High consumption of ultra-processed foods among children under 1 year of age was found. Both maternal socioeconomic status and time until the child's first appointment at the primary healthcare unit were associated with the prevalence of ultra-processed food intake.

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Objective: To test the hypothesis that a continuing educational strategy (ie, “the manual”) in primary health-care improves infant feeding practices among infants under 1 year of age. Methods: A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to support continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estratégia Amamenta e Alimenta Brasil with health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results: Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions: The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.

Objetivo: Avaliar a implementação do Manual de Apoio ao Tutor da Estratégia Amamenta e Alimenta Brasil (EAAB) – “o Manual”, elaborado para apoiar atividades de educação permanente (AEP) na atenção primária à saúde. Métodos: Pesquisa avaliativa com abordagem quantitativa e qualitativa. A intervenção avaliada consistiu no uso do Manual pelos tutores de Embu das Artes-SP. O Manual propõe o desenvolvimento de cinco AEP com a equipe de saúde. A coleta de dados, antes e depois da intervenção, compreendeu: 1) teste de conhecimentos para tutores e trabalhadores; 2) questionário com os gerentes das unidades básicas de saúde (UBS) sobre a implementação da intervenção e o cumprimento dos critérios de certificação da EAAB propostos pelo Ministério da Saúde. Realizou-se uma oficina de escuta com informantes-chave sobre o uso do Manual. Empregou-se análise quantitativa dos indicadores de implementação e análise qualitativa da oficina de escuta. Resultados: O Manual foi utilizado por oito de 13 tutores. A mediana de realização de AEP nas UBS foi de 5 [0-5]. A média de acertos dos tutores (pré 31,43 ± 5,25; pós 34,86 ± 4,45; p=0,021) e trabalhadores (pré 26,09 ± 4,45; pós 30,28 ± 3,55; p=0,002) no teste de conhecimentos final foi maior do que no inicial. O número de critérios de certificação alcançados pelas UBS foi maior na pós-intervenção (mediana: pré 3 [1-6]; pós 5 [3-6]) e apresentou consistência com a percepção de mudanças dos gerentes, assim como com o número de AEP conduzidas pelos tutores.  Conclusões: O uso do Manual melhorou o conhecimento dos tutores e trabalhadores, e promoveu mudanças positivas no processo de trabalho das equipes.DOI: 10.12957/demetra.2019.43322

This article aims to map promotion, protection, and support strategies aimed at working women who breastfeed and their potential impact on achieving the Sustainable Development Goals (SDGs), in particular SDGs 5 (gender equality and women’s empowerment) and 8 (decent work and economic growth). This study is a scoping review based on the Joanna Briggs Institute (JBI) framework, whose searches were performed in PubMed, Web of Science, Scopus, Social Science Research Network, and Open Knowledge Repository databases. This study’s search obtained 576 publications, of which 33 were included in the study. The narrative synthesis was organized into three axes: 1) promotion; 2) protection, and 3) support for breastfeeding in the work context. Actions aimed at women who breastfeed at work have the potential to directly achieve SDGs 5 and 8, and indirectly achieve SDGs 1 and 10. Increased breastfeeding rates also help to achieve another four SDGs (2, 3, 4, 12). Actions aimed at working women who breastfeed can contribute directly and indirectly to the achievement of eight of the 17 SDGs, and should therefore be encouraged and reinforced.

Background Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary healthcare teams to ultimately improving infant feeding practices in the Brazilian population. In primary healthcare units, continuing education in breastfeeding and complementary feeding is facilitated by EAAB tutors. A Manual to Support EAAB Tutor (the Manual) was developed following a problem-based learning methodology. This study aimed to evaluate the effectiveness of using the Manual by analyzing exclusive breastfeeding and complementary feeding indicators. Methods A before and after study was conducted at primary healthcare units in Embu das Artes, Brazil. The intervention consisted in the use of the Manual by EAAB tutors who performed some comprehensive training activities with healthcare teams, in a period of 8 months. Subjects consisted of mothers of infants under one year of age attended at primary healthcare units. 561 mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions The Manual is a continuing educational strategy that improved complementary feeding practices in primary health care. Key messages The use of a continuing education strategy grounded on a problem-based learning methodology was effective to produce improvements in complementary feeding practices in primary health care. The 'Manual to Support EAAB Tutor' consists of a tool that has the potential to be adapted for different contexts and easy to disclose to all EAAB tutors in the country.

Descritores: avaliação de intervenções, práticas de alimentação infantil, aleitamento materno, alimentação complementar, educação permanente em saúde, atenção primária em saúde.

Objective: To develop a rapid review on effective actions for the promotion of breastfeeding and healthy complementary feeding in primary health care and to summarize a list of actions and their elements for implementation. Data source: The review included systematic reviews on the effectiveness of interventions to promote breastfeeding and/or healthy complementary feeding for mothers and other caregivers, and/or professionals who work with this population, in comparison with any usual approach or none. Data synthesis: A total of 32 systematic reviews were included in the evidence synthesis. Ten types of interventions were evaluated in systematic reviews on promotion of breastfeeding and four types of interventions on promotion of healthy complementary feeding. The synthesis allowed six aspects to be discussed, and these must be considered to increase the chances of interventions’ impact: type of intervention, target audience, timing of intervention, actors that can implement it, strategies and methods of intervention, and intensity of intervention. Conclusions: It was possible to assemble a list of actions whose effectiveness has already been demonstrated, providing elements for local adaptations. Evidence is expected to support and strengthen the implementation of programs aimed at promoting breastfeeding and complementary feeding in primary health care.