Roberto Mario Silveira Issler

Poverty levels and children's health status: study of risk factors in an urban population of low socioeconomic level

To test the hypothesis that the low socioeconomic population living in shanty towns in Porto Alegre presents different levels of poverty which are reflected on its health status, a cross-sectional study was designed involving 477 families living in Vila Grande Cruzeiro, Porto Alegre, Brazil. The poverty level of the families was measured by using an instrument specifically designed for poor urban populations. Children from families living in extreme poverty (poorest quartile) were found to have higher infant mortality rate, lower birth weights, more hospitalizations, and higher malnutrition rates, in addition to belonging to more numerous families. Thus, the shanty town population of Porto Alegre is not homogeneous, and priority should be given to the more vulnerable subgroups.

Breastfeeding pattern in a population with different levels of poverty in southern Brazil.

A cross‐sectional study was conducted on 477 poor children aged 12–59 months in order to investigate their breastfeeding pattern, taking into account the poverty level of their families. Although the population living in extreme poverty had the same pattern of breastfeeding as the rest of the poor population, the former group should still have priority in breastfeeding promotion programs, since they are the population who benefit most with breastfeeding.

Infant Sleep Position: A Randomized Clinical Trial of an Educational Intervention in the Maternity Ward in Porto Alegre, Brazil

BACKGROUND Few studies in Brazil have been published about sudden infant death syndrome (SIDS), and none has addressed the mothers orientation about placing the infant to sleep in the supine position. The aim of this study was to evaluate the effect on mothers of an individual educational intervention in the maternity ward about infant sleep position. METHODS A randomized clinical trial was conducted with a study sample of 228 mother-infant pairs assigned to an intervention or a control group. The intervention consisted of an individual orientation session at the maternity ward, at which folders and an oral explanation were given to mothers at discharge about the importance of the supine position as a preventive measure for SIDS. The outcome was the sleeping position at 3 months of age assessed during a home visit. The variables with p< 0.2 at a bivariate analysis were included in a logistic regression model. RESULTS Among mothers in the intervention group, 42.9 percent put their infants to sleep in a supine position at the 3-month visit, compared with 24 percent of mothers in the control group (p = 0.009). In a multivariate analysis, the intervention at the hospital was the only variable that influenced maternal practices with respect to infant sleep positioning (OR 2.22; 95% CI 1.17-4.19). CONCLUSIONS An individual educational session in the maternity ward about infant sleep position significantly increased the prevalence of supine position for sleeping in the infants third month. Nevertheless, the intervention was not sufficient to guarantee that most mothers would put their infants to sleep in the recommended position.

Coleito no primeiro semestre de vida: prevalência e fatores associados

The aim of this study was to verify the prevalence of bed-sharing and factors associated with this sleeping environment in an urban population in Southern Brazil. This was a cross-sectional nested cohort study with 233 mother-infant pairs selected at the maternity ward of the University Hospital in Porto Alegre. When the infant was 3 and 6 months old, home visits were performed to collect data on bed-sharing and associated variables. The main outcome was the place shared by the mother and infant for sleeping. Variables with p < 0.2 were included in a Poisson regression model. At 3 and 6 months, 31.2% and 28.5% of infants slept with their mothers at night. At 3 months, prevalence was higher for single mothers (PR: 1.56; CI: 1.01-2.39) and mothers sharing the home with the infants maternal grandmother (PR: 1.70; CI: 1.09-2.65). Prevalence of bed-sharing at 3 months was high and associated with single mothers and sharing the home with the infants maternal grandmother.

Association between the degree of implementation of the Brazilian Breastfeeding Network and breastfeeding indicators

O objetivo foi avaliar a implantacao da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se analise de implantacao de segundo tipo, incluindo 56 unidades basicas de saude (UBS) de tres municipios brasileiros. Para a avaliacao do grau de implantacao, criou-se um escore para cada UBS baseado no cumprimento dos criterios de certificacao do Ministerio da Saude; para a analise dos efeitos da implantacao, foram pesquisadas as prevalencias de amamentacao exclusiva e de amamentacao. Verificou-se que 18 (32,1%) UBS cumpriam os quatro criterios preconizados para certificacao. Foram incluidas no estudo 1.052 criancas menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro criterios de certificacao tiveram maior prevalencia de amamentacao exclusiva (44%), quando comparadas as demais UBS. Dificuldades para a implantacao da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o numero de criterios de certificacao cumpridos pelas UBS.This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.

Effectiveness of the National Strategy for Healthy Complementary Feeding to improve complemantary feeding of infants in a municipality in Southern Brazil

The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.

Efectividad de la Estrategia Nacional para una Alimentación Complementaria Saludable en la mejora de la alimentación complementaria de lactantes de un municipio del Sur de Brasil

The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.

Efetividade da Estratégia Nacional para Alimentação Complementar Saudável na melhoria da alimentação complementar de lactentes em um município do Sul do Brasil

The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategys positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.

Asociación entre el grado de implantación de la Red Amamanta Brasil e indicadores de lactancia materna

O objetivo foi avaliar a implantacao da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se analise de implantacao de segundo tipo, incluindo 56 unidades basicas de saude (UBS) de tres municipios brasileiros. Para a avaliacao do grau de implantacao, criou-se um escore para cada UBS baseado no cumprimento dos criterios de certificacao do Ministerio da Saude; para a analise dos efeitos da implantacao, foram pesquisadas as prevalencias de amamentacao exclusiva e de amamentacao. Verificou-se que 18 (32,1%) UBS cumpriam os quatro criterios preconizados para certificacao. Foram incluidas no estudo 1.052 criancas menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro criterios de certificacao tiveram maior prevalencia de amamentacao exclusiva (44%), quando comparadas as demais UBS. Dificuldades para a implantacao da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o numero de criterios de certificacao cumpridos pelas UBS.This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.

Associação entre o grau de implantação da Rede Amamenta Brasil e indicadores de amamentação

O objetivo foi avaliar a implantacao da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM). Realizou-se analise de implantacao de segundo tipo, incluindo 56 unidades basicas de saude (UBS) de tres municipios brasileiros. Para a avaliacao do grau de implantacao, criou-se um escore para cada UBS baseado no cumprimento dos criterios de certificacao do Ministerio da Saude; para a analise dos efeitos da implantacao, foram pesquisadas as prevalencias de amamentacao exclusiva e de amamentacao. Verificou-se que 18 (32,1%) UBS cumpriam os quatro criterios preconizados para certificacao. Foram incluidas no estudo 1.052 criancas menores de um ano, sendo 563 menores de seis meses. Verificou-se que as UBS que cumpriam os quatro criterios de certificacao tiveram maior prevalencia de amamentacao exclusiva (44%), quando comparadas as demais UBS. Dificuldades para a implantacao da Rede Amamenta Brasil foram identificadas, e os indicadores de AM variaram de acordo com o numero de criterios de certificacao cumpridos pelas UBS.This study aimed to evaluate the implementation of the Brazilian Breastfeeding Network and its impact on breastfeeding indicators. Implementation was analyzed according to type, including 56 primary healthcare units from three Brazilian municipalities. For evaluation of the degree of implementation, a score was created for each unit based on compliance with Ministry of Health certification criteria. Effects of implementation were analyzed according to exclusive and overall breastfeeding rates. Eighteen (32.1%) of the units met the four criteria for certification. The study sample included 1,052 children less than one year of age, of whom 563 were less than six months old. Units that met the four criteria for certification showed higher rates of exclusive breastfeeding (44%) when compared to the other units. Difficulties in implementing the Brazilian Breastfeeding Network were identified, and breastfeeding indicators varied according to the number of certification criteria met by the primary healthcare unit.