A prática do aleitamento materno e seus determinantes em Feira de Santana, Bahia

Abstract

O objetivo principal desta tese de doutoramento foi avaliar a prática do aleitamento materno (AM) e os seus fatores determinantes na cidade de Feira de Santana, Bahia. Foram conduzidas pesquisas com diferentes abordagens metodológicas: revisão sistemática de literatura, estudo de coorte e corte transversal; e, elaborados oito artigos originais: um artigo de revisão sobre a intenção materna de amamentar (IMA); três artigos relacionados a um estudo de coorte iniciado em 2004, sobre os determinantes do AM na primeira hora de vida (AMPHV), fatores preditivos da interrupção do AM exclusivo (AME) no primeiro mês de lactação e fatores associados à duração do AME no primeiro semestre de vida; além do artigo sobre a tendência dos indicadores de AM no município, que analisou os resultados de três inquéritos alimentares, aplicados nos anos de 1996, 2001 e 2009. Em apêndice, encontra-se um artigo sobre parto cesáreo, além de dois artigos elaborados por bolsistas de Iniciação Científica, que contaram com a colaboração desta autora. Ficou demonstrada evolução positiva dos indicadores de AM, embora as proporções apresentadas estejam distantes das recomendações da Organização Mundial de Saúde. Os determinantes de interrupção precoce do AM foram múltiplos e variaram entre a IMA, o AMPHV e o AME no primeiro mês e no primeiro semestre de vida. Orientação às mães quanto às vantagens do AM foi o único fator que esteve associado a todos os desfechos (IMA, AMPHV e duração do AME), seguido de uso de chupeta e fissura mamilar (AME 1 mês e duração AME por 6 meses). Notou-se que os determinantes mais freqüentes da interrupção do AME são características modificáveis, mediante medidas de intervenção, sobretudo, pelos profissionais de saúde, por meio de informações relevantes sobre a importância da prática de amamentar, ensinamento de técnicas que previnam a fissura mamilar e o desestímulo ao uso de chupeta.

ABSTRACT The main objective of this doctoral thesis was to evaluate breastfeeding practices and their determinants in the city of Feira de Santana, Bahia. Investigations using different methodological approaches were conducted: a systematic review of the literature, a cohort study and a cross-sectional study; and eight original articles were prepared: one review article on the mother’s intention to breastfeed; three articles relating to a cohort study that was started in 2004, on the determinants of breastfeeding in the first hour of life, factors predicting the interruption of exclusive breastfeeding within the first month of lactation and factors associated with the duration of exclusive breastfeeding in the first six months of life; and an article on trends in breastfeeding indicators in the municipality, which analyzed the results from three dietary surveys that were applied in the years 1996, 2001 and 2009. In the appendix, there is an article on cesarean delivery and two articles produced by scientific initiation students, which the present author also collaborated in. It was shown that there has been positive evolution in the breastfeeding indicators, although the proportions presented are far from the recommendations of the World Health Organization. There were many determinants for early interruption of breastfeeding, and they varied between the mother’s intention to breastfeed, breastfeeding in the first hour of life and exclusive breastfeeding in the first and six months of life. Guidance for mothers regarding the advantages of breastfeeding was the only factor that was associated with all outcomes (mother’s intention to breastfeed, breastfeeding in the first hour of life and duration of exclusive breastfeeding), followed by use of a dummy/pacifier and nipple cracks (exclusive breastfeeding for one month and duration of exclusive breastfeeding for six months). It was noted that the most frequent determinants of the ending of exclusive breastfeeding were characteristics that it would be possible to modify through intervention measures, which could especially be applied by healthcare professionals, through providing relevant information on the importance of breastfeeding practices and teaching techniques that would prevent nipple cracks and would discourage dummy/pacifier use.