Trends and patterns of exclusive breastfeeding for under-6-month-old children.

OBJECTIVES: 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 (Pearsons 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%; in the 2003-2006 period, increase of 6.6%, thus reaching the annual increase rate of 2.3% in the first period and 2.2% in the second period. Significant inverse association was observed between EBF and the use of pacifiers (hazard ratio = 2.03; 95% 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% in 1999 to 24.2% in 2006, which represents an increase of 184.7%. The use of pacifiers was the only factor associated with greater chances of EBF interruption.

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.

[Mother's ability of childcare and children malnutrition]. / Capacidade materna de cuidar e desnutrição infantil.

OBJECTIVES: To identify and measure the risk of malnutrition associated to determining indicators of mother's ability of childcare: familial structure, education level, work, maternal physical and mental health. METHODS: A case-control study was performed. Cases (101 children whose weight/age was below 5th percentile) and controls (200 children whose weight/age was above 25th percentile) were selected using anthropometric surveys during three vaccination campaigns in 1996 and 1997. Data was collected by interviewing the children's mothers at home. To detect the net effect of each factor studied, multivariate hierarchical analyses were carried out. The factors investigated and possible control variables were grouped in blocks, arranged according to order they affected the child's nutritional status. In order to identify the control variables a p<0.20 (univariate analyses) was assumed and to identify associations between a given factor and malnutrition a p<0.05 was assumed. RESULTS: Malnutrition risk factors identified are: (a) adverse familial structure, indicated by single parenting (OR=2.2; 95%CI, 1.1-4.5); (b) hospitalization of the mother during pregnancy (OR=3.5; 95%CI, 1.6-7.7); (c) mother's poor mental health, determined by the presence of 3 to 4 symptoms of depression included in the SRQ-20 (OR=3.1; 95%CI, 0.9-10.3); and (d) family stress factors, suggestive signs of alcoholism in at least one family member (OR=2.1; 95%CI, 1.2-3.9). In addition to these factors, child's age at the time the mother resumed/started working was also independently associated to malnutrition. However, it produced mixed effects: for children aged 4 to 12 months, the mothers' resuming work resulted in a protection factor whereas their resuming later tended to increase the risk of malnutrition. CONCLUSIONS: It was evidenced that the factors that define the mother's ability of child care affect the child's nutritional status.