Orientación sobre la lactancia materna en un hospital para enfermedades diarréicas / Breast-feeding counseling in a diarrhoeal disease hospital

Se adiestró a consejeras en materia de lactancia materna para que dieran asesoramiento a las madres de lactantes parcialmente amamantados y hospitalizados por diarrea, con el fin de lograr que las madres iniciaran la lactancia materna exclusiva durante su permanencia en el hospital. Se asignó de forma aleatoria a lactantes (n = 250) de 12 meses de edad o menos a un grupo de intervención y a un grupo testigo. Las madres del grupo de intervención fueron asesoradas individualmente por las consejeras, mientras que las madres del grupo testigo recibieron solo la educación sanitaria impartida en grupo rutinariamente. Durante el seguimiento que hicieron las consejeras en el hogar una semana más tarde, solo las madres del grupo de intervención fueron asesoradas. A las 2 semanas de su egreso, todas las madres fueron evaluadas en términos de sus prácticas de amamantamiento en el hogar. En cuanto a los 125 pares de madres e hijos que había en cada grupo, 60% de las madres del grupo de intervención alimentaban a sus hijos al pecho exclusivamente en el momento del egreso, en comparación con solo 6% de las madres del grupo testigo (P < 0,001); 2 semanas más tarde, estos porcentajes subieron a 75 y 8 en el grupo de intervención y en el grupo testigo, respectivamente (P < 0,001). Sin embargo, 49% de las madres del grupo testigo volvieron a alimentar a sus hijos con biberón, en comparación con 12% de las madres del grupo de intervención (P < 0,001). Por consiguiente, la orientación individual tuvo un efecto favorable en las madres, ya que hizo que iniciaran la lactancia materna exclusiva durante la hospitalización y que la siguieran practicando en el hogar. Los centros de salud maternoinfantil deben incluir la orientación sobre lactancia materna como parte integral de sus programas para mejorar las prácticas de alimentación de los lactantes.

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother­infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programmes to improve infant feeding practices.

Antibodies to heat-labile Escherichia coli enterotoxins in human milk and sera. A study of Ethiopian and Swedish mothers and their children.

Maternal serum and cord blood from 50 Ethiopian, 10 Costa Rican and 20 Swedish newly delivered mothers and their babies was examined for the presence of antibodies against heat labile (LT) enterotoxin from a human strain of E. coli. 96% of the Ethiopian, 80% of the Costa Rican and 30% of the Swedish mothers and infants had detectable antibody levels. The titres were significantly higher in the Ethiopian material. Furthermore, antibody titres to E. coli enterotoxin were determined in breast milk collected from Ethiopian mothers at 48 h and at 1 month after delivery. One third of these mothers had detectable levels of antibodies in samples from early lactation. Experiments performed with LT enterotoxin from another human and with LT from a porcine E. coli strain confirmed the results. Neutralization tests with cholera enterotoxin as antigen were all negative in sera and milk samples from all these groups. The material has been collected in three different geographical areas which are nonendemic for cholera.