Patricia de Moraes Mello Boccolini

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.

O papel do aleitamento materno na redução das hospitalizações por pneumonia em crianças brasileiras menores de 1 ano

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.

Padrões de aleitamento materno exclusivo e internação por diarréia entre 1999 e 2008 em capitais brasileiras

The prevalence of breastfeeding has increased over the past two decades in Brazil, as a result of public breastfeeding policies. The scope of this paper is to analyze the correlation between the increase in the prevalence of breastfeeding and hospitalization rates due to diarrhea. It is an epidemiological ecological study, based on secondary data from Brazilian Capital Cities and the Federal District. The prevalence of breastfeeding, the number of live births, and cases of hospitalization due to diarrhea were compared for the years 1999 and 2008 and the Spearman non-parametric test was used to correlate the variables. During the period, 1,329,618 children under one year of age in 1999 and 2008 were studied. The increase in the prevalence of exclusive breastfeeding among children under 4 months old had a negative correlation with hospitalization rates due to diarrhea (Rho=-0.483, p=0.014). This correlation was stronger for girls (Rho=-0.521, p=0.008) than for boys (Rho=-0.476, p=0.016). The increase in the prevalence of breastfeeding between 1999 and 2008 appears to be correlated to a reduction in hospitalization rates due to diarrhea over the same period, corroborating the importance of public policies to protect, support and promote breastfeeding.

Inequities in Milk-Based Prelacteal Feedings in Latin America and the Caribbean The Role of Cesarean Section Delivery

Background: Prelacteal feeds (ie, foods other than breast milk offered before the milk comes in) have been identified as a risk factor for shorter breastfeeding duration and neonatal mortality. Objective: This study aimed to test for socioeconomic inequities on the risk of milk-based prelacteal feeding associated with cesarean section delivery. Methods: We conducted secondary cross-sectional data analyses of 7 Demographic and Health Surveys conducted in Latin American and Caribbean countries between 2005 and 2010 (N = 49 253 women with children younger than 3 years of age). Multivariate logistic regression was used to test the association between cesarean section delivery and the risk of milk-based prelacteal feeding in the total samples as well as within the lowest and highest wealth quintile subsamples by country and in the pooled sample. Results: Almost one-third of newborns received milk-based (22.9%) prelacteal feeds. Prelacteal feeding prevalence varied from 17.6% in Guiana to 55% in Dominican Republic. Cesarean section delivery was associated with significantly higher odds of introduction of milk-based prelacteals in all countries (adjusted odds ratio [AOR] range, 2.34 in Bolivia to 4.50 in Peru). The association between cesarean section delivery and risk of milk-based prelacteal feeds was stronger among the poorest than wealthiest women (AOR [95% confidence interval], 2.94 [2.58-3.67] vs 2.17 [1.85-2.54]). Conclusion: Women of lower socioeconomic status may need additional breastfeeding support after cesarean section delivery to prevent the introduction of milk-based prelacteals. Reducing the rates of cesarean section deliveries is likely to reduce the prevalence of prelacteal feeding.

Breastfeeding indicators trends in Brazil for three decades

ABSTRACT OBJECTIVE Update breastfeeding indicators trend in Brazil for the last three decades, incorporating more up-to-date information from the National Health Survey. METHODS We used secondary data from national surveys with information on breastfeeding (1986, 1996, 2006, and 2013) to construct the time series of prevalence for the following indicators: exclusive breastfeeding in children under six months of age (EBF6m), breastfeeding in toddlers under 2 years of age (BF), continued breastfeeding at one year of age (BF1year), and continued breastfeeding at two years of age (BF2years). RESULTS The prevalence of EBF6m, BF, and BF1year increased until 2006 (rising from 4.7%, 37.4%, and 25.5% in 1986 to 37.1%, 56.3%, and 47.2% in 2006, respectively). For these three indicators, there was relative stabilization between 2006 and 2013 (36.6%, 52.1%, and 45.4%, respectively). The BF2years indicator had a distinct behavior – relatively stable prevalence, around 25% between 1986 and 2006, and a subsequent increase, reaching 31.8% in 2013. CONCLUSIONS The time series of breastfeeding indicators in Brazil shows an upward trend until 2006, stabilizing from that date onwards on three of the four indicators evaluated. This result, which can be considered as a warning sign, requires evaluation and revision of policies and programs to promote, protect and support breastfeeding, strengthening existing ones and proposing new strategies so that the prevalence of breastfeeding indicators returns to an upwards trend.

Pesticide exposure and low birth weight prevalence in Brazil

INTRODUCTION Brazil is one of the major global consumers of pesticides and exposure to these substances can affect fetal growth. OBJECTIVE To estimate the correlation between pesticide sales in 1996 and the prevalence of low birth weight during the period 1996-1998 in Brazil. METHOD This ecological study employed secondary data aggregated at the level of Brazilian micro-regions (cluster of cities). Prevalence of low birth weight in 1996, 1997, and 1998 was obtained from the Brazilian health databases, and per capita pesticides sales in 1996 obtained from the Brazilian Institute of Geography and Statistics were utilized as an indirect measure of population exposure to these chemicals. Spearman correlation coefficient and Prevalence Ratio by quartiles were estimated, considering per capita pesticide sales and the prevalence of low birth weight. RESULTS A total of 552 micro-regions were analyzed (446 non-urban and 106 urban). In rural areas, the per capita pesticide sales were directly associated with higher prevalence of children born with low birth weight (r=0.403), with birth weights between 1500 and 2500 grams (r=0.366), and very low birth weight birth (r=0.476). All correlations were statistically significant (p<0.001). On the other hand, in urban areas there was no significant correlation. There was a gradual increase in the prevalence of low birth weight according to the quartiles of pesticide consumption. CONCLUSIONS Pesticide per capita sales may affect the prevalence of newborns with low birth weight in non-urban micro-regions of Brazil, indicating the need to strengthen policies and actions to protect the health of populations exposed to pesticides.

Relação entre aleitamento materno e internações por doenças diarreicas nas crianças com menos de um ano de vida nas Capitais Brasileiras e Distrito Federal, 2008

Endereco para correspondencia: Escola Nacional de Saude Publica, Departamento de Epidemiologia e Metodos Quantitativos em Saude. Rua Leopoldo Bulhoes, 1480, 8o andar, sala 806, Manguinhos, Rio de Janeiro-RJ, Brasil. CEP: 21041-210 E-mail: cristianoboccolini@yahoo.com.br Cristiano Siqueira Boccolini Programa de Pos-Graduacao de Epidemiologia e Saude Publica, Escola Nacional de Saude Publica Sergio Arouca, Fundacao Oswaldo Cruz, Rio de Janeiro-RJ, Brasil Secretaria Municipal de Saude e Defesa Civil, Prefeitura Municipal do Rio de Janeiro, Rio de Janeiro-RJ, Brasil

Prevalence of very low birthweight, malformation, and low Apgar score among newborns in Brazil according to maternal urban or rural residence at birth

Adverse birth outcomes are a major public health issue in rural areas, where several environmental risk factors, including pesticides, may endanger the health of women of reproductive age. We investigated the prevalence of selected birth outcomes among newborns from mothers living in urban and rural areas of a Brazilian municipality.

Non-Hodgkin lymphoma among Brazilian agricultural workers: A death certificate case-control study

ABSTRACT To estimate the non-Hodgkin lymphoma (NHL) mortality risk among agricultural workers in Brazils southern states, we used death certificates to identify cases of NHL between the ages of 20 and 69 years from residents of nonurban municipalities between 1996 and 2005 (n = 1,317). Controls were randomly selected from those whose underlying cause of death did not include neoplasm or hematological diseases and paired with cases by sex, age, year of death, and state of residence (n = 2,634). Odds of being an agricultural worker among cases and controls were estimated by conditional logistic regression, stratified and adjusted by sex, state, education, and race. An increased risk of death by NHL was observed among agricultural workers 20–39 years old (ORadj = 2.06; 95% CI 95%, 1.20–3.14). Our results suggest that the young agricultural workers from southern Brazil were more likely to die of NHL compared to nonagricultural workers.

Tendência de mortalidade por linfomas não Hodgkin no Brasil, 1980 a 2012

ObjectiveThis paper aims to analyze the Non Hodgkin Lymphoma (NHL) mortality time trend in Brazil.MethodologyIt is an epidemiological temporal trend study with information on NHL deaths from 1980 to 2012 (obtained from the Mortality National System), standardized by age using the direct method. A Poisson (joinpoint) model was employed to estimate the Annual Percent Change (APC) of NHL mortality.ResultsIn Brazil and the southeastern region, there was a statistically significant increasing trend in the mortality ratio by NHL only from 1989 to 1998 (APC=3.4%; p<0.05 and APC=3.0%; p<0.05, respectively), while in the middle west (APC=2.3%; p<0.05), north (APC=1.5%; p<0.05) and northeast regions (APC=3.1%; p<0.05), the increasing trend was constant throughout the whole study period. In the south region, there was no statistically significant trend in NHL mortality during the study period.ConclusionsThe increasing trends in NHL mortality observed were not homogeneous; therefore, future studies should be conducted to understand its risk factors.