Correlates of breastfeeding duration in an urban cohort from Argentina

AIM

To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio-demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices.

METHODS

The study was conducted in the city of Cordoba, between 1993 and 1998. Mother-child binomials from all public and private hospitals were asked to participate. Follow-up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan-Meier method, and factors associated with weaning were studied using Cox's proportional risk regression.

RESULTS

The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82-2.82]; breastfeeding of a previous child for less than 6 mo (RR = 1.64; 95% CI = 1.32-2.02); delay in the first mother-child contact for over 90 min (RR = 1.50; 95% CI = 1.17-1.93); mother's having completed primary or partially completed secondary education (RR = 1.40; 95% CI = 1.01-1.92) or completed secondary education or higher (RR = 1.59; 95% CI = 1.14-2.22); primiparous mother (RR = 1.39; 95% CI = 1.12-1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01-1.61).

CONCLUSIONS

The purpose of strategies to promote breastfeeding should be to eliminate inappropriate care practices, such as delay in the first mother-child contact, as well as reducing the impact of other factors leading to the introduction of artificial milk. Moreover, mothers need more and better support from professionals and peers.

Caries experience in 3 year old children of Cordoba, Argentina

The results of a study of caries in a 3 year old cohort of children performed by the CLACyD (Spanish abbreviation by initials for Nutrition, Growth and Development Program of Córdoba) are analysed. The prevalence of caries was 19.7% for boys and 16.1% for girls. Dmf-t and dmf-s values were 0.55-0.75% for girls and 0.73-1.22% for boys. The most affected element was the first mandibular molar (16.30% of the population). Extracted and filled elements accounted for 1.8 and 5.9% of the dmf-t index. According to the Caries Analysis System, a higher prevalence of the PF (pits and fissures) pattern and the AM (anterior maxillary bone) pattern was observed as compared to the PP (proximal posterior) and BL (buccolingual) patterns. The percentage distribution of BL lesions over all the patterns exhibited statistically significant (p = 0.05) differences between girls and boys. The PF and PP patterns were more severe in boys (p = 0.0006 and p = 0.002 respectively). Based on the present data we conclude that this population exhibits marked prevalence which can rapidly increase and pose a threat to temporary and mixed dentitions. We herein recommend preventive measures of widespread use (regarding toothbrushing, and eating habits with particular reference to carbohydrate consumption) and preventive-therapeutic treatments for diseased patients (topical applications of fluoride, sealing agents and active treatment of caries).

Premature cessation of breastfeeding in infants: development and evaluation of a predictive model in two Argentinian cohorts: the CLACYD study, 1993-1999. Córdoba Lactation, Feeding, Growth and Development study

The objective of this study was to develop a model to predict premature cessation of breastfeeding of newborns, in order to detect at-risk groups that would benefit from special assistance programmes. The model was constructed using 700 children with a birthweight of 2000 g or more, in 2 representative cohorts in 1993 and 1995 (CLACYD I sample) in Córdoba, Argentina. Data were analysed from 632 of the cases. Mothers were selected during hospital admittance for childbirth and interviewed in their homes at 1 mo and 6 mo. To evaluate the model, an additional sample with similar characteristics was drawn during 1998 (CLACYD II sample). A questionnaire was administered to 347 mothers during the first 24-48 h after birth and a follow-up was completed at 6 mo, with weaning information on 291 cases. Premature cessation of breastfeeding was considered when it occurred prior to 6 mo. A logistic regression model was fitted to predict premature end of breastfeeding, and was applied to the CLACYD II sample. The calibration (Hosmer-Lemeshow C statistic) and the discrimination [area under the receiver operating characteristics (ROC) curve] of the model were evaluated. The predictive factors of premature end of breastfeeding were: mother breastfed for less than 6 mo [odds ratio (OR) = 1.84, 95% confidence interval (CI) 1.26-2.70], breastfeeding of previous child for less than 6 mo (OR = 4.01, 95% CI 2.58-6.20), the condition of the firstborn child (OR = 2.75, 95% CI 1.79-4.21), the first mother-child contact occurring after 90 min of life (OR = 1.88; 95% CI 1.22-2.91) and having an unplanned pregnancy (OR = 1.50, 95% CI 1.05-2.15). The calibration of the model was acceptable in the CLACYD I sample (p = 0.54), as well as in the CLACYD II sample (p = 0.18). The areas under the ROC curve were 0.72 and 0.68, respectively.

CONCLUSION

A model has been suggested that provides some insight onto background factors for the premature end of breastfeeding. Although some limitations prevent its general use at a population level, it may be a useful tool in the identification of women with a high probability of early weaning.

[Growth of breastfed and bottle-fed infants up to 2 years of age: CLACYD (Lactation, Alimentation, Growth and Development) study 1993-1995]

Studies done in various countries show important differences in the growth of breastfed and bottle-fed children. In addition, it has been found that breast-fed children grow more slowly beginning at the age of 2 or 3 months in comparison with the reference pattern of the U.S. National Center for Health Statistics (NCHS) and the World Health Organization (WHO). These results cast doubt on whether maximum growth is the same as optimal growth. The objective of this study was to compare the growth in weight and length, from birth to 24 months, for a group of children who were breast-fed with that of a group who were bottle-fed. The study was also intended to describe the growth of the breastfed group in relation to the NCHS/WHO norms and a WHO "12-month breast-fed pooled data set." For this research, data were analyzed from the "Cordoba: lactation, feeding, growth, and development" study (or CLACYD study, for its Spanish-language acronym). That study looked at a representative cohort, stratified by social class, of children born in 1993 in the city of Cordoba, Argentina. The researchers analyzed anthropometric data on 74 children who were breast-fed during the first year of life and on 108 bottle-fed children. The data had been recorded, using standardized techniques, at birth and at 6, 12, and 24 months of age. Both groups were homogenous with respect to the age and schooling of the parents, social stratum, birth order, maternal height, and child's weight and length at birth. The living conditions (housing construction and availability of water and sewer services) were better among the group that was bottle-fed (P = 0.04). The breast-fed children had a lower weight and a shorter length at 6, 12, and 24 months than did the bottle-fed children. The breast-fed children also showed a slowing in growth with respect to the NCHS/WHO guidelines beginning in the second semester. This indicates that the NCHS/WHO norms are not totally adequate for evaluating the growth of breast-fed children in Cordoba, Argentina. In the high and middle social strata, the values for the breast-fed group resembled those for the WHO "pooled data set," both in weight and length. In the low and very low social strata, weight values were satisfactory, but the figures for length were less than those of the "pooled data set." The gap in length found among the low and very low social strata does not reduce the validity of the WHO "pooled data set" reference, but rather indicates the influence of living conditions on linear growth.

[Adult body height in women in Cordoba, Argentina, and exploration of the current trend (1978-198)]

The objective of this work was to contribute local data concerning the full adult height of women in Cordoba, Argentina, and to explore the possibility of a secular trend in their heights. For the study, 513 women were examined during May and June 1994. All of the women were between 18 and 40 years of age and were mothers of children who were included in a study on lactation, feeding, growth, and development in Córdoba. The measurements were carried out applying standardized techniques and using as a reference standard the 50th-percentile level data from the U.S. National Center for Health Statistics. The mean full height of the Córdoba population studied was 157.9 cm, 0.97 standard deviation (SD) below the reference norm. For the women from the highest of six socioeconomic strata, the mean height was 159.7 cm (-0.67 SD); the mean for women from the lowest stratum was 156.2 cm (-1.25 SD). The difference in the means of those two socioeconomic groups was statistically significant (P < 0.001). Of the population studied, 2.3% (6.4% of the lowest social stratum) were shorter than 145 cm. In order to explore the possibility of a secular trend, the resulting data were categorized into two groups according to the mother's age at the time of the anthropometric examination, one group with a mean age of 24 and a second group with a mean age of 34. The younger women had a mean adult height 0.4 cm greater than that of the older women (P = 0.47). This secular increase in height is notably smaller than that reported for other Argentine provinces (1.2 and 1.4 cm/decade) and somewhat lower than the average reported in population studies in Australia, Belgium, the United States, Japan, and Norway (0.6 cm/decade). The authors conclude that in the period analyzed, 1978-1988, the living conditions in the city of Córdoba have not improved in a way that is reflected in a significant increase in the height of adult women. The authors recommend that maternal health and nutrition programs concentrate their resources on the mothers from the lowest socioeconomic stratum who are shorter than 145 cm.

[Breast-feeding during the first month of life in Cordoba city, Argentina]

In the foregoing investigation breast-feeding during the first 30 days of life was studied in a representative sample of 620 babies born and settled down in the city of Cordoba Argentina. To analyse this information, the classification of breastfeeding suggested by the WHO/UNICEF was used. The results reveal that being a month old, 26% of the babies had complete breastfeeding 60% had partial breastfeeding and the remaining 14% did not have it at all. Among the children with complete breast-feeding, 21% was exclusive and 5% was prevailing. 18% of the babies were exposed to breastfeeding before an hour and a half after they were born, the average number of nursings a day was 7.3 (D.S. 1.9) taking less than 15 minutes to reach the 57%; and with a free-demanding timetable in 44%. The children with partial breast-feeding were classified into low, medium, and high being 20%, 54%, 22% respectively. The average age in which another milk was introduced was 3.7 days, and the main reasons were "insufficient mother milk", and "the child's hunger". Among the children with artificial lactation, 87% were once exposed to breastfeeding, the weaning took place during the 4 days in average (D.S. 5.6) and in an abrupt way in 55% of them. The Health personnel helped supporting the introduction of lacteal formula in 68% of the children with partial lactation and in 42% of the cases of complete abandon of natural breastfeeding.

Feeding in the first month of life, by social strata, in Córdoba, Argentina

A study was made of the feeding history from birth to 1 month of age in a cohort of children born and residing in the city of Córdoba, Argentina, in 1993. The sample was divided into six social strata, in accordance with the occupation of the individual primarily responsible for family support. A total of 620 mothers were surveyed 1 month (mean = 31 days; SD = 1.2 days) following delivery in order to obtain information on the occupational, housing, and demographic characteristics of the family. In addition, information was collected on the first food given to infants following birth as well as on the type of food received at 1 month of age, the latter being based on 24-hour recall. The living conditions and demographic characteristics of the families were associated with their social strata. Families in Stratum I (high) and strata II and III (intermediate) tended to have higher standards of living and to have parents who were older when the children were born than did families in the lowest strata (V and VI), while families in Stratum IV tended to approach the average values found for the entire sample. With regard to feeding practices, it was found that 98% of the children had begun breast-feeding during the first week of life. A statistical association was observed between first food and social strata, with breast-feeding being more prevalent among the very low strata (V and VI) and use of bottle feeding being more prevalent in strata I and III. At 1 month of age, 26% of the sample was receiving complete natural breast-feeding, 60% was receiving partial natural breast-feeding, and 14% was being entirely bottle-fed. A significant association (P < 0.05) was observed between type of breast-feeding and social strata, with a figure of 38% complete natural breast-feeding recorded for Stratum I as compared to 16% for Stratum IV and 17% for Stratum V. Other findings of this study that stood out were that a high percentage of children in all the strata were initially breast-fed; a high percentage of the children were given breast-milk substitutes during the first month of life; and a low prevalence of complete natural breast-feeding was observed at 1 month of age.

[Food consumption of school children regarding their social condition. Córdoba, Republic of Argentina]

This report reveals the daily consumption of nourishing food in primary school children coming from the north of Córdoba, Argentina, in relationship with their socio economic status, SES. Four categories were determined according to the place the chief support of the family occupies in the productive system. A 24 hours recall test was applied to obtain nutritional data as well as the weight and method of measure. Differences among the established categories were pointed out by socioeconomic indicators (P < 0.001). Powder and liquid milk ingesta showed statistic differences (P < 0.005), at the same time, the consumption of this food was poor, and it was not being incorporated into the scholarship's diet. The per-capita proportion of meat ingesta was over 100 g, in the whole group. Difference (P < 0.005) were noticed among the SES when the consumption was over 200 g. The consumption of fruits and vegetables is low. On the contrary, it was shown an increase in cereals and legumes ingesta as the SES decreased (P < 0.005). Analyzing the fitness of the diet it was found that the 53% of SES IV children showed calorie shortage whereas the proteins evaluation revealed excess consumption in the 88% of the studied scholarships. Other deficiencies were also found, such as calcium, riboflavin, thiamine, niacin in the whole group. This study also showed statistic differences with respect to the consumption of energy, calcium and ascorbic acid (P < 0.05).

[Nutrition surveys in children attending kindergartens in the city of Cordoba]

A nutritional inquest was carried out in 1857 children attending kindergartens in Córdoba, Argentina, in 1974. Determinations were made for the socioeconomical level each child belonged (NES) and clinical and anthropometric examinations. Nutritional inquests were carried out in 414 of these children, psychological examinations in 51, and biochemical inquests in 61 children.