Prácticas de alimentación del lactante y del niño pequeño en tres instituciones de salud en el Caribe colombiano, bajo la estrategia "Instituciones amigas de la mujer y la infancia integral" / Feeding practices of the infant and child, in three health institutions in the Colombian Caribbean / Práticas de alimentação do lactante y del niño pequeño en tres instituciones de salud en el Caribe colombiano, bajo la estrategia "Instituciones amigas de la mujer y la infancia integral "

Resumen Objetivo: Describir las prácticas de alimentación de niños lactantes y de niños pequeños atendidos en instituciones de tres municipios del Caribe colombiano, incluidos en el proceso de implementación de la estrategia "Instituciones amigas de la mujer y la infancia integral" de la Unicef. Metodología: Estudio cualitativo enmarcado en la etnografía, llevado a cabo mediante entrevistas semiestructuradas, cartografía social y grupos focales, dirigido a madres beneficiarias de instituciones de salud priorizadas. Resultados: Las madres reconocieron los beneficios nutricionales de la lactancia materna, y en dos de los territorios, los beneficios emocionales. Además, presentan apropiación en lo relacionado con la alimentación perceptiva. No obstante, no cumplen con el periodo de exclusividad de la lactancia, refieren algunas creencias populares acerca de la misma y se observa un inicio temprano de la alimentación complementaria. También reconocieron la importancia de las redes de apoyo familiar y social, como, por ejemplo, del Instituto Colombiano de Bienestar Familiar. Conclusión: Esta investigación permitió reconocer factores que favorecen y limitan las adecuadas prácticas de alimentación del lactante y del niño pequeño, en madres gestantes y lactantes y su red de apoyo, las cuales viven en condiciones de vulnerabilidad social y económica, y son atendidas en tres instituciones de salud del Caribe colombiano que se encuentran en proceso de implementación de la estrategia enunciada. Lo anterior brinda elementos para la formulación de procesos educativos en salud para la población materno infantil, tanto en la población objetivo como en instituciones que se encuentren en proceso de implementación de dicha estrategia, y de requerimientos políticos acerca de la salud materno infantil.

Abstract Objective: Describe the infant and young child feeding practices of children cared for in institutions of the Colombian Caribbean, includes in implementing the baby friendly hospital strategy. Methodology: Qualitative study framed in ethnography through semi-structured interviews, aimed at beneficiary mothers of prioritized health institutions. Results: The mothers recognized the nutrtitionals benefits of breastfeeding, in two territories also the emotional benefits. They also show appropriation in relation to perceptual feeding. However, they do not comply with the exclusive period of breastfeeding, they refer to some beliefs around it, an early start of complementary feeding is observed. In turn, the mothers recognized the importance of family and social support networks, such as the Instituto Colombiano de Bienestar Familiar. Conclusion: This research made it possible to recognize factors that favor and limit the adequate feeding practices of infants and young children, in pregnant and lactating mothers and their support network, who live in conditions of social and economic vulnerability and are cared for in three health institutions of the Colombian Caribbean that are in the process of implementing the baby-friendly hospitals initiative. The foregoing provides elements for the formulation of educational processes in health in the maternal and child population, both in the target population and in institutions that are in the process of implementing the baby-friendly hospitals initiative and policies to maternal and child health.

Resumo Objetivo: Descrever as práticas alimentares de lactentes e crianças atendidas em instituições de três municípios do Caribe colombiano, incluídas no processo de implementação da estratégia do Unicef "Instituições Amigas da Mulher e Infância Integral". Metodologia: Estudo qualitativo enquadrado na etnografia, realizado por meio de entrevistas semiestruturadas, cartografia social e grupos focais, dirigido a mães beneficiárias de instituições de saúde priorizadas. Resultados: As mães reconheceram os benefícios nutricionais da amamentação e, em dois dos territórios, os benefícios emocionais. Além disso, apresentam apropriação em relação à alimentação perceptiva. Porém, não cumprem o período exclusivo de aleitamento materno, referem-se a algumas crenças populares a respeito, e observa-se o início precoce da alimentação complementar. Também reconheceram a importância das redes de apoio familiar e social, como o Instituto Colombiano de Bem-Estar Familiar. Conclusão: Esta pesquisa permitiu reconhecer fatores que favorecem e limitam as práticas alimentares adequadas de lactentes e crianças pequenas, em gestantes e lactantes e sua rede de apoio, que vivem em condições de vulnerabilidade social e econômica, sendo atendidas em três. Instituições de saúde do Caribe colombiano que estão em processo de implementação da estratégia declarada. O exposto fornece elementos para a formulação de processos educativos em saúde para a população materno-infantil, tanto na população-alvo como nas instituições que estão em processo de implementação dessa estratégia, e de requisitos políticos relativos à saúde materno-infantil.

Knowledge, attitude and practices regarding breastfeeding and infant milk substitutes among mothers of upper middle-class society in a baby friendly hospital initiative accredited hospital of New Delhi, India

Background: Exclusive breastfeeding is considered a major public health intervention to promote both child and maternal health. Introduction and awareness of infant milk substitutes among mothers appear as a threat to this important practice.Methods: The study is an observational cross-sectional study using a questionnaire containing socio-demographic variables. The study was conducted among 300 mothers who reported to immunization clinic and paediatrics OPD of a BFHI accredited hospital in Delhi. Data collected in the study has been analysed using SPSS version 21.0 and MS-Excel. Student 't' test for quantitative variables and 'chi square test' for categorical variable have been used for statistical significance. p-value <0.05 was considered to be significant.Results: In this study 78.7% mothers intended to breastfeed. 71.3% knew that breastfeeding should be continued up to 2 years and 96.3% knew exclusive breastfeed should be given till 6months. Major source of knowledge were doctors and elders of society. However, 49.6% mothers started breastmilk substitutes before 6 months of age. Major causes that appeared as barriers against exclusive breastfeeding were insufficient quantity of milk (23.4%), child refusal (61%) and maternal health problems (15.6%).Conclusions: Despite good knowledge about breastfeeding among upper middle-class mothers, practice of exclusive breastfeeding remains suboptimal. There is a need for more reinforcement upon importance of breastfeeding, its benefits for both mother and baby so as to foster the practice.

Achieving Early Mother-baby Skin-to-skin Contact in Caesarean Section: A Quality Improvement Initiative

Objective: To improve rate of skin-to-skin contact for earlyinitiation of breastfeeding at birth on operation table amonghealthy term and late pretem babies born by caesarean sectionsfrom 0% to 80% in eight weeks.Methods: A quality improvement initiative was undertaken atmaternity-newborn care unit of a tertiary-care hospital. A teaminvolving Neonatologists/Pediatricians, Obstetricians,Anaesthesiologists, and Nurses in concerned areas identifiedproblem areas using Fish bone analysis. Situational analysis wasdone through process flow mapping. Three Plan-do-study-actcyles were undertaken. Firstly, sensitization of personnel wasdone and a written policy was made. Secondly, maternalcounselling and procedural modifications were done. Lastly,efforts were made to improve duration of contact.Results: Rate of earlyskin-to-skin contact after Plan-do-study-act cycle 1, 2 and 3, respectively was 87.5%, 90% and 83.3%. Itwas 100% after sustainability phase after four months.Conclusion: Early skin-to-skin contact was achievable throughsensitization of all persons involved and simple proceduralchanges. Prolonging duration of contact remained a challenge.

Improving the Breastfeeding Practices in Healthy Neonates During Hospital Stay Using Quality Improvement Methodology

Objective: To demonstrate the applications of the principles ofQuality Improvement (QI) in a tertiary-care centre with the aim toimprove the breastfeeding practices during hospital stay.Methods: An operational team was formulated to identify thereasons for low proportion of exclusive breast feeding (EBF) inhealthy neonates. Reason specific solutions were proposed,discussed, prioritized and tested using Plan-Do-Study-Act Cycle(PDSA Cycle). Strategies included clear departmental policy planand creation of Breastfeeding support package (BFSP). PDSAcycles were tested and implemented over 6 weeks period and itssustainability was measured monthly for five months duration.Results: After implementation of PDSA cycles, the proportion ofneonates receiving early breastfeeding within one hour of birthincreased from 55% to 95%, and the proportion of neonates onEBF during hospital stay increased from 72% to 98%.Conclusion: Quality Improvement principles are feasible andeffective to improve breastfeeding practices in the hospitalsetting.

Positive Effect of Baby-Friendly Hospital Initiatives on Improving Mothers' Intention for Successful Breastfeeding in Korea

BACKGROUND: In Korea, the breastfeeding (BF) rate of infants aged 6 months or more is drastically decreasing, and this phenomenon is particularly worrisome for the future health of the population. The present study aimed to identify an antenatal strategy for initiation and continuation of human BF, and to identify how Baby-Friendly Hospitals (BFHs) may positively influence the intention to breastfeed. METHODS: A total of 414 pregnant Korean antenatal women were surveyed using questionnaires to determine current knowledge of the benefits of human breast milk, whether they planned to breastfeed after delivery, to continue BF after reinstatement in the workforce, are willing to abide by rooming-in care for infants, and plan to give birth at BFHs. RESULTS: We found that planning room-in care, greater awareness of BF benefits for infant and mother, participation in antenatal education programs, and provision of BF facilities in the workplace were positively associated with plans for exclusive breastfeeding (EBF) and longer BF duration. The mothers who planned to give birth at BFHs also desired to breastfeed immediately after birth, implement in-room care, continue BF at their workplace, participate in antenatal BF educational programs, and were more aware of the benefits of BF. CONCLUSION: If the beneficial effects of BFHs were well known to individuals, these would enhance the success rate of BF in Korea. Antenatal education and consequent acquisition of better knowledge of the benefits of BF are important for increasing the rate of BF practices.

Capacitação de profissionais de saúde em aleitamento materno e sua associação com conhecimentos, habilidades e práticas / Training of health professionals in breastfeeding and its association with knowledge, skills and practices

Resumo Para verificar a associação entre capacitação em aleitamento materno e conhecimentos, habilidades e práticas profissionais, foi conduzido estudo transversal nos 15 hospitais com mais de 1000 partos/ano do município do Rio de Janeiro. Foram entrevistados 215 profissionais, sendo 48,4% em Hospitais Amigos da Criança, por adaptação de questionário de reavaliação desta iniciativa. Os três desfechos, dicotomizados, foram utilizados em análises bivariadas e multivariadas, sendo obtidas razões de prevalência ajustadas por modelo de regressão de Poisson. Dos profissionais, 48,1% tinham conhecimentos; 58,9% habilidades e 74,9% práticas adequadas. A capacitação teórico-prática ≥ 18 horas, considerada adequada, presente em 65,6% dos profissionais, mostrou associação significativa com conhecimentos (RPa = 1,575), habilidades (RPa = 1,530) e práticas (RPa = 1,312). Profissionais com menor tempo de trabalho apresentaram menos conhecimentos (RPa = 0,723), mas relataram melhores práticas (RPa = 1,183). A enfermagem relatou melhores práticas em relação aos médicos (RPa = 0,808) e a outras categorias (RPa = 0,658). Conclui-se que a capacitação contribui para o aprimoramento de conhecimentos, habilidades e práticas em aleitamento materno, fundamentais à assistência materno-infantil.

Abstract A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0.723), but with better practices (aPR = 1.183). Nursing staff reported better practices than physicians (aPR = 0.808) and other categories (aPR = 0.658). The study concludes that training contributes to improved breastfeeding knowledge, skills and practices that are essential for maternal and child care.

Impact of health professional training in breastfeeding on their knowledge, skills, and hospital practices: a systematic review / Repercussão da capacitação de profissionais de saúde em aleitamento materno sobre seus conhecimentos, habilidades e práticas hospitalares: uma revisão sistemática

Abstract Objective To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. Data source The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. Summary of data The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Conclusions Training of hospital health professionals has been effective in improving knowledge, skills, and practices.

Resumo Objetivo Identificar a repercussão da capacitação em aleitamento materno sobre conhecimentos, habilidades e práticas profissionais e hospitalares. Fontes dos dados A busca da revisão sistemática foi efetuada nas bases MedLine, Scopus e Lilacs. Foram excluídos artigos de revisão, de metodologia qualitativa, estudos sem grupo controle, conduzidos na atenção primária, com clientelas específicas, cujos desfechos eram crença e/ou atitude profissional e trabalhos com foco no período pós-alta hospitalar. Não houve limitação quanto ao ano ou idioma, foi feita avaliação da qualidade dos artigos por critério adaptado de Downs & Black. Síntese dos dados Na busca de literatura foram encontrados 276 artigos e selecionados 37 para leitura integral. Foram excluídos 26 artigos e incluídos seis mediante busca das referências. Foram incluídos 17 artigos de intervenção e três apresentaram boa validade interna. Os estudos foram conduzidos entre 1992 e 2010, quatro no Brasil, em países de cinco continentes. O principal público-alvo das capacitações foram profissionais de enfermagem, médicos, parteiras e visitadores domiciliares. Os cursos de capacitação foram diversos, cinco intervenções empregaram o treinamento teórico-prático da Iniciativa Hospital Amigo da Criança. Todas as formas de capacitação apresentaram algum resultado positivo sobre os conhecimentos, as habilidades e/ou práticas profissionais e hospitalares, a maioria com significância estatística. Conclusões As capacitações de profissionais de saúde que atuam em hospitais têm sido efetivas em aprimorar conhecimentos, habilidades e práticas.

Influence of the support offered to breastfeeding by maternity hospitals / Influência do apoio ao aleitamento materno oferecido pelas maternidades

ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals.

RESUMO OBJETIVO Analisar se o apoio oferecido pelas maternidades associa-se à maior prevalência de aleitamento materno exclusivo e predominante. MÉTODOS Estudo transversal, com amostra representativa de 916 crianças com menos de seis meses nascidas em maternidades, em Ribeirão Preto, SP, em 2011. As maternidades foram avaliadas em relação ao cumprimento dos Dez Passos para o Sucesso do Aleitamento Materno. Foram coletados dados sobre padrão de amamentação, hospital de nascimento e demais características. O efeito individualizado do fator de estudo sobre o aleitamento materno exclusivo e o predominante foi avaliado mediante análise de regressão múltipla de Poisson, com variância robusta. RESULTADOS O aleitamento materno predominante tendeu a ser mais prevalente quanto maior o número de passos cumpridos (p de tendência = 0,057). Os passos relacionados a não oferecer bicos artificiais a crianças amamentadas e a encorajar o estabelecimento de grupos de apoio à amamentação associaram-se, respectivamente, à maior prevalência de aleitamento materno exclusivo (RP = 1,26; IC95% 1,04;1,54) e predominante (RP = 1,55; IC95% 1,01;2,39), após ajuste pelas variáveis de confusão. CONCLUSÕES Observou-se associação positiva entre o apoio oferecido pelas maternidades e as prevalências de aleitamento materno exclusivo e predominante. Os resultados trazem subsídios para que localidades com características semelhantes (municípios com hospitais que cumprem os Dez Passos para o Sucesso do Aleitamento Materno) incentivem a amamentação, por meio da promoção, proteção e apoio ao aleitamento materno em maternidades.

Feeding newborns after hospital discharge from a Baby-Friendly Health Care Institution / Alimentação do recém-nascido após alta hospitalar de uma Instituição Amiga da Criança / Alimentación del recién nacido después del alta hospitalaria de una Institución Amiga del Niño

OBJECTIVE: To characterize how babies are fed during their hospital stay and after hospital discharge from a Baby-Friendly Health Care Institution, using indicators proposed by the World Health Organization. METHODS: This investigation was performed 30 days after the binomial's discharge, through a telephone interview with the puerperal woman. Data from medical records constituted secondary sources of information. RESULTS: It was observed that, even though newborns had come from these institutions, some of them were weaned early from breastfeeding. CONCLUSION: Some factors were shown to be associated to weaning in the studied sample, such as the small percentage of binomials placed in skin-to-skin contact and early suction, mothers who smoked, the use of pacifiers and the use of dairy complements during the hospital stay.

OBJETIVO: Caracterizar a forma de alimentação dos bebês durante a internação e após a alta hospitalar de uma Instituição Amiga da Criança, utilizando indicadores propostos pela Organização Mundial de Saúde. MÉTODOS: A investigação foi realizada 30 dias após a alta dos binômios, através de entrevista estabelecida via contato telefônico com a puérpera. Dados registrados nos prontuários constituíram-se em fontes secundárias de informações. RESULTADOS: Observou-se que, mesmo oriundos de tais instituições, alguns recém-nascidos são desmamados precocemente do seio materno. CONCLUSÃO: Alguns fatores apresentaram-se associados ao desmame na amostra estudada, como a pequena porcentagem de binômios colocados em contato pele a pele e sucção precoce, o tabagismo materno, o uso de chupeta e a utilização de complementos lácteos durante a internação.

OBJETIVO: Caracterizar la forma de alimentación de los bebés durante el internamiento y después del alta hospitalaria de una Institución Amiga del Niño, utilizando indicadores propuestos por la Organización Mundial de la Salud. MÉTODOS: La investigación fue realizada 30 días después del alta de los binomios, a través de una entrevista establecida vía contacto telefónico con la puérpera. Los datos registrados en las historias clínicas constituyeron fuentes secundarias de informaciones. RESULTADOS: Se observó que, pese a ser oriundos de tales instituciones, algunos recién nacidos son destetados precozmente del seno materno. CONCLUSIÓN: Algunos factores se presentaron asociados al destete en la muestra estudiada, como el pequeño porcentaje de binomios colocados en contacto piel a piel y succión precoz, el tabaquismo materno, el uso de chupón y la utilización de complementos lácteos durante el internamiento.

Proteção, promoção e apoio ao aleitamento materno em um hospital universitário / Breastfeeding protection, promotion and support at an university hospital

Estudo de natureza quantitativa descritiva em um Hospital Universitário do Estado de São Paulo, teve como objetivo avaliar a promoção, proteção e apoio ao aleitamento materno através da verificação do cumprimento dos "dez passos para o sucesso do aleitamento" de acordo com a iniciativa Hospital Amigo da Criança, proposta pelo Ministério da Saúde. A avaliação revela práticas facilitadoras da amamentação, no entanto, faz-se necessário algumas mudanças nas rotinas hospitalares para a efetivação dos "dez passos". Em média, 79 por cento das respostas foram afirmativas para o cumprimento dos passos, o que está próximo aos 80 por cento preconizado. No entanto, se analisarmos as respostas para cada passo, identificamos pontos para serem melhorados. Chamou-nos a atenção o fato de que a prática de colocar o recém-nascido junto à mãe logo após o nascimento, permitindo a amamentação na primeira meia hora, foi relatada por 100 por cento das mães entrevistadas que tiveram parto normal e por 80 por cento daquelas que tiveram parto cesárea. Investimentos e mudanças em direção ao cumprimento dos dez passos contribuirão para um melhor atendimento à população e para a formação de profissionais amigos da criança.

A quantitative and descriptive study hold in a University Hospital in São Paulo State aimed at evaluating breastfeeding protection, promotion and support by ensuring compliance with the "Baby-Friendly Hospital's ten steps" for successful breastfeeding proposed by the Ministry of Health. The evaluation has found practices to facilitate breastfeeding, but some changes in the hospital routines in order to meet the "ten steps" must be made. On average, 79 percent of the answers were positive for the compliance with the "ten steps", which is close to the 80 percent suggested. However, if we analyze each step, we can identify items which need to be improved. The practice of placing the baby with the mother just after birth allowing breastfeeding at the first half hour, was reported by 100 percent and 80 percent of the interviewed mothers who had natural vaginal delivery and cesarean section, respectively. Investments and changes toward the compliance with the "ten steps" will improve the population assistance and education of baby-friendly professionals.

Evaluation of the Effect of BFHI (Baby-Friendly Hospital Initiative) Developed by WHO/UNICEF / 대한주산의학회잡지

OBJECTIVES: In Korea, the BFHI (Baby-Friendly Hospital Initiative) committee organized in the Korean Committee for UNICEF in 1992, and continued to promote breastfeeding more than 10 years, we need reassess the designated hospitals and BFHI program. As a part of BFHI program, the committee continued to train health care personnels to carry out promotion of breastfeeding since 1994. The curriculum, contents and methods of the training course needs re-evaluation. METHODS: The breastfeeding rates in the BF (Baby-Friendly) hospitals and non-BF hospitals are compared. Changes of the breastfeeding rate before and after designation in baby friendly hospitals are evaluated. The education program for the health care personnels to promote successful breastfeeding are evaluated. RESULTS: The exclusively breastfeeding rates during hospitalization are higher in the BF hospitals than non-BF hospitals (p=0.026). The self assessment scores higher in the BF hospitals than non-BF hospitals (41.3 vs 31.5, p=0.001). Average breastfeeding rate of BF hospitals maintained 3.9 years after accredition (52.65% vs 47.62%). Education program for the health care personnels were satisfied in 82.8%. The score increased from 9.24 before the education course to 12.0 at 1 month after education (p=0.000) and remained as 12.19 at 3~6 months after education. CONCLUSION: This study revealed BFHI program improved breastfeeding rates and maintained high in the BF hospitals. Health care personnels who trained through education courses held by the Korean Committee for UNICEF assisted in the promotion of breastfeeding. This results can be used as a basic data for the planning of the breastfeeding promotion program in the future.