INTRODUCTION

The breastfeeding practice has been widely discussed in Brazil and in the world. From the nutritional point of view, exclusive breastfeeding (EBF) is the most nutritious and adequate food for children until the first six months of life, for being rich in vitamins, proteins, carbohydrates, fats, minerals and water. These nutrients are crucial for children’s growth and development. After this period, to satisfy infants’ nutritional needs, the supplementary feeding (SF) should be initiated with the continuity of breastfeeding until two years of age or older⁽¹⁾.

EBF until six months of age and, after this age, breastfeeding (BF) until two years of age or more, combined with suitable introduction of balanced SF are emphasized by the World Health Organization (WHO) as important measures that cause an effective impact on reducing the risk of developing chronic noncommunicable diseases (CNCD), as obesity, hypertension and diabetes mellitus, and promote physical and psychological health for the infant and the woman who breastfeeds⁽²⁾.

Although Brazil has advanced with regard to improvement of breastfeeding indicators⁽³⁾, there is a lot to evolve, especially if the aim is to accomplish the recommendation proposed by the WHO, of having at least 50% of children in exclusive breastfeeding. For that, there must be intersectoral collective efforts aiming at implementing actions of protection and promotion of BF and appropriate SF, within a perspective of integral and humanized approach⁽⁴⁾.

In this sense, the role of healthcare professionals is essential in the process, through actions on services directed to promotion, encouragement and support to BF and healthy SF. For that, the professional must be qualified and demonstrate safety for the mother regarding breastfeeding difficulties, assisting her in moments of anxiety and providing consistent information⁽⁵⁾.

However, this will only be possible when the action is based and instrumentalized on up-to-date technical and scientific knowledge. Thus, professionals’ satisfactory knowledge about the subject are of utmost importance. Therein, studies have been evidencing a deficit of knowledge about this subject by professionals involved in providing health care to mothers, standing out the need for adequate preparation and commitment in breastfeeding promotion^(6-7).

Based on problematic exposed, the investment on permanent health education (EPS – Educação Permanente em Saúde) is mandatory when aiming at promoting a better communication with mothers and family members, so that they can discuss their needs, expectations, anxieties and choices as well as effectively contribute to the promotion of BF and SF⁽⁸⁾.

OBJECTIVE

To analyze the knowledge about BF and SF of professionals in the Primary Health Care working in the teams of the Family Health Strategy (ESF – Estratégia Saúde da Família) of a municipality.

METHOD

RESULTS

A total of 168 ESF professionals participated in the study, being 112 (66.67%) community health agents (CHA), 19 (11.31%) nursing technicians, 20 (11.90%) nurses and 17 (10.12%) doctors. From the respondents, 87.50% are female and 12.50% are male, with age ranging between 23 and 63 years. Considering the total service time, a predominance of professionals with over 10 years of occupation (71.43%) was noted. With regard to the respondent’s educational level, 53.57% completed high school and 46.43% had higher education (Table 1).

When questioned about the health care on BF an SF, 78.57% of respondents reported providing assistance on BF and 74.40% assist in SF. As for participation in training/preparation on BF and SF, 63.10% reported having had participated in training/preparation on BF and 42.26% on SF. Regarding the knowledge of EAAB, 74.40% claimed not knowing this program (Table 1).

Table 2 describes the means and medians of the percentage of hits in relation to ESF professionals’ knowledge about BF and SF. Regarding the knowledge of breastfeeding, there was statistical difference between the means of percentages of hits of compared to the CHA (p=0.01). Among nurses the hit ratio was 83%, higher than the CHA (71.8%). In relation to the supplementary feeding, a statistically significant difference was noted between the means of proportion of hits of nursing technicians and CHA (p<0.01). For nursing technicians, the mean of hits was 64.4%; as for CHA, this proportion was only 54.9%. Considering the other categories, the means of proportions of hits was similar. It must be emphasized that, when the knowledge about BF was compared to the SF for each professional category, a statistically significant difference was noted between the means of hits, because all categories had higher mean of hits for BF compared to SF (Table 2).

Table 3 shows the results of the analysis of association between level of knowledge about breastfeeding and variables of sociodemographic factors and professionals’ training. It is noted that there was significant statistical association between professionals’ level of knowledge and variables: education level (p=0.04), i.e., professionals who had education beyond high school had higher level of knowledge; occupation (p=0.05), in which doctors and nurses had better level of knowledge about BF than other professionals in the Primary Health Care team; and those who provide assistance in BF to lactating mothers have a better level of knowledge of BF (p=0.04). According to the contingency coefficient (CC) values, these three variables had moderate association (0.1 to 0.3) with the performance of participants of the study.

Table 4 displays the association between sociodemographic and training variables with the level of knowledge about BF in 168 healthcare professionals. According to the CC, the variable for educational level had strong association (CC=0.34) with high level of statistical significance (p<0.01); professionals who had educational level beyond high school had better level of knowledge and those who provided BF health care to lactating mothers have better level of knowledge about BF. This variable had moderate association (CC=0.19) with significant p-value (p=0.04).

DISCUSSION

The analysis of knowledge about BF and SF of professionals working in the ESF showed a better performance on issues of BF in relation to SF. This finding is a matter of concern, since healthcare professionals must be prepared and trained to monitor the process of breastfeeding and introduction of supplementary foods, growth and development of the child, especially in the first two years of life, both in individual appointments and home visits. In addition, they must guide the women and their families with regard to the access to other services and support groups related to breastfeeding and supplementary feeding.

Furthermore, mothers need active and emotional support, as well as precise information, to feel confident. The healthcare professional must understand what kind of support, information and interaction the mothers desire, need or expect from him/her⁽¹⁶⁾.

In this sense, EAAB stands out as an important tool to aid achieving the goals regarding BF and SF. This strategy was prepared by the Brazilian Ministry of Health, in 2012, and it is the main program focused on preparing the professionals working in the Primary Health Care for BF and SF. The program was launched with the purpose of training healthcare professionals based on participatory activities that allow exchange and acquisition of knowledge, taking into account the local reality to directly influence the breastfeeding indicators⁽¹⁷⁾. About this strategy, the knowledge of professionals was identified as insufficient, which reinforces the need for more information.

The knowledge of healthcare professionals proved to be associated with important variables of training and performance, in especial with the education level. Thus, this study showed that the higher the educational level, the better are the professional’s conditions of incorporating new knowledge and abilities to assist the families under his/her responsibility.

This result may be related to the large number of professionals without higher education, as the CHA in the sample of our study. The emergence of Primary Health Care established the ability of reading and writing as minimum education criterion, without demanding a more technical and scientific knowledge based on the needs of people closer to and from the community. However, this may impair the performance of Primary Health Care, since a previous research has identified that, in relation to nutrition and feeding, CHA have insufficient knowledge to face the problems of their routine, presenting difficulties ranging from the practice of breastfeeding and supplementary feeding until the insufficient knowledge about which foods the child can consume in the first year of life. It is worth mentioning that this same research showed that CHA with higher education had higher ease in executing their duties⁽¹⁸⁾.

This finding reinforces the need for permanent education of professionals working in the Primary Health Care, regardless of their educational level, aiming at enabling the theoretical basis of their actions, making the latter more effective in the promotion of breastfeeding. On this matter, a study conducted in southern Brazil identified that the preparation in BF increased the hit scores of professionals compared with those who had no preparation⁽¹⁹⁾.

The scientific literature is categorical when stating that permanent education is a strategy to enhance the knowledge and practices aimed at management and care on feeding and nutritional actions, creating an opportunity to contribute to the reversal of the organizational logic based only on the disease. Permanent health education can guide the transformation of health promotion practices, aiming at changing the hegemonic conception of the biomedical model to a constructivist and problematizing conception, which favors the subject’s participation in the actions of health and social mobilization^(19-20).

There is the need of better preparing healthcare professionals to work the actions of feeding and nutrition through constant training and continuous monitoring of these actions, identifying difficulties and providing conditions to overcome them, leading to their full development⁽²¹⁾.

The team planning of actions is important because it will directly influence the achievement of goals and, consequently, the improvement of the quality of service provision. To this end, the health education planning must not to be individualized because the integration of management, healthcare professionals and community, is crucial and uses varied tools and resources⁽²²⁾.

To assist the collective approach of promotion practices for proper and healthy feeding by healthcare professionals, the Brazilian Government has recently launched an instrument aiming at supporting the planning and development of these actions in Primary Health Care. The project includes proposals of methodologies, in addition to the theoretical and practical basis for their development, as well as the publication of manuals and ordinances that address the principles and recommendations on BF and SF⁽²³⁾.

Therefore, there is need for enabling courses and training programs that qualify these professionals on BF and on SF, especially. To this end, actions of permanent health education are suggested, in a constant promotion process as well as full and contextualized development of teams. On this matter, the implementation of EAAB in the municipality is recommended to qualify the professionals’ working process and to strengthen the actions of promotion, protection and support to breastfeeding and supplementary feeding of children under two years old in the context of Primary Health Care. In addition, it can contribute to the improvement of indicators for breastfeeding and supplementary feeding.

CONCLUSION

This study verified that healthcare professionals working in the ESF have greater knowledge about breastfeeding when compared to knowledge of supplementary feeding. This finding was associated with important training (education level) and performance (health care on BF and SF provided by professionals to the lactating mothers) variables.