Prelacteal Feeding Practices in a Rural Community.

Background: It is a common misbelief that milk comes only on the second or third day of life. Prelacteal feeds are often given to a newborn for fear that he may be hungry or may become dehydrated. Objectives: 1. To study the prelacteal feeding practices in rural community. 2. To study some factors related to prelacteal feeding. Materials & Methods: The present cross sectional study was conducted in three adopted villages of Department of P.S.M., S.R.T.R. Medical College, Ambajogai, Maharashtra. 306 mothers with youngest child in age group of 4-24 months were included in the study. The information was collected by interviewing the mothers with the help of pretested, pre-designed proforma. Results: Out of these 306, 123 (40.2%) mothers offered various prelacteal feeds to their children. More number of illiterate mothers offered prelacteal feeds as compared to literate mothers. Significant number of mothers from joint families gave prelacteals as compared to mothers from nuclear families. 81 (62.79%) of 129 home delivered mothers practiced prelacteal feeding as compared to 42 (23.73%) of 177 hospital delivered mothers where chi square was significant. Prelacteal feeding was more prevalent in mothers of lower socioeconomic status than the upper one. Maximum i.e. 19 (15.45%) mothers gave cow’s milk as prelacteal feed followed by cow’s milk and honey (13.01%) and goat’s milk (10.57%). Conclusion: About 40% mothers followed prelacteal feeding which is a harmful practice. There is a need of health education, motivation, postnatal help to such mothers.

Comportamiento de algunos factores biosociales en la lactancia materna en los menores de un año / Behavior of some biosocial factors related to breastfeeding in babies aged less than 1 year

INTRODUCCIÓN: El abandono progresivo de la lactancia materna se ha considerado una nueva enfermedad propia de los siglos XX y XXI, en la cual han influido una serie de factores de muy diversa Índole. OBJETIVO: Caracterizar el comportamiento de los factores biosociales en la lactancia materna en los menores de un año. MÉTODOS: Se realizó un estudio descriptivo de corte transversal, en un universo de 158 nacimientos ocurridos en el 2008 del Área de salud Aleida Fernández Chardiet . Se empleó el estudio bibliográfico, documental y la contrastación de criterios de diferentes autores como procedimiento teórico, además de procedimientos empíricos. RESULTADOS: Solo en el 55,7 por ciento de los lactantes estudiados, se logró una lactancia materna exitosa, cifras por debajo de las recomendaciones internacionales. El destete precoz ocurrió en el 44,3 por ciento y el motivo más frecuente fue la hipogalactia materna. CONCLUSIONES: El motivo más frecuente del destete precoz, fue sustentado por el criterio de las madres de que era insuficiente la producción y obtención de leche

INTRODUCTION: The progressive neglect of breastfeeding has been considered a new disease own of XX and XXI centuries where a series of very diverse factors have been influenced. OBJECTIVE: To characterize the behavior of biosocial factors related to breastfeeding in babies aged less than 1 year. METHODS: A cross-sectional and descriptive study was conducted in 158 births occurred in 2008 in Aleida Chardiet health area. Authors used the bibliographic, documentary study and the criteria contrast from different authors as a theoretical procedure, in addition to the empirical ones. RESULTS: Only in the 55.7 percent of study infants it was possible to achieve a successful breastfeeding, figures under the international recommendations. The early wean occurred in the 44.3 percent and the more frequent reason was the mother hypogalactia. CONCLUSIONS: The more frequent reason for the early wean was supported by the mother criterion related to a insufficient milk production and obtaining

Factores socioculturales y psicológicos vinculados a la lactancia materna exclusiva / Sociocultural and psychological factors linked to exclusive breastfeeding

Introducción: la lactancia materna ha sido la forma de alimentación más segura para el ser humano en toda su historia. Esta leche es la única que asegura al niño pequeño una alimentación adecuada y le protege de las infecciones. Objetivo: determinar el comportamiento de los principales factores socioculturales y psicológicos vinculados a la práctica y abandono de la lactancia materna exclusiva y su repercusión en el estado de salud de los lactantes. Métodos: se realizó un estudio descriptivo de corte transversal, en el municipio Diego Ibarra, Estado de Carabobo, en el año 2008. La muestra estuvo conformada por 96 lactantes cuyas madres dieron su consentimiento informado para participar en este. Resultados: se observó un predominio de las madres adolescentes asociado al abandono de la lactancia materna antes de los 4 meses, la secundaria fue el nivel escolar más frecuente en la serie, sin embargo, el predominio de la categoría de obrera o técnica se asoció a una lactancia menor de 4 meses. Conclusiones: al nacimiento predominó la lactancia materna mixta, con una tendencia progresiva al uso de la lactancia artificial a partir del cuarto mes. Se encontró mayor frecuencia de madres con conocimientos deficientes sobre la lactancia materna, y fueron estas las que lactaron a sus bebés por menor tiempo. Más de las tres cuartas partes de las mujeres refirieron como causa de abandono de la lactancia materna exclusiva, que el niño se quedaba con hambre y la insuficiente disponibilidad de leche en las mamas.

Introduction: the breastfeeding has been the more safe feeding way for human being in all its history. This type of milk is the only assuring the infant a proper feeding while protecting him of infections. Objective: to determine the behavior of main sociocultural and psychological factors linked to practice and giving up of the exclusive breastfeeding and its repercussion on infant health status. Methods: a cross-sectional and descriptive study was conducted in "Diego Ibarra" municipality of Carabobo State during 2008. Sample included 96 infants whose mothers gave its informed consent to participate in this study. Results: there was predominance of adolescents mothers associated with breast feeding giving up before four months; the more frequent schooling was of secondary one, however, predominance of working or technique was associated with a breastfeeding during less than four months. Conclusions: at birth there was predominance of mixed breastfeeding, with a progressive trend to use of artificial breastfeeding from the fourth month. There was a great frequency of mothers with poor knowledge of breastfeeding and they were those that breastfeed during a minor time. More of the three quarter of women recounted as exclusive breastfeeding giving up cause hat infants starved and the enough availability of breast milk.

La lactancia materna y su influencia en el comportamiento de las infecciones respiratorias agudas / The breastfeeding and its influence on the behavior of acute respiratory infections

INTRODUCCION: la lactancia materna es reconocida como el mejor inductor de la maduración inmunológica de la etapa posnatal. La leche materna provee una nutrición completa para cualquier bebé desde el nacimiento hasta los 6 meses de vida. MÉTODOS: se estudiaron 80 transicionales, pertenecientes al Grupo Básico de Trabajo No. 2 del Policlínico Ana Betancourt, con el objetivo de identificar la frecuencia y variedad de las infecciones respiratorias agudas en relación con el tipo de lactancia recibida. Para la recolección de los datos se consideró la información reflejada en las consultas de puericultura realizadas, durante el primer año de vida, contempladas en las historias clínicas pediátricas (revisión documental). RESULTADOS: predominaron los niños lactados (83 por ciento), aunque de estos, solo el 25 por ciento se alimentó de forma exclusiva. La lactancia mixta, aunque mayoritaria (58 por ciento), predomina por debajo del cuarto mes de vida y el 17 por ciento de los casos fue lactado de manera artificial. Las infecciones respiratorias agudas fueron más frecuentes en niños que recibieron poco tiempo de lactancia mixta (19 por ciento), así como en los que se alimentaron de modo artificial (14 por ciento), con predominio en ellos de la mayor parte de las otitis medias y la totalidad de las neumonías. Solo en 3 de estos pacientes fue necesaria la hospitalización, y la evolución en todos los casos fue satisfactoria. CONCLUSIONES: predominó la variedad mixta de lactancia materna. Se comprobó una alta morbilidad por infecciones respiratorias agudas en los transicionales estudiados. Mientras más breve es el período de lactancia materna, mayor es el riesgo de infección y la severidad de estas. Las dos terceras partes de la otitis media y la totalidad de las neumonías ocurren en casos con lactancia materna mixta breve o artificial

INTRODUCCION: breastfeeding is recognized as the better inductor of the immunologic maturation of postnatal stage. Mother milk provides a complete nutrition for any baby from the birth to 6 months of life. METHODS: eighty transitional cases were studied from the No. 2 Basic Work Group of the Ana Betancourt Polyclinic to identify the frequency and variety of acute respiratory infections related to the type of breastfeeding received. To data collection authors considered the information achieved in the puericulture consultations during the first year of life, completed in the pediatric medical records (documentary review). RESULTS: there was predominance of breast-fed children (83 percent) although from these, only the 25 percent was feed in an exclusive way. Mixed lactation even so majority (58 percent) predominates under the fourth month of life and the 17 percent of cases was lactated in an artificial way. The acute respiratory infections were the most frequent in children with a short period of mixed lactation (19 percent), as well as in those lactated in an artificial way (14 percent) with predominance in them most of the otitis media and the total of pneumonia. Only in three of these patients it was necessary hospitalization and the course in all the cases was satisfactory. CONCLUSIONES: there was predominance of mixed breastfeeding. It was proved a high morbidity due to acute respiratory infections in study transitional cases. The more is brief the period of breastfeeding, greater is the infection risk and severity of these infections. The two third of otitis media and the total of pneumonias occur en cases with brief mixed breastfeeding or artificial

A prática do aleitamento materno nas capitais brasileiras e Distrito Federal: situação atual e avanços / Breastfeeding practice in the Brazilian capital cities and the Federal District: current status and advances

OBJETIVOS: Apresentar os indicadores de aleitamento materno (AM), obtidos na II Pesquisa de Prevalência de Aleitamento Materno nas Capitais Brasileiras e Distrito Federal, bem como analisar sua evolução no período de 1999 a 2008. MÉTODOS: Pesquisa de corte transversal, envolvendo crianças menores de 1 ano de idade que participaram da segunda fase da campanha de multivacinação de 2008. Foram utilizadas amostras por conglomerados, com sorteio em dois estágios. O questionário era composto por questões fechadas, incluindo o consumo de leite materno, outros tipos de leite e outros alimentos no dia anterior à pesquisa. Foram analisadas as prevalências de AM na primeira hora de vida; aleitamento materno exclusivo (AME) em menores de 6 meses; AM em crianças de 9 a 12 meses; e medianas do AME e AM. A variação temporal do AM foi estabelecida por meio da comparação das medianas do AME e AM em 1999 e 2008. RESULTADOS: Obtiveram-se dados de 34.366 crianças. Verificou-se que 67,7 por cento (IC95 por cento 66,7-68,8) mamaram na primeira hora de vida; a prevalência do AME em crianças de 0 a 6 meses foi de 41 por cento (IC95 por cento 39,7-42,4), e do AM em crianças de 9 a 12 meses foi de 58,7 por cento (IC95 por cento 56,8-60,7). Houve aumento de 30,7 dias na duração mediana do AME e de 45,7 dias na mediana do AM. CONCLUSÃO: Houve melhora significativa da situação do AM na última década. Porém, ainda são necessários esforços para que o Brasil atinja índices de AM compatíveis com as recomendações da Organização Mundial da Saúde.

OBJECTIVES: To present the breastfeeding (BF) indicators obtained in the Second Survey on Prevalence of Breastfeeding in the Brazilian Capitals and the Federal District and to analyze their evolution from 1999 to 2008. METHODS: A cross-sectional study was conducted in children younger than 1 year old who participated in the second phase of the multivaccination campaign in 2008. We used two-stage cluster sampling. The questionnaire consisted of closed questions, including data on consumption of breast milk, other types of milk, and other foods on the day prior to the survey. We analyzed the prevalence of BF in the first hour of life; exclusive BF in children younger than 6 months; BF in children aged 9 to 12 months; and medians of exclusive BF and BF. The time variation of BF was established by comparing the medians of exclusive BF and BF in 1999 and 2008. RESULTS: We obtained data from 34,366 children. We found that 67.7 percent (95 percentCI 66.7-68.8) of the children were breastfed in the first hour of life; the prevalence of exclusive BF in children aged 0 to 6 months was 41 percent (95 percentCI 39.7-42.4), while the prevalence of BF in children aged 9 to 12 months was 58.7 percent (95 percentCI 56.8-60.7). There was an increase of 30.7 days in the median duration of exclusive BF and 45.7 days in the median of BF. CONCLUSION: There was a significant improvement in the breastfeeding prevalence in the last decade. However, further efforts are required so that Brazil can reach BF rates compatible with the recommendations of the World Health Organization.

Fatores associados ao aleitamento materno exclusivo em Guarapuava, Paraná / Factors associated with exclusive breastfeeding in Guarapuava, Paraná, Brazil

OBJETIVO: Esta pesquisa investigou a prevalência do aleitamento materno exclusivo aos seis meses de idade e sua associação com características socioeconômicas, demográficas, ambientais, de morbidade e biológicas. MÉTODOS: Foi realizado um estudo transversal e a amostra foi composta por 426 crianças entre zero e 23,9 meses, assistidas pelo Programa Saúde da Família e residentes na área urbana da cidade de Guarapuava (PR). Foram realizadas entrevistas domiciliares com a aplicação de questionários pré-codificados para investigar fatores relacionados ao aleitamento materno RESULTADOS: A mediana de aleitamento materno exclusivo aos seis meses foi de sessenta dias e a prevalência foi de 12,9 por cento. Verificou-se associação estatisticamente significante (p<0,05) do aleitamento materno exclusivo aos seis meses de idade com o trabalho materno fora do lar e com a continuidade do aleitamento materno até o momento da entrevista. CONCLUSÃO: Os resultados indicam baixas prevalências de aleitamento materno exclusivo, além da necessidade de ações mais efetivas de amparo à mãe trabalhadora, que possui maiores dificuldades para a manutenção desta prática.

OBJECTIVE: This research investigated the prevalence of exclusive breastfeeding at the age of six months and its association with socioeconomic, demographic, environmental, biological and morbidity characteristics. METHODS: A cross-sectional study was done with a sample of 426 children from Guarapuava, PR, aged 0 to 23.9 months seen by the Family Health Program. Pre-coded questionnaires were administered during home interviews to investigate breastfeeding-associated factors. RESULTS: The median of exclusive breastfeeding at six months was 60 days and the prevalence was 12.9 percent. Exclusive breastfeeding at six months was significantly associated (p<0.05) with the mother's employment status and with breastfeeding continuing until the occasion of the interview. CONCLUSION: The results indicate low prevalences of exclusive breastfeeding and the need of more effective actions to support working mothers, since it is harder for them to continue exclusive breastfeeding once they go back to work.

Práticas alimentares no primeiro ano de vida de filhos de adolescentes / Adolescents' infant feeding practices in the first year of life

OBJETIVO: Estudar as práticas alimentares de menores de um ano, filhos de adolescentes, residentes no município de Volta Redonda (RJ). MÉTODOS: Estudo transversal com 1 014 crianças selecionadas aleatoriamente na Campanha de Multivacinação de 2006, com aplicação de questionário fechado (recordatório de 24h). Foram analisadas características das mães e de seus filhos. As prevalências de aleitamento materno, aleitamento materno exclusivo, aleitamento materno predominante, a oferta de outros leites, a alimentação no primeiro dia em casa, a alimentação complementar oportuna, a oferta de sólidos ou semi-sólidos, e o uso de chupetas e mamadeiras foram investigadas. RESULTADOS: As prevalências aleitamento materno, aleitamento materno exclusivo e aleitamento materno predominante foram 85,5 por cento, 32,0 por cento e 9,6 por cento, respectivamente, sem diferenças entre filhos de adolescentes e adultas. A oferta de outros leites, entretanto, foi significativamente maior junto aos filhos de adultas (45,3 por cento, contra 31,2 por cento observados entre adolescentes). Maiores de seis meses, filhos de adolescentes, revelaram menor prevalência de aleitamento materno que os de adultas (49,2 por cento e 66,0 por cento, respectivamente), assim como maior frequência no uso de chupetas, com diferenças significativas. A alimentação complementar foi similar entre filhos de adolescentes e adultas, com predominância da oferta de sopas ou papas. Carne e feijão foram utilizados com mais frequência em sólidos. CONCLUSÃO: Não foram observadas diferenças no aleitamento considerando a variável idade materna, adolescente ou não, antes de seis meses de vida e sim após esse período. Nos maiores de seis meses, chama também a atenção o maior no uso de chupetas, assim como a oferta e as características da alimentação complementar de filhos de adolescentes. Estudos de natureza compreensiva mostram-se necessários.

OBJECTIVE: The objective of this work was to study the feeding practices of adolescent mothers' infants under one year of age living in the city of Volta Redonda (RJ). METHODS: This cross-sectional study included 1,014 infants selected randomly at the 2006 Multiple Vaccination Campaign. The 24-hour recall was used. Characteristics of the mothers and infants were analyzed. The prevalences of breastfeeding, exclusive and predominant breastfeeding and the use of other kinds of milk, in addition to the feeding practices in the first day at home and use of complementary foods, solid or semi-solid foods and pacifiers and bottles were investigated. RESULTS: The prevalences of breastfeeding and exclusive and predominant breastfeeding were 85.5 percent, 32.0 percent and 9.6 percent, respectively, with no differences between adolescents' and adults' children. Adult mothers were significantly more likely to offer other kinds of milk than adolescent mothers (45.3 percent and 31.2 percent respectively). Infants at six or more months of age of adolescent mothers were significantly less likely to be breastfed than those of adult mothers (49.2 percent and 66.0 percent respectively) and more likely to be given pacifiers. Adult and adolescent mothers presented similar complementary feeding practices, with soups and soft foods prevailing. Meat and beans were the most common solid foods given to the infants. CONCLUSION: There are no differences in breastfeeding practices among mothers of different ages, whether adolescent or not, in the first six months of an infant's life but the practices do differ after this age. Among the six-monthold infants or older of adolescent mothers, the extensive use of pacifiers and the characteristics of the complementary foods deserve attention. Comprehensive studies are necessary.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento / Delivering rapid HIV tests results after delivery: a threat to breastfeeding at birth

OBJETIVO: Analisar fatores associados à não-amamentação na primeira hora de vida, sobretudo a influência do momento do resultado do teste rápido anti-HIV. MÉTODOS: Estudo de coorte, sendo o ponto inicial a submissão ao teste rápido e o final a primeira mamada do bebê. A população estudada incluiu 944 parturientes submetidas ao teste rápido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da criança do Sistema de Gestação de Alto Risco no município do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratório e do prontuário e no pós-parto aplicaram questionário para entrevista às mães. O modelo multinível foi adotado para analisar a influência de características sociodemográficas, de assistência pré-natal e ao parto sobre a não-amamentação na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6 por cento receberam seu resultado antes do parto, 30,8 por cento depois do parto e 53,6 por cento ainda desconheciam o resultado ao ser entrevistada. A prevalência de não-amamentação na primeira hora de vida foi de 52,5 por cento (IC 95 por cento: 49,3;55,8). Após ajuste, o recebimento do resultado do teste rápido após o parto dobrou o risco da não-amamentação na primeira hora de vida (RR=2,06; IC 95 por cento: 1,55;2,75). Outros fatores de risco foram: cor não branca, renda materna de um salário mínimo ou menos, parto cesáreo, mãe não querer amamentar o bebê ao nascimento e mãe referir que a equipe hospitalar não a escutava. O desconhecimento da realização do teste rápido anti-HIV pela mãe se mostrou como fator de proteção. CONCLUSÕES: O principal fator de risco para a não-amamentação na primeira hora de vida foi o recebimento do resultado do teste rápido após o parto. O teste anti-HIV deve ser amplamente disponibilizado no pré-natal e o teste rápido deve ser realizado sob indicação, na admissão, com busca ativa e pronta comunicação do resultado à mulher.

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 percent received the result of rapid HIV testing before delivery, 30.8 percent after delivery, and 53.6 percent 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 percent (95 percent 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 percent CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mother's lack of desire to breastfeed at birth, and mother's report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mother's 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...

Effects of Breast-feeding Education and Support Services on Breast-feeding Rates and Infant's Growth

PURPOSE: This study was done to investigate the effects of breast-feeding education and support services on rate of breast-feeding three and six months after birth, and the effect on infant's growth (weight, height, body mass index [BMI]). The experimental group which had both education and support services was compared with the control group which had only breast-feeding education. METHODS: This study was a quasi-experimental study with a time-series design. The participants were 39 mothers who were hospitalized for childbirth. Twenty mother were assigned to the experimental group and 19 mothers, to the control group. The breast feeding education was done during hospitalization, and support services were provided once a week after discharge for a month (a total 4 times) by a maternity ward nurse. Data regarding breastfeeding rate at one month after childbirth was collected by phone call; the breast-feeding rates at three and six months after childbirth were collected in a visit to the families. The child's weight and height were also measured during the visit. RESULTS: The experimental group had a statistically significant higher rate for frequency of breast-feeding at one, three and six months after childbirth than the control group. However, there was no meaningful difference between the two groups for infant growth. CONCLUSION: The results of this study suggest that breast-feeding education is helpful for a start, but support services are also necessary to sustain breast-feeding.

Tendência temporal da amamentação na cidade do Rio de Janeiro: 1996-2006 / Time trend in breast-feeding in the city of Rio de Janeiro, Southeastern Brazil: 1996-2006

OBJETIVO: Analisar a tendência temporal da prática de aleitamento materno (AM) e de aleitamento materno exclusivo (AME). MÉTODOS: Foram analisados dados de sistema de monitoramento baseado em inquéritos realizados nos anos de 1996, 1998, 2000, 2003 e 2006 durante a Campanha Nacional de Imunização na cidade do Rio de Janeiro, RJ. A população de estudo foi constituída de 19.044 crianças menores de um ano de idade que compareceram aos postos de vacinação. Para cada ano foi estudada uma amostra probabilística por conglomerado (postos de vacinação), auto-ponderada representativa da população de crianças menores de 12 meses (<12). Foi aplicado questionário estruturado com questões fechadas sobre alimentação da criança no momento do estudo e características sociodemográficas da mãe. Foram adotados os indicadores de AM e de AME propostos pela Organização Mundial da Saúde. RESULTADOS: O AM<12 aumentou de 61,3 por cento para 73,4 por cento entre 1996 e 2006. Tendência similar foi observada em todas as faixas etárias analisadas. O AME em crianças <4 e <6 meses (AME<6) aumentou, respectivamente, de 18,8 por cento para 42,4 por cento e de 13,8 por cento para 33,3 por cento. Melhorias em AM>6 e em AME<6 foram observadas em todas as categorias de todas as variáveis sociodemográficas maternas. Para AME<6, a desvantagem observada em 1996 entre mulheres de menor escolaridade e em 1998 entre mulheres que trabalhavam não foi completamente superada até 2006. CONCLUSÕES: O AM e o AME aumentaram no período estudado independentemente da faixa etária da criança e das características sociodemográficas maternas. Não foram totalmente superadas diferenças observadas entre mulheres em diferentes situações sociodemográficas.

OBJECTIVE: To analyze time trend in breast-feeding (BF) and exclusive breast-feeding (EBF). METHODS: Data from a monitoring system, based on surveys conducted during the National Immunization Campaign in the city of Rio de Janeiro, Southeastern Brazil, in 1996, 1998, 2000, 2003 and 2006, were analyzed. Study population was comprised of 19,044 children younger than one year of age, who were present in vaccination stations. A probability cluster sample (vaccination stations), self-weighted and representative of the population of children younger than 12 months of age (<12), was studied for each year. A structured questionnaire with closed questions about the child's diet at the moment of the study and maternal sociodemographic characteristics was applied. The BF and EBF indicators proposed by the World Health Organization were adopted. RESULTS: BF<12 increased from 61.3 percent to 73.4 percent between 1996 and 2006. Similar trend was observed in all age groups analyzed. EBF in children <4 and <6 months of age (EBF<6) increased from 18.8 percent to 42.4 percent and from 13.8 percent to 33.3 percent, respectively. Improvements in BF>6 and EBF<6 were found in all categories of all maternal sociodemographic variables. For EBF<6, the disadvantage observed in women with a lower level of education in 1996 and in women who worked in 1998 was not completely overcome by 2006. CONCLUSIONS: BF and EBF increased in the period studied, independently from child age group and maternal socio-demographic characteristics. The differences found among women in distinct sociodemographic situations were not completely overcome.

Fatores associados à duração mediana do aleitamento materno em lactentes nascidos em município do estado de São Paulo / Factors associated with the median breastfeeding duration of infants born in a city of São Paulo State

OBJETIVO: Verificar a prevalência do aleitamento materno entre lactentes, correlacionada com variáveis sócio-demográficas, em Campinas (SP). MÉTODOS: Entre os anos de 2004 e 2005, entrevistadores visitaram 2 857 domicílios de crianças menores de dois anos e aplicaram às mães um questionário estruturado, composto por perguntas sobre nível socioeconômico, amamentação e alimentação complementar. O estudo foi transversal, de base populacional, randomizado, realizado com base nos dados da Declaração de Nascidos Vivos e da prevalência do aleitamento. A duração mediana do aleitamento foi determinada pela análise de sobrevida de Kaplan Méier, e o ajuste do tempo, pela análise multivariada de Cox. A significância estatística adotada foi de 5 por cento. RESULTADOS: A mediana do aleitamento materno exclusivo foi de 90 dias (Intervalo de Confiança - IC95 por cento: 87,6-92,4) e a do aleitamento materno geral foi de 120 dias (IC95 por cento: 117,7-122,3). Com um mês de vida, 66,2 por cento das crianças estavam sendo amamentadas exclusivamente com leite do peito, índice que diminuiu para 2,3 por cento aos seis meses. A introdução mediana para chá (IC95 por cento: 113,2-126,8) e para leite em pó (IC95 por cento: 112,7-127,3) foi de 120 dias. A cor da pele da criança, a escolaridade, a profissão e o estado civil maternos foram fatores associados à duração e ao tipo de amamentação. CONCLUSÃO: Fatores sócio-demográficos podem interferir na duração mediana do aleitamento materno que, embora esteja melhor do que em outros locais do Brasil, está abaixo do padrão recomendado internacionalmente, sugerindo a necessidade de maiores investimentos em relação a este fato, no município.

OBJECTIVE: The aim of this study was to verify the proportion of breastfed infants and correlate it with sociodemographic data in Campinas (SP), Brazil. METHODS: Between 2004 and 2005, interviewers visited 2,857 homes of children under two years of age and interviewed their mothers with a structured questionnaire containing questions regarding their socioeconomic level, breastfeeding practices and complementary foods. This randomized, cross-sectional, population-based study was based on data of "Children Born Alive" and on the prevalence of breastfeeding. The median breastfeeding duration was determined by Kaplan Meier's survival analysis and the time was adjusted by Cox's multivariate analysis. The significance level was set at 5 percent. RESULTS: Median exclusive breastfeeding was 90 days (CI 95 percent: 87.6 - 92.4); and median general breastfeeding was 120 days (CI 95 percent: 117.7 - 122.3). At 1 month of age, 66.2 percent of the children were exclusively breastfed; this percentage decreased to 2.3 percent at 6 months of age. Tea and powdered milk were introduced at a median age of 120 days (CI 95 percent: 113.2 - 126.8 and CI 95 percent: 112.7 - 127.3 respectively). The child's skin color and the mother's education level, profession and marital status were associated with breastfeeding duration and practices. CONCLUSION: Sociodemographic factors can interfere in median breastfeeding duration. Although the median breastfeeding duration in Campinas is better than elsewhere in Brazil, it is below the internationally recommended median, the city needs to invest more in this area.

Tendência e determinantes do aleitamento materno exclusivo em crianças menores de 6 meses / Trends and patterns of exclusive breastfeeding for under-6-month-old children

OBJETIVO: Estudar a tendência e os determinantes do aleitamento materno exclusivo no município de Bauru (SP). MÉTODOS: Foram comparados três inquéritos transversais, metodologicamente equivalentes, que integram projeto de monitoramento de indicadores de aleitamento materno no estado de São Paulo. Foram estudadas crianças de 0 a 6 meses de idade que compareceram a uma das duas etapas da campanha de multivacinação nos anos de 1999, 2003 e 2006, com respectivamente 496, 674 e 509 crianças. Apresentam-se estatísticas descritivas comparando a prevalência de aleitamento materno exclusivo segundo idade (em meses) e conjunto de crianças menores de 6 meses. As diferenças de prevalência foram expressas em termos de pontos percentuais e submetidas a teste estatístico (qui-quadrado de Pearson e tendência), adotando-se p < 0,05 como nível crítico. Também foram pesquisados fatores associados à interrupção do aleitamento materno exclusivo em 2006, mediante análise uni e multivariada. RESULTADOS: Detectou-se aumento da prevalência de aleitamento materno exclusivo em menores de 6 meses: no período 1999-2003, acréscimo de 9,1 pontos percentuais; no período 2003-2006, aumento de 6,6 pontos percentuais, alcançando taxa de crescimento anual de 2,3 pontos percentuais no primeiro período e de 2,2 pontos percentuais no segundo. Observou-se associação inversa significativa entre aleitamento materno exclusivo e uso de chupeta (razão de prevalência = 2,03; intervalo de confiança de 95 por cento 1,44-2,84). CONCLUSÃO: A prevalência de aleitamento materno exclusivo em menores de 6 meses no município de Bauru quase triplicou no período estudado, passando de 8,5 por cento em 1999 para 24,2 por cento em 2006, aumento de 184,7 por cento. O uso de chupeta foi o único fator associado com maior chance de interrupção do aleitamento materno exclusivo.

OBJECTIVE: To study the trends and patterns of exclusive breastfeeding (EBF) for under-6-month-old infants in the city of Bauru, Brazil. METHODS: Data from three methodologically equivalent cross-sectional surveys integrating the project for monitoring breastfeeding indicators in São Paulo state were compared. Infants aged zero to 6 months who attended one of the two phases of the Multivaccination Campaign in 1999, 2003 and 2006, respectively 496, 674 and 509 infants, were studied. Descriptive statistics were presented to compare the prevalence of EBF according to age (in months) and for the set of children under 6 months. The differences in prevalence were expressed in percentage and submitted to statistical tests (Pearson's chi-square and tendency), adopting p < 0.05 as the critical level. Factors associated with EBF interruption in 2006 were also studied by uni- and multivariate analysis. RESULTS: Increase in EBF prevalence was found in under-6-month-old infants: in the 1999-2003 period, increase of 9.1 percent; in the 2003-2006 period, increase of 6.6 percent, thus reaching the annual increase rate of 2.3 percent in the first period and 2.2 percent in the second period. Significant inverse association was observed between EBF and the use of pacifiers (hazard ratio = 2.03; 95 percent confidence interval 1.44-2.84). CONCLUSION: EBF prevalence in under-6-month-old infants in the city of Bauru, Brazil, increased almost threefold in the studied period, changing from 8.5 percent in 1999 to 24.2 percent in 2006, which represents an increase of 184.7 percent. The use of pacifiers was the only factor associated with greater chances of EBF interruption.

Avaliação do conhecimento da mãe em relação ao aleitamento materno durante o período pré-natal em gestantes atendidas no Ambulatório Materno Infantil em Tubarão, (SC) / Evaluaton of knowledge of mather in relation to breastfeeding during prenatal in pregnants attended at maternal-child ambulatory (MIA) in Tubarão (SC)

Introdução: o conhecimento sobre o aleitamento materno vem sendo relacionado como indicador de maiortempo de amamentação. O pré-natal é um dos momentos mais importantes para a gestante aceitar e adaptar-se à futura função. Objetivos: caracterizar a população em estudo quanto às características demográficas e socioeconômicas. Verificar os conhecimentos das mães sobre amamentação, as principais causas do desmame precoce, e a freqüênciaao pré-natal. Métodos: estudo transversal. Realizado com gestantesatendidas no Ambulatório Materno Infantil (AMI), em Tubarão, no período pré-natal, nos meses de junho aoutubro de 2007. As gestantes responderam a um protocolo de pesquisa, contendo informações relativas à amamentação. Resultados: a média de idade das gestantes foi de25 anos, Observou-se que 41,9% das gestantes tinham o segundo grau completo, sendo a maioria delas casadas,(77%). Cinqüenta por cento das entrevistadas eram multíparas, sendo que a média do aleitamento maternoexclusivo do último filho foi de 3 meses. Mais de 70% das entrevistadas disseram ter recebido alguma informação sobre aleitamento materno. Quase 90% das gestantes citaram a proteção contra doenças como outrafunção do leite materno. A média da renda familiar da amostra foi de três salários mínimos. A maioria das gestantes, 64,7% tinha mais de 20 semanas de gestação, sendo que a média de consultas de pré-natal entre asgestantes fora de 3 consultas. E 41,9% delas, mostraram que a volta ao trabalho é fator impeditivo para amamentação exclusiva até os 6 meses.Conclusões: este estudo mostra que apesar do conhecimento materno sobre aleitamento e suas vantagens, a taxa de aleitamento materno exclusivo ainda mantémse baixa, em torno de três meses. Para melhorar esta taxa é importante que a equipe multidisciplinar esteja capacitada a prestar atendimento para a gestante e a sua família, visando elucidar as dúvidas, temores sobreo assunto.

Introduction: the knowledge about breastfeeding has been cited how an indicator of long periods of breastfeeding. The prenatal is one of the most important moments to the pregnant accept and adapt to the futurefunction. Objective: characterize the population under study about demographic and socioeconomic characteristics. Check the knowledge of mothers about breastfeeding, the main causes of early weaning, and the frequency of prenatal. Methods: this is a transversal study. The study coasmade with pregnant attended at maternal-infant ambulatory (MIA), in Tubarão, in the prenatal period, betweenJuly and October 2007. The pregnant answered a research protocol about breastfeeding. Results: : the age mean of the pregnants were 25 years old, 41,9% of the pregnants had high school completed, and most of them were married, (77%). 50% wasn’t the first gestation, and the mean time of exclusive breastfeeding of the last child was 3 months only. More than 70% of the interviewed related that have received information about brastfeeding. Almost 90% of the pregnants cited the protection against disease like other function of human milk. The mean of family income was of 3 Minimum wage. Most of the pregnant women, 64,7% had more than 20 weeks of pregnancy, and the mean number of prenatal consultation were of 3. And 41,9% of them showed that the comeback to thework is the factor blocking for breastfeeding exclusive until the 6 months. Conclusion: this study bring to shows that despite the knowledge on maternal lactation and its advantages,the rate of exclusive breastfeeding still remains low, around three months. To improve this rate is important that the multidisciplinary team is equipped to provide care for pregnant women and their families, aiming to clarifythe doubts, fears about it.

Avaliação da introdução precoce da alimentação complementar em crianças de 0 a 24 meses atendidas em uma unidade básica de saúde / Assessment of early introduction of complementary food for children aged to 0 to 24 months who visit a health care unit

Objetivo: Verificar a frequência, os principais alimentos e motivos da introdução precoce da alimentação complementar, além do uso de mamadeira e chupeta em crianças de 0 a 24 meses. Métodos: Estudo transversal com crianças de 0 a 24 meses de idade atendidas numa Unidade Básica de Saúde. No período de junho a agosto de 2006, aplicou-se um questionário às mães ou acompanhantes sobre a alimentação complementar das crianças. Foi considerada precoce a introdução de alimentos sólidos e/ou líquidos em adição ou substituição ao leite materno antes dos seis meses de idade. Resultados: Das 109 crianças avaliadas, 78% receberam precocemente a introdução dos alimentos complementares, sendo chá o alimento predominante. O principal motivo relatado pelas mães foi “cólica do lactente”. A duração média do aleitamento materno exclusivo foi de 73 ± 30 dias. As crianças que usavam chupeta foram amamentadas por um período menor (218 ± 21 dias) em relação às crianças que não usavam chupeta (305 ± 25 dias; p= 0,026). O ganho médio de peso das crianças que receberam precocemente os alimentos complementares foi maior do que das crianças que receberam os alimentos complementares a partir dos seis meses de idade (22 ± 8 vs. 17 ± 4 g/dia; p = 0,007). Conclusão: Encontramos elevada freqüência na introdução precoce dos alimentos complementares. Houve tendência significativa entre o uso de mamadeira e a redução da duração do aleitamento materno. O uso de chupeta levou a um menor tempo de aleitamento materno.

Background: To verify the frequency, main foods and reasons for the early introduction of complementary food, besides using bottle feeding and pacifiers for children aged 0 to 24 months. Methods: Cross-sectional study with children aged 0 to 24 months, who visit a Basic Health Care Unit. During the period from June to August 2006 a questionnaire was applied to the mothers or caregivers concerning the complementary feeding of the infants. The introduction of solid and/or liquid foods besides or in place of breast milk before the age of six months was considered early. Results: Seventy-eight percent of the 109 children evaluated were introduced early to complementary foods, mainly to tea. The main reason reported by the mothers was “infant colic”. The mean duration of breastfeeding was 73 ± 30 days. The children who used a pacifier were breastfeed for less time (218 ± 21 days) compared to the children who did not use a pacifier (305 ± 25 days; p= 0.026). The children who received complementary food early gained more weight than those who received the complementary foods from the age of six months onwards (22 ± 8 vs. 17 ± 4 g/day; p = 0.007). Conclusion: We found a high frequency of early introduction of complementary foods. There was a significant tendency between the use of the bottle and the reduction of the duration of breastfeeding. The use of a pacifier led to a shorter time of breastfeeding.

Determinants of Exclusive Breastfeeding Practices in Ethiopia

Background: Despite the demonstrated benefits of breast milk; the prevalence of breastfeeding; in-particular exclusive breastfeeding (EBF); in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life. Objective: To assess the practice of EBF and explore its determinants in Ethiopia and provide policy makers and NGOs with relevant information for future planning and interventions. Methods: Raw data collected from nine regions and two city administrations using stratified cluster sampling method by the Ethiopian Demographic Health Survey (EDHS) 2005 were used to study the practice and determinants of EBF countrywide. Analysis was based on children whose age was less than six months and alive at the time of interview that was extracted from the women's database. Results: The overall rates of exclusive and full breastfeeding were 49.0and 68.2respectively. Maternal education; marital status; wealth index and age of the child were closely associated with EBF practices; nonetheless; in the hierarchical analysis; being not married; middle/ richer/ richest wealth index; and child age 0-1and 2-3 month were retained as the predictors of EBF (P0.05). Conclusion: A range of maternal and child health attributes such as marital status; economical status and child age were found to influence the practice of EBF in Ethiopia. Actions to empower women and promotion of EBF campaign are recommended to achieve the fourth millennium development goal

Determinants of exclusive breastfeeding practices in Ethiopia

Background: Despite the demonstrated benefits of breast milk; the prevalence of breastfeeding; in-particular exclusive breastfeeding (EBF); in many developing countries including Ethiopia is lower than the international recommendation of EBF for the first six months of life Objective: To assess the practice of EBF and explore its determinants in Ethiopia and provide policy makers and NGOs with relevant information for future planning and interventions. Methods: Raw data collected from nine regions and two city administrations using stratified cluster sampling method by the Ethiopian Demographic Health Survey (EDHS) 2005 were used to study the practice and determinants of EBF countrywide. Analysis was based on children whose age was less than six months and alive at the time of interview that was extracted from the women's database. Results: The overall rates of exclusive and full breastfeeding were 49.0and 68.2respectively. Maternal education; marital status; wealth index and age of the child were closely associated with EBF practices; nonetheless; in the hierarchical analysis; being not married; middle/ richer/ richest wealth index; and child age 0-1and 2-3 month were retained as the predictors of EBF (P0.05). Conclusion: A range of maternal and child health attributes such as marital status; economical status and child age were found to influence the practice of EBF in Ethiopia. Actions to empower women and promotion of EBF campaignare recommended to achieve the fourth millennium development goal

Influência do apoio à amamentação nas tendências das taxas de aleitamento materno da cidade de Pelotas (RS), 1982-2004 / Influence of breastfeeding support on the tendencies of breastfeeding rates in the city of Pelotas (RS), Brazil, from 1982 to 2004

OBJETIVO: Avaliar a influência do apoio à amamentação sobre as taxas de aleitamento materno no município de Pelotas (RS). MÉTODOS: Foram comparadas as prevalências de aleitamento materno de quatro coortes de crianças, nascidas em 1982, 1993, 1997-1998 e 2004. Participaram crianças que preenchiam os critérios de inclusão do Estudo Multicêntrico de Curvas de Crescimento da Organização Mundial da Saúde, já que este originou a coorte de 1997-1998, na qual houve apoio sistematizado à amamentação. RESULTADOS: Houve aumento nas taxas de aleitamento materno exclusivo: com 1 mês de vida, de 26 por cento em 1993 para 77 por cento em 2004, e, aos 3 meses, de 16 para 46 por cento, respectivamente. As taxas de aleitamento materno mostraram ascendência, porém menos significativa: aos 12 meses de 15 por cento em 1982 para 34 por cento em 2004 e, aos 24 meses, de 6 para 14 por cento, respectivamente. CONCLUSÕES: O apoio à amamentação contribuiu na tendência ascendente das taxas de aleitamento materno.

OBJECTIVE: To evaluate the influence of breastfeeding support on breastfeeding rates in the city of Pelotas (RS), Brazil. METHODS: The prevalence rates of exclusive breastfeeding and of overall breastfeeding were compared in four cohorts of children, born in 1982, 1993, 1997-1998 and 2004. The children selected for this study fulfilled the inclusion criteria for the WHO Multicenter Growth Reference Study, in order to afford comparison with the 1997-1998 cohort, which was made up of children selected for that study. The 1997-1998 cohort received systematic breastfeeding support. RESULTS: There was an increase in the rates of exclusive breastfeeding: from 26 percent at 1 month of age in 1993 to 77 percent at the same age in 2004, and from 16 percent at 3 months to 46 percent for the same dates, respectively. Breastfeeding rates at later ages exhibited a tendency to increase, although with less significance: from 15 percent in 1982 at 12 months to 34 percent in 2004 at the same age and from 6 percent at 24 months to 14 percent for the same dates, respectively. CONCLUSIONS: Breastfeeding support has contributed to a tendency for breastfeeding rates to increase.

Cow's milk allergy in Thai children.

Cow's milk allergy (CMA) is nowadays a common problem in Thai children. We reviewed medical records of patients with CMA from the Department of Pediatrics at King Chulalongkom Memorial Hospital of the past 10 years, from 1998 to 2007. The criteria for the diagnosis of CMA included: elimination of cow's milk formula resulting in improvement of symptoms, and: recurrence of symptoms after reintroduction of cow's milk by oral challenge or by accidental ingestion. Of the 382 children with a diagnosis of CMA, 168 were girls and 214 were boys. The average age at the time of diagnosis was 14.8 months (7 days-13 years). The average duration of symptoms before diagnosis was 9.2 months. A family history of atopic diseases was found in 64.2% of the patients. All of the mothers reported an increased consumption of cow's milk during their pregnancy. The most common symptoms were respiratory (43.2%) followed by gastrointestinal (GI) (22.5%) and skin manifestations (20.1%). Less common symptoms included failure to thrive (10.9%), anemia (2.8%), delayed speech due to chronic serous otitis media (0.2%) and anaphylactic shock (0.2%). A prick skin test with cow milk extract was positive in 61.4%. Exclusively breast-fed was found in 13.2% of the patients. Successful treatment included elimination of cow's milk and milk products and substitution with soy formula in 42.5%, partial hydrolysate formula (pHF) in 35.7%, extensive hydrolysate formula (eHF) in 14.2%, and amino acid formula in 1.7%. Continued breast feeding was successful in 5.9% (with maternal restriction of cow's milk and milk products). Our study demonstrates the variety of clinical manifestations of CMA in Thai children especially respiratory symptoms which are usually overlooked.

Abandono de la lactancia materna exclusiva antes de los seis meses, en mujeres de Villa del Rosario, Córdoba, Argentina / Abandon of exclusive breastfeeding before six months, in women from Villa del Rosario, Cordoba, Argentina

La lactancia materna es un proceso biológico condicionado opr la cultura, existen creencias que se reflejan en prácticas que no siempre favorecen el amamantamiento. El objetivo del estudio fue analizar el momento y las posibles causas de abandono de la lactancia materna exclusiva (LME) y su posible relación con variables demográficas y socioculturales, en puérperas residentes en Villa del Rosario, Córdoba, Argentina. Se realizó un estudio observacional, descriptivo y correlacional, durante los primeros 6 meses de vida, en niños nacidos en el período entre noviembre del 2004 y febrero del 2005, en los servicios de maternidad (privados y públicos). La población de estudio se conformó con 62 madres parturientas con consentimiento escrito firmado. A través de encuesta por cuestionario se indagaron las características sociodemográficas y socioculturales y por medio de entrevista abierta, los motivos de abandono de LME. El seguimiento de la LME durante los primeros seis meses del niño, se realizó en forma personal con una visita mensual al hogar. Se aplicó chi cuadrado (p<0.05) y análisis de correspondencia para para el estudio de diferencia deproporciones y asociaciones respectivamente. Sólo el 11.29 por ciento de las madres sostuvieron hasta los 6 meses la LME. El 74,54 por ciento abandonó la LME en el primer trimestre. El 47 por ciento abandonó la LME por indicación médica. El análisis de correspondencia pone de manifiesto la importancia de las características demográficas y socioculturales en el contexto en el mantenimiento de la práctica de LME o no. Nuestros hallazgos evidencian la necesidad de realizar un análisis profundo del discurso médico, para contrastar la práctica médica con la coherencia discursiva en un contexto particular de mujeres urbano-rurales.

Nutrition: basis for healthy children and mothers in Bangladesh.

Recent data from the World Health Organization showed that about 60% of all deaths, occurring among children aged less than five years (under-five children) in developing countries, could be attributed to malnutrition. It has been estimated that nearly 50.6 million under-five children are malnourished, and almost 90% of these children are from developing countries. Bangladesh is one of the countries with the highest rate of malnutrition. The recent baseline survey by the National Nutrition Programme (NNP) showed high rates of stunting, underweight, and wasting. However, data from the nutrition surveillance at the ICDDR,B hospital showed that the proportion of children with stunting, underweight, and wasting has actually reduced during 1984-2005. Inappropriate infant and young child-feeding practices (breastfeeding and complementary feeding) have been identified as a major cause of malnutrition. In Bangladesh, although the median duration of breastfeeding is about 30 months, the rate of exclusive breastfeeding until the first six months of life is low, and practice of appropriate complementary feeding is not satisfactory. Different surveys done by the Bangladesh Demographic and Health Survey, United Nations Children's Fund (UNICEF), and Bangladesh Breastfeeding Foundation (BBF) showed a rate of exclusive breastfeeding to be around 32-52%, which have actually remained same or declined over time. The NNP baseline survey using a strict definition of exclusive breastfeeding showed a rate of exclusive breastfeeding (12.8%) until six months of age. Another study from the Abhoynagar field site of ICDDR,B reported the prevalence of exclusive breastfeeding to be 15% only. Considerable efforts have been made to improve the rates of exclusive breastfeeding. Nationally, initiation of breastfeeding within one hour of birth, feeding colostrum, and exclusive breastfeeding have been promoted through the Baby-Friendly Hospital Initiative (BFHI) implemented and supported by BBF and UNICEF respectively. Since most (87-91%) deliveries take place in home, the BFHI has a limited impact on the breastfeeding practices. Results of a few studies done at ICDDR,B and elsewhere in developing countries showed that the breastfeeding peer-counselling method could substantially increase the rates of exclusive breastfeeding. Results of a study in urban Dhaka showed that the rate of exclusive breastfeeding was 70% among mothers who were counselled compared to only 6% who were not counselled. Results of another study in rural Bangladesh showed that peer-counselling given either individually or in a group improved the rate of exclusive breastfeeding from 89% to 81% compared to those mothers who received regular health messages only. This implies that scaling up peer-counselling methods and incorporation of breastfeeding counselling in the existing maternal and child heath programme is needed to achieve the Millennium Development Goal of improving child survival. The recent data showed that the prevalence of starting complementary food among infants aged 6-9 months had increased substantially with 76% in the current dataset. However, the adequacy, frequency, and energy density of the complementary food are in question. Remarkable advances have been made in the hospital management of severely-malnourished children. The protocolized management of severe protein-energy malnutrition at the Dhaka hospital of ICDDR,B has reduced the rate of hospital mortality by 50%. A recent study at ICDDR,B has also documented that home-based management of severe protein-energy malnutrition without follow-up was comparable with a hospital-based protocolized management. Although the community nutrition centres of the NNP have been providing food supplementation and performing growth monitoring of children with protein-energy malnutrition, the referral system and management of complicated severely-malnourished children are still not in place.