Based on three cross-sectional studies conducted in the 1970s, 80s, and 90s, an analysis of the nutritional transition in Brazil was performed. This analysis found a rapid decrease in

ABSTRACT. Objectives. To describe breastfeeding practices from 0 to 12 months of age in 4 small towns that are representative of urban northeast Brazil and to identify factors associated with introduction of other milk in the first month of life.Methods. From January to August 1998, 364 mothers were interviewed at delivery to ascertain antenatal care; delivery room practices; and their intentions regarding breastfeeding, pacifiers, and introduction of water, teas, and other milk. Their perceptions of home support and the advantages of breastfeeding also were assessed. Thereafter, daily information about feeding practices was collected at twice-weekly home visits. When other milk was started, a second interview was conducted to ascertain initial and current breastfeeding problems and use of a pacifier. Reasons for starting other milk were investigated using 5-point Likert scales.Results. Mothers were positive toward breastfeeding, and 99% breastfed their new infant. Few intended to breastfeed exclusively, and in the first week 80% gave water/tea and 56% used a pacifier. The median duration of exclusive breastfeeding was 0 days, and the median age for starting other milk was 24 days. The median duration of breastfeeding was 65 days for mothers who started other milk within 1 month and 165 days for other mothers. After adjustment for confounding variables, the main factors associated with introduction of other milk within 1 month were pacifier use in the first week (odds ratio [OR], 4.01; 95% confidence interval [CI]: 2.07-7.78), intention to start other milk in the first month (OR, 3.79; 95% CI: 1.74 -8.24), giving water/tea in the first week (OR, 3.07; 95% CI: 1.56 -6.03), and leaving the maternity ward before breastfeeding was started (OR, 2.59; 95% CI: 1.34 -5.04).Conclusion. Although breastfeeding is common in this community, it rarely is exclusive and takes place for a relatively short duration. Identification of risk factors for early introduction of other milk offers potential avenues for future intervention, including improvement of breastfeeding support in antenatal and maternity services. Pediatrics 2001;108(4). URL: http://www. pediatrics.org/cgi/content/full/108/4/e66; pacifiers, breastfeeding, exclusive breastfeeding, risk factors.ABBREVIATIONS. OR, odds ratio; IQR, interquartile range; CI, confidence interval.T he Brazilian national breastfeeding promotion program began in 1981 and was noted for its intensity, coverage, and innovation. 1 Each state organized training for all categories of health professionals and also for traditional healers and others in the nonformal health sector. High-profile mass media campaigns featured national superstars, and legislation was passed on issues such as the advertising of breast milk substitutes and increased maternity leave. 2 Brazil also has been an active participant in the Baby Friendly Hospital Initiative, and in 1998 there were 103 accredited hospitals. 3 Data from national surveys showed an increase in the median duration of breastfeeding from 74 days in 1...

Vitamin A is a crucial micronutrient for pregnant women and their fetuses. In addition to being essential for morphological and functional development and for ocular integrity, vitamin A exerts systemic effects on several fetal organs and on the fetal skeleton. Vitamin A requirements during pregnancy are therefore greater. Vitamin A deficiency (VAD) remains the leading cause of preventable blindness in the world. VAD in pregnant women is a public health issue in most developing countries. In contrast, in some developed countries, excessive vitamin A intake during pregnancy can be a concern since, when in excess, this micronutrient may exert teratogenic effects in the first 60 days following conception. Routine prenatal vitamin A supplementation for the prevention of maternal and infant morbidity and mortality is not recommended; however, in regions where VAD is a public health issue, vitamin A supplementation is recommended to prevent night blindness. Given the importance of this topic and the lack of a complete, up-to-date review on vitamin A and pregnancy, an extensive review of the literature was conducted to identify conflicting or incomplete data on the topic as well as any gaps in existing data.

Abstract

OBJECTIVE:To estimate the prevalence of anemia and to identify its associated factors in children aged 6-59 months. METHODS:This was a cross-sectional study on data from the Third Health and Nutrition Survey of the State of Pernambuco, Northeastern Brazil, with a representative sample of 1,403 children from urban and rural areas. Anemia was diagnosed by means of hemoglobin assays. Multivariate analysis was performed though a hierarchical model, using robust-variance Poisson regression to estimate the prevalence ratio as a function of the following variables: biological factors, morbidity, child nutritional state, socioeconomic factors, housing, sanitation and maternal factors. RESULTS:The weighted prevalence of anemia was 32.8% overall: 31.5% in urban areas and 36.6% in rural areas. In urban areas, anemia was signifi cantly associated with maternal education, consumer goods, number of children less than fi ve years old in the home, drinking water treatment, maternal age, maternal anemia and the child's age. In rural areas, only maternal age and the child's age were signifi cantly associated with anemia. CONCLUSIONS:The prevalence of anemia in children in Pernambuco was similar in urban and rural areas. The factors associated with anemia that are presented here should be taken into consideration in planning effective measures for its control.