Resumo O objetivo foi avaliar a implantação da Rede Amamenta Brasil e seu impacto sobre indicadores de aleitamento materno (AM

Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.

Objective: To analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breast-feeding during the first hour of life (BFFHL) and reducing late neonatal mortality. Design: Cost-effectiveness economic assessment from the health system perspective, preceded by a prospective cohort of mother–baby followed from birth to 6 months of life. The direct costs associated with two health outcomes were analysed: intermediate end point (BFFHL) and final end point (reduction in late neonatal mortality). Setting: Study was carried out in six hospitals in the city of São Paulo (Brazil), three being Baby-Friendly Hospitals (BFH) and three non-BFH. Participants: Mothers with 24 h postpartum, over 18 years old, single fetus and breast-feeding at the time of the interview were included. Poisson regressions adjusted for maternal age and level of education were estimated to identify factors related to BFFHL and late neonatal mortality. Sensitivity analysis was performed to ensure robustness of the economic assessment. Results: Cost-effectiveness analysis showed that BFHI was highly cost-effective in raising BFFHL by 32·0 % at lower cost in comparison with non-BFHI. In addition, BFHI was cost-effective in reducing late neonatal mortality rate by 13·0 % from all causes and by 13·1 % of infant mortality rate from infections. Conclusions: The cost-effectiveness of the BFHI in promoting breast-feeding and reducing neonatal mortality rates justifies the investments required for its expansion within the Brazilian health system.

Title: Cost-effectiveness analysis of the Baby-Friendly Hospital Initiative to promote breastfeeding and reduce infant mortality INTRODUCTION: Breastfeeding practice has the greatest impact on the prevention of infant morbimortality. The Baby-Friendly Hospital Initiative (BFHI) is an important strategy on the promotion of breastfeeding and its costs might justify to study it to evaluate effectiveness for the health system. OBJECTIVES: To evaluate the cost-effectiveness of BFHI in promoting exclusive breastfeeding and reducing infant mortality in the city of São Paulo. METHODOLOGY: This is a study of economic evaluation of public health policy with data from a prospective cohort study conducted in six public hospitals. The intervention group was composed of three Baby-Friendly Hospitals (BFH) and the comparison group by three Not Baby-Friendly Hospitals (NBFH). The effectiveness of BFHI was evaluated by analyzing intermediate outcomes: the increase first-hour breastfeeding, breastfeeding (BF), exclusive breastfeeding (EBF) and final outcomes: avoided cases of late neonatal deaths, at six months and hospitalizations. The outcomes were estimated by calculating the Preventive Fraction (PF) for neonatal mortality and hospital admissions, and the Risk Reduction Ratio for estimating infant mortality in children under six months. The average costs according to type of delivery and length of stay were calculated, by micro-accounting for the cost items: medicines, supplies, exams and human resources to obtain the cost-Effectiveness Ratio (CER) and incremental Cost-Effectiveness Ratio (ICER) for the intermediate and final outcomes. Tests for comparison of proportions and means were applied. The Poisson regression was adjusted according to maternal age and schooling (significance of 95% (α = 5%)) and univariate and deterministic sensitivity analysis to evaluate the robustness of the ICER. RESULTS: 969 mothers were included in the first interview, 902 in the second and 814 in the third. Among children born in BFH, the prevalence of breastfeeding was higher in all indicators compared to those born in NBFH: 30.7% higher for first-hour breastfeeding; 1.2% in EBF at 30 days; 7.2% in BF and 21.9% in EBF at 6 months of life. Only the first-hour breastfeeding increment showed a statistically significant difference between BFH and NBFH. After adjustment of variables firsthour breastfeeding was negatively associated with: born in NBFH (RP1,29 IC1,04-1,59), cesarean delivery (RP1,90 IC 1.53-2,36) and did not make skin-to-skin (RP4,13 CI 2,38-7,13). EBF at 30 days was negatively associated with the mother having had difficulty in breastfeeding (RP1,38 CI 1.03-1.85), not living with a partner (RP1,46 CI 1.08-1.96), not having received support (RP1,40 CI1,01-1,95) non-compliance with step 6 (RP1,86 CI 1.36-2.55), noncompliance with step 9 (RP1,95 IC 1.32-2 , 88) and children use pacifiers (RP1,84 IC1,39-2,42). EBF at 180 days were negatively associated: use of pacifiers (RP 1.19 CI 1.02-1.39) and maternal work (RP1.27 CI 1.08-1.49). The s...

Objetivo: descrever a evolução do Sistema de Vigilância Alimentar e Nutricional (Sisvan) e do estado nutricional de crianças indígenas menores de cinco anos de idade no estado de Mato Grosso do Sul, no período de 2002 a 2011. Métodos: estudo ecológico, realizado a partir de dados provenientes dos relatórios de gestão do Distrito Sanitário Especial Indígena de Mato Grosso do Sul (DSEI/MS), referentes a todas as crianças indígenas menores dessa idade que tiveram seu estado nutricional avaliado pelo indicador 'peso por idade'. Resultados: observou-se aumento da cobertura do Sisvan Indígena de 82,0% em 2002 para 97,2% em 2011, acompanhado da redução na prevalência de baixo peso de 16,0% para 6,5% no período. Conclusão: houve aumento da cobertura do Sisvan indígena e significativa redução da desnutrição infantil no período estudado; entretanto, não se pode negligenciar os grandes desafios, todavia existentes, para promoção da saúde e nutrição infantil nessa população.