Breastfeeding In Brazil Research Articles

Lhia: A Smart Chatbot for Breastfeeding Education and Recruitment of Human Milk Donors

Human milk is the most important way to feed and protect newborns as it has the components to ensure human health. Human Milk Banks (HMBs) form a network that offers essential services to ensure that newborns and mothers can take advantage of the benefits of human milk. Despite this, there is low adherence to exclusive breastfeeding in Brazil, and human milk stocks available in HMBs are usually below demand. This study aimed to co-develop a smart conversational agent (Lhia chatbot) for breastfeeding education and human milk donor recruitment for HMBs. The co-design methodology was carried out with health professionals from the HMB of the University Hospital of the Federal University of Maranhão (HMB-UHFUMA). Five natural language processing pipelines based on deep learning were trained to classify different user intents. During the rounds in the co-design procedure, improvements were made in the content and structure of the conversational flow, and the data produced were used in subsequent training sessions of pipelines. The best-performing pipeline achieved an accuracy of 93%, with a fallback index of 15% for 1851 interactions. In addition, the conversational flow improved, reaching 2904 responses given by the chatbot during the last co-design round. The pipeline with the best performance and the most improved conversational flow were deployed in the Lhia chatbot to be put into production.

Principais causas da não adesão ao aleitamento materno exclusivo no brasil: revisão integrativa de literatura

Exclusive breastfeeding is of fundamental importance for the neuropsychomotor development of the child, as well as for the maintenance of their health. The aim of the study proposed here was to evaluate the reasons for the abandonment of exclusive breastfeeding in Brazil, described in the scientific literature. This is an integrative literature review, carried out in the databases linked to the Virtual Health Library (VHL), Scientific Electronic Libray Online (SciELO), Latin American and Caribbean Literature/Bibliographic Index EspañolenCiencias de la Salud (Lilacs/Ibecs), and Medical Literature Analysis and Retrievel System Online (Medline). The search was conducted with the descriptors in health sciences (DECS): "Breastfeeding" AND "Child nutrition", "Breastfeeding" AND "Child health", "Breastfeeding" OR "Breastfeeding". "Child nutrition" AND "Infant". Given the relevance of breastfeeding for child development, it is understood that from the understanding of possible reasons that lead to low adhering or abandonment of breastfeeding, it is possible to devise strategies for coping with such obstacles. The existence of myths about breastfeeding, the woman's need to return to work, as well as deficient knowledge about the importance of exclusive breastfeeding were the main reasons mentioned in the literature for non-smoking. The protective factors of exclusive breastfeeding were mentioned: promotion of breastfeeding during prenatal care, puerperal home visit, as well as family support and greater knowledge of women about the benefits of the practice.

BRAZIL'S PROGRESS IN PROTECTING, PROMOTING AND SUPPORTING BREASTFEEDING FROM THE PERSPECTIVE OF THE GLOBAL BREASTFEEDING COLLECTIVE.

ABSTRACTObjective: To identify and to discuss the progress of actions for the protection, promotion and support of breastfeeding in Brazil from the perspective of the indicators proposed by the Global Breastfeeding Collective.Data source: A narrative review was conducted according to the methodological orientation of the implementation research and through a qualitative approach. Publications from the World Health Organization and the United Nations Children’s Fund were selected, as well as publications from the Brazilian Ministry of Health were collected from the Virtual Health Library and from the libraries of the Department of Primary Care’s portal and the Brazilian’s Institute of Geography and Research.Data synthesis: Brazil has shown promising results regarding the implementation of breastfeeding protection legislation, the participation of municipalities in community breastfeeding support programs, and the continued evaluation of these programs. However, reports of breastfeeding rates have not been produced every five years and the progress of these indicators is very far from the agreed targets for 2030. There is also a need to improve the number of births in child-friendly hospitals and financial donations for breastfeeding programs.Conclusions: It is necessary to strengthen systematic monitoring of breastfeeding and following up current strategies to more effectively impact the breastfeeding rates in the country. Furthermore, it is suggested that the practice of donations is a pathway to be explored to support breastfeeding programs.

BABY FRIENDLY HOSPITAL INITIATIVE: 25 YEARS OF EXPERIENCE IN BRAZIL.

ABSTRACTObjective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992.Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children’s Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: “iniciativa hospital amigo da criança”, “hospital amigo da criança”, “baby friendly initiative hospital”, “aleitamento materno” and “breastfeeding”. The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated.Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries.Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

Negotiated Legality and Political Work – The Social Constructions of the Legal Environment around Breastfeeding in Brazil

Negotiated Legality and Political Work – The Social Constructions of the Legal Environment around Breastfeeding in Brazil

Legalidade Negociada e Political Work – A Construção Social do Ambiente Legal em Torno da Amamentação no Brasil

Legalidade Negociada e Political Work – A Construção Social do Ambiente Legal em Torno da Amamentação no Brasil

A importância da cooperação sul-sul em saúde no processo de implantação da Rede Latino-americana de Banco de Leite Humano

Objetivo: Este estudo tem como objetivo analisar a importância do modelo de cooperação sul-sul para a implantação da Rede Latino-americana de Banco de Leite Humano e as ações desempenhadas pelo Brasil neste processo de implantação. Metodologia: Tratou-se de uma pesquisa com a utilização da análise bibliográfica e documental, para a compreensão da cooperação estruturante. Sendo realizada a busca nas bases de dados do SciELO, e LILACS, e no site da Rede Global de Banco de Leite da Fundação Oswaldo Cruz. Foram selecionados 10 artigos e cinco documentos oficiais. Resultados: Percebe-se que a trajetória de cooperação entre os países teve sua construção marcada por eventos e acordos, que permitiram a estruturação da Rede Global de Leite Humano, maior articuladora para o sucesso da política pública em amamentação no Brasil, enfrentando da mortalidade infantil, e afirmando o protagonismo feminino que movimenta todas as ações que cooperam para a redução da mortalidade infantil. Conclusão: A estratégia mantém um perfil solidário entre os países pactuados, pois o objetivo de redução da mortalidade é enfrentado como experiência exitosa.

Gestational, perinatal, and postnatal factors that interfere with practice of exclusive breastfeeding by six months after birth

BackgroundDespite evidences indicating the superiority of breastfeeding and recent advances in the indicators of breastfeeding in Brazil, exclusive breastfeeding (EBF) during the first six months after birth continues to be an infrequent practice in the country. The objective of the present study was to determine which gestational, perinatal, and postnatal factors of the mother-baby dyad might be associated with the cessation of EBF by six months after birth.MethodsData were collected at the rooming-in facility of the Reference Center of Women’s Health of Ribeirão Preto-Mater (CRSM-Mater) during the postpartum period (24 to 72 h after birth) from December 2012 to April 2013 and by telephone contact between the researcher and participating mothers by six months after birth.Questionnaires were applied to collect data, such as the practice of EBF in the last 24 h in the sixth month after birth. The hierarchical theoretical model was proposed and data were analyzed statistically by log-binomial regression models using SAS 9.3.ResultsThe study involved 283 mother-baby dyads in which the mother evaluated did not present pregnancy-puerperal complications that could impede breastfeeding and confirmed the interest in breastfeeding her child. After the telephone contact in the exact sixth month after the birth of each participating baby, 84.8% of the participating mothers reported that they were no longer exclusively breastfeeding their babies. After statistical analysis, we found that there was a significant association between cessation of EBF and maternal report of previous experience with EBF for one month (0.91, 95% CI 0.81, 0.99) and six months (0.81; 95% CI 0.68, 0.94). These practices were associated with the maintenance of EBF and, even after adjustment for maternal socio-demographic variables, this association was maintained (0.85; 95% CI 0.73, 0.99). Thus, there is a greater chance of practicing and maintaining EBF by six months after birth when mother had previous experience with it.ConclusionThe identification of the risk variables associated with cessation of EBF by six months postpartum, such as previous experience with exclusive breastfeeding, may contribute to the effectiveness of EBF intervention and support measures during the first six months after birth.

HABITS AND ATTITUDES OF MOTHERS OF INFANTS IN RELATION TO BREASTFEEDING AND ARTIFICIAL FEEDING IN 11 BRAZILIAN CITIES.

ABSTRACTObjective: To analyze the relationship between habits and attitudes of mothers and the types of milk offered to their children in their first two years of life.Methods: Retrospective study including 773 interviews of mothers from 11 Brazilian cities with children under 2 years of age. Interviews were conducted in 11 cities of Brazil. The following factors were analyzed: breastfeeding method planned during pregnancy and the method actually applied after birth; type(s) of milk(s) used on the day of the interview and earlier; age at which the child was introduced to whole milk; and source of advice used to choose a certain type of milk.Results: Breast milk was offered to 81.7% of infants during their first six months of life, to 52.2% of infants during their second semester (p<0.001) and to 32.9% of infants during their second year of life (p<0.001). In contrast, cow’s milk consumption increased from 31.1 to 83.8% (p<0.001) and 98.7% (p=0.05), respectively, for these three age groups. Infant (15.0%) and follow-on (also known as toddler’s) (2.3%) formulas were used by a much smaller number of infants than whole cow’s milk. Most mothers were not prescribed whole cow’s milk. Pediatricians were the health care professionals who most often recommended infant formulas.Conclusions: Rates of breastfeeding in Brazil remain below recommended levels. Brazilian mothers often decide to feed their infants with whole cow’s milk on their own initiative. The use of infant formulas after weaning is still too low.

Pacifier Use and Exclusive Breastfeeding in Brazil.

Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF. This study aimed to find out if pacifier use is an independent risk factor for the interruption of EBF among Brazilian infants. We conducted secondary cross-sectional data analyses of 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (N = 42 395 children < 6 months). Multivariate logistic regression was used to test the association between pacifier use and the risk of interruption of EBF in a pooled sample and within each survey wave, adjusting for socioeconomic, demographic, and biomedical confounders. In the pooled sample, a third of the infants were exclusively breastfed (32.7%) and almost 50% had used a pacifier. Whereas EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 58.5% to 41.6% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (adjusted odds ratio [AOR] = 2.65; 95% confidence interval [CI], 2.38-2.94), in 2008 (AOR = 3.18; 95% CI, 2.81-3.60), and in the pooled sample (AOR = 2.77; 95% CI, 2.63-2.91) after adjusting for key confounders. Pacifier use was the strongest risk factor for EBF interruption. Effective strategies to reduce pacifier use among infants younger than 6 months may further improve EBF rates in Brazil.

Avanços e desafios do aleitamento materno no Brasil: uma revisão integrativa

Objective: To analyze the panorama of breastfeeding in Brazil through an integrative literature review highlighting its advances and challenges. Methods: We carried out an integrative literature review in the SciELO and PubMed databases and in booklets published on the websites of the Ministry of Health and the International Baby Food Action Network (IFBAN) using the following Portuguese and English descriptors: aleitamento materno (breastfeeding), autoeficacia (self-efficacy), promocao da saude (health promotion) and desmame (weaning) in the period from 2002 to 2015. Results: We identified at first 43 articles, 33 booklets, 1 thesis and 3 dissertations, including in the study 17 articles, 3 dissertations and 19 booklets due to information saturation. It was verified that breastfeeding rates have reduced significantly over time with direct implications in infant mortality rates, being associated with early weaning and the lack of promotion of maternal self-efficacy in the prenatal and postpartum. To change this situation, Brazil imposed a number of public policies aimed at breastfeeding success, which advocated to raise rates. Conclusion: Despite the advances, the Brazilian panorama of breastfeeding shows that the country remains below the recommendations of international organizations, and overcoming the obstacles to successful breastfeeding constitutes a major challenge for the Brazilian public health.

Tendencia secular da amamentacao no Brasil

The objective of this study was to document the secular trend in breastfeeding in Brazil. Data bases from seven national surveys conducted from 1975 to 2008 were reanalyzed. To obtain compatible data from the different surveys, children in the same age group and the same indicators were analyzed, using the same statistical techniques. The median duration of breastfeeding increased from 2.5 to 11.3 months, and the prevalence of exclusive breastfeeding in infants under six months of age increased from 3.1% to 41.0% in the period. The results indicate important challenges in accelerating the rhythm at which this practice in Brazil moves towards meeting international recommendations.

&lt;b&gt;"Nothing is more natural than breastfeeding" - Contemporary Discourses on breastfeeding in Brazil&lt;/b&gt; - DOI: 10.3395/reciis.v6i4.666en

&lt;b&gt;"Nothing is more natural than breastfeeding" - Contemporary Discourses on breastfeeding in Brazil&lt;/b&gt; - DOI: 10.3395/reciis.v6i4.666en

Aleitamento materno entre crianças de até quatro meses do Jardim Santo Amaro de Cambé – PR

Despite the massive campaign encouraging breastfeeding in Brazil, exclusive breastfeeding is still very little practiced. This research was carried out in order to check the index of exclusive breastfeeding in the first four months in the lives of children born in Santo Amaro, Cambe, Parana State. Records were analyzed and 46 mothers were interviewed through home visits when their children were four months old. Only 13% of the children were being exclusively breastfed at the fourth month of their birth, 21.7% were predominantly being breastfed, 47.8% were being breastfed, and 17.4% were exclusively being fed with artificial milk. It was observed that 63% of those children were being fed with another type of milk besides mother’s milk up to the fourth month of age. This research shows the need to re-evaluate and re-orient actions of promotion and support to breastfeeding by health professionals, thus increasing the number of children who benefit from such a practice.

Prevalência do aleitamento materno nas capitais brasileiras

To estimate the prevalence of breastfeeding and of exclusive breastfeeding in Brazilian capital cities, in the 5 major geographical areas of Brazil and in the whole country, at the ages of 30, 120 and 180 days, as agreed among specialists. Restudy of data from the population inquiry about breastfeeding in 25 capital cities and in the Federal District during a mass immunization campaign, on October 16th, 1999, National Day of Vaccination, supervised by one of the authors. The random sample of this study refers to 10,778 children, according to the ages mentioned above. The point and interval estimates (95% CI) were given for the capital cities and then extrapolated to the major geographical areas and to Brazil. The regression analysis was used on the SAS statistical program. The estimated prevalence of breastfeeding in Brazil was 87.3% (CI 95%: 86.8-87.7) at the age of 30 days, 77.5% (77.1-78.0) at the age of 120 days and 68.6% (68.2-69.1) at the age of 180 days. The exclusive breastfeeding prevalence was 47.5% (46.4-48.5), 17.7% (17.2-18.3) and 7.7% (7.2-8.2) at the ages mentioned. At the age of 30 days, variation of the frequency of exclusive breastfeeding was wide, from 73.4% (Fortaleza) to 25.2% (Cuiabá). At the age of 180 days, the prevalence ranged from 16.9% in Belém to 2.8% in Cuiabá. There was a moderate reduction of the prevalence of breastfeeding and a steep decline of the prevalence of exclusive breastfeeding from birth to the age of 180 days. Important differences were noted in the frequency of exclusive breastfeeding among the capital cities surveyed.

In practice, the theory is different: A processual analysis of breastfeeding in northeast Brazil

‘Na prática, a teoria è outra’ (in practice, the theory is different) is an old Brazilian saying. This phrase summarizes well the general practice of breastfeeding in Brazil: ‘Breast is best’ is central in the pregnant women's future oriented ‘theory’ of how their infant should be fed. In the subsequent weeks after delivery, however, in the daily practicalities of feeding their infant, this theory is, to a large extent, abandoned. The present study is based on a sample of 300 mothers in the city of Aracaju in the Northeast of Brazil. Through interviews, the differences and similarities between knowledge and practice with respect to infant feeding were established. An explanation of these differences is developed on the basis of a processual analysis of the qualitative and quantitative results of the interview data. Nearly all mothers were knowledgeable of the need to breastfeed, and nearly all mothers had initiated breastfeeding. However, only a minority was exclusively breastfeeding at the time of the interview. A distinction is made between a breastfeeding process and a de-breastfeeding process. The data suggest that mothers, in general, start the de-breastfeeding process with the positive intention of ameliorating the infant's situation without realizing the negative processual consequences that most likely ends in a cessation of breastfeeding. The study supports the view that health policy should underline the processual character of both breastfeeding and de-breastfeeding when promoting the importance of exclusive breastfeeding.

Comparison of the effect of two systems for the promotion of exclusive breastfeeding

Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits. In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat. The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none. The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed.

Trends in breastfeeding research by Brazilian nurses

Exclusive breastfeeding is acknowledged as important for survival, optimal growth, and development of infants. The current review presents a synthesis of research output by Brazilian nurses on breastfeeding over the last 20 years, analyzes the theoretical and methodological issues emerging from studies on breastfeeding in Brazil, and provides directions for future research and practice by nurses in the area breastfeeding. Studies included in this review were identified through LILACS searches of Portuguese-language sources. Articles were organized and analyzed chronologically by comparing the evolution of the Brazilian Breastfeeding Program. The incomplete research output of the Brazilian nursing profession in regard to breastfeeding research needs to be addressed. In addition, specific cultural, sociological, and anthropological characteristics of Brazilian regional settings remain to be explored. Emphasis on potential confounders and critical interrelations is warranted.

Estimation of births averted due to breast-feeding and increases in levels of contraception needed to substitute for breast-feeding.

After contraceptive use, breast-feeding duration is the major determinant of the birth interval length. Three methods of estimating births averted by breast-feeding, and the increase in contraceptive use needed to substitute for breast-feeding, are presented. Method 1 simply utilizes Bongaarts' Ci, and the other two are based on mean birth intervals with and without breast-feeding. Estimates for each method are derived for six countries with DHS surveys from the mid-1990s: Burkina Faso, Uganda, India, Indonesia, Brazil and Peru. The estimated percentage of additional births that would occur if there were no breast-feeding ranged from 1-4%, in Brazil to about 50% in Burkina Faso and Uganda, reflecting very low breast-feeding in Brazil and very high levels in the sub-Saharan African nations. Strengths and limitations of the three methods are considered.

A review of breastfeeding in Brazil and how the country has reached ten months' breastfeeding duration

In 1975, one out of two Brazilian women only breastfed until the second or third month; in a survey from 1999, one out of two breastfed for 10 months. This increase over the course of 25 years can be viewed as a success, but it also shows that many activities could be better organized, coordinated, and corrected when errors occur. Various relevant decisions have been made by international health agencies during this period, in addition to studies on breastfeeding that have reoriented practice. We propose to review the history of the Brazilian national program to promote breastfeeding, focusing on an analysis of the influence of international policies and analyzing them in four periods: 1975-1981 (when little was done), 1981-1986 (media campaigns), 1986-1996 (breastfeeding-friendly policies), and 1996-2002 (planning and human resources training activities backed by policies to protect breastfeeding). The challenge for the future is to continue to promote exclusive breastfeeding until the sixth month, taking specific population groups into account.