Strategies of Health Surveillance in the construction of a support network for breastfeeding women

Abstract In 2018 the Municipal Health Department of the city of Diadema, São Paulo, Brazil, started the implementation of strategies to promote, protect and support breastfeeding in health surveillance actions. Supervised compliance with the Brazilian Standards of Commercialization of Foods for Infants and Children of 1st Childhood, nipples, pacifiers and bottles and encouraged the installation of breast-feeding support rooms in public and private workplaces in the city, aiming to intervene in the infant mortality rates. According to the Global Strategy of the World Health Organization (WHO/UNICEF), for the Feeding of Infants and Children in the First Childhood, only 35% of children worldwide are breastfed exclusively during the first four months of life. What are the contributions of the surveillance area in encouraging the installation of breast-feeding facilities in the workplace? What are the responsibilities of the Health Surveillance to promote breastfeeding? The strategies implemented aimed to create a culture of respect and support for breastfeeding as a way to promote the health of the working woman and her baby, bringing direct benefits to society.The importance of women in promoting breastfeeding is evident, but it is essential to implement public policies. The surveillance began to integrate the municipal network of incentive to breastfeeding in search of the integrality of the attention aiming to contribute to increase the rates of breastfeeding in the city. Measures of a supervisory nature were implemented to comply with the rules that protect the practice of breastfeeding, in order to avoid early weaning and to reduce infant mortality. Intra and intersectoral strategies, permanent education and awareness-raising among professionals and the population were used. Isolated and fragmented initiatives do not contribute to structuring a breastfeeding support network in the workplace and many companies have not expressed an interest in promoting breastfeeding space. Key messages Dissemination of the pro-breastfeeding culture in which the workplace is a mainstay for a network of support for working women. Surveillance Area acted in the Network of Women’s and Children’s Health Care contributing to the reduction of maternal and infant mortality and healthy infant development.

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Breast Feeding versus Formula Feeding and Diarrheal Diseases in Infants and Children- A Review

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v32i1.21033 ◽

2014 ◽

Vol 32 (1) ◽

pp. 26-30 ◽

Cited By ~ 1

Author(s):

MUH Begum

Keyword(s):

Breast Feeding ◽

Exclusive Breastfeeding ◽

Diarrheal Disease ◽

Formula Feeding ◽

Infants And Children ◽

World Health ◽

Human Breast Milk ◽

Diarrheal Diseases ◽

Health Organization ◽

In Infants And Children

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) emphasize the value of breastfeeding for mothers as well as children. Both recommend exclusive breastfeeding for the first six months of life. Human breast milk is the healthiest form of milk for babies. Breastfeeding promotes health and helps to prevent diseases including diarrheal diseases. It contains all nutrients including antibodies (IgA),and lactoferrin, that potentially prevent infection and diarrhea in infants and children. Studies conducted in both developed and under developed nations have found that breast feeding is associated with significantly ( upto 64%) less diarrheal disease and the protective effect of breast feeding does not persist beyond two months after breast feeding is stopped. On the other hand, formula fed infants are found an upto 80% increased in the risk of developing diarrhea compared to breast fed infants and there is significantly more diarrheal disease in formula fed infants. Infection may be attributable to contamination of bottles, teats, milk, and food in infants who are not exclusively breastfed. Exclusive breastfeeding for the first six months of life and there after complementary feedings while breastfeeding continues for up to two years of age or beyond, enthusiastic support and involvement from clinicians, obstetricians and pediatricians, are essential in breastfeeding vs formula feeding issue and to reduce incidence of diarrheal diseases in infants and children. DOI: http://dx.doi.org/10.3329/jbcps.v32i1.21033 J Bangladesh Coll Phys Surg 2014; 32: 26-30

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Infant Mortality, Breast-Feeding, and Improved Health Surveillance

PEDIATRICS ◽

10.1542/peds.50.5.823a ◽

1972 ◽

Vol 50 (5) ◽

pp. 823-824

Author(s):

Allan S. Cunningham

Keyword(s):

Mortality Rate ◽

Infant Mortality ◽

Breast Feeding ◽

Vital Statistics ◽

Health Surveillance ◽

Breast Fed

In light of Dr. Wegman's comments on infant mortality in his review of vital statistics I thought it would be of interest to recall two morbidity-mortality studies of infants born between 1910 and 1930. Grulee et al. studied 20,000 welfare infants in Chicago. Nearly 10,000 of them were breast-fed exclusively for ten months and had a mortality rate less than 1.6 per thousand. Mortality in otherwise comparable groups of partly breast-fed and exclusively bottle-fed infants were 6.9 and 84 per thousand, respectively.

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Protection, promotion and support of breast-feeding in Europe: current situation

Public Health Nutrition ◽

10.1079/phn2004660 ◽

2005 ◽

Vol 8 (1) ◽

pp. 39-46 ◽

Cited By ~ 8

Author(s):

Adriano Cattaneo ◽

Agneta Yngve ◽

Berthold Koletzko ◽

Luis Ruiz Guzman

Keyword(s):

Young Child ◽

Breast Feeding ◽

Current Situation ◽

Global Strategy ◽

World Health ◽

Child Feeding ◽

Eu Countries ◽

Young Child Feeding ◽

Infant And Young Child ◽

Service Training

AbstractObjective:To describe the current situation regarding protection, promotion and support of breast-feeding in Europe, as a first step towards the development of a blueprint for action.Design and setting:A questionnaire was completed by 29 key informants and 128 other informants in the EU, including member states, accession and candidate countries.Results:EU countries do not fully comply with the policies and recommendations of the Global Strategy on Infant and Young Child Feeding that they endorsed during the 55th World Health Assembly in 2002. Some countries do not even comply with the targets of the Innocenti Declaration (1990). Pre-service training on breast-feeding practice is inadequate and in-service training achieves only low to medium coverage. The Baby Friendly Hospital Initiative is well developed only in three countries; in 19 countries, less than 15% of births occur in baby-friendly hospitals. The International Code of Marketing of Breastmilk Substitutes, endorsed in 1981 by all countries, is not fully applied and submitted to independent monitoring. The legislation for working mothers meets on average the International Labour Organization standards, but covers only women with full formal employment. Voluntary mother-to-mother support groups and trained peer counsellors are present in 27 and 13 countries, respectively. Breast-feeding rates span over a wide range; comparisons are difficult due to use of non-standard methods. The rate of exclusive breast-feeding at 6 months is low everywhere, even in countries with high initiation rates.Conclusions:EU countries need to revise their policies and practices to meet the principles inscribed in the Global Strategy on Infant and Young Child Feeding in order to better protect, promote and support breast-feeding.

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Infant Mortality, Breast-Feeding, and Improved Health Surveillance

PEDIATRICS ◽

10.1542/peds.51.1.156 ◽

1973 ◽

Vol 51 (1) ◽

pp. 156-156

Author(s):

Allan S. Cunningham

Keyword(s):

Infant Mortality ◽

Breast Feeding ◽

Health Surveillance ◽

Artificial Feeding ◽

Morbidity And Mortality

References 3 and 4 of the letter: Infant Mortality, Breast-Feeding, and Improved Health Surveillance, by Dr. Allan S. Cunningham, Pediatrics, 50:823, were in error. They should be corrected to: 3. Grulee, C. S., Sanford, H. N., and Schwartz, H.: Breast and artificially fed infants. A study of the age incidence in the morbidity and mortality in twenty-thousand cases. JAMA, 104: 1986, 1935. 4. Woodbury, R. M.: The relation between breast and artificial feeding and infant mortality. Amer. J. Hygiene, 2:668, 1922.

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The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study

International Breastfeeding Journal ◽

10.1186/s13006-021-00377-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Walusa Assad Gonçalves-Ferri ◽

◽

Fábia Martins Pereira-Cellini ◽

Kelly Coca ◽

Davi Casale Aragon ◽

...

Keyword(s):

Cross Sectional Study ◽

World Health ◽

Breastfeeding Support ◽

Cross Sectional ◽

Maternity Services ◽

Community Needs ◽

Care Services ◽

Skin Contact ◽

Health Organization ◽

The Impact

Abstract Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.

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Effect of consumption of animal milk compared to infant formula for non-breastfed/mixed-fed infants 6–11 months of age: a systematic review (protocol)

BMJ Open ◽

10.1136/bmjopen-2020-046370 ◽

2021 ◽

Vol 11 (2) ◽

pp. e046370

Author(s):

Aamer Imdad ◽

Julie Melissa Ehrlich ◽

Joseph Catania ◽

Emily Tanner-Smith ◽

Abigail Smith ◽

...

Keyword(s):

Systematic Review ◽

Infant Formula ◽

Breast Feeding ◽

Meta Analysis ◽

Risk Of Bias ◽

World Health ◽

Control Group ◽

Breastfed Infants ◽

Evaluation Approach ◽

Animal Milk

IntroductionPrevalence rates of breastfeeding remain low even though the World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breast feeding for the first 6 months of life in combination with appropriate complementary feeding beyond six 6 months of age. There have been several studies that address the implication of drinking animal milk and/or infant formula on children’s health and development when breast feeding is not offered during the first year of life. Vast improvements have been made in infant formula design, which may increase its benefits compared with animal’s milk. The objective of this review is therefore to synthesise the most recent evidence on the effects of the consumption of animal milk compared with infant formula in non-breastfed or mixed breastfed infants aged 6–11 months.Methods and analysisWe will conduct a systematic review and meta-analysis of studies that assessed the effect of animal milk compared with formula or mixed-fed (breastmilk and formula) on infants aged 6–11 months. The primary outcomes of interest include anaemia, gastrointestinal blood loss, weight for age, height for age and weight for height. We will include randomised and non-randomised studies with a control group. We will use the Cochrane risk of bias tools to assess the risk of bias. We will use meta-analysis to pool findings if the identified studies are conceptually homogenous and data are available from more than one study. We will assess the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.Ethics and disseminationThis is a systematic review, so no patients will be directly involved in the design or development of this study. The findings from this systematic review will be disseminated to relevant patient populations and caregivers and will guide the WHO’s recommendations on formula consumption versus animal milk in infants aged 6–11 months.Trial registration numberCRD42020210925.

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The Search for Natural and Synthetic Inhibitors That Would Complement Antivenoms as Therapeutics for Snakebite Envenoming

Toxins ◽

10.3390/toxins13070451 ◽

2021 ◽

Vol 13 (7) ◽

pp. 451

Author(s):

José María Gutiérrez ◽

Laura-Oana Albulescu ◽

Rachel H. Clare ◽

Nicholas R. Casewell ◽

Tarek Mohamed Abd Abd El-Aziz ◽

...

Keyword(s):

Snake Venom ◽

Serine Proteinase ◽

Global Strategy ◽

World Health ◽

Wide Range ◽

Variable Chemical ◽

Snake Venom Metalloproteinase ◽

Health Organization ◽

The Impact ◽

Natural And Synthetic

A global strategy, under the coordination of the World Health Organization, is being unfolded to reduce the impact of snakebite envenoming. One of the pillars of this strategy is to ensure safe and effective treatments. The mainstay in the therapy of snakebite envenoming is the administration of animal-derived antivenoms. In addition, new therapeutic options are being explored, including recombinant antibodies and natural and synthetic toxin inhibitors. In this review, snake venom toxins are classified in terms of their abundance and toxicity, and priority actions are being proposed in the search for snake venom metalloproteinase (SVMP), phospholipase A2 (PLA2), three-finger toxin (3FTx), and serine proteinase (SVSP) inhibitors. Natural inhibitors include compounds isolated from plants, animal sera, and mast cells, whereas synthetic inhibitors comprise a wide range of molecules of a variable chemical nature. Some of the most promising inhibitors, especially SVMP and PLA2 inhibitors, have been developed for other diseases and are being repurposed for snakebite envenoming. In addition, the search for drugs aimed at controlling endogenous processes generated in the course of envenoming is being pursued. The present review summarizes some of the most promising developments in this field and discusses issues that need to be considered for the effective translation of this knowledge to improve therapies for tackling snakebite envenoming.

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Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽

10.3390/nu13020681 ◽

2021 ◽

Vol 13 (2) ◽

pp. 681

Author(s):

Ritu Rana ◽

Marie McGrath ◽

Ekta Sharma ◽

Paridhi Gupta ◽

Marko Kerac

Keyword(s):

At Risk ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

World Health ◽

Cochrane Library ◽

Breastfeeding Support ◽

Middle Income ◽

Middle Income Countries ◽

Breastfeeding Practices ◽

Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

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Physical Activity, Sedentary Behavior, Sleep and Self-Regulation in Spanish Preschoolers during the COVID-19 Lockdown

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020693 ◽

2021 ◽

Vol 18 (2) ◽

pp. 693

Author(s):

Alicia M. Alonso-Martínez ◽

Robinson Ramírez-Vélez ◽

Yesenia García-Alonso ◽

Mikel Izquierdo ◽

Antonio García-Hermoso

Keyword(s):

Physical Activity ◽

Sedentary Time ◽

Self Regulation ◽

National Level ◽

Global Strategy ◽

World Health ◽

Lifestyle Behaviors ◽

Public Health Response ◽

Validated Questionnaire ◽

Health Organization

Background: A better understanding of the effects of the lockdown on lifestyle behaviors may help to guide the public health response to COVID-19 at a national level and to update the global strategy to respond COVID-19 pandemic. The aim of the study was to examine the effects of the COVID-19 lockdown on device-measured physical activity (PA), sedentary time, sleep and self-regulation; and to determine whether PA and sleep are related to self-regulation problems during the lockdown. Methods: PA, sedentary time and sleep were assessed using accelerometry in the week in which the Spanish national state of alarm was declared (n = 21). Parents reported preschooler’s self-regulation difficulties (internalizing and externalizing) before (n = 268) and during the lockdown (n = 157) by a validated questionnaire. Results: Preschoolers showed a decrease in total PA (mean difference [MD] = −43.3 min per day, 95% CI −68.1 to −18.5), sleep efficiency (MD = −2.09%, 95% CI −4.12 to −0.05), an increase in sedentary time (MD = 50.2 min per day, 95% CI 17.1 to 83.3) internalizing (MD = 0.17, 95% CI 0.06 to 0.28) and externalizing (MD = 0.33, 95% CI 0.23 to 0.44) problems. Preschoolers who met the World Health Organization recommendations for PA had lower internalizing scores than non-active peers (MD = −1.28, 95% CI −2.53 to −0.03). Conclusions: Our findings highlight the importance of meeting PA recommendations to reduce psychosocial difficulties during a lockdown situation.

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“How about We Give It a Go?”: A Case Study on Supporting Breastfeeding Families in an Australian Child Care Centre

Children ◽

10.3390/children7110195 ◽

2020 ◽

Vol 7 (11) ◽

pp. 195

Author(s):

Emma Woolley ◽

Shirley Wyver

Keyword(s):

Child Care ◽

World Health ◽

Future Research ◽

Care Centre ◽

Breastfeeding Support ◽

Child Care Centre ◽

Collective Case Study ◽

Instrumental Case Study ◽

Health Organization

The World Health Organization (WHO) recommends exclusive breastfeeding for six months and continuation of breastfeeding for up to two years. Formal child care has an important role in supporting breastfeeding, as many Australian infants commence care before two years of age. Currently, little is known about support or barriers in child care contexts. The present qualitative instrumental case study explores practices which protect, promote and support breastfeeding at a child care centre located in the Australian Capital Territory’s outer suburbs. Extending from a previously published collective case study, a cultural-institutional focus of analysis was used to explore the roles of proximity, flexibility and communication in supporting breastfeeding within a child care centre located close to an infant’s home. Interviews with centre staff and mothers, triangulated with observations of the centre environment and policy documents provide insight into the environment. Affirming the roles of flexibility in routine and staff rostering and two-way communication, findings suggest longer-term benefits may be derived from selecting a child care centre close to an infant’s home, provided mothers can overcome barriers to breastmilk expression in the workplace. The study recognises the role of non-lactating caregivers in the transition to formal child care, and of the support culture for educators who breastfeed. This study extends the knowledge base of breastfeeding support interventions in the child care setting to inform future research and policy.

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