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Infant feeding practices and determinant variables for early complementary feeding in the first 8 months of life: results from the Brazilian MAL-ED cohort site

  • BLL Maciel (a1), ML Moraes (a2), AM Soares (a3), IFS Cruz (a3), MIR de Andrade (a3), JQ Filho (a3), FS Junior (a3), PN Costa (a1), CB Abreu (a3), R Ambikapathi (a4) (a5), RL Guerrant (a6), LE Caulfield (a7) and AAM Lima (a3)...

Abstract

Objective

The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community.

Design

A birth cohort was conducted (n 233), with data collection twice weekly, allowing close observation of breast-feeding, complementary feeding introduction and description of the WHO core indicators on infant and young child feeding. Infant feeding practices were related to socio-economic status (SES), assessed by Water/sanitation, wealth measured by a set of eight Assets, Maternal education and monthly household Income (WAMI index). Two logistic regression models were constructed to evaluate risk factors associated with early complementary feeding.

Results

Based on twice weekly follow-up, 65 % of the children received exclusive breast-feeding in the first month of life and 5 % in the sixth month. Complementary feeding was offered in the first month: 29 % of the children received water, 15 % infant formulas, 13 % other milks and 9·4 % grain-derived foods. At 6 months, dietary diversity and minimum acceptable diet were both 47 % and these increased to 69 % at 8 months. No breast-feeding within the first hour of birth was a risk factor for the early introduction of water (adjusted OR=4·68; 95 % CI 1·33, 16·47) and low WAMI index a risk factor for the early introduction of other milks (adjusted OR=0·00; 95 % CI 0·00, 0·02).

Conclusions

Data suggest local policies should promote: (i) early breast-feeding initiation; (ii) SES, considering maternal education, income and household conditions; (iii) timely introduction of complementary feeding; and (iv) dietary diversity.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Corresponding author: Email brunalimamaciel@gmail.com

References

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1. World Health Organization (2008) Indicators for Assessing Infant and Young Child Feeding Practices. Part I: Definitions. Geneva: WHO.
2. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355, 451455.
3. Horta, BL, Bahl, R, Martines, JC et al. (2007) Evidence on the Long-term Effects of Breastfeeding. Geneva: WHO.
4. Rollins, NC, Bhandari, N, Hajeebhoy, N et al. (2016) Why invest, and what it will take to improve breastfeeding practices? Lancet 387, 491504.
5. Hawkes, C (2007) Globalization, Food and Nutrition Transitions. Ottawa: WHO Commission on Social Determinants of Health.
6. de Souza, NP, de Lira, PIC, Fontbonne, A et al. (2017) (Mal)nutrition and the new epidemiological trend in a context of development and inequalities. Cien Saude Colet 22, 22572266.
7. Sawaya, AL, Dallal, G, Solymos, G et al. (1995) Obesity and malnutrition in a shantytown population in the city of Sao Paulo, Brazil. Obes Res 3, Suppl. 2, 107S115S.
8. Ministry of Health (Brazil), Health Attention Secretariat, Department of Basic Attention (2013) National Policy for Food and Nutrition. Brasíllia: Ministério da Saúde.
9. Ministry of Health (Brazil), Health Attention Secretariat, Department of Basic Attention (2015) National Strategy for Promotion of Breastfeeding and Healthy Complementary Feeding in the Brazilian Health System (SUS/Brazil): Implementation Guide. Brasília: Ministério da Saúde.
10. Ministry of Health (Brazil), Health Attention Secretariat, Department of Basic Attention (2015) Child Health: Breastfeeding and Complementary Feeding, 2nd ed., p. 184. Brasília: Ministério da Saúde.
11. World Health Organization/UNICEF (2003) Global Strategy for Infant and Young Child Feeding. Geneva: WHO/UNICEF.
12. Victora, CG, Adair, L, Fall, C et al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.
13. Kramer, MS & Kakuma, R (2012) Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev issue 8, CD003517.
14. Heymann, J, Raub, A & Earle, A (2013) Breastfeeding policy: a globally comparative analysis. Bull World Health Organ 91, 398406.
15. Chuang, CH, Chang, PJ, Hsieh, WS et al. (2007) The combined effect of employment status and transcultural marriage on breast feeding: a population-based survey in Taiwan. Paediatr Perinat Epidemiol 21, 319329.
16. Tang, L, Binns, CW, Luo, C et al. (2013) Determinants of breastfeeding at discharge in rural China. Asia Pac J Clin Nutr 22, 443448.
17. Ku, CM & Chow, SK (2010) Factors influencing the practice of exclusive breastfeeding among Hong Kong Chinese women: a questionnaire survey. J Clin Nurs 19, 24342445.
18. Inoue, M, Binns, CW, Otsuka, K et al. (2012) Infant feeding practices and breastfeeding duration in Japan: a review. Int Breastfeed J 7, 15.
19. The MAL-ED Network Investigators (2014) The MAL-ED study: a multinational and multidisciplinary approach to understand the relationship between enteric pathogens, malnutrition, gut physiology, physical growth, cognitive development, and immune responses in infants and children up to 2 years of age in resource-poor environments. Clin Infect Dis 59, Suppl. 4, S193S206.
20. Lima, AAM, Oria, RB, Soares, AM et al. (2014) Geography, population, demography, socioeconomic, anthropometry, and environmental status in the MAL-ED cohort and case–control study sites in Fortaleza, Ceara, Brazil. Clin Infect Dis 59, Suppl. 4, S287S294.
21. Labbok, MH & Starling, A (2012) Definitions of breastfeeding: call for the development and use of consistent definitions in research and peer-reviewed literature. Breastfeed Med 7, 397402.
22. Caulfield, LE, Bose, A, Chandyo, RK et al. (2014) Infant feeding practices, dietary adequacy, and micronutrient status measures in the MAL-ED study. Clin Infect Dis 59, Suppl. 4, S248S254.
23. Rutstein, SO & Johnson, K (2004) The DHS Wealth Index. DHS Comparative Reports no. 6. Calverton, MD: ORC Macro; available at http://www.dhsprogram.com/publications/publication-cr6-comparative-reports.cfm
24. Psaki, SR, Seidman, JC, Miller, M et al. (2014) Measuring socioeconomic status in multicountry studies: results from the eight-country MAL-ED study. Popul Health Metr 12, 8.
25. Garcia, C, Mullany, L, Rahmathullah, L et al. (2011) Breast-feeding initiation time and neonatal mortality risk among newborns in South India. J Perinatol 31, 397403.
26. Mullany, LC, Katz, J, Li, YM et al. (2008) Breast-feeding patterns, time to initiation, and mortality risk among newborns in southern Nepal. J Nutr 138, 599603.
27. Michaelsen, KF, Lauritzen, L & Mortensen, EL (2009) Effects of breast-feeding on cognitive function. In Breast-Feeding: Early Influences on Later Health. Advances in Experimental Medicine and Biology, pp. 199215 [GR Goldberg, A Prentice, A Prentice et al., editors]. Dordrecht: Springer Netherlands.
28. Straub, N, Grunert, P, Northstone, K et al. (2016) Economic impact of breast-feeding-associated improvements of childhood cognitive development, based on data from the ALSPAC. Br J Nutr. Published online 22 January 2016. doi: 10.1017/S0007114515001233.
29. Venancio, SI, Saldiva, SRDM & Monteiro, CA (2013) Secular trends in breastfeeding in Brazil. Rev Saude Publica 47, 12051208.
30. Ambikapathi, R, Kosek, MN, Lee, GO et al. (2016) How multiple episodes of exclusive breastfeeding impact estimates of exclusive breastfeeding duration: report from the eight-site MAL-ED birth cohort study. Matern Child Nutr 12, 740756.
31. Lima, AA, Moore, SR, Barboza, MS Jr et al. (2000) Persistent diarrhea signals a critical period of increased diarrhea burdens and nutritional shortfalls: a prospective cohort study among children in northeastern Brazil. J Infect Dis 181, 16431651.
32. Moore, SR, Lima, AA, Schorling, JB et al. (2000) Changes over time in the epidemiology of diarrhea and malnutrition among children in an urban Brazilian shantytown, 1989 to 1996. Int J Infect Dis 4, 179186.
33. Moore, SR, Lima, NL, Soares, AM et al. (2010) Prolonged episodes of acute diarrhea reduce growth and increase risk of persistent diarrhea in children. Gastroenterology 139, 11561164.
34. Dashti, M, Scott, JA, Edwards, CA et al. (2010) Determinants of breastfeeding initiation among mothers in Kuwait. Int Breastfeed J 5, 7.
35. Engebretsen, IM, Wamani, H, Karamagi, C et al. (2007) Low adherence to exclusive breastfeeding in Eastern Uganda: a community-based cross-sectional study comparing dietary recall since birth with 24-hour recall. BMC Pediatr 7, 10.
36. Chapman, DJ & Perez-Escamilla, R (1999) Identification of risk factors for delayed onset of lactation. J Am Diet Assoc 99, 450454.
37. Buccini, GDS, Benicio, MHDA & Venancio, SI (2014) Determinants of using pacifier and bottle feeding. Rev Saude Publica 48, 571582.
38. World Health Organization (2009) Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. Geneva: WHO.
39. Sachdev, HPS, Krishna, J, Puri, RK et al. (1991) Water supplementation in exclusively breastfed infants during summer in the tropics. Lancet 337, 929933.
40. Guerrant, RL, DeBoer, MD, Moore, SR et al. (2013) The impoverished gut -- a triple burden of diarrhoea, stunting and chronic disease. Nat Rev Gastroenterol Hepatol 10, 220229.
41. Brown, K, Dewey, K & Allan, L (1998) Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva: WHO.
42. Pan American Health Organization/World Health Organization (2003) Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC: PAHO/WHO.
43. Bernardi, JLD, Jordão, RE & Barros Filho, AA (2009) Supplementary feeding of infants in a developed city within the context of a developing country. Rev Panam Salud Publica 26, 405411.
44. Caetano, MC, Ortiz, TTO, Silva, SGL da et al. (2010) Complementary feeding: inappropriate practices in infants. J Pediatr (Rio J) 86, 196201.
45. de Oliveira, DA, de Castro, IRR, Jaime, PC et al. (2014) Complementary feeding patterns in the first year of life in the city of Rio de Janeiro, Brazil: time trends from 1998 to 2008. Cad Saude Publica 30, 17551764.
46. Saldiva, SR, Venancio, SI, Gouveia, AG et al. (2011) Regional influence on early consumption of foods other than breast milk in infants less than 6 months of age in Brazilian State capitals and the Federal District. Cad Saude Publica 27, 22532262.
47. Ministry of Health (Brazil), Health Attention Secretariat, Department of Basic Attention (2012) Ten Steps for a Healthy Feeding: Feeding Guide for Child Under Two Years: a Guide for the Professional in the Primary Health Care. Brasília: Ministério da Saúde.
48. Baldissera, R, Mário, R, Issler, S et al. (2016) Effectiveness of the National Strategy for Healthy Complementary Feeding to improve complementary feeding of infants in a municipality in Southern Brazil. Cad Saude Publica 9, e0010131.
49. Mallard, SR, Houghton, LA, Filteau, S et al. (2016) Micronutrient adequacy and dietary diversity exert positive and distinct effects on linear growth in urban Zambian infants. J Nutr 146, 20932101.
50. Lamichhane, DK, Leem, JH, Kim, HC et al. (2016) Association of infant and young child feeding practices with under-nutrition: evidence from the Nepal Demographic and Health Survey. Paediatr Int Child Health 36, 260269.
51. Zongrone, A, Winskell, K & Menon, P (2012) Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr 15, 16971704.

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