Breastfeeding-Friendly Primary Care Unit Initiative and the relationship with exclusive breastfeeding

Alves, Ana Lúcia Naves; Oliveira, Maria Inês Couto de; Moraes, José Rodrigo de

doi:10.1590/S0034-8910.2013047004841

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Health Public Practice • Rev. Saúde Pública 47 (6) • Dec 2013 • https://doi.org/10.1590/S0034-8910.2013047004841 copy

Breastfeeding-Friendly Primary Care Unit Initiative and the relationship with exclusive breastfeeding

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

: To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-Friendly Primary Care Unit Initiative.

METHODS

: Cross-sectional study, whose data source were research on feeding behaviors in the first year of life conducted in the vaccination campaigns of 2003 and 2006, at the municipality of Barra Mansa, RJ, Southeastern Brazil. For the purposes of this study, infants under six months old, accounting for a total of 589 children in 2003 and 707 children in 2006, were selected. To verify the relationship between being followed-up by Breastfeeding-Friendly Primary Care Unit Initiative units and exclusive breastfeeding practice, only data from the 2006 inquiry was used. Variables that in the bivariate analysis were associated (p-value ≤ 0.20) with the outcome (exclusive breastfeeding practice) were selected for multivariate analysis. Prevalence ratios (PR) of exclusive breastfeeding were obtained by Poisson Regression with robust variance through a hierarchical model. The final model included the variables that reached p-value ≤ 0.05.

RESULTS

: The prevalence of exclusive breastfeeding increased from 30.2% in 2003 to 46.7% in 2006. Multivariate analysis showed that mother’s low education level reduced exclusive breastfeeding practice by 20.0% (PR = 0.798; 95%CI 0.684;0.931), cesarean delivery by 16.0% (PR = 0.838; 95%CI 0.719;0.976), and pacifier use by 41.0% (PR = 0.589; 95%CI 0.495;0.701). In the multiple analysis, each day of the infant’s life reduced exclusive breastfeeding prevalence by 1.0% (PR = 0.992; 95%CI 0.991;0.994). Being followed-up by Breastfeeding-Friendly Primary Care Initiative units increased exclusive breastfeeding by 19.0% (PR = 1.193; 95%CI 1.020;1.395).

CONCLUSIONS

: Breastfeeding-Friendly Primary Care Unit Initiative contributed to the practice of exclusive breastfeeding and to the advice for pregnant women and nursing mothers when implemented in the primary health care network.

Breast Feeding; Infant Nutrition; Maternal-Child Health Centers; Quality of Health Care; Primary Health Care; Cross-Sectional Studies

Characteristics	2003		2006		p

	n	%	n	%
Mother’s age (years)					0.883
13 to 19	83	16.6	104	17.0
20 to 46	416	83.4	509	83.0
Student					0.138
Yes	32	6.4	62	8.7
No	467	93.6	648	91.3
Mother’s schooling					< 0.001
Completed primary school	277	55.7	310	45.1
Completed high school and over	220	44.3	378	54.9
Paid work					< 0.001
Yes	173	34.7	126	17.8
No	326	65.3	580	82.2
Births					0.129
First	239	47.9	370	52.3
Multiple	260	52.1	337	47.7
Municipality of birth					0.003
Barra Mansa	440	74.6	573	81.4
Other	150	25.4	131	18.6
Born in the Baby-Friendly hospital					0.001
No	525	89.0	662	94.2
Yes	65	11.0	41	5.8
Type of delivery					< 0.001
Cesarean	352	59.9	494	70.2
Vaginal	236	40.1	210	29.8
Sex					0.996
Female	291	49.7	351	49.6
Male	295	50.3	356	50.4
Birth weight (g)					0.333
< 2,500	59	10.2	60	8.6
≥ 2,500	519	89.8	636	91.4
Baby’s age (months)					0.353
0 to 3	311	52.8	355	50.2
4 to 5	278	47.2	352	49.8
Hospitalized					0.055
Yes	31	5.3	29	4.1
No	556	94.7	674	95.9
Use of pacifier					0.009
Yes	299	50.9	308	43.6
No	289	49.1	399	56.4
Vaccination center					0.055
Rural	13	2.2	29	4.1
Urban	576	97.8	678	95.9
Monitored in a Breastfeeding-Friendly Primary Health Care Center					< 0.001
Yes	0	0.0	188	26.6
No	589	100.0	519	73.4

Characteristics	% EBF	PR_b	p
Mother’s age (years)			0.258
13 to 19	41.7	0.869
20 to 46	48.0	1
Student			0.297
Yes	40.3	0.846
No	47.6	1
Mother’s schooling			0.049
Completed primary school	42.9	0.849
Completed high school and over	50.5	1
Paid work			0.090
Yes	39.5	0.817
No	48.4	1
Births			0.544
First	45.6	0.952
Multiple	47.9	1
Municipality of birth			0.831
Barra Mansa	46.3	0.978
Other	47.3	1
Born in the Baby-Friendly hospital			0.168
No	46.0	0.819
Yes	56.1	1
Type of delivery			0.051
Cesarean	44.3	0.849
Vaginal	51.9	1
Sex			0.147
Female	44.0	0.889
Male	49.4	1
Birth weight (g)			0.132
< 2,500	36.7	0.769
≥ 2,500	44.7	1
Hospitalized			0.264
Yes	34.6	0.738
No	46.9	1
Use of pacifier			< 0.001
Yes	31.3	0.532
No	58.7	1
Vaccination center			0.130
Rural	31.0	0.655
Urban	47.4	1
Monitored in a Breastfeeding-Friendly Primary Health Care Center			0.090
Yes	51.6	1.156
No	45.0	1

	Model 1		Model 2		Model 3		Final model
	PR_a	p	PR_a	p	PR_a	p	PR_a	p	95%CI
Mother’s schooling
Completed primary school	0.841	0.036	0.798	0.009	0.807	0.006	0.798	0.004	0.684;0.931
Completed high school and over	1		1		1		1
Paid work
Yes	0.821	0.096	–	–	–	–	–	–	–
No	1
Born in the Baby-Friendly hospital
No			0.828	0.187	–	–	–	–	–
Yes			1
Type of delivery
Cesarean			0.779	0.004	0.832	0.018	0.838	0.023	0.719;0.976
Vaginal			1		1		1
Birth weight (g)
< 2,500			0.760	0.125	–	–	–	–	–
≥ 2,500			1
Sex
Female			0.891	0.154	–	–	–	–	–
Male			1
Baby’s age
Age in days					0.992	< 0.001	0.992	< 0.001	0.991;0.994
Vaccination center
Rural					0.637	0.086	–	–	–
Urban					1
Use of pacifier
Yes					0.589	< 0.001	0.589	< 0.001	0.495;0.701
No					1		1
Monitored in a Breastfeeding-Friendly Primary Health Care Center
Yes					1.204	0.020	1.193	0.027	1.020;1.395
No					1		1

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Correspondence
: Ana Lúcia Naves Alves. Secretaria Municipal de Saúde de Barra Mansa. Rua das Orquídeas, 111. Colônia Santo Antônio. 27350-120 Barra Mansa, RJ, Brasil. E-mail: utinaves@uol.com.br