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Papers by maria inês couto de oliveira
![Research paper thumbnail of [Breastfeeding-Friendly Primary Care Unit Initiative and the relationship with exclusive breastfeeding]](https://attachments.academia-assets.com/122919792/thumbnails/1.jpg)
](DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2013
To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-F... more To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-Friendly Primary Care Unit Initiative. 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. 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). 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.
Revista De Saude Publica, Dec 1, 1997
Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da... more Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da rede pública e conveniada do Estado do Rio de Janeiro e verificar se o AC guarda associação com outro indicador de qualidade de assistência que tem influência sobre o aleitamento materno: as taxas de cesárea (TC) praticadas por esses hospitais. Procedeu-se a um levantamento sobre a existência de AC através de questionário enviado às Secretarias Municipais de Saúde, informação validada por inquérito telefônico. As TC foram obtidas junto à Secretaria Estadual de Saúde-RJ. Foi utilizada a razão de prevalência para a medida da associação entre as variáveis. Foi encontrada uma proporção de 65,2% das maternidades com AC, no Estado. Verificou-se relação direta entre a presença de AC e baixas taxas de cesárea no conjunto dos hospitais, porém essa associação não se confirmou com o mesmo peso em todas as regiões. A menor proporção de hospitais com AC foi verificada no cinturão metropolitano (44,2%), enquanto a maior proporção de hospitais com elevadas taxas de cesárea está no interior (73,1%). Alojamento conjunto, provisão e distribuição. Cesárea, estatística e dados numéricos. Indicadores de serviços.
Reproductive Health
Background The Baby-Friendly Hospital Initiative’s Step 4 recommends: “support mothers to start b... more Background The Baby-Friendly Hospital Initiative’s Step 4 recommends: “support mothers to start breastfeeding as soon as possible after birth”, thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the “Adequate Childbirth Project”, a quality-of-care improvement project, and to analyze determinants of this outcome. Methods Secondary analysis of data collected by the cross-sectional evaluative “Healthy Birth Study”, conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns’ severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. Results The prevalence of breastfeed...
Revista De Saude Publica, Dec 1, 1997
Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da... more Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da rede pública e conveniada do Estado do Rio de Janeiro e verificar se o AC guarda associação com outro indicador de qualidade de assistência que tem influência sobre o aleitamento materno: as taxas de cesárea (TC) praticadas por esses hospitais. Procedeu-se a um levantamento sobre a existência de AC através de questionário enviado às Secretarias Municipais de Saúde, informação validada por inquérito telefônico. As TC foram obtidas junto à Secretaria Estadual de Saúde-RJ. Foi utilizada a razão de prevalência para a medida da associação entre as variáveis. Foi encontrada uma proporção de 65,2% das maternidades com AC, no Estado. Verificou-se relação direta entre a presença de AC e baixas taxas de cesárea no conjunto dos hospitais, porém essa associação não se confirmou com o mesmo peso em todas as regiões. A menor proporção de hospitais com AC foi verificada no cinturão metropolitano (44,2%), enquanto a maior proporção de hospitais com elevadas taxas de cesárea está no interior (73,1%). Alojamento conjunto, provisão e distribuição. Cesárea, estatística e dados numéricos. Indicadores de serviços.
Revista De Saude Publica, Jul 25, 2022
To analyze the receipt of sponsorships from breast-milk substitute companies by health profession... more To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events. Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals' knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL -Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession. We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%). The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships.
Revista de la Sociedad Boliviana de Pediatría, 2013
Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia a... more Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. Methods: Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confi dence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. Results: Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). Increased prevalence rates of breastfeeding during the fi rst year of life and exclusive breastfeeding during the fi rst 6 months of life can reduce the number of hospitalizations for pneumonia.
Ciencia & Saude Coletiva, Apr 1, 2018
Guidance on breastfeeding in primary health care and the association with exclusive breastfeeding... more Guidance on breastfeeding in primary health care and the association with exclusive breastfeeding Resumo O objetivo deste artigo é analisar a associação entre o recebimento de orientações sobre amamentação na atenção básica à saúde e o aleitamento materno exclusivo. Estudo transversal conduzido em 2013, mediante entrevista a 429 mães de crianças menores de seis meses, em unidades básicas da cidade do Rio de Janeiro. Razões de prevalência ajustadas do desfecho foram obtidas por regressão de Poisson, sendo mantidas no modelo final as variáveis associadas ao desfecho (p ≤ 0,05). A prevalência de aleitamento materno exclusivo foi de 50,1%. Na análise múltipla, a mãe receber orientação sobre aleitamento materno exclusivo na unidade básica se associou positivamente ao desfecho (RP =1,32). Associaram-se negativamente ao desfecho: renda materna < 1 salário mínimo (RP = 0,77), experiência prévia em amamentar por menos de 6 meses (RP = 0,73), não viver com companheiro (RP = 0,76), não amamentação exclusiva na alta hospitalar (RP = 0,78), consumo de bebida alcoólica (RP = 0,57), receber orientação sobre uso de bombas para ordenha das mamas (RP = 0,53), uso de chupeta (RP = 0,74) e idade crescente do bebê em meses (RP = 0,78). Ter recebido orientação sobre o aleitamento materno exclusivo contribuiu para o mesmo, enquanto orientações e práticas inadequadas se associaram a uma menor prevalência do desfecho. Palavras-chave Aleitamento materno, Orientação, Atenção Primária à Saúde, Estudos transversais
Cadernos De Saude Publica, Dec 1, 2010
The aim of this study was to assess the association between promotion, protection, and support fo... more The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (
Cadernos De Saude Publica, Nov 1, 2015
Cadernos De Saude Publica, Nov 1, 2015
Identificar fatores de risco independentes para a não amamentação na primeira hora de vida. Revis... more Identificar fatores de risco independentes para a não amamentação na primeira hora de vida. Revisão sistemática nas bases de dados Medline, Lilacs, Scopus e Web of Science, sem restrição de idioma ou período de publicação, até 30 de agosto de 2013. Foram incluídos estudos que utilizaram modelos de regressão e forneceram medidas de associação ajustadas. Foram excluídos artigos que não especificaram o modelo de regressão utilizado ou que abordaram populações específicas quanto à faixa etária ou presença de morbidade. Foram identificados 155 artigos, dos quais 18 preencheram os critérios de inclusão. Foram realizados na Ásia (nove), África (cinco) e América do Sul (quatro) entre 1999 e 2010. A prevalência da amamentação na primeira hora de vida variou de 11,4%, em uma província da Arábia Saudita, a 83,3% no Sri Lanka. A cesariana foi o fator de risco mais consistente para a não amamentação na primeira hora de vida. "Baixa renda familiar", "idade materna menor que 25 anos", "baixa escolaridade materna", "ausência de consultas pré-natais", "parto domiciliar", "falta de orientação sobre amamentação no pré-natal" e "prematuridade" foram fatores de risco identificados em pelo menos dois estudos. CONCLUSÕES: Além de rotinas hospitalares, indicadores associados a pior nível socioeconômico e menor acesso a serviços de saúde foram também identificados como fatores de risco independentes para a não amamentação na primeira hora de vida. Políticas de promoção da amamentação, adequadas a cada contexto, devem ter como meta a redução das desigualdades em saúde.
This study aimed to analyze factors associated with delayed initiation of breastfeeding (lack of ... more This study aimed to analyze factors associated with delayed initiation of breastfeeding (lack of breastfeeding in the first hour of life). This was a cross-sectional study conducted in 2009 with 673 postpartum women at hospitals belonging to the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro, Brazil. Statistical analysis used multilevel logistic regression, with two levels (individual and hospital).
Revista Paulista de Pediatria
Objective: To analyze if milk and complementary foods are being sold under the Brazilian Code of ... more Objective: To analyze if milk and complementary foods are being sold under the Brazilian Code of Marketing of Infant and Toddler's Food, Teats, Pacifiers and Baby Bottles (NBCAL), Law 11265/2006 of breastfeeding protection. Methods: Epidemiological survey that analyzed the marketing practices of pharmacies, supermarkets, and department stores in the Southern region of the city of Rio de Janeiro, Brazil, by direct observation. Results: Among the 349 stores in Rio de Janeiro's South Region, 339 traded milk and complementary foods and, among them, 60.8% were not complying with NBCAL. Infractions to NBCAL were more common for the selling of milk (58.6%) than complementary foods (22.8%). The most recurrent promotion strategy infringing NBCAL was discount pricing without the Ministry of Health disclaimer. Conclusions: Most retail stores infringe NBCAL in the commercialization of milk and complementary foods in the city of Rio de Janeiro, Brazil, a violation of the right to informa...
Cadernos de Saúde Pública, 2021
A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância... more A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (Lei Federal nº 11.265/2006) visa controlar o marketing abusivo de produtos que competem com o aleitamento materno. O objetivo foi avaliar o impacto de uma intervenção educativa sobre o cumprimento da Lei em farmácias. Pesquisa de intervenção randomizada conduzida em 155 farmácias que infringiam a Lei na Zona Sul do Rio de Janeiro, Brasil. A prática comercial das farmácias foi avaliada antes e depois da intervenção com o farmacêutico e com o gerente, comparados ao grupo controle. O intervalo entre a intervenção e a segunda avaliação foi de um mês. Para aferir as mudanças no quantitativo de farmácias com infração à Lei, antes e depois da intervenção, foi utilizado o teste de McNemar. O teste de Wilcoxon foi usado para comparar a variação no número de infrações em cada grupo de alocação. Um mês após a intervenção houve redução de 16,1% (n = 25) no total de fa...
Jornal De Pediatria, Jan 10, 2011
Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia a... more Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. Methods: Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confidence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. Results: Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). Conclusion: Increased prevalence rates of breastfeeding during the first year of life and exclusive breastfeeding during the first 6 months of life can reduce the number of hospitalizations for pneumonia.
Revista de Saúde Pública
OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (... more OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (outcome) and to analyze the association between delivery in a Baby-Friendly Hospital (BFH) and the outcome. The hypothesis is that accreditation to this program improves exclusive breastfeeding during maternity hospital stay. Exclusive breastfeeding is essential in reducing neonatal morbidity and mortality. METHODS: This study is based on secondary data collected by the “Birth in Brazil: National Survey into Labour and Birth”, a population-based study, conducted with 21,086 postpartum women, from February 1, 2011, to October 31, 2012, in 266 hospitals from all five Brazilian regions. Face-to-face interviews were conducted mostly within the first 24 hours after birth, regarding individual and gestational characteristics, prenatal care, delivery, newborn’s characteristics, and breastfeeding at birth. A theoretical model was created, allocating the exposure variables in three levels based o...
Jornal de Pediatria, 2015
Objective: The purpose of this study was to analyze the factors that influence of the time betwee... more Objective: The purpose of this study was to analyze the factors that influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery. Methods: Cohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby-Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan-Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing. Results: Hospitals with median time to breastfeeding onset at birth of up to 60 min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR = 1.75 [95% CI: 1.38-2.22]; RR = 3.83 [95% CI: 3.03-4.85]) and rapid test result after birth (RR = 1.45 [95%
OBJETIVO: Analisar a associação entre a licença-maternidade e o aleitamento materno exclusivo e e... more OBJETIVO: Analisar a associação entre a licença-maternidade e o aleitamento materno exclusivo e estimar a prevalência de aleitamento materno exclusivo em crianças menores de seis meses de vida. MÉTODOS: Estudo transversal, com mães de crianças menores de seis meses, assistidas por unidades básicas de saúde com Posto de Recolhimento de Leite Humano Ordenhado no município do Rio de Janeiro, Brasil, em 2013 (n = 429). Foram analisadas características sociodemográficas maternas, domiciliares, da assistência pré-natal, do parto, do estilo de vida materno, da criança, da assistência à saúde e da alimentação infantil. Razões de prevalências ajustadas foram obtidas por regressão de Poisson com variância robusta, segundo abordagem hierarquizada, sendo mantidas no modelo final as variáveis que se associaram (p ≤ 0,05) ao aleitamento materno exclusivo (desfecho). RESULTADOS: Entre as mães entrevistadas, 23,1% estavam em licença-maternidade e 17,2% estavam trabalhando. A prevalência de aleitame...
![Research paper thumbnail of [Training of health professionals in breastfeeding and its association with knowledge, skills and practices]](https://attachments.academia-assets.com/98517713/thumbnails/1.jpg)
](Ciencia & saude coletiva, 2017
A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio d... more A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0...
Cadernos de Saúde Pública
A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância... more A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), vigente no Brasil desde 1988, ainda é sistematicamente infringida, expondo mães e familiares ao marketing ilegal de produtos que competem com o aleitamento materno. O objetivo foi descrever metodologia de estudo multicêntrico e propor indicadores padronizados para monitoramento da NBCAL. Estudo Multicêntrico para Monitoramento da NBCAL (Multi-NBCAL) conduzido em sete cidades brasileiras: Rio de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasília (Distrito Federal); João Pessoa (Paraíba) e Belém (Pará). Instrumentos de avaliação foram adaptados do NetCode/WHO e da IBFAN Brasil (Rede Internacional em Defesa do Direito de Amamentar) para condução de dois inquéritos: (1) avaliação do cumprimento da NBCAL em estabelecimentos comerciais e das práticas e conhecimento dos seus gerentes sobre a NBCAL; (2) avaliação em mat...
DOAJ (DOAJ: Directory of Open Access Journals), Dec 1, 2013
To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-F... more To analyze the prevalence of exclusive breastfeeding and the association with the Breastfeeding-Friendly Primary Care Unit Initiative. 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. 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). 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.
Revista De Saude Publica, Dec 1, 1997
Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da... more Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da rede pública e conveniada do Estado do Rio de Janeiro e verificar se o AC guarda associação com outro indicador de qualidade de assistência que tem influência sobre o aleitamento materno: as taxas de cesárea (TC) praticadas por esses hospitais. Procedeu-se a um levantamento sobre a existência de AC através de questionário enviado às Secretarias Municipais de Saúde, informação validada por inquérito telefônico. As TC foram obtidas junto à Secretaria Estadual de Saúde-RJ. Foi utilizada a razão de prevalência para a medida da associação entre as variáveis. Foi encontrada uma proporção de 65,2% das maternidades com AC, no Estado. Verificou-se relação direta entre a presença de AC e baixas taxas de cesárea no conjunto dos hospitais, porém essa associação não se confirmou com o mesmo peso em todas as regiões. A menor proporção de hospitais com AC foi verificada no cinturão metropolitano (44,2%), enquanto a maior proporção de hospitais com elevadas taxas de cesárea está no interior (73,1%). Alojamento conjunto, provisão e distribuição. Cesárea, estatística e dados numéricos. Indicadores de serviços.
Reproductive Health
Background The Baby-Friendly Hospital Initiative’s Step 4 recommends: “support mothers to start b... more Background The Baby-Friendly Hospital Initiative’s Step 4 recommends: “support mothers to start breastfeeding as soon as possible after birth”, thus contributing to the reduction of neonatal mortality. The objective of this study is to estimate the prevalence of breastfeeding in the first hour of life in private maternity hospitals participating in the “Adequate Childbirth Project”, a quality-of-care improvement project, and to analyze determinants of this outcome. Methods Secondary analysis of data collected by the cross-sectional evaluative “Healthy Birth Study”, conducted in 2017 in 12 maternity hospitals participating in the Adequate Childbirth Project, where 4800 mothers were interviewed, and hospital records were observed. Conditions that prevented breastfeeding at birth, such as maternal HIV-infection and newborns’ severe malformations, were excluded. Multiple logistic regression was performed according to a hierarchical theoretical model. Results The prevalence of breastfeed...
Revista De Saude Publica, Dec 1, 1997
Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da... more Conhecer a existência de alojamento conjunto (AC) nos hospitais que possuem leitos obstétricos da rede pública e conveniada do Estado do Rio de Janeiro e verificar se o AC guarda associação com outro indicador de qualidade de assistência que tem influência sobre o aleitamento materno: as taxas de cesárea (TC) praticadas por esses hospitais. Procedeu-se a um levantamento sobre a existência de AC através de questionário enviado às Secretarias Municipais de Saúde, informação validada por inquérito telefônico. As TC foram obtidas junto à Secretaria Estadual de Saúde-RJ. Foi utilizada a razão de prevalência para a medida da associação entre as variáveis. Foi encontrada uma proporção de 65,2% das maternidades com AC, no Estado. Verificou-se relação direta entre a presença de AC e baixas taxas de cesárea no conjunto dos hospitais, porém essa associação não se confirmou com o mesmo peso em todas as regiões. A menor proporção de hospitais com AC foi verificada no cinturão metropolitano (44,2%), enquanto a maior proporção de hospitais com elevadas taxas de cesárea está no interior (73,1%). Alojamento conjunto, provisão e distribuição. Cesárea, estatística e dados numéricos. Indicadores de serviços.
Revista De Saude Publica, Jul 25, 2022
To analyze the receipt of sponsorships from breast-milk substitute companies by health profession... more To analyze the receipt of sponsorships from breast-milk substitute companies by health professionals in scientific events. Multicenter study (Multi-NBCAL) performed from November 2018 to November 2019 in six cities in different Brazilian regions. In 26 public and private hospitals, pediatricians, nutritionists, speech therapists, and a hospital manager were interviewed using a structured questionnaire. Descriptive analyses were carried out regarding the health professionals' knowledge about the Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL -Brazilian Code of Marketing of Infant and Toddlers Food and Childcare-related Products), companies sponsoring scientific events, and material or financial sponsorships received, according to profession. We interviewed 217 health professionals, mainly pediatricians (48.8%). Slightly more than half of the professionals (54.4%) knew NBCAL, most from Baby-friendly Hospitals. Most health professionals (85.7%) attended scientific events in the last two years, more than half of them (54.3%) sponsored by breast-milk substitute companies, especially Nestlé (85.1%) and Danone (65.3%). These professionals received sponsorships in the events, such as office supplies (49.5%), meals or invitations to parties (29.9%), promotional gifts (21.6%), payment of the conference registration fee (6.2%) or ticket to the conference (2.1%). The infant food industries violate NBCAL by harassing health professionals in scientific conferences, offering diverse material and financial sponsorships.
Revista de la Sociedad Boliviana de Pediatría, 2013
Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia a... more Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. Methods: Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confi dence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. Results: Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). Increased prevalence rates of breastfeeding during the fi rst year of life and exclusive breastfeeding during the fi rst 6 months of life can reduce the number of hospitalizations for pneumonia.
Ciencia & Saude Coletiva, Apr 1, 2018
Guidance on breastfeeding in primary health care and the association with exclusive breastfeeding... more Guidance on breastfeeding in primary health care and the association with exclusive breastfeeding Resumo O objetivo deste artigo é analisar a associação entre o recebimento de orientações sobre amamentação na atenção básica à saúde e o aleitamento materno exclusivo. Estudo transversal conduzido em 2013, mediante entrevista a 429 mães de crianças menores de seis meses, em unidades básicas da cidade do Rio de Janeiro. Razões de prevalência ajustadas do desfecho foram obtidas por regressão de Poisson, sendo mantidas no modelo final as variáveis associadas ao desfecho (p ≤ 0,05). A prevalência de aleitamento materno exclusivo foi de 50,1%. Na análise múltipla, a mãe receber orientação sobre aleitamento materno exclusivo na unidade básica se associou positivamente ao desfecho (RP =1,32). Associaram-se negativamente ao desfecho: renda materna < 1 salário mínimo (RP = 0,77), experiência prévia em amamentar por menos de 6 meses (RP = 0,73), não viver com companheiro (RP = 0,76), não amamentação exclusiva na alta hospitalar (RP = 0,78), consumo de bebida alcoólica (RP = 0,57), receber orientação sobre uso de bombas para ordenha das mamas (RP = 0,53), uso de chupeta (RP = 0,74) e idade crescente do bebê em meses (RP = 0,78). Ter recebido orientação sobre o aleitamento materno exclusivo contribuiu para o mesmo, enquanto orientações e práticas inadequadas se associaram a uma menor prevalência do desfecho. Palavras-chave Aleitamento materno, Orientação, Atenção Primária à Saúde, Estudos transversais
Cadernos De Saude Publica, Dec 1, 2010
The aim of this study was to assess the association between promotion, protection, and support fo... more The aim of this study was to assess the association between promotion, protection, and support for breastfeeding in primary health care services and prevalence of exclusive breastfeeding in the first six months of life. A cross-sectional study was conducted in a representative sample of 1,029 mothers of infants younger than six months treated at primary health care facilities in the city of Rio de Janeiro, in southeastern Brazil. Prevalence ratios (PR) were estimated by Poisson regression. Prevalence of exclusive breastfeeding was 58.1%. Factors associated with increased prevalence of exclusive breastfeeding were: white skin color (
Cadernos De Saude Publica, Nov 1, 2015
Cadernos De Saude Publica, Nov 1, 2015
Identificar fatores de risco independentes para a não amamentação na primeira hora de vida. Revis... more Identificar fatores de risco independentes para a não amamentação na primeira hora de vida. Revisão sistemática nas bases de dados Medline, Lilacs, Scopus e Web of Science, sem restrição de idioma ou período de publicação, até 30 de agosto de 2013. Foram incluídos estudos que utilizaram modelos de regressão e forneceram medidas de associação ajustadas. Foram excluídos artigos que não especificaram o modelo de regressão utilizado ou que abordaram populações específicas quanto à faixa etária ou presença de morbidade. Foram identificados 155 artigos, dos quais 18 preencheram os critérios de inclusão. Foram realizados na Ásia (nove), África (cinco) e América do Sul (quatro) entre 1999 e 2010. A prevalência da amamentação na primeira hora de vida variou de 11,4%, em uma província da Arábia Saudita, a 83,3% no Sri Lanka. A cesariana foi o fator de risco mais consistente para a não amamentação na primeira hora de vida. "Baixa renda familiar", "idade materna menor que 25 anos", "baixa escolaridade materna", "ausência de consultas pré-natais", "parto domiciliar", "falta de orientação sobre amamentação no pré-natal" e "prematuridade" foram fatores de risco identificados em pelo menos dois estudos. CONCLUSÕES: Além de rotinas hospitalares, indicadores associados a pior nível socioeconômico e menor acesso a serviços de saúde foram também identificados como fatores de risco independentes para a não amamentação na primeira hora de vida. Políticas de promoção da amamentação, adequadas a cada contexto, devem ter como meta a redução das desigualdades em saúde.
This study aimed to analyze factors associated with delayed initiation of breastfeeding (lack of ... more This study aimed to analyze factors associated with delayed initiation of breastfeeding (lack of breastfeeding in the first hour of life). This was a cross-sectional study conducted in 2009 with 673 postpartum women at hospitals belonging to the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro, Brazil. Statistical analysis used multilevel logistic regression, with two levels (individual and hospital).
Revista Paulista de Pediatria
Objective: To analyze if milk and complementary foods are being sold under the Brazilian Code of ... more Objective: To analyze if milk and complementary foods are being sold under the Brazilian Code of Marketing of Infant and Toddler's Food, Teats, Pacifiers and Baby Bottles (NBCAL), Law 11265/2006 of breastfeeding protection. Methods: Epidemiological survey that analyzed the marketing practices of pharmacies, supermarkets, and department stores in the Southern region of the city of Rio de Janeiro, Brazil, by direct observation. Results: Among the 349 stores in Rio de Janeiro's South Region, 339 traded milk and complementary foods and, among them, 60.8% were not complying with NBCAL. Infractions to NBCAL were more common for the selling of milk (58.6%) than complementary foods (22.8%). The most recurrent promotion strategy infringing NBCAL was discount pricing without the Ministry of Health disclaimer. Conclusions: Most retail stores infringe NBCAL in the commercialization of milk and complementary foods in the city of Rio de Janeiro, Brazil, a violation of the right to informa...
Cadernos de Saúde Pública, 2021
A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância... more A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (Lei Federal nº 11.265/2006) visa controlar o marketing abusivo de produtos que competem com o aleitamento materno. O objetivo foi avaliar o impacto de uma intervenção educativa sobre o cumprimento da Lei em farmácias. Pesquisa de intervenção randomizada conduzida em 155 farmácias que infringiam a Lei na Zona Sul do Rio de Janeiro, Brasil. A prática comercial das farmácias foi avaliada antes e depois da intervenção com o farmacêutico e com o gerente, comparados ao grupo controle. O intervalo entre a intervenção e a segunda avaliação foi de um mês. Para aferir as mudanças no quantitativo de farmácias com infração à Lei, antes e depois da intervenção, foi utilizado o teste de McNemar. O teste de Wilcoxon foi usado para comparar a variação no número de infrações em cada grupo de alocação. Um mês após a intervenção houve redução de 16,1% (n = 25) no total de fa...
Jornal De Pediatria, Jan 10, 2011
Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia a... more Objective: To evaluate the relationship between breastfeeding and hospitalization for pneumonia among children under 1 year old. Methods: Ecological study using secondary data of hospitalizations for pneumonia (outcome) and breastfeeding prevalence data (exposure) among children under 1 year old living in the Brazilian state capital cities and the Federal District in 2008. A negative binomial model of hospitalization was used to estimate the rate ratio (95% confidence interval), adjusted according to the Gini Index, and the prevalence rates of smokers in the general population and low birth weight individuals in the population investigated. Results: Breastfeeding prevalence among children between 9 and 12 months old and exclusive breastfeeding prevalence among children under 6 months old were associated with a lower rate ratio of hospitalization for pneumonia (RR = 0.62; 95%CI 0.51-0.74 and RR = 0.52; 95%CI 0.39-0.69, respectively). Conclusion: Increased prevalence rates of breastfeeding during the first year of life and exclusive breastfeeding during the first 6 months of life can reduce the number of hospitalizations for pneumonia.
Revista de Saúde Pública
OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (... more OBJECTIVE: To estimate the prevalence of exclusive breastfeeding during maternity hospital stay (outcome) and to analyze the association between delivery in a Baby-Friendly Hospital (BFH) and the outcome. The hypothesis is that accreditation to this program improves exclusive breastfeeding during maternity hospital stay. Exclusive breastfeeding is essential in reducing neonatal morbidity and mortality. METHODS: This study is based on secondary data collected by the “Birth in Brazil: National Survey into Labour and Birth”, a population-based study, conducted with 21,086 postpartum women, from February 1, 2011, to October 31, 2012, in 266 hospitals from all five Brazilian regions. Face-to-face interviews were conducted mostly within the first 24 hours after birth, regarding individual and gestational characteristics, prenatal care, delivery, newborn’s characteristics, and breastfeeding at birth. A theoretical model was created, allocating the exposure variables in three levels based o...
Jornal de Pediatria, 2015
Objective: The purpose of this study was to analyze the factors that influence of the time betwee... more Objective: The purpose of this study was to analyze the factors that influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery. Methods: Cohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby-Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan-Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing. Results: Hospitals with median time to breastfeeding onset at birth of up to 60 min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR = 1.75 [95% CI: 1.38-2.22]; RR = 3.83 [95% CI: 3.03-4.85]) and rapid test result after birth (RR = 1.45 [95%
OBJETIVO: Analisar a associação entre a licença-maternidade e o aleitamento materno exclusivo e e... more OBJETIVO: Analisar a associação entre a licença-maternidade e o aleitamento materno exclusivo e estimar a prevalência de aleitamento materno exclusivo em crianças menores de seis meses de vida. MÉTODOS: Estudo transversal, com mães de crianças menores de seis meses, assistidas por unidades básicas de saúde com Posto de Recolhimento de Leite Humano Ordenhado no município do Rio de Janeiro, Brasil, em 2013 (n = 429). Foram analisadas características sociodemográficas maternas, domiciliares, da assistência pré-natal, do parto, do estilo de vida materno, da criança, da assistência à saúde e da alimentação infantil. Razões de prevalências ajustadas foram obtidas por regressão de Poisson com variância robusta, segundo abordagem hierarquizada, sendo mantidas no modelo final as variáveis que se associaram (p ≤ 0,05) ao aleitamento materno exclusivo (desfecho). RESULTADOS: Entre as mães entrevistadas, 23,1% estavam em licença-maternidade e 17,2% estavam trabalhando. A prevalência de aleitame...
Ciencia & saude coletiva, 2017
A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio d... more A cross-sectional study was conducted in the 15 hospitals with over 1000 deliveries/year in Rio de Janeiro, Brazil, to verify the association between training of health professionals in breastfeeding and professional knowledge, skills and practices. Interviews were staged with 215 health professionals, 48.4% working in Baby-Friendly Hospitals, by means of a questionnaire adapted from the revalidation instrument of the initiative. The three dichotomized outcomes were subjected to bivariate and multivariate analysis. Adjusted prevalence ratios were obtained by the Poisson regression model: 48.1% of the professionals had adequate knowledge, 58.9% adequate skills and 74.9% reported adequate practice. Theoretical and practical training ≥ 18 hours considered adequate (by 65.6% of the professionals) showed a significant association with professional knowledge (aPR = 1.575), skills (aPR = 1.530) and practices (aPR = 1.312). Less working experience was associated with less knowledge (aPR = 0...
Cadernos de Saúde Pública
A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância... more A Norma Brasileira de Comercialização de Alimentos para Lactentes e Crianças de Primeira Infância, Bicos, Chupetas e Mamadeiras (NBCAL), vigente no Brasil desde 1988, ainda é sistematicamente infringida, expondo mães e familiares ao marketing ilegal de produtos que competem com o aleitamento materno. O objetivo foi descrever metodologia de estudo multicêntrico e propor indicadores padronizados para monitoramento da NBCAL. Estudo Multicêntrico para Monitoramento da NBCAL (Multi-NBCAL) conduzido em sete cidades brasileiras: Rio de Janeiro; São Paulo; Ouro Preto (Minas Gerais); Florianópolis (Santa Catarina); Brasília (Distrito Federal); João Pessoa (Paraíba) e Belém (Pará). Instrumentos de avaliação foram adaptados do NetCode/WHO e da IBFAN Brasil (Rede Internacional em Defesa do Direito de Amamentar) para condução de dois inquéritos: (1) avaliação do cumprimento da NBCAL em estabelecimentos comerciais e das práticas e conhecimento dos seus gerentes sobre a NBCAL; (2) avaliação em mat...