Maria Inês Couto de Oliveira

Fatores associados à amamentação na primeira hora de vida

OBJECTIVE To identify factors associated with breastfeeding in the first hour of life (Step 4 of the Baby-Friendly Hospital Initiative). METHODS A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect--at maternity hospital level--Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance. RESULTS Only 16% of the mothers breastfed in the first hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically significant. CONCLUSIONS At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals.OBJETIVO: Identificar fatores associados a amamentacao na primeira hora de vida (Passo 4 da Iniciativa Hospital Amigo da Crianca). METODOS: Foi realizado estudo transversal com amostra representativa de parturientes em maternidades do Rio de Janeiro, RJ, entre 1999 e 2001. Foram excluidos recem-nascidos ou maes com restricao ao aleitamento materno, resultando em amostra de 8.397 binomios. Foi adotado modelo Poisson com efeitos aleatorios ao nivel das maternidades, em abordagem hierarquizada com tres niveis: distal, intermediario e proximal para caracteristicas maternas, do recem-nascido, e de assistencia ao pre-natal e hospitalar. RESULTADOS: Amamentaram na primeira hora de vida 16% das maes. O aleitamento materno nesse periodo foi menos prevalente entre os recem-nascidos com intercorrencias imediatas apos o parto (RP = 0,47; IC99% 0,15;0,80); entre as maes que nao tiveram contato com os recem-nascidos na sala de parto (RP = 0,62; IC99% 0,29;0,95), as que tiveram parto cesariano (RP = 0,48; IC99% 0,24;0,72); e cujo parto ocorreu em maternidade privada (RP = 0,06; IC99% 0,01;0,19) ou conveniada com o Sistema Unico de Saude (RP = 0,16; IC99% 0,01;0,30). O efeito de contexto das maternidades foi estatisticamente significativo. CONCLUSOES: Em nivel individual, a amamentacao na primeira hora de nascimento foi prejudicada por praticas inadequadas nas maternidades, em particular as privadas e conveniadas com o Sistema Unico de Saude. O efeito de grupo das maternidades e a ausencia de fatores individuais maternos que expliquem o desfecho sugerem que as maes tem pouco ou nenhum poder de decisao sobre essa amamentacao e dependem das praticas institucionais vigentes nas maternidades.

Fatores que interferem no tempo entre o nascimento e a primeira mamada

The current study investigated factors associated with time between birth and first breastfeeding. A representative sample of mothers (10% of deliveries in 47 maternity hospitals in Rio de Janeiro, Brazil) was interviewed (n = 10,077). A random effects proportional risks survival model (at the maternity ward level) was employed, in a three-tier hierarchical approach. Models were fitted separately for normal and cesarean delivery. Time to initiation of breastfeeding in the first 24 hours of life differed between mothers with vaginal delivery (median 4 hours) versus cesarean section (10 hours). Common risk and protective factors were identified: maternal age; neonatal complications; neonatal care considered sub-optimal by the mother; admission of the newborn to the nursery; parity; birth weight. The model predicted 33% of variance in first breastfeeding. In conclusion, time from delivery to first breastfeeding was increased by biological factors, high cesarean rates, and inadequate childbirth and neonatal care practices.

Breastfeeding during the first hour of life and neonatal mortality

OBJECTIVE To analyze the correlation between breastfeeding in the first hour of life with neonatal mortality rates. METHODS The present study used secondary data from 67 countries, obtained from the Demographic and Health Surveys. Initially, for data analysis, Spearman Correlation (95% CI) and Kernel graphical analysis were employed, followed by a Negative Binomial Pois- son regression model, adjusted for potential confounders. RESULTS Breastfeeding within the first hour of life was negatively correlated with neo- natal mortality (Spearmans Rho = -0.245, p = 0.046), and this correlation was stronger among countries with more than 29 neonatal deaths per 1000 newborns (Spearmans Rho = -0.327, p = 0.048). According to the statistical model, countries with the lowest breastfeeding tertiles had 24% higher neonatal mortality rates (Rate ratio = 1.24, 95% CI = 1.07-1.44, p < 0.05), even when adjusted for potential confounders. CONCLUSION The protective effect of breastfeeding during the first hour of life on neo- natal mortality in this ecological study is consistent with findings from previous observa- tional studies, indicating the importance of adopting breastfeeding within the first hour as a routine neonatal care practice.

Factors associated to breastfeeding in the first hour of life: systematic review

OBJECTIVE To identify independent risk factors for non-breastfeeding within the first hour of life. METHODS A systematic review of Medline, LILACS, Scopus, and Web of Science electronic databases, till August 30, 2013, was performed without restrictions on language or date of publishing. Studies that used regression models and provided adjusted measures of association were included. Studies in which the regression model was not specified or those based on specific populations regarding age or the presence of morbidities were excluded. RESULTS The search resulted in 155 articles, from which 18 met the inclusion criteria. These were conducted in Asia (9), Africa (5), and South America (4), between 1999 and 2013. The prevalence of breastfeeding within the first hour of life ranged from 11.4%, in a province of Saudi Arabia, to 83.3% in Sri Lanka. Cesarean delivery was the most consistent risk factor for non-breastfeeding within the first hour of life. “Low family income”, “maternal age less than 25 years”, “low maternal education”, “no prenatal visit”, “home delivery”, “no prenatal guidance on breastfeeding” and “preterm birth” were reported as risk factors in at least two studies. CONCLUSIONS Besides the hospital routines, indicators for low socioeconomic status and poor access to health services were also identified as independent risk factors for non-breastfeeding within the first hour of life. Policies to promote breastfeeding, appropriate to each context, should aim to reduce inequalities in health.

A Method for the Evaluation of Primary Health Care Units' Practice in the Promotion, Protection, and Support of Breastfeeding: Results from the State of Rio de Janeiro, Brazil:

A method to assess the effectiveness of primary health care (PHC) units in enabling mothers to breastfeed was developed from the tool used for accreditation of baby-friendly hospitals. A 10-step scoring system assessed the extent to which procedures known to be effective at extending breastfeeding duration were applied within PHC units. Using this method, 13 PHC units showed a fair performance, whereas 11 performed poorly in the state of Rio de Janeiro. More babies younger than 6 months were being exclusively breastfed in fair performance than in poor performance units (38.6% vs 23.6%, respectively, P < .001). Twice as many pregnant women and mothers in fair performance units (61.9%) were satisfied with the support provided for breastfeeding than in poor performance units (31.4%). The differences were not explained by hospital care or working status of the women. The association found between structure, process, and outcomes support the validity of the method. J Hum Lact. 19(4):365-373.

Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review

ABSTRACT OBJECTIVE To identify factors associated with exclusive breastfeeding in the first six months of life in Brazil. METHODS Systematic review of epidemiological studies conducted in Brazil with exclusive breastfeeding as outcome. Medline and LILACS databases were used. After the selection of articles, a hierarchical theoretical model was proposed according to the proximity of the variable to the outcome. RESULTS Of the 67 articles identified, we selected 20 cross-sectional studies and seven cohort studies, conducted between 1998 and 2010, comprising 77,866 children. We identified 36 factors associated with exclusive breastfeeding, being more often associated the distal factors: place of residence, maternal age and education, and the proximal factors: maternal labor, age of the child, use of a pacifier, and financing of primary health care. CONCLUSIONS The theoretical model developed may contribute to future research, and factors associated with exclusive breastfeeding may subsidize public policies on health and nutrition.

Fatores associados ao aleitamento materno exclusivo: o papel do cuidado na atenção básica

The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (PR = 1.20; 95%CI: 1.05-1.36); schooling (PR = 1.19; 95%CI: 1.05-1.35); marital status (married or in common-law marriage) (PR = 1.72; 95%IC:1.02-2.90); previous breastfeeding (PR = 1.27; 95%CI: 1.08-1,49); exclusive breastfeeding at the time of hospital discharge (PR = 2.01; 95%CI: 1.20-3.36); group support for the mother (PR = 1.14; 95%CI: 1.01-1.28); and orientation on breastfeeding (PR = 1.20; 95%CI: 1.08-1.33). Prevalence of exclusive breastfeeding decreased 17% per month in the infants life. Support groups and orientation by primary health care for breastfeeding were associated with increased exclusive breastfeeding prevalence.

Breastfeeding can prevent hospitalization for pneumonia among children under 1 year old

OBJECTIVE To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. METHODS Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confidence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. RESULTS Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). CONCLUSION Increased prevalence rates of breastfeeding during the first year of life and exclusive breastfeeding during the first 6 months of life can reduce the number of hospitalizations for pneumonia.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.

Factors associated with breastfeeding in the first hour of life

OBJECTIVE To identify factors associated with breastfeeding in the first hour of life (Step 4 of the Baby-Friendly Hospital Initiative). METHODS A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and 2001. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect--at maternity hospital level--Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance. RESULTS Only 16% of the mothers breastfed in the first hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically significant. CONCLUSIONS At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the first hour of life, and depend on the institutional practices that prevail at the maternity hospitals.OBJETIVO: Identificar fatores associados a amamentacao na primeira hora de vida (Passo 4 da Iniciativa Hospital Amigo da Crianca). METODOS: Foi realizado estudo transversal com amostra representativa de parturientes em maternidades do Rio de Janeiro, RJ, entre 1999 e 2001. Foram excluidos recem-nascidos ou maes com restricao ao aleitamento materno, resultando em amostra de 8.397 binomios. Foi adotado modelo Poisson com efeitos aleatorios ao nivel das maternidades, em abordagem hierarquizada com tres niveis: distal, intermediario e proximal para caracteristicas maternas, do recem-nascido, e de assistencia ao pre-natal e hospitalar. RESULTADOS: Amamentaram na primeira hora de vida 16% das maes. O aleitamento materno nesse periodo foi menos prevalente entre os recem-nascidos com intercorrencias imediatas apos o parto (RP = 0,47; IC99% 0,15;0,80); entre as maes que nao tiveram contato com os recem-nascidos na sala de parto (RP = 0,62; IC99% 0,29;0,95), as que tiveram parto cesariano (RP = 0,48; IC99% 0,24;0,72); e cujo parto ocorreu em maternidade privada (RP = 0,06; IC99% 0,01;0,19) ou conveniada com o Sistema Unico de Saude (RP = 0,16; IC99% 0,01;0,30). O efeito de contexto das maternidades foi estatisticamente significativo. CONCLUSOES: Em nivel individual, a amamentacao na primeira hora de nascimento foi prejudicada por praticas inadequadas nas maternidades, em particular as privadas e conveniadas com o Sistema Unico de Saude. O efeito de grupo das maternidades e a ausencia de fatores individuais maternos que expliquem o desfecho sugerem que as maes tem pouco ou nenhum poder de decisao sobre essa amamentacao e dependem das praticas institucionais vigentes nas maternidades.