Abstract
Abstract Objectives: to summarize Brazilian studies that analyzed the risk factors for Exclusive Breastfeeding (EBF) interruption before the child's six months of life. Methods: systematic review and meta-analysis indexed articles from Bireme, Scielo and Pubmed databases published in the period of January 2000 to December 2015. Results: 22 articles were included in the meta-analysis. The factors related to newborns were observed, such as birth weight (OR= 1.17; CI 95%: 1.05-1.29), female gender (OR= 1,09; CI 95%: 1.04-1.13) and the use of pacifier (OR= 2.29; CI 95%: 1.68-2.91) were the main factors responsible for the increase in the occurrence of EBF interruption. The factors were related to the mother, maternal age below twenty years old (OR= 1.22; CI 95%: 1.12-1.33) low schooling level (OR=1.28; CI 95%: 1.11-1.45), primiparity (OR= 1.17; CI 95%: 1.02-1.32) maternal employment during the postpartum period (OR= 1.26; CI 95%: 1.11-1.41), and low family income (OR= 1.22; CI 95%: 1.08-1.37) contributed significantly to the EBF interruption . Conclusions: the meta-analysis of Brazilian epidemiological studies demonstrated evidences to conclude that below the age of twenty, low schooling, primiparity, maternal employment in the postpartum period and low family income are associated to the interruption of exclusive breastfeeding until 6 months of age. Children with low birth weight, female gender and used a pacifier had greater vulnerability to not be exclusively breastfed. In conclusion, most of these factors can be modified through appropriate public policies throughout the adequate prenatal period to promote exclusive breastfeeding.
Highlights
Identification and selection of articles A systematic review with meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses norms (PRISMA),[6] on studies that evaluated the main risk factors associated to early interruption of exclusive breastfeeding in Brazil
The reasons for the exclusion of the articles were the absence of the association measurements, non-observational study designs, the Exclusive Breastfeeding (EBF) interruption assessment in groups of adolescent mothers and only breastfeeding analysis in the first month of life
The results from the this meta-analysis conducted by Brazilian observational studies published from 2000 to 2015, indicated that the associated factors of EBF interruption were low birth weight, female gender, pacifier use, maternal age less than 20 years old, less than nine years of maternal schooling, primiparity, maternal employment outside the home and low family income
Summary
The EBF is characterized by a single supply of breast milk, straight from the breast or milked from other sources without providing any other liquids or solids with the exception of drops of syrup or vitamins, oral rehydration salts, mineral supplements or medicine products.[1] It is emphasized that the EBF practice is recommended by the World Health Organization (WHO) and the Ministry of Health in Brazil (MHB).[1,3]. A national survey resulted on breastfeeding between 1999 and 2008 found that the median duration of EBF increased from 23.4 to 54.1 days in this period.[5] The survey identified a similar trend regarding to breastfeeding (BF), which had increased an average of 210 to 341.6 days.[5] These results indicate that, despite the improvement in breastfeeding rates, Brazil still presents BF and EBF rates beyond the recommendation proposed by WHO
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