OBJECTIVE Update breastfeeding indicators trend in Brazil for the last three decades, incorporating more up-to-date information from the National Health Survey.METHODS We used secondary data from national surveys with information on breastfeeding (1986, 1996, 2006, and 2013) to construct the time series of prevalence for the following indicators: exclusive breastfeeding in children under six months of age (EBF6m), breastfeeding in toddlers under 2 years of age (BF), continued breastfeeding at one year of age (BF1year), and continued breastfeeding at two years of age (BF2years).RESULTS The prevalence of EBF6m, BF, and BF1year increased until 2006 (rising from 4.7%, 37.4%, and 25.5% in 1986 to 37.1%, 56.3%, and 47.2% in 2006, respectively). For these three indicators, there was relative stabilization between 2006 and 2013 (36.6%, 52.1%, and 45.4%, respectively). The BF2years indicator had a distinct behavior – relatively stable prevalence, around 25% between 1986 and 2006, and a subsequent increase, reaching 31.8% in 2013.CONCLUSIONS The time series of breastfeeding indicators in Brazil shows an upward trend until 2006, stabilizing from that date onwards on three of the four indicators evaluated. This result, which can be considered as a warning sign, requires evaluation and revision of policies and programs to promote, protect and support breastfeeding, strengthening existing ones and proposing new strategies so that the prevalence of breastfeeding indicators returns to an upwards trend.

OBJECTIVE To identify factors associated with exclusive breastfeeding in the first six months of life in Brazil.METHODS Systematic review of epidemiological studies conducted in Brazil with exclusive breastfeeding as outcome. Medline and LILACS databases were used. After the selection of articles, a hierarchical theoretical model was proposed according to the proximity of the variable to the outcome.RESULTS Of the 67 articles identified, we selected 20 cross-sectional studies and seven cohort studies, conducted between 1998 and 2010, comprising 77,866 children. We identified 36 factors associated with exclusive breastfeeding, being more often associated the distal factors: place of residence, maternal age and education, and the proximal factors: maternal labor, age of the child, use of a pacifier, and financing of primary health care.CONCLUSIONS The theoretical model developed may contribute to future research, and factors associated with exclusive breastfeeding may subsidize public policies on health and nutrition.

OBJECTIVE:To identify factors associated with breastfeeding in the fi rst hour of life (Step 4 of the Baby-Friendly Hospital Initiative). METHODS:A cross-sectional study was conducted with a representative sample of mothers who gave birth in maternity wards in the city of Rio de Janeiro, Southeastern Brazil, between 1999 and. Newborns or mothers with restriction to breastfeeding were excluded, resulting in a sample of 8,397 pairs. A random effect -at maternity hospital level -Poisson model was employed in a hierarchical approach with three levels: distal, intermediate and proximal for characteristics of the mother, of the newborn, and of prenatal and hospital assistance. RESULTS:Only 16% of the mothers breastfed in the fi rst hour of life. Breastfeeding in this period was less prevalent among neonates with immediate intercurrences after birth (PR = 0.47; CI99% 0.15;0.80); among mothers who did not have contact with their newborns in the delivery room (PR = 0.62; CI99% 0.29;0.95); among mothers submitted to cesarean section delivery (PR = 0.48; CI99% 0.24;0.72); and among mothers who gave birth at private maternity hospitals (PR = 0.06; CI99% 0.01;0.19) or at maternity hospitals contracted out to National Health System (SUS) (PR = 0.16; CI99% 0.01;0.30). The context effect of maternity wards was statistically signifi cant. CONCLUSIONS:At an individual level, breastfeeding within one hour after birth was constrained by inappropriate practices in private or SUS-contracted maternity hospitals. The group effect of maternity hospitals and the absence of individual maternal-related factors that explain the outcome suggest that mothers have little or no autonomy to breastfeed their babies within the fi rst hour of life, and depend on the institutional practices that prevail at the maternity hospitals.

BackgroundThe Brazilian Unified Health System is a public healthcare system that has universal and equitable access among its main principles, but the continental size of the country and the complexity of the public health system complicate the task of providing equal access to all. We aim to investigate the factors associated with inequities in healthcare utilization in Brazil.MethodsWe employed data from a nationally representative cross-sectional study (2013 National Health Survey; n = 60,202). The outcome was underutilization of healthcare by adults, defined as lack of utilization of one or more of these services: physician or dentist consultation, and blood glucose or blood pressure screening. A logistic regression model, considering the complex sample, was employed (alpha = 5 %).Results0.7 % of the sample never visited a physician, 3.3 % never visited a dentist, 3 % never underwent blood pressure screening, 11.5 % never underwent blood glucose screening, and 15 % never utilized at least one of these services. Multivariate models showed a higher likelihood of underutilization of healthcare among individuals of the lowest social class “E” (AOR = 6.31, 95 % CI = 3.76–10.61), younger adults (Adjusted Odds Ratio, or AOR = 4.40, 95 % CI = 3.78–5.12), those with no formal education or incomplete primary education (AOR = 2.93, 95 % CI = 2.30–3.74), males (AOR = 2.16, 95 % CI = 1.99–2.35), and those without private health insurance (AOR = 2.11, 95 % CI = 1.83–2.44). Individuals self-classified as “white” were less likely to report underutilization (AOR = 0.82, 95 % CI = 0.75–0.90).ConclusionsDespite recent expansion of primary healthcare and oral health programs in Brazil, we observed gaps in healthcare utilization among the most vulnerable segments of the population.

The protective effect of breastfeeding during the first hour of life on neo- natal mortality in this ecological study is consistent with findings from previous observa- tional studies, indicating the importance of adopting breastfeeding within the first hour as a routine neonatal care practice.

Women of lower socioeconomic status may need additional breastfeeding support after cesarean section delivery to prevent the introduction of milk-based prelacteals. Reducing the rates of cesarean section deliveries is likely to reduce the prevalence of prelacteal feeding.

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.J Pediatr (Rio J). 2011;87(5):399-404: Breastfeeding, hospitalization, pneumonia. ResumoObjetivo: Avaliar a relação entre o aleitamento materno e as internações hospitalares por pneumonia entre crianças com menos de 1 ano de vida. Métodos:Estudo epidemiológico ecológico que utilizou dados secundários de internação por pneumonia (desfecho) e de prevalência de aleitamento materno (exposição) na população de crianças com menos de 1 ano de vida nas capitais brasileiras e no Distrito Federal em 2008. A razão de taxas (RT) de internação hospitalar foi estimada por modelo estatístico binomial negativo (intervalo de confiança de 95%), ajustado pelo índice de Gini da população e pela prevalência de fumantes na população em geral e de baixo peso ao nascer na população estudada.Resultados: A prevalência de aleitamento materno em crianças de 9 a 12 meses incompletos de vida e a prevalência do aleitamento materno exclusivo entre crianças menores de 6 meses mostraram-se associadas a uma menor taxa de internação hospitalar por pneumonia (RT = 0,62; IC95% 0,51-0,74, e RT = 0,52; IC95% 0,39-0,69, respectivamente). Conclusão:O aumento das prevalências de aleitamento materno no 1º ano de vida e de aleitamento materno exclusivo nos primeiros 6 meses de uma população podem reduzir as internações hospitalares por pneumonias.J Pediatr (Rio J). 2011;87(5):399-404

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