Sostenibilidad de la Iniciativa Unidad Primaria Amiga de la Lactancia Materna: un estudio transversal

Febrone, Rafaele Rosa; Oliveira, Maria Inês Couto de; Rito, Rosane Valéria Viana Fonseca; Moraes, José Rodrigo de

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0869 copiar

Sostenibilidad de la Iniciativa Unidad Primaria Amiga de la Lactancia Materna: un estudio transversal

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

evaluar sostenibilidad de la Iniciativa Unidad Primaria Amiga de la Lactancia Materna por análisis del cumplimiento de Diez Pasos en unidades acreditadas; y asociación con satisfacción materna y lactancia materna exclusiva.

Métodos:

estudio transversal conducido en 2016. Evaluación del cumplimiento, realizada por entrevistas con profesionales de salud, embarazadas y madres. Asociación entre cumplimiento y satisfacción, analizada por test de correlación de Spearman; y asociación entre características contextuales/individuales y lactancia materna exclusiva, por regresión de Poisson multinivel.

Resultados:

el cumplimiento fue de 5,4-10 puntos y satisfacción de 36,8%-100%. Prevalencia de lactancia materna exclusiva fue 56,7%. Hubo correlación entre cumplimiento y satisfacción. Mayor escolaridad, orientación prenatal, alta hospitalaria en lactancia materna exclusiva, asistencia en unidades mistas y sexo femenino del niño se asociaron a mayores prevalencias de lactancia materna exclusiva; ya edad creciente y uso de chupete a menores prevalencias.

Conclusiones:

la iniciativa se mostró sustentable; el cumplimiento de los Diez Pasos elevado y se reflejó en la satisfacción materna.

Descriptores:
Atención Primaria de Salud; Lactancia Materna; Evaluación de Programas y Proyectos de Salud; Comportamiento del Consumidor; Estudios Transversales

IUBAAM's Ten Steps to Successful Breastfeeding		Score
Superior group
2	Train the whole health unit team to implement the policy on breastfeeding promotion, protection and support.	0.95
4	Listen to pregnant women and mothers' concerns, living experiences and doubts about the practice of breastfeeding, supporting them, and strengthening their self-confidence.	0.94
5	Guide pregnant women about the importance of initiating breastfeeding within the first hour of birth and of rooming-in.	0.93
Intermediate Group
3	Guide pregnant women and mothers about their rights and the advantages of breastfeeding, promoting exclusive breastfeeding up to 6 months and complementary breastfeeding until 2 years or more.	0.92
9	Advise pregnant women and mothers about the risks of using infant formulas, bottles, and pacifiers, not allowing advertisements and donations of these products in the unit.	0.91
7	Guide nursing mothers about the lactational amenorrhea method and other adequate contraceptive methods to breastfeeding.	0.86
10	Implement breastfeeding support groups available to all pregnant women and mothers, searching to involve family members.	0.83
Lower Group
8	Encourage breastfeeding on demand.	0.82
1	Have a written policy on breastfeeding promotion, protection and support that should be routinely communicated to all staff in the unit.	0.82
6	Show pregnant women and mothers how to breastfeed and how to maintain breastfeeding, even if they are separated from their babies.	0.80

	N	%	EBF (%)	cPR	p
Contextual characteristics
Type of Primary Health Care Unit
Type A - Assigned clientele	1.552	84.1	54.3	1
Type B - Mixed clientele	294	15.9	69.0	1.273	0.002
Number of Health Care Teams
1 to 4	578	31.3	63.5	1
5 to 7	1268	68.7	53.5	0.842	0.013
Location in an area of armed conflict
No	1.292	70.0	56.5	1
Yes	554	30.0	56.9	0.997	0.963
IUBAAM accreditation time
1 to 5 years	1.421	77.0	54.4	1
6 years or more	425	23.0	64.0	1.174	0.049
Degree of Compliance with IUBAAM's Ten Steps to Successful Breastfeeding
5.4 to 8.5	401	21.7	60.1	1
8.6 to 9.2	767	41.5	58.3	0.977	0.801
9.3 to 10	678	36.7	52.7	0.883	0.215
Individual characteristics
Maternal age
Adolescent	347	18.8	54.2	1
Adult	1.499	81.2	57.2	1.053	0.357
Maternal education
Incomplete elementary school	394	21.3	57.5	1
Complete elementary school or higher	1.452	78.7	53.3	1.083	0.087
Presence of a partner
No	296	16.0	51.7	1
Yes	1.550	84.0	57.5	1.112	0.136
Parity
Primimarous	833	45.1	57.1	1
Multiparous	1.013	54.9	56.2	0.987	0.801
Number of prenatal visits
< 5	125	6.8	49.6	1
6 or more	1.721	93.2	57.1	1.148	0.194
Guidance on breastfeeding in the prenatal period
No	234	12.7	49.6	1
Yes	1.609	87.2	57.6	1.187	0.026
Mother studies
Studying	95	5.1	51.6	1
On leave or does not study	1.751	94.9	56.9	1.107	0.196
Mother in paid work
Working	456	24.7	46.9	1
Not Working	1.138	61.6	58.8	1.250	< 0.001
On maternity leave	251	13.6	64.5	1.367	< 0.001
Baby's sex
Male	890	48.2	54.2	1
Female	956	51.8	58.9	1.085	0.081
Birth weight
Low weight	141	7.6	45.4	1
Adequate weight	1.704	92.3	57.6	1.263	0.032
Type of breastfeeding at discharge from the maternity hospital
Not breastfed	41	2.2	17.1	1
Was breastfed and received complement	253	13.7	37.9	2.237	0.018
Exclusively breastfed	1.551	84.0	60.7	3.560	< 0.001
Baby's age (in months)
0	290	15.7	86.2	1
1	275	14.9	70.2	0.814	0.002
2	313	17.0	67.1	0.778	< 0.001
3	320	17.3	57.8	0.671	< 0.001
4	334	18.1	36.5	0.424	< 0.001
5	314	17.0	27.1	0.314	< 0.001
Use of a pacifier
No		60.5	72.0	1
Yes	727	39.4	28.0	0.596	< 0.001

Variables	aPR	(95%)CI	p
Type of Primary Health Care Unit
Type A - Assigned clientele	1
Type B - Mixed clientele	1.154	1.028-1.296	0.015
Maternal education
Incomplete elementary school	1
Complete elementary school or higher	1.096	1.017-1.182	0.017
Guidance on breastfeeding in the prenatal period
No	1
Yes	1.228	1.074-1.405	0.003
Baby's sex
Male	1
Female	1.076	1.022-1.133	0.005
Type of breastfeeding at discharge from the maternity hospital
Not breasfed	1
Was breastfed and received complement	1.924	1.024-3.616	0.042
Exclusively breastfed	2.995	1.634-5.491	< 0.001
Baby's age
Increasing age in months	0.824	0.800-0.850	< 0.001
Use of a pacifier
No
Yes	0.691	0.633-0.754	< 0.001

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[1] Corresponding author: Maria Inês Couto de Oliveira. E-mail: marinescoutoliveira@gmail.com