Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-27T03:02:12.040Z Has data issue: false hasContentIssue false
  • English
  • Français

Individual and contextual determinants of exclusive breast-feeding in São Paulo, Brazil: a multilevel analysis

Published online by Cambridge University Press:  02 January 2007

Sonia Isoyama Venancio  and
Carlos Augusto Monteiro
Sonia Isoyama Venancio*
Affiliation:
Núcleo de Investigação em Nutrição, Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo, Rua Santo Antônio 590, 3° andar, Bela Vista, São Paulo, CEP 01314-000, Brazil
Carlos Augusto Monteiro
Affiliation:
Departamento de Nutrição da Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
*
*Corresponding author: Email soniav@isaude.sp.gov.br
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To identify individual and contextual factors associated with the practice of exclusive breast-feeding (EBF).

Methodology

We analysed 34 435 children under 6 months of age living in 111 municipalities in the state of São Paulo, south-eastern Brazil, who participated in a survey investigating feeding practices during the first year of life, carried out during the 1999 national vaccination campaign. The questionnaire employed included questions on the consumption, in the last 24 h, of breast milk, water, tea, other types of milk and other foods, in addition to mother and child characteristics. Information on the pro-breast-feeding measures implemented in the municipalities was also collected. The effects of individual and contextual characteristics on EBF were analysed using multilevel models.

Results

The final model showed a greater chance of EBF in women with tertiary education (odds ratio (OR) = 1.91; 95% confidence interval (CI) 1.75–2.06); women aged between 25 and 29 years (OR = 1.52; 95% CI 1.41–1.63); multiparae (OR = 1.42; 95% CI 1.33–1.49); female babies (OR = 1.12; 95% CI 1.05–1.18); birth weight ≥3000 g (OR = 1.73; 95% CI 1.49–1.97); child follow-up in the private health-care network (OR = 1.10; 95% CI 1.02–1.18); and municipalities with four or five pro-breast-feeding measures (OR = 2.4; 95% CI 2.19–2.88). An analysis of the interactions between individual and contextual variables showed that the presence of at least four pro-breast-feeding measures in the municipality attenuated the risk of early termination of EBF associated with low maternal schooling and low birth weight, and transformed child follow-up in the public network into a protective factor against the early termination of breast-feeding.

Conclusions

The presence of measures aimed at protecting, promoting and supporting breast-feeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breast-feeding.

Keywords

Breast-feedingExclusive breast-feedingExclusive breast-feeding determinantsBreast-feeding policiesMultilevel analysis
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 1 , February 2006 , pp. 40 - 46
Copyright
Copyright © The Authors 2006

References

1Victora, CG, Smith, PG, Vaughan, JP, Lombardi, C, Fuchs, SMC, Gigante, LP, et al. Evidence for protection by breastfeeding against infant deaths from infectious diseases in Brazil. Lancet 1987; 2: 317–22.Google Scholar
2César, JA, Victora, CG, Barros, FC, Santos, IS, Flores, JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case–control study. British Medical Journal 1999; 318: 1316–20.CrossRefGoogle ScholarPubMed
3Betrán, AP, Onis, M, Lauer, J, Villar, J. Ecological study of effect of breastfeeding on infant mortality in Latin America. British Medical Journal 2001; 323: 303–6.Google Scholar
4Sanghvi, TG. Melhora da eficácia em função dos custos da promoção do aleitamento materno em maternidades. Resumo do estudo USAID/LAC HNS na América Latina (1992–1995). New York: United Nations Children's Fund, Nutrition Section, 1996.Google Scholar
5Venancio, SI, Monteiro, CA. A evolução da prática da amamentação nas décadas de 70 e 80. Revista Brasileira de Epidemiologia 1998; 1: 40–9.CrossRefGoogle Scholar
6Monteiro, CA. Evolução da nutrição infantil nos anos 90. In: Velhos e novos males da saúde no Brasil: a evolução do país e suas doenças. São Paulo: Hucitec, Nupens/USP, 2000.Google Scholar
7World Health Organization (WHO). Infant and young child nutrition. 54th World Health Assembly, Resolution WHA54.2. Geneva: WHO, 2001.Google Scholar
8Silva, NN. Amostragem probabilística: um curso introdutório. São Paulo: Universidade de São Paulo, 1998.Google Scholar
9World Health Organization (WHO), Division of Child Health and Development. Indicators for Assessing Breastfeeding Practices. Geneva: WHO, 1991.Google Scholar
10Ministério da Saúde, Instituto Nacional de Alimentação e Nutrição. Programa Nacional de Incentivo ao Aleitamento Materno–PNIAM/INAN e UNICEF. Aleitamento Materno e o Município. Brasília: Ministério da Saúde, 1995.Google Scholar
11 Fundação SEADE [homepage]. http://www.seade.sp.gov.br, 3 06 2001.Google Scholar
12Silva-Ayçaguer, LC. Excursão a la regresión logística en ciencias de la salud. Madrid: Ed. Diaz de Santos, 1995.Google Scholar
13Diex-Roux, AV. Bringing context back into epidemiology: variables and fallacies in multilevel analysis. American Journal of Public Health 1998; 88: 216–22.Google Scholar
14Susser, M. The logic in ecological: I. The logic of analysis. American Journal of Public Health 1994; 84: 825–9.Google Scholar
15Fuchs, SC, Victora, CG, Fachel, J. Modelo hierarquizado: uma proposta de modelagem aplicada à investigação de fatores de risco para a diarréia grave. Revista de Saúde Pública 1996; 30: 168–78.Google Scholar
16Victora, CG, Huttly, SR, Fuchs, SC, Olinto, MT. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. International Journal of Epidemiology 1997; 26: 224–7.CrossRefGoogle ScholarPubMed
17Hox, JJ. Applied Multilevel Analysis. Amsterdam: TT-Publikaties, 1995.Google Scholar
18Yang, M, Rasbash, J, Goldstein, H, Barbosa, M. MLwiN Macros for Advanced Multilevel Modelling. London: Institute of Education, 1999.Google Scholar
19Hosmer, DW, Lemeshow, S. Applied Logistic Regression. New York: John Wiley and Sons, 1989.Google Scholar
20Ministério da Saúde, Brasil. Prevalência de aleitamento materno nas capitais brasileiras e no distrito federal. Brasília: Ministério da Saúde, 2001.Google Scholar
21Sociedade Civil Bem Estar Familiar no Brasil (BEMFAM). Pesquisa Nacional sobre Demografia e Saúde. Rio de Janeiro: BEMFAM, 1997 [Relatório de Pesquisa]Google Scholar
22Pérez-Escamilla, R, Lutter, C, Segall, AM, Rivera, A, Trevino-Siller, S, Sanghvi, T. Exclusive breast-feeding duration is associated with attitudinal, socioeconomic and biocultural determinants in three Latin American countries. Journal of Nutrition 1995; 125: 2972–84.Google Scholar
23Eregie, CO. Studies on exclusive breastfeeding: a report on associated factors in an African population. Journal of Tropical Pediatrics 1998; 44: 172–3.Google Scholar
24Notzon, F. Trends in infant feeding in developing countries. Pediatrics 1984; 74(Suppl.): 648–66.Google Scholar
25Forman, MR. Review of research on the factors associated with choice and duration of infant feeding in less-developed countries. Pediatrics 1984; 74(Suppl.): 667–94.Google Scholar
26Adair, LS, Popkin, BM, Guikey, DK. The duration of breastfeeding: how it is affected by biological, socio-economic, demographic, health sector and food industry factors? Demography 1993; 30: 63–80.CrossRefGoogle Scholar
27Horta, BL, Barros, FC, Halpern, R, Victora, CG. Baixo peso ao nascer em duas coortes de base populacional no Sul do Brasil. Cadernos de Saúde Pública 1996; 12(Suppl. 1): 27–31.Google Scholar
28Pérez-Escamilla, R, Cohen, R, Brown, KH, Landa-Rivera, L, Canahuati, J, Dewey, KG. Maternal anthropometric status and lactation performance in a low-income Honduran population; evidence for the role of infants. American Journal of Clinical Nutrition 1995; 61: 528–34.CrossRefGoogle Scholar
29Giugliani, ERJ. Technical consultation on infant and young child feeding. How can we increase exclusive breastfeeding, 2001 [mimeo].Google Scholar