Aconselhamento em amamentação no domicílio : ensaio clínico randomizado controlado

• Autor(a) principal: Amor Divino, Eveline do
• Data de Publicação: 2020
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFMT
• Texto Completo: http://ri.ufmt.br/handle/1/3465
• topic: Aleitamento materno; Aconselhamento; Ensaio clínico; Atenção primária à saúde; Assistência domiciliar; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM; Breast feeding; Counseling; Clinical trial; Primary health care; Home nursing

ABSTRACT: Breastfeeding is a complex process that undergoes influence from various aspects interfering the woman’s decision-making process with regard to this practice. Breastfeeding counseling requires from the professional to listen to, understand and offer help to puerperal mothers, thereby strengthening them to deal with strains and preparing them to make decisions regarding breastfeeding. This thesis was aimed to evaluate the effectiveness of home breastfeeding counseling in the practice of breastfeeding and the factors associated with the permanent interruption of its exclusivity, in the first 120 days of the child’s life, in Cuiabá-MT. The results were exposed in two articles. The first evaluated the effectiveness of home breastfeeding counseling on the duration of exclusive breastfeeding and the frequency of the types of breastfeeding in the first 120 days of the child’s life. Randomized Controlled Clinical Trial (RCT), targeted at women between 18 and 49 years old, from the 35th week of pregnancy and who were in prenatal follow-up in the Family Health Strategy of the urban area of CuiabáMT/Brazil. The field work was conducted between January and August 2019. We followed-up 40 women, 26 in the Intervention Group (IG) and 14 in the Control Group (CG). The breastfeeding counseling intervention was held by the Community Health Worker (CHW), in eight home visits: during pregnancy, up to five days after delivery, at 15, 30, 45, 60, 90 and 120 days after delivery. The data were analyzed adopting significance levels of 5%. In order to compare the averages of the duration of exclusive breastfeeding (EBF) between IG and CG, we used the Wald’s test by means of Poisson Regression. The same regression was used to check the effect on the group, adjusted by possible confounding variables. The counseling proved to be effective in increasing the duration of EBF in the first 120 days after delivery, 64 days on average in the IG and 52 days in the CG (p<0,001), but did not show statistical significance in the proportions of any type of breastfeeding, in the measurements over time. We should highlight the importance of home breastfeeding support throughout the pregnancy-purperal cycle, especially after delivery. The second article was a longitudinal study with the aim of analyzing the factors associated with the interruption of EBF in the first 120 days of the child’s life, prepared from the data of the participants of a RCT conducted in the homes of 40 pregnant women, Brazilians, aged between 18 and 49 years, living in areas covered by CHW, undergoing health care in the Family Health Units of the urban area of Cuiabá-MT/Brazil. The data were collected in eight home visits during pregnancy up to 120 days after delivery. We performed the univariate regression analysis, where the explanatory variables that showed a p-value <0.20 were included in the multivariate analysis. Those with a p-value <0,05 remained in the final model. The data showed that the interruption proportion of EBF increases with time, from 25% at 15 days to 61.1% at 120 days after delivery. We noted that the factors associated with the interruption of EBF were: the female gender of the current child (PR=1,62) and the use of pacifiers (PR=2,23). The number of prenatal consultations had a negative association with interruption (PR=0,91). It is necessary and urgent to implement actions for the promotion, protection and support of breastfeeding, with a view to improving the rates and duration of EBF, considering the specificities of each community and each woman/family.