Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study

Araújo, Vanessa Gabrielle dos Santos; Santos, Tamara Rodrigues dos; Vieira, Ana Carolina Santana; Assunção, Monica Lopes de; Ferreira, Haroldo da Silva

doi:10.1590/1806-93042021000200008

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ORIGINAL ARTICLES • Instituto de Medicina Integral Prof. Fernando Figueira 21 (2) • Apr-Jun 2021 • https://doi.org/10.1590/1806-93042021000200008 copy

Common Mental Disorder and early interruption of exclusive maternal breastfeeding in Quilombola women: a population-based study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to investigate the prevalence of exclusive maternal breastfeeding (EMBF) and evaluate whether common mental disorder (CMD) and other predictors promote its early interruption (EI-EMBF4).

Methods:

a cross-sectional study involving all children <24 months (n=252) residing in 50% (n=34) of the Quilombola communities in Alagoas. The EI-EMBF4 was established when EMBF was ≤4 months. The Self-Reporting Questionnaire was used to identify the occurrence of CMD. Other predictors were obtained through interviews. The measure of association was the prevalence ratio calculated by the Poisson regression, following a hierarchical theoretical model. The prevalence of EMBF for 4 and 6 months, and its median duration (survival analysis) were calculated.

Results:

the prevalence of EI-EMBF4 and CMD was 57.6% and 42.9%, respectively. The risk factors independently associated with EI-EMBF4 were: living in a mud house, maternal age ≤18 years, low birth weight and the use of a pacifier or baby bottle. There was no association with CMD. The prevalence of EMBF for four and six months was 42.4% and 25.4%, respectively, and the median duration was 106 days.

Conclusion:

EMBF indicators are below the established recommendations, justifying the implementation of measures that prioritize women subjected to risk factors identified here. CMD is not configured among these.

Key words:
Maternal breastfeeding; Epidemiology; Mental health; Mental disorders; African Continental ancestry group

Variables	N^a a Number of samples differ in some variables due to non-response cases.	%	Early interruption of EMBF			p ^b b Wald test.
Variables		%	n	%	PR (CI95%)	p ^b b Wald test.
Household material
Mud	10	4.0	10	100.0	1.79 (1.60 - 2.01)	<0.001^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
Masonry	242	96.0	126	55.7	1
Occupation regime
Financed/Leased/Rented	40	15.9	24	63.2	1.11 (0.85 - 1.46)	0.428
Owned	212	84.1	112	56.6	1
Residents in the household
> 4 people	102	40.5	53	56.4	0.96 (0.76 - 1.20)	0.755
≤ 4 people	150	59.5	83	58.4	1
Family beneficiary of the Bolsa
Família Program
No	47	18.6	23	53.5	0.91 (0.67 - 1.23)	0.559
Yes	205	81.4	113	58.5	1
Social class ABEP
B2+C1+C2	9	3.6	5	55.6	0.96 (0.53 - 1.74)	0.900
D+E	243	96.4	131	57.7	1
Maternal age group
≤ 18 years	26	10.3	18	78.3	1.41 (1.10 - 1.81)	0.006^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
> 18 years	226	89.7	118	55.4	1
Maternal marital status
Single, widow or separated	39	15.5	21	58.3	1.01 (0.75 - 1.37)	0.906
Married/lives with partner	212	84.5	114	57.3	1
Maternal schooling
≤ 8 years	130	51.8	73	59.3	1.07 (0.85 - 1.33)	0.539
> 8 years	121	48.2	62	55.4	1
Occupation outside the home
Yes	59	23.8	33	58.9	1.00 (0.78 - 1.29)	0.957
No	189	76.2	103	58.5	1
Mother's skin color (self-declared)
White	27	10.8	13	52.0	0.88 (0.59 - 1.31)	0.554
Black or Mixed	224	89.2	123	58.6	1
Maternal common mental disorder
Yes	108	42.9	59	59.0	1.04 (0.83 - 1.29)	0.714
No	144	57.1	77	56.6	1
Parity
Primiparous	100	40.4	54	58.1	1.02 (0.81 - 1.28)	0.841
Multiparous	149	59.6	80	56.7	1
Prenatal
No	3	1.2	1	33.3	0.57 (0.11 - 2.85)	0.497
Yes	248	98.8	135	58.2	1
Beginning of prenatal (in months)
> 3^th quarter	56	22.9	32	61.5	1.08 (0.84 - 1.39)	0.533
≤ 3th quarter	188	77.1	100	56.8	1
Number of prenatal consultations
< 6	61	25.6	37	66.1	1.20 (0.95 - 1.52)	0.117
≥ 6	177	74.4	91	54.8	1
Guidance on breastfeeding during prenatal care
No	36	14.5	17	50.0	0. 85 (0.59 - 1.21)	0.373
Yes	213	85.5	117	58.8	1
Type of delivery
Cesarean section	115	45.8	67	60.4	1.08 (0.87 - 1.34)	0.465
Normal	136	54.2	69	55.6	1
Breastfeeding in the 1^st hour after birth
No	54	24.2	28	53.8	0.94 (0.70 - 1.25)	0.693
Yes	169	75.8	89	57.0	1
Child's sex
Male	120	47.6	69	62.2	1.15 (0.93 - 1.44)	0.184
Female	132	52.4	67	53.6	1
Child's skin color (reported by the mother or legal responsible)
Black or brown	195	77.7	103	56.6	0.90 (0.71 - 1.16)	0.446
Others	56	22.3	33	62.3	1
Gestational age at birth
< 37 weeks	17	6.7	11	78.6	1.39 (1.03 - 1.87)	0.028^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
≥ 37 weeks	234	93.3	125	56.3	1
Weight at birth (g)
< 2,500	15	6.7	14	93.3	1.73 (1.43 - 2.08)	<0.001^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
≥ 2,500	209	93.3	106	54.1	1
Use of a pacifier
Yes	102	40.6	66	70.2	1.41 (1.14 - 1.75)	0.001^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
No	149	59.4	70	49.6	1
Use of baby bottle
Yes	170	67.7	114	68.7	2.15 (1.50 - 3.09)	<0.001^* * Statistically significant difference (p<0.05). ABEP=Associação Brasileira de Empresas de Pesquisa.
No	81	32.3	22	31.9	1

Variables	PR^b (CI95%)	p	PR^a a Wald test. (CI95%)	p ^a a Wald test.
Household material		<0.001		<0.001^* * Variable independently associated with early termination of EMBF (p<0.05). ns =Variable that, after multiple analysis, was not associated with the outcome in a statistically significant way (p>0.05).
Mud	1.79 (1.60 - 2.01)		1.56 (1.24 - 1.99)
Masonry	1		1
Maternal age group (years)		0.006		0.027^* * Variable independently associated with early termination of EMBF (p<0.05). ns =Variable that, after multiple analysis, was not associated with the outcome in a statistically significant way (p>0.05).
≤ 18 years	1.41 (1.10 - 1.81)		1.32 (1.03 - 1.70)
> 18 years	1		1
Number of prenatal consultations		0.117		ns
< 6	1.20 (0.95 - 1.52)		1.14 (0.90 - 1.45)
≥ 6	1		1
Sex		0.184		ns
Male	1.15 (0.93 - 1.44)		1.20 (0.96 - 1.50)
Female	1		1
Gestational age at birth		0.028		ns
< 37 weeks	1.39 (1.03 - 1.87)		0.98 (0.96 - 1.39)
≥ 37 weeks	1		1
Weight at birth		<0.001		0.002^* * Variable independently associated with early termination of EMBF (p<0.05). ns =Variable that, after multiple analysis, was not associated with the outcome in a statistically significant way (p>0.05).
< 2,500g	1.73 (1.43 - 2.08)		1.43 (1.13 - 1.81)
≥ 2,500g	1		1
Use of pacifiers		0.001		0.025^* * Variable independently associated with early termination of EMBF (p<0.05). ns =Variable that, after multiple analysis, was not associated with the outcome in a statistically significant way (p>0.05).
Yes	1.41 (1.14 - 1.75)		1.29 (1.03 - 1.61)
No	-		-
Use of baby bottle		<0.001		<0.001^* * Variable independently associated with early termination of EMBF (p<0.05). ns =Variable that, after multiple analysis, was not associated with the outcome in a statistically significant way (p>0.05).
Yes	2.15 (1.50 - 3.09)		2.14 (1.41 - 3.25)
No	1		1

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[1] Authors’ contribution

Araújo VGS and Santos TR contributed to data collection during fieldwork, data typing and tabulation, analysis and interpretation of results, and writing the preliminary version of the article. Vieira ACS and Assunção ML participated in the analysis and interpretation of the results and the writing of the preliminary version of the paper. Ferreira HS was responsible for writing the project and obtaining funding, overall coordination of the research, interpretation of data, and critical review of the manuscript. All authors participated in writing the final version of the paper and declared their approval for publication.