[Variables associated with breast-feeding patterns in Tijuana, Mexico]. / Variables asociadas a patrones de lactancia en Tijuana, México.

The aim of this study was to determine the prevalence of feeding patterns among infants born in four community hospitals of the city of Tijuana, Mexico. From a total of 1964 live births, a random sample of 236 was chosen from the clinical files and distributed according to the total number of births in each hospital. 182 mothers from the original sample were contacted and accepted to participate in the study: 61 in the three-month group, 60 in the six-month group, and 61 in the twelve-month group. The most usual feeding patterns were: at three months of age, breast milk plus formula; at six months, formula plus other foods; and, at twelve months, fresh milk plus other foods. Three infants (1.65%) were never breastfed; at three months of age, 43 per cent of the infants were not receiving their mother's milk; and, at six months of age, 90 per cent were dependent on formula and other food only. Furthermore, 20.4 per cent of the infants were weaned before reaching their first month of age; 61.3 per cent between 30 and 119 days of age, 16.8 per cent between 120 and 209 days of age, and the rest after 209 days of age. It may be concluded that infants born in community hospitals in Tijuana show tendencies in feeding patterns similar to those of Mexican-American infants and those of urban regions in developing countries; that is, the substitution of breastfeeding for formula, and early weaning.

PIP: A study of the prevalence of breast feeding and the variables associated with early weaning was conducted among infants born in four community hospitals in the city of Tijuana, Mexico. A random sample of 236 infants was selected from the 1964 live births in the four hospitals in proportion to the number of births at each hospital. 182 of the 236 mothers of selected infants were interviewed. 61 of the infants were three months old, 60 were six months old, and 61 were twelve months old at the time of the interview. 78% of the mothers were aged 20-29 years and 70% had 4 to 6 years of schooling. Three infants were never breast fed and none of the 182 was exclusively breast fed at the time of the interview. 19.8% of the total sample was exclusively breast fed for 1-30 days and 76.4% for 31-90 days. 20.4% were weaned at 1-30 days, 61.3% at 31-90 days, 16.8% at 91-180 days, and 1.5% at 180 or more days. The most common diets were breast milk and formula at three months, formula and other foods at six months, and fresh milk and other foods at twelve months. 26 of the 61 mothers interviewed at three months had weaned their infants, as had 54 of the 60 interviewed at six months and 60 of the 61 interviewed at one year. Only 35% of mothers who received nutritional advice in the hospital weaned their babies before 120 days, while 68% who did not receive advice weaned early. Significant differences were observed between mothers weaning or not weaning their infants by three months in nine study variables: maternal occupation, maternal smoking, employment during pregnancy, domestic help in the household, timing of the first breast feeding, advice outside the hospital, contraceptive method used, expenditures for powdered milk, and family income.

Breast-feeding determinants in Chile.

PIP: In Chile in low income populations, research shows that the longer infants breast feed the lower the incidence of malnutrition (p.05) in these infants. Yet mothers with 9 years of formal education and often members of the low income group are at the highest risk of giving birth to infants 3000 g who are at highest risk of death. Indeed, it is among these groups that infant malnutrition rates are the highest. Therefore, to reduce infant mortality in these groups, more women should breast feed longer. Other determinants of women choosing to not breast feed or not breast feeding for a long period of time in Chile include work, poor nutritional status, smoking, and poor health team attitudes and practices. To counteract the negative trend in breast feeding and thereby increase the duration of breast feeding in low income mothers in Chile, the Ministry of Health (MOH) initiated its National Program for Breast-feeding Promotion (NPBP) in 1980. The educational component included training primary health care and maternity hospital health teams and distribution of educational brochures to pregnant women. If pregnant women weighed less than what the new 1980 standard recommended, they received nutritional supplements as part of the Supplementary Food Program (SPF). A study revealed that in an area where pregnant mothers received educational materials and support from the health team and food supplements, the proportion of 6 month olds exclusively breast fed rose 61.4% (p.001) in 2 years while it rose 40.7% in the area where only the SPF had been implemented. In Santiago, the percentage of breast fed 3 month olds also increased after introduction of NPBP (46%-63% [1977-1982]). The Ministries of Education and Labor could also contribute to healthier babies by preparing a family life curriculum and sponsoring legislation to extend maternity leave for working mothers.^ieng

Breast-feeding among the urban poor in southern Brazil: reasons for termination in the first 6 months of life.

A study of breast-feeding practices over the first 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breast-feeding was 18 weeks, and at 6 months 41% of the infants were still being breast-fed. The duration of breast-feeding was significantly associated with the following: the infant's sex, mother's colour, type of first feed, timing of the first breast-feed, breast-feeding regimen and frequency of breast-feeding at 1 month, and the use of hormonal contraceptives by the mother. The following were significant risk factors for early termination of breast-feeding: the infant's sex, type of first feed, use of supplementary feeds, frequency of breast-feeding, feeding regimen, weight-for-age, and weight-for-age after controlling for birth weight. Dissatisfaction with their infant's growth rate was the most frequent reason given by mothers for supplementing the diets of infants who were exclusively breast-fed in the first 3 months of life. Also, the mothers' perception that their milk output was inadequate was the most frequent reason expressed for stopping breast-feeding in the first 4 months. The roles of health services and family support in providing favourable conditions for increasing the duration of breast-feeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother's decision to continue breast-feeding.

PIP: A study of breastfeeding practices over the 1st 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breastfeeding was 18 weeks, and at 6 months, 41% of the infants were still being breastfed. The duration of breastfeeding was significantly associated with the following: infant's sex, mother's color, type of 1st feed, timing of the 1st breastfeed, breastfeeding regimen and frequency of breastfeeding at 1 month, and the use of hormonal contraceptives by the mother. The significant risk factors for early termination of breastfeeding were: infant's sex, type of 1st feed, use of supplementary feeds, frequency of breastfeeding, feeding regimen, weight-for-age, and weight-for age after controlling for birthweight. Dissatisfaction with infant growth rate was the most frequent reason given for mothers for supplementing the diets of those infants who were exclusively breastfed for the 1st 3 months of life. Also, them other's perception that their milk output was inadequate was the most frequent reason expressed for the cessation of breastfeeding in the 1st 4 months. The roles of health services and family support in providing favorable conditions for increasing the duration of breastfeeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother;s decision to breastfeed. (author's)

[Breast feeding and socioeconomic level of Chilean infants under 1 year of age]. / Lactancia materna y nivel socioeconómico en lactantes chilenos menores de un año.

PIP: 500 mothers of infants under 1 year old who were registered in 2 health service centers in Chile were interviewed between January and July 1982 as part of a collaborative study on breast feeding in Latin America conducted by the Latin American Association of Pediatrics. 5% of the infants were never breast fed, at 3 months approximately 50% were breastfed, and by 6 months only about 28% were breastfed. Classification of households according to ownership of automobiles and other household equipment, education of the household head, and household domestic help showed 6.0% in class A, the highest, 18.2% in class B, 40.4% in class C, 30.2% in class D and 5.2% in class E. 79.9% of infants in all social classes were breastfed at least in the 1st month, but the proportion was negatively related to class. 59.4% in class A were breastfed, compared to 69.1% in B, 84.8% in C, 82.6% in D, and 92.0% in E. Educational level and marital status of the mother were not related to breastfeeding practice. The relationship of employment outside the home could not be determined since 440 of the women were not in the labor force at the time of interview. 41.6% of mothers not breastfeeding cited lack of milk and 19.4% illness as the reason. 81.3% of mothers receiving prenatal care breastfed their babies compared to 52.4% who did not. 43.1% of the study children were aged 5 months or under. 79% of the mothers were aged 20-29 years. 33% discontinued breastfeeding because of declining milk supply, .48% for esthetic reasons, 3.3% for medical reasons, and 7.2% because of rejection by the infant. The introduction of other foods was cited by 24.3% as the reason for discontinuing breastfeeding.^ieng

Breastfeeding and use of the health care system in Bahia State, Brazil: three multivariate analyses.

Three multivariate methods--deviation from total proportion breastfeeding, polynomial regression, and proportional hazards--are used on current status breastfeeding data to explain an inverse relationship between use of the health care system and breastfeeding in Bahia State, Brazil. Among the intervening variables analyzed--urban/rural residence, educational attainment, age of woman, and place of last live birth--education and place of last live birth are found to have a net effect on breastfeeding by all three methods of analysis. The advantages and disadvantages of each method are described.

PIP: The health care system in northeastern Brazil (Bahia State) should be encouraging breast feeding, but data suggest that women who use the system breast feed for a shorter time than those who do not use the system. The question posed in the multivariate analysis is whether this relationship is due to the association between the use of health care and socioeconomic status, residence, or demographic characteristics. 3 multivariate methods--deviation from total proportion breast feeding, polynomic regression, and proportional hazards--are compared. Data were obtained as part of the 1980 Northeastern Brazil Survey of Maternal-Child Health and Family Planning. The survey was a statewide sample of households with 1 woman of childbearing age (15-44) selected/household. Interviews were obtained with 2091 women. All had births 1-24 months before the interview. Measures of the entent and duration of breast feeding for selected variables are given, as are zero-order correlation coefficients for the polynomial regression method with current breast feeding status as a dependent variable. The proportion of women who are currently breast feeding is given by 2 regression methods, as is the net effects on the proportion currently breast feeding. Estimated coefficients for the proportional hazards method are also given, as is the relative risk of weaning in the same multivariate analysis model. The results of the comparisons made suggest that, of variables considered--educational status, urban/rural residence, age, and place of last live birth--only education and place of last live birth are found to have a net effect on breast feeding.