Jacobo Sabulsky

Correlates of breastfeeding duration in an urban cohort from Argentina

Aim: To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio‐demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Methods: The study was conducted in the city of Cordoba, between 1993 and 1998. Mother‐child binomials from all public and private hospitals were asked to participate. Follow‐up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan‐Meier method, and factors associated with weaning were studied using Coxs proportional risk regression. Results. The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82–2.82]; breastfeeding of a previous child for less than 6 mo (RR=1.64; 95% CI = 1.32–2.02); delay in the first mother‐child contact for over 90 min (RR=1.50; 95% CI = 1.17–1.93); mothers having completed primary or partially completed secondary education (RR= 1.40; 95% CI = 1.01–1.92) or completed secondary education or higher (RR= 1.59; 95% CI = 1.14–2.22); primiparous mother (RR= 1.39; 95% CI = 1.12–1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01–1.61).

Premature cessation of breastfeeding in infants: development and evaluation of a predictive model in two Argentinian cohorts: the CLACYD study, 1993–1999*

The objective of this study was to develop a model to predict premature cessation of breastfeeding of newborns, in order to detect at‐risk groups that would benefit from special assistance programmes. The model was constructed using 700 children with a birthweight of 2000 g or more, in 2 representative cohorts in 1993 and 1995 (CLACYD I sample) in Córdoba, Argentina. Data were analysed from 632 of the cases. Mothers were selected during hospital admittance for childbirth and interviewed in their homes at 1 mo and 6 mo. To evaluate the model, an additional sample with similar characteristics was drawn during 1998 (CLACYD II sample). A questionnaire was administered to 347 mothers during the first 24–48 h after birth and a follow‐up was completed at 6 mo, with weaning information on 291 cases. Premature cessation of breastfeeding was considered when it occurred prior to 6 mo. A logistic regression model was fitted to predict premature end of breastfeeding, and was applied to the CLACYD II sample. The calibration (Hosmer‐Lemeshow C statistic) and the discrimination [area under the receiver operating characteristics (ROC) curve] of the model were evaluated. The predictive factors of premature end of breastfeeding were: mother breastfed for less than 6 mo [odds ratio (OR) = 1.84,95% confidence interval (CI) 1.26–2.70], breastfeeding of previous child for less than 6 mo (OR = 4.01, 95% CI 2.58–6.20), the condition of the firstborn child (OR = 2.75, 95% CI 1.79–4.21), the first mother‐child contact occurring after 90min of life (OR =1.88; 95% CI 1.22–2.91) and having an unplanned pregnancy (OR = 1.50, 95% CI 1.05–2.15). The calibration of the model was acceptable in the CLACYD I sample (p= 0.54), as well as in the CLACYD II sample (p= 0.18). The areas under the ROC curve were 0.72 and 0.68, respectively.

Alimentación del recién nacido en el periodo de posparto inmediato

OBJECTIVE: To describe the type of newborn feeding in public and private institutions and to investigate its relationship with health practices during delivery and in the puerperium and sociodemographic characteristics. METHODS: Three hundred and forty-seven representative binomials mother - child of births that occurred in public and private maternity wards in the city of Cordoba, Argentina, were studied. Mothers were interviewed between 24 to 48 hours after delivery. By means of logistic regression analysis the association between health care practices and the type of newborn feeding in public and private institutions was studied, controlling for the effect of sociodemographic and perinatal factors. Statistical analysis was performed using logistic regression, odds ratio, and 95%CI. RESULTS: Of the total, 60.4% newborns in public institutions and 2.9% in private institutions were exclusively breastfed. In the public institutions, the risk of partial breastfeeding in the immediate postpartum was significantly higher in children who were not initially fed with mothers milk [odds ratio (OR)=149; confidence interval (CI): 95%: 16.7-1332], the first mother-child contact was delayed for more than 45 minutes (OR:4.43; IC 95%: 1.02-19.20) and mothers intention was to breastfeed her child for less than 6 months (OR: 5.80; IC: 95% 1.32-25.52); and in private institutions when children were not initially fed with mothers milk (OR: 9.88; IC 95%: 1.07-91.15). CONCLUSIONS: Labor and postpartum care does not comply with the current recommendations and it affects the type of feeding regardless of other factors studied.

Crecimiento de niños amamantados y alimentados con biberón hasta los 2 años de vida: estudio CLACYD, 1993-1995

The growth in weight and height from birth to 24 months were compared for 2 groups of breast- or bottle-fed infants in Cordoba Argentina and the growth pattern of the breast-fed infants was compared to the reference norms of the US National Center for Health Statistics/WHO and the WHO 12-month breast-fed pooled data set. Information on 74 infants breast-fed for 1 year and 108 infants weaned within 60 days and bottle-fed were recorded using standardized procedures at birth and 6 12 and 24 months from the Cordoba lactation feeding growth and development study (CLACYD). The infants were stratified by socioeconomic status (SES). The 2 groups were homogeneous in parental age and education SES birth order maternal height and childrens birth weight and length. Living conditions as indicated by housing construction potable water and sewage services were significantly better for the bottle-fed group. The breast-fed infants showed slower increases in both weight and length at 6 12 and 24 months than did the bottle-fed infants. They also showed slowing of growth in comparison to the NCHS/WHO norms beginning at 6 months. Infants in the upper and middle social strata were similar in weight and length to the values of the WHO 12-month pooled data set. Infants in low and very low social strata were similar in weight to the norms in the pooled data set but not in length reflecting the influence of their living conditions. The study findings suggest that the NCHS/WHO norms may not be ideal for evaluating the growth of breast-fed children in Cordoba.

Talla final de mujeres de Córdoba, Argentina, y exploración de la tendencia secular (1978­1988)

Este trabajo tuvo por objeto aportar datos locales sobre la talla final de mujeres de Cordoba, Argentina, y explorar la posibilidad de una tendencia secular en su crecimiento. Se examinaron 513 mujeres de 18 a 40 anos de edad, madres de ninos incluidos en el estudio CLACYD (Cordoba: lactancia, alimentacion, crecimiento y desarrollo). Las mediciones se realizaron segun tecnicas estandarizadas, durante mayo y junio de 1994. Usando como normas de referencia datos del Centro Nacional de Estadisticas de Salud de los Estados Unidos de America, la media de la talla final de la poblacion estudiada (157,9 cm) correspondio a una desviacion estandar (DE) de 0,97 con respecto al percentil 50 de la norma de referencia de ese centro; la del grupo de estrato social alto (159,7 cm), a una DE de 0,67 y la del estrato muy bajo (156,2 cm), a una DE de 1,25. La diferencia entre los valores de los estratos sociales fue estadisticamente significativa (P : 24 anos) y G 2 ( : 34 anos). Las mujeres del primer grupo registraton una talla final 0,4 cm mayor que la observada en las del segundo grupo (P = 0,47). El aumento secular registrado es notoriamente inferior a los publicados en relacion con otras provincias argentinas (1,2 y 1,4 cm/decenio) y algo menor al promedio que se notifica en estudios de poblaciones en Australia, Belgica, los Estados Unidos, Japon y Noruega (0,6 cm/decenio). Se concluye que en el periodo analizado (19781988) las condiciones de vida en la ciudad de Cordoba no han mejorado de forma que se refleje en un aumento significativo de la talla de las mujeres adultas. Se recomienda que los programas de salud y nutricion materna concentren sus recursos en las madres de estrato social muy bajo que registran tallas inferiores a 145 cm.Data on the height of 513 women 18-40 years old was used in an analysis of height of women in the city of Cordoba Argentina and the possible existence of a secular trend in height. The women were mothers of infants included in a long-term study of child nutrition and development that began in 1993. The mothers were measured in May and June 1994 when the children were 1 year old. The study population was classified into 6 social strata defined by occupation. The mean full height of the study population was 157.9 cm 0.97 standard deviation below the reference norm which was the 50th-percentile level obtained from the US National Center for Health Statistics. The average height of the highest status group was 159.7 cm 0.67 standard deviation below the reference norm while that of the lowest status group 156.2 cm was 1.25 standard deviation below the norm. The difference between the highest and lowest strata was statistically significant. 2.3% of the study population were under 145 cm tall the level generally defined as at increased risk in childbearing. A comparison of the final heights of 344 women whose mean age was 24 with those of 169 women whose mean age was 34 showed the younger women to be 0.4 cm taller on average. The increase was less than the 1.2 and 1.4 cm observed for other Argentine provinces. It was concluded that living conditions in the city of Cordoba did not improve sufficiently to reflect a significant increase in the height of women.