Impacto do aconselhamento face a face sobre a duração do aleitamento exclusivo / Impact of face-to-face counseling on duration of exclusive breast-feeding: a review

OBJETIVO: Realizar uma revisäo da literatura e uma avaliaçäo dos estudos sobre intervençöes com aconselhamento face a face para a promoçäo do aleitamento exclusivo. FONTE DOS DADOS: Foram pesquisadas as bases de dados MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Cochrane Library no período de 1990 e 2001. Foram selecionados estudos que descrevessem o aconselhamento face a face às mäes no período pós-natal ou no pré e pós-natal. Näo foram incluídos estudos descrevendo a intervençäo somente na gravidez. Os estudos foram classificados conforme os critérios modificados de Downs e Black. RESULTADOS: Foram incluídos 19 estudos. O tempo de acompanhamento dos bebês, o tipo de intervençäo realizada e as características étnicas, socioeconômicas e reprodutivas dos grupos estudados foram bastante variáveis. As limitaçöes mais freqüentes foram descriçäo inadequada dos fatores de confusäo e das características da amostra, metodologia pobremente documentada e ausência de análise ajustada para fatores de confusäo. Dezessete estudos mostraram um efeito benéfico da intervençäo, embora a magnitude de tal efeito tenha variado bastante. Dois estudos mostraram um efeito dose-resposta, isto é, o impacto foi diretamente proporcional ao número de visitas. Apenas um estudo relatou um efeito nulo da intervençäo sobre os índices de aleitamento exclusivo aos 3 e 5 meses. Contudo, dentre os 19 estudos avaliados, este teve o menor número de sessöes de orientaçäo (no máximo duas). CONCLUSÖES: A orientaçäo face a face, realizada em diferentes momentos, levou a mudanças significativas nos índices de aleitamento exclusivo. A presente análise sugere ainda que o apoio às mäes deve continuar após a alta hospitalar e incluir orientaçöes quanto à técnica de amamentaçäo e à resoluçäo de problemas

Breastfeeding indicators in Dakahlia Governorate

This study was carried out in Dakahlia Governorate to assess current breastfeeding practices using the standardized breastfeeding indicators developed by the World Health Organization and to highlight the impact of some socioeconomic and maternal factors on these indicators. An interview was carried out with mothers of 1200 infants and children < 24 months during a poliomyelitis immunization campaign in urban and rural areas. The findings indicate that 84.6% of infants aged 0-4 months are fully breastfed, with 42.5% and 42.1% of them exclusively and predominantly breastfed respectively. Rural infants are more likely to be exclusively breastfed, to continue breastfeeding for 1 year and to initiate breastfeeding early. Non-working mothers are more likely to breastfeed exclusively and more likely to continue breastfeeding for 1 year

Nutrition education and infant growth in rural Indian infants: narrowing the gender gap?

Growth faltering and malnutrition are highly prevalent in most South Asian countries. Among the serious consequences of malnutrition are increased risks of morbidity and mortality in children as well as deficits in physical stature and lowered cognitive measures. Childhood malnutrition in poor households has been well documented in India, with the highest rates observed in those aged 12-23 months. Countrywide National Family Health Survey II (NFHS II) data show mean underweight prevalence increases from 11.9% among infants under six months of age to 58.4% at 12-23 months of age. This paper discusses the results of an analysis of a longitudinal community-based study of infant growth feeding and care practices in rural south India, for which data have been collected since 1997 and completed in May 2001. In 1998 an intervention began in which a monthly visit for nutrition counselling was made by a trained worker. Mothers were counselled about the need for exclusive breastfeeding for four to six months, choice of appropriate complementary foods, and feeding frequency. Infants enrolled in the study prior to 1998, did not receive this intervention in the first year of life. Using bivariate analysis and regression modelling, weight velocity and feeding practices for intervention and non-intervention infants, controlling for a range of socio-economic and demographic factors for infants aged 6 to 10 months, are compared. Both descriptive and multivariate analyses show a statistically significant positive association between intervention and weight velocity for female infants. The intervention group as a whole had improved feeding practices such as avoidance of feeding bottle and increased variety of foods. The implication of this association, in a culture where discrimination against females exists, is promising for the development of low-cost educational interventions to improve nutritional status without the need to provide supplementary food.

Effectiveness of training on infant feeding practices among community influencers in a rural area of west Bengal.

Total 34 Influencers were trained in a subcentre area of South 24-parganas district of West Bengal. Knowledge was imparted to community influencers on infant feeding practices through lecture, group discussion, question-answer session and hand-on-training by trained health workers. Pre-assessment was done before initiation of training. Repeat training was conducted at frequent intervals within a period of 3 months. Mean score of knowledge of influencers during pre-training assessment was 13.3 and improved thereafter-following training to 20.8 (1st assessment), 20.6 (2nd assessment), 23.7 (3rd assessment) and 25.2 (final-assessment). Repeat training had also desired impact.

Promoting and supporting breastfeeding for optimal nutrition during infancy.

As general physician one can significantly influence a mother's or family's decision to optimally feed their baby and good feeding practices during first year greatly reduce the risk of a child being sick and being malnourished. It is recommended that health personnel should focus on exclusive breastfeeding for first six months and continued breastfeeding for up to two years along with appropriate and timely complementary foods that are started at the age of six months. Mothers need breastfeeding information and support during antenatal time; during hospital stay or at health care facility, and during postpartum visits. Encouragement especially during antenatal period increases breastfeeding rates. Subsequent paediatric and matemal visits are also important for promotion of breastfeeding. In this paper we would provide you new and updated information on recommended feeding practices, how you can support and help mothers, and what kind of skilled help is needed to initiate breastfeeding early, maintain exclusive breastfeeding and avoid artificial feeding. We will also discuss some strategies to support mothers.

Nutrition education and mega-dose vitamin A supplementation in Nepal.

Two approaches to improve vitamin A nutriture are compared: nutrition education and mega-dose capsule distribution. The impact of these programmes on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality are compared for approximately 40,000 children who were assigned to either intervention cohorts or a control group from 75 sites within seven districts in two ecological settings (Terai, or lowland, and hills) of Nepal. Twenty-four months after the implementation of the project, the reduction of risk of xerophthalmia was greater among children of mothers who were able to identify vitamin A-rich foods [relative risk (RR) = 0.25; 95% CI = 0.10-0.62] than among children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at two years was reduced for both the nutrition education cohort (RR = 0.64; 95% CI = 0.48-0.86) and capsule distribution cohort (RR = 0.57; 95% CI = 0.42-0.77). The nutrition education program, however, was more expensive to deliver than the capsule distribution programme. High rates of participation in the supplementation programme were achieved within a short period. The nutrition education message spread rapidly throughout the study population, although practice was slower to change. Where maternal literacy was low and channels of communication were limited, the capsule programme appeared to be more cost-effective. However, economies of scale for nationwide programmes exist for nutrition education programmes that do not exist for capsule distribution programmes. A comprehensive national programme requires both dietary supplementation and nutrition education.