And the winners are…

"Individual and contextual determinants of exclusive breastfeeding in Sao Paulo, Brazil: a multilevel analysis" - Brazil

Authors: Venancio SI, Monteiro CA.

Objective: To identify individual and contextual factors associated with the practice of exclusive breastfeeding (EBF).

Method: 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-breastfeeding 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 > or = 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 breastfeeding in the municipality had a positive influence on EBF and attenuated the impact of risk factors for the termination of breastfeeding.

"Educational intervention on breastfeeding promotion to the Family Health Program team"- Brazil

Author: Antonio Prates Caldeira

Source: Rev Saude Publica. 2008 Dec;42(6):1027-33.

Objective: Breastfeeding Friendly Primary Care Initiative comprises educational activities focused on primary care units. To evaluate the effectiveness of a strategy on breastfeeding promotion to the Family Health Program team.

Method: A controlled intervention study was performed with 20 family health care teams randomly selected into intervention and control group in Montes Claros, Southeastern Brazil, in 2006. The intervention group took part in a 24-hour training program on breastfeeding promotion for health providers, modeled on the Baby-Friendly Hospital Initiative. It emphasized health provider's support for breastfeeding and management of major lactation problems. The control group received routine breastfeeding training. Mothers of all children under two cared for by the teams were interviewed at home before (n=1,423) and 12 months after the intervention (n=1,491) and answered questions about breastfeeding practices. Survival curves of breastfeeding were plotted and compared for both time points studied using the log rank test.

Results: There was a significant increase in exclusive breastfeeding after the educational activities for the Family Health Program teams. Survival curves of exclusive breastfeeding at the first time point studied showed no statistical significance difference between the groups by log rank test (p=0.502). After the intervention, survival curves of exclusive breastfeeding were significantly different by the log rank test (p=0.001).

Conclusions: The training of Family Health Program teams as proposed by the Baby-Friendly Hospital Initiative proved to be an effective, low-cost strategy for raising awareness among health providers, providing consistent information, and assuring the required support to mothers with breastfeeding issues.

"The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment"- Sweden

Authors: Kvist LJ, Larsson BW, Hall-Lord ML, Steen A, Schalén C.

Objective: The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts.

Method: In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms.

Results: Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with >/= 10(7) cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003).

Conclusion: Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.

"The important role of deep attachment in the uniform drainage of breast milk from the mammary lobe" - Japan

Authors: Mizuno K, Nishida Y, Mizuno N et al.

Source: Acta Paediatr. 2008 Sep;97(9):1200-4.

Objective: To determine if the degree of attachment affects uniformity in the drainage of breast milk from the mammory lobe during breastfeeding.

Method: Thirty-seven pairs of healthy breast-fed infants and mothers were the subjects. A total of 48 measurements were obtained. Foremilk was obtained from three nipple openings. After the breastfeeding session, hindmilk was sampled from the same three nipple openings and creamatocrit (CrCt) was measured. The difference in CrCt values of hindmilk, which corresponds to the degree of emptying of the lobe, and the difference in CrCt values between fore- and hindmilk samples (delta CrCt), which corresponds to the change in the degree of emptying among the lobe were calculated.

Results: The maximum difference in the CrCt value of hindmilk samples among nipple ducts was 7.0 +/- 4.1% in the shallow attachment (S) group (n = 23) and 2.9 +/- 1.2% in the deep attachment (D) group (n = 25) in the left breast and 5.4 +/- 2.2% in the S group (n = 21) and 3.6 +/- 1.9% in the D group (n = 27) in the right breast. The mean maximum difference in delta CrCt values among nipple ducts was 7.6 +/- 2.9% and 2.6 +/- 1.3% in the left and 5.8 +/- 2.3% and 3.4 +/- 1.4% in the right breast, in the S group and D group, respectively. These differences were significantly smaller in the D group than the S group (p < 0.01).

Conclusion: The results revealed that deep attachment is helpful in draining milk from all the mammory lobe uniformly, which may contribute to successful breastfeeding.