means of a standardized questionnaire. Being counseling about HIV testing was the dependent variable. Confidence intervals, chi-square test and hierarchical logistic model were used to determine the association between counseling and maternal variables. RESULTS: Of 1,658 mothers interviewed, 1,603 or 96.7% (95% CI: 95.7-97.5) underwent HIV testing, and 51 or 3.1% (95% CI: 2.3-4.0) were not tested. Four (0.2%) refused to undergo testing after counseling. Of 51 women not tested in this study, 30 had undergone the testing previously. Of 1,603 women tested, 630 or 39.3% (95% CI: 36.9-41.7) received counseling, 947 or 59.2% (95% CI: 56.6-61.5) did not, and 26 (1.6%) did not inform. Low income, lack of prenatal care, late beginning of prenatal care, use of rapid testing, and receiving prenatal in the public sector were variables independently associated with a lower probability of getting counseling about HIV testing. CONCLUSIONS: The study findings confirmed the high rate of prenatal HIV testing in Porto Alegre. However, women coming from less privileged social groups were less likely to receive information and benefit from counseling.OBJETIVO: O aconselhamento e teste voluntário para o HIV foram instituídos no Brasil para todas as gestantes com o objetivo de reduzir a transmissão materno-infantil do vírus. O objetivo do estudo é verificar as características de testagem do HIV e identificar os fatores associados com a oportunidade da gestante ser aconselhada para esse teste. MÉTODOS: Estudo transversal que incluiu 1.658 mães residentes em Porto Alegre, RS. Variáveis biológicas, reprodutivas e sociais foram obtidas utilizando-se um questionário padronizado. Ser aconselhada para o teste de detecção do HIV foi a variável dependente. Para determinar os fatores associados à oportunidade de aconselhamento foram utilizados intervalos de confiança de 95%, o teste de qui-quadrado e uma análise multivariada utilizando o modelo hierarquizado. RESULTADOS: De um total de 1.658 mulheres entrevistadas, 1.603 ou 96,7% (IC 95%, 95,7%-97,5%) foram testadas para o HIV, 51 ou 3,1% (IC 95%, 2,3%-4,0%) não foram testadas e quatro (0,2%) se negaram a fazer o teste. Das 51 não-testadas, 30 haviam feito o teste previamente. Das 1.603 mulheres testadas durante a gestação, 630 ou 39,3% (IC 95%, 36,9%-41,7%) foram aconselhadas sobre o teste, 947 ou 59,1% não o foram (IC 95%, 56,6%-61,5%) e 26 (1,6%) não informaram. Baixa renda, não ter acesso ao pré-natal, iniciá-lo tardiamente, uso do teste rápido, e realizar o pré-natal no setor público estavam independentemente associados a uma menor probabilidade de ser aconselhada. CONCLUSÃO: O estudo confirmou uma alta taxa de testagem para o HIV. As gestantes provenientes de grupos sociais menos privilegiados foram aconselhadas em menor freqüência para a realização do teste de HIV