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Toledo MC, Lee JS, Batista BL, Olympio KPK, Nardocci AC. Essential and Toxic Elements in Infant Cereal in Brazil: Exposure Risk Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:381. [PMID: 38673295 PMCID: PMC11050093 DOI: 10.3390/ijerph21040381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/16/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024]
Abstract
Infant cereals, one of the first solid foods introduced to infants, have been reported to pose risks to human health because they contain toxic elements and an excess of essential elements. The objective of this study was to assess the cancer and non-cancer risk of exposure to essential and toxic elements in infant cereal in Brazil. In our analyses, we included data from 18 samples of infant cereals made from different raw materials and estimated the incremental lifetime cancer risks and non-cancer hazard quotients (HQs) for their consumption. Rice cereal is particularly concerning because it is immensely popular and usually contains high levels of inorganic arsenic. In addition to arsenic, we assessed aluminum, boron, barium, cadmium, chromium, copper, lead, manganese, nickel, selenium, silver, strontium, and zinc. The cancer risk was highest for rice cereal, which was also found to have an HQ > 1 for most of the tested elements. Inorganic As was the element associated with the highest cancer risk in infant cereal. All of the infant cereals included in this research contained at least one element with an HQ > 1. The essential and non-essential elements that presented HQ > 1 more frequently were zinc and cadmium, respectively. The cancer and non-cancer risks could potentially be decreased by reducing the amount of toxic and essential elements (when in excess), and public policies could have a positive influence on risk management in this complex scenario.
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Affiliation(s)
- Michele C. Toledo
- School of Public Health, University of São Paulo, São Paulo 01246-904, SP, Brazil; (K.P.K.O.); (A.C.N.)
| | - Janice S. Lee
- United States Environmental Protection Agency, Research Triangle Park, NC 27711, USA;
| | - Bruno Lemos Batista
- Center for Natural and Human Sciences, Federal University of the ABC, Santo André 09210-170, SP, Brazil;
| | - Kelly P. K. Olympio
- School of Public Health, University of São Paulo, São Paulo 01246-904, SP, Brazil; (K.P.K.O.); (A.C.N.)
| | - Adelaide C. Nardocci
- School of Public Health, University of São Paulo, São Paulo 01246-904, SP, Brazil; (K.P.K.O.); (A.C.N.)
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de Carvalho RBN, Louzada MLDC, Rauber F, Levy RB. Characteristics associated with dietary patterns in Brazilian children under two years of age. Rev Saude Publica 2022; 56:118. [PMID: 36629709 PMCID: PMC9749735 DOI: 10.11606/s1518-8787.2022056003757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/13/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the dietary patterns of Brazilian children under two years of age and assess their association with sociodemographic characteristics and health service use. METHODS This is a cross-sectional study with data from the 2013 National Health Survey (PNS). Patterns were found for two age groups by principal component analysis and their correlation with characteristics of interest was tested by linear regression models. RESULTS We found two dietary patterns for our groups. The first consisted of the consumption of fresh or minimally processed foods and the second, of ultra-processed foods. The greater adherence of children between six and 11 months to the first pattern was associated with higher per capita family income and urban residences in the most developed regions of Brazil. At 12 months or more, adherence related to white race/color, higher per capita family incomes, residence in more developed regions, and visits to private childcare. Adherence to the second pattern among children under one year of age was inversely associated with Yellow or Indigenous race/color, residence in the Brazilian Northeast, and childcare in specialized public or private services. At 12 months or more, greater adherence was directly associated with Black or Brown children who resided in more developed regions, and inversely associated with those living in the Brazilian Northeast. CONCLUSION We found two opposite dietary patterns in Brazilian children under two years of age and that several social determinants modify their chance of adhering to these patterns.
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Affiliation(s)
- Rumão Batista Nunes de Carvalho
- Universidade Federal do PiauíFaculdade de EnfermagemPicosPIBrasilUniversidade Federal do Piauí. Faculdade de Enfermagem. Picos, PI, Brasil
| | - Maria Laura da Costa Louzada
- Universidade de São PauloFaculdade de Saúde PúblicaNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Fernanda Rauber
- Universidade de São PauloFaculdade de Saúde PúblicaNúcleo de Pesquisas Epidemiológicas em Nutrição e SaúdeSão PauloSPBrasil Universidade de São Paulo. Faculdade de Saúde Pública. Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde. São Paulo, SP, Brasil
| | - Renata Bertazzi Levy
- Universidade de São PauloFaculdade de MedicinaDepartamento de Medicina PreventivaSão PauloSPBrasil Universidade de São Paulo. Faculdade de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
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Moura AS, Gubert MB, Venancio SI, Buccini G. Implementation of the Strategy for Breastfeeding and Complementary Feeding in the Federal District in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5003. [PMID: 35564399 PMCID: PMC9104574 DOI: 10.3390/ijerph19095003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND The Brazilian Breastfeeding and Complementary Feeding Strategy-Estratégia Amamenta e Alimenta Brasil (EAAB) aims to promote optimal breastfeeding (BF) and complementary feeding (CF) practices through the training of primary health professionals. Competition among health priorities and programs is one of the organizational contextual barriers to consolidating the implementation of the EAAB. METHODS This case study included six Primary Health Units (PHU) certified in the EAAB. Documentary analysis, interviews, and surveys were conducted, which informed a conceptual logical model. Organizational context indicators (positive and negative) were identified across the logical model based on the Matus Triangle, and they were used to analyze the degree of implementation of the EAAB in the PHUs. RESULTS The logic model elucidated six stages of EAAB implementation, but none on post-certification monitoring. Ten indicators positively influenced the implementation, including having legislation that prioritizes BF and CF. Seven indicators exerted negative influence, especially the lack of specific funding resources for the EAAB. Only one PHU had a consolidated degree of implementation. CONCLUSIONS Lack of specific funding, monitoring of BF and CF practices, and compliance with certification criteria are the main challenges for the EAAB's sustainability.
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Affiliation(s)
- Amanda Souza Moura
- Department of Nutrition, Center of Epidemiological Studies of Health and Nutrition (NESNUT), Faculty of Health Sciences, University of Brasília, Brasília 70910-900, Brazil;
| | - Muriel Bauermann Gubert
- Department of Nutrition, Center of Epidemiological Studies of Health and Nutrition (NESNUT), Faculty of Health Sciences, University of Brasília, Brasília 70910-900, Brazil;
| | - Sonia Isoyama Venancio
- Institute of Health, State Secretariat of São Paulo Health, São Paulo 01314-000, Brazil;
| | - Gabriela Buccini
- Department of Social and Behavioral Health, University of Nevada, Las Vegas, NV 89119, USA;
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Almeida MAM, Rossato SL, Ferrari AP, de Barros Gomes C, Tonete VLP, de Lima Parada CMG, de Barros Leite Carvalhaes MA. The Determinants of Complementary Feeding Introduction Vary According to the Type of Food and Infants' Ages: A Cohort Study-ClaB, Brazil. Matern Child Health J 2022; 26:1384-1400. [PMID: 35088296 DOI: 10.1007/s10995-021-03360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Food inadequacies in the first 6 months of life are considered a global problem, with an emphasis on early complementary feeding introduction (CFI). This study aimed to identify the determinants of CFI. METHODS A birth cohort study (N = 641). Data on infant feeding was collected before 30 days, and at 2, 4, and 6 months of age and, at baseline, data regarding socioeconomic status, demographics, maternal and infant health, obstetric history, and infant care. The hypothesis was that the risk determinants for early CFI vary according to the type of food and the age range of this introduction. Twelve Cox regression models were fit with four outcomes (formula; other types of milk; other beverages; and solid/semi-solid foods) considering three different age ranges of the infant at their introduction (< 2 months, 2-4 months, and 4-6 months). RESULTS The introduction of the four food groups analyzed was early (median ages of introduction: formulas = 45 days; other milks = 135 days; other beverages = 120 days; solids and semi-solids = 135 days). The determinants that increased the risk of introducing formulas before 2 months were: primiparity, employed without maternity leave, mothers with unsatisfactory prenatal counseling and those who had cesarean sections. Not living with a partner, infant pacifier use at 2 months of age had a higher risk of introducing formula between 2 and 4 months of age. Non-white skin color, more than 35 years old, low maternal education, and lower family income increased the risk of introducing other types of milk between 2 and 4 months of age. Between 4 and 6 months of age, adolescent and low education level mothers had a higher risk of introducing other types of milk, unemployed was a protective factor against the introduction of other foods and beverages in this age group. CONCLUSIONS The determinants of early CFI varied according to the type of food and the age of introduction.
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Affiliation(s)
- Maiara Aparecida Mialich Almeida
- Department of Nursing, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil. .,Departamento de Enfermagem, Faculdade de Medicina de Botucatu-UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil.
| | - Sinara Laurini Rossato
- Department of Public Health, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
| | - Anna Paula Ferrari
- Department of Nursing, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
| | - Caroline de Barros Gomes
- Department of Public Health, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
| | - Vera Lúcia Pamplona Tonete
- Department of Nursing, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
| | - Cristina Maria Garcia de Lima Parada
- Department of Nursing, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
| | - Maria Antonieta de Barros Leite Carvalhaes
- Department of Nursing, Botucatu Medical School, São Paulo State University - UNESP, Avenida Professor Montenegro, Distrito de Rubião Júnior, s/n, Botucatu, SP, CEP 18618-970, Brazil
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Bortolini GA, de Oliveira TFV, da Silva SA, Santin RDC, de Medeiros OL, Spaniol AM, Pires ACL, Alves MFM, Faller LDA. [Feeding and nutrition efforts in the context of primary healthcare in BrazilMedidas relativas a la alimentación y la nutrición en la atención primaria de salud en Brasil]. Rev Panam Salud Publica 2020; 44:e39. [PMID: 32355501 PMCID: PMC7189826 DOI: 10.26633/rpsp.2020.39] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/04/2020] [Indexed: 12/22/2022] Open
Abstract
In Brazil, the promotion, protection, and recovery of health are among the initiatives provided by the public and universal Unified Health System (SUS). The primary healthcare level (PHC), the preferred point of access to the system, plays the role of coordinating and ordinating health care services and actions in the network. In the context of PHC, feeding and nutrition efforts must be aligned with National Feeding and Nutrition Policy (PNAN) guidelines and may be supported by feeding and nutritional surveillance actions. Data from PHC information systems and population surveys show that excess weight affects more than half the adult population of Brazil, and that consumption of ultra-processed foods is on the rise. This scenario requires that health care teams be prepared to prioritize initiatives for users with chronic diseases, using risk stratification, stabilization of the disease, and enhancement of supported self-care with a focus on diet and physical activity. At the same time, considering the country's epidemiological profile, teams must carry out initiatives to fight undernutrition and prevent anemia and hypovitaminosis A to address the multiple burden of malnutrition. The present article describes the current scenario of feeding and nutrition initiatives implemented at the PHC level in Brazil via the SUS.
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Affiliation(s)
- Gisele Ane Bortolini
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Thais Fonseca Veloso de Oliveira
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Sara Araújo da Silva
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Rafaella da Costa Santin
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Olivia Lucena de Medeiros
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Ana Maria Spaniol
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Ana Carolina Lucena Pires
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Maria Fernanda Moratori Alves
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
| | - Lívia de Almeida Faller
- Ministério da Saúde, Secretaria de Atenção Primária à Saúde Departamento de Promoção da Saúde Coordenação-Geral de Alimentação e Nutrição Brasília (DF) Brasil Ministério da Saúde, Secretaria de Atenção Primária à Saúde, Departamento de Promoção da Saúde, Coordenação-Geral de Alimentação e Nutrição, Brasília (DF), Brasil
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Pedraza DF. Percepção de enfermeiros sobre o cuidado nutricional à criança na Estratégia Saúde da Família. SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivou-se analisar a percepção de enfermeiros sobre o cuidado nutricional de crianças menores de cinco anos. Trata-se de um estudo qualitativo envolvendo 18 profissionais de equipes de saúde da família de dois municípios da região metropolitana de João Pessoa, Paraíba. Realizou-se entrevista com foco na importância do desenvolvimento das ações de alimentação e nutrição para o cuidado nutricional da criança. As entrevistas foram conduzidas por meio de um roteiro de perguntas. O material foi submetido à análise de conteúdo e dela emergiram quatro categorias temáticas. Os enfermeiros apontaram a utilidade dos manuais do Ministério da Saúde para as ações de atenção nutricional e a educação em alimentação saudável como a prática mais importante desse cuidado. Entretanto, destacaram a situação socioeconômica das famílias e a capacitação dos profissionais como empecilhos para o desenvolvimento das ações. Ainda, apontaram a importância da atuação do nutricionista junto à equipe multidisciplinar para o desenvolvimento das ações de alimentação e nutrição. Além da necessidade implícita de capacitação em nutrição, evidencia-se a valorização dos documentos técnicos do Ministério da Saúde e do nutricionista para a melhoria do cuidado nutricional de crianças menores de cinco anos.
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Moreira LCDQ, Oliveira EBE, Lopes LHK, Bauleo ME, Sarno F. Introduction of complementary foods in infants. EINSTEIN-SAO PAULO 2019; 17:eAO4412. [PMID: 31116228 PMCID: PMC6533076 DOI: 10.31744/einstein_journal/2019ao4412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: To analyze frequency, age and time trend of complementary feeding introduction in infants. Methods: Retrospective study of infants’ data evaluated at nutrition sector of Programa de Atenção aos Bebês of Programa Einstein na Comunidade de Paraisópolis from 2012 to 2015. Survival analyzes were performed, and the outcome considered was the time until the introduction of each specific food. Results: Participants were 700 infants, with 5.5 months of median age. Water was the most consumed supplement (80.0%), followed by infant formula (64.1%) and juice (51.1%). Regarding the beginning of complementary feeding, water, infant formula and tea were the first to be introduced, with a median age of 3 months. It is noteworthy that almost one-fifth of the infants had already received processed foods. Water introduction proportions showed a significant tendency to increase over the years, and among infants at 6 months of age, varied from 72.8%, in 2012, to 91.1%, in 2015. The introduction of processed food category items presented a significant trend of change, showing, however, a reduction from 30.8%, in 2012, to 15.6%, in 2015, in this same age group. Among the processed foods, flour based thickeners (36.3%) and biscuits (26.3%) presented the highest proportions of consume. Conclusion: Water and infant formula were the most widely consumed and early introduced foods. Among the studied years, water introduction presented a significant tendency to increase and processed foods category to reduce consumption.
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Affiliation(s)
| | | | - Lucia Hitomi Kamata Lopes
- Instituto Israelita de Responsabilidade Social, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mariana Ercole Bauleo
- Instituto Israelita de Responsabilidade Social, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Flavio Sarno
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Rimes KA, Oliveira MICD, Boccolini CS. Maternity leave and exclusive breastfeeding. Rev Saude Publica 2019; 53:10. [PMID: 30726491 PMCID: PMC6390669 DOI: 10.11606/s1518-8787.2019053000244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the association between maternity leave and exclusive breastfeeding and to estimate the prevalence of exclusive breastfeeding in children under six months of life. METHODS Cross-sectional study, with mothers of children under six months of life, attended in primary health care units with Breast Milk Collection Services in the municipality of Rio de Janeiro, Brazil, in 2013 (n = 429). We analyzed characteristics concerning: maternal sociodemographic aspects, household, prenatal care, childbirth, maternal lifestyle, the child, health care, and infant feeding. Adjusted prevalence ratios (APR) were obtained by Poisson regression with robust variance according to hierarchical approach, and we kept in the final model variables that were associated (p ≤ 0.05) with exclusive breastfeeding (outcome). RESULTS Among the interviewed mothers, 23.1% were on maternity leave and 17.2% were working. The prevalence of exclusive breastfeeding was 50.1%. The maternal work with maternity leave was associated with higher prevalence of the outcome (APR = 1.91; 95%CI 1.32-2.78), compared with mothers who worked without maternity leave. CONCLUSIONS Maternity leave has contributed to the practice of exclusive breastfeeding for children under six months of life, which indicates the importance of this benefit in protecting exclusive breastfeeding for women inserted in the formal labor market.
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Affiliation(s)
- Karina Abibi Rimes
- Universidade Federal Fluminense. Instituto de Saúde Coletiva. Programa de Pós-Graduação em Saúde Coletiva. Niterói, RJ, Brasil
| | - Maria Inês Couto de Oliveira
- Universidade Federal Fluminense. Instituto de Saúde Coletiva. Departamento de Epidemiologia e Bioestatística. Niterói, RJ, Brasil
| | - Cristiano Siqueira Boccolini
- Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informação em Saúde. Rio de Janeiro, RJ, Brasil
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Araújo RG, Fonseca VDM, de Oliveira MIC, Ramos EG. External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil. Int Breastfeed J 2019; 14:1. [PMID: 30627208 PMCID: PMC6321706 DOI: 10.1186/s13006-018-0195-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 12/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the “Ten Steps to Successful Breastfeeding”, International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI’s criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.
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Affiliation(s)
- Renara Guedes Araújo
- Coordination of the Brazilian Child Health and Breastfeeding Program, Anexo do Ministério da Saúde, SAF Sul Quadra 1, Bloco B, 4 andar, Brasília, DF CEP 70058-900 Brazil
| | - Vânia de Matos Fonseca
- 2Fernandes Figueira Institute, Oswaldo Cruz Foundation, Unidade de Pesquisa Clínica, Av. Rui Barbosa, 716, Rio de Janeiro, RJ CEP 20021-140 Brazil
| | - Maria Inês Couto de Oliveira
- 3Biostatistics and Epidemiology Department, Public Health Institute, Fluminense Federal University, Av. Marquês do Paraná, 303, Niterói, RJ CEP 24020-071 Brazil
| | - Eloane Gonçalves Ramos
- 2Fernandes Figueira Institute, Oswaldo Cruz Foundation, Unidade de Pesquisa Clínica, Av. Rui Barbosa, 716, Rio de Janeiro, RJ CEP 20021-140 Brazil
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Abstract
ABSTRACT Objective To describe the profile and performance of nutritionists in Primary Health Care. Methods A cross-sectional study was carried out, and all nutritionists in two municipalities of Paraíba, Brazil, were interviewed. Information was collected through structured interviews on demographic characteristics, professional qualification, development of food and nutrition activities, knowledge and use of essential bibliography for the work in Primary Care. Results In one municipality there were 28 teams of the Family Health Strategy and in the other, nineteen teams. In all, nineteen nutritionists were interviewed, fourteen of whom were working in the health teams and five were working exclusively in the Family Health Support Centers. All but one were women and the majority were between 20 and 39 years; the majority (n=10) had no graduate training. Nutritionists from the basic health teams developed more public health nutrition actions, such as defining nutritional care protocols and vitamin A and iron supplementation than those from the Family Health Support Centers (11 versus 1; and 13 versus 1, respectively). About half were satisfied with work in general, and dissatisfaction was related to deficiencies in the availability and quality of anthropometric equipment, physical structure and material. Conclusion Nutritionists work in food and nutrition actions in collective health, emphasizing the importance of qualification and practices that better combine the programmatic agenda of this area with Primary Care.
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