Encuesta nacional sobre conocimientos de lactancia materna de los residentes de pediatría en España

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Abstract

RESUMEN Fundamentos: Una de las metas para mejorar la salud materno-infantil es aumentar las tasas de lactancia, y la Pediatría tiene un papel fundamental en ello. El objetivo del estudio fue averiguar el nivel de conocimientos sobre lactancia materna de los residentes de Pediatría y su relación con la acreditación IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia). Métodos: Se realizó un estudio transversal mediante encuesta validada (ECoLa) de cumplimentación online. Se elaboró un muestreo por estratos y conglomerados de los residentes de Pediatría en España. El tamaño muestral necesario fue de 142 sujetos. Se enviaron 315 encuestas a 21 hospitales. La variable principal fue el porcentaje de aciertos a las preguntas de la encuesta, que se evaluó con técnicas no paramétricas. Resultados: Hubo 189 respuestas (tasa de respuesta del 60%). La Mediana (Me) global de aciertos fue del 76,9% (Intervalo de Confianza al 95%=;IC95; 74,2-79,6). La mediana de aciertos no difirió entre residentes de primer y segundo año (Me=76,9%) y los de tercer y cuarto año (Me=73,1%) (p=0,541). Los residentes de los hospitales acreditados por la IHAN (Me=84,6%) obtuvieron mejores resultados que los de hospitales no acreditados (Me=73,1%) (p=0,002). En los hospitales no acreditados, la variabilidad de conocimientos fue amplia, con puntuaciones muy bajas en algunos de ellos. El porcentaje de residentes que había realizado cursos específicos fue muy superior en los hospitales acreditados por la IHAN (95% vs 52%). Conclusiones: Se detectan lagunas en la formación en lactancia de los residentes de Pediatría. Existen hospitales cuyos residentes tienen unos conocimientos en la materia claramente insuficientes, aunque no se hallan carencias en residentes de hospitales acreditados por la IHAN. Consideramos necesario universalizar y sistematizar la formación en lactancia.

Translated abstract

ABSTRACT Background: Increasing breastfeeding rates is a desirable goal for improving maternal and child health. Pediatricians have a main role in this subject. The objective was to document breastfeeding knwoledge in Pediatric residents, and its relationship with the BFHI (Baby Friendly Hospital Initiative) status of their hospitals. Methods: Transversal study with a validated online survey (ECoLa). Polietapic sampling of Pediatric residentes in Spain by strata (BFHI degree) and clusters (hospitals). Estimated sample size was 142 residents. 312 surveys were sent to 21 hospitals. Main variable was the percentage of correct answers to survey questions, it was analyzed with non parametric techniques. Results: 189 answers (response rate 60%). Global median (Me) of correct answers was 76.9% (95% Confidence Interval ;95CI; 74.2-79.6). There was no difference among first and second year residents (Me=76.9%) and third and fourth year residents (Me=73.1%) (p=0.541). Residents from BFHI hospitals (Me=84.6%) achieved better results than those from non-BFHI hospitals (Me=73.1%) (p=0.002). Variability at non-BFHI hospitals was considerable, where some hospitals showed unacceptable scores. Prevalence of courses was greater at BFHI hospitals (95% vs 52%). Conclusions: There are some deficiencies in Pediatric residents’ breastfeeding training. There are hospitals whose residents have an insufficient breastfeeding knowledge. No low scores were found in residents from BFHI hospitals. We consider neccesary to systematize and universalize breastfeeding training during Pediatric Residency.

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Most cited references 22

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Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs.

Melissa C Bartick, Eleanor Schwarz, Brittany Green … (2016)

The aim of this study was to quantify the excess cases of pediatric and maternal disease, death, and costs attributable to suboptimal breastfeeding rates in the United States. Using the current literature on the associations between breastfeeding and health outcomes for nine pediatric and five maternal diseases, we created Monte Carlo simulations modeling a hypothetical cohort of U.S. women followed from age 15 to age 70 years and their children from birth to age 20 years. We examined disease outcomes using (a) 2012 breastfeeding rates and (b) assuming that 90% of infants were breastfed according to medical recommendations. We measured annual excess cases, deaths, and associated costs, in 2014 dollars, using a 2% discount rate. Annual excess deaths attributable to suboptimal breastfeeding total 3,340 (95% confidence interval [1,886 to 4,785]), 78% of which are maternal due to myocardial infarction (n = 986), breast cancer (n = 838), and diabetes (n = 473). Excess pediatric deaths total 721, mostly due to Sudden Infant Death Syndrome (n = 492) and necrotizing enterocolitis (n = 190). Medical costs total $3.0 billion, 79% of which are maternal. Costs of premature death total $14.2 billion. The number of women needed to breastfeed as medically recommended to prevent an infant gastrointestinal infection is 0.8; acute otitis media, 3; hospitalization for lower respiratory tract infection, 95; maternal hypertension, 55; diabetes, 162; and myocardial infarction, 235. For every 597 women who optimally breastfeed, one maternal or child death is prevented. Policies to increase optimal breastfeeding could result in substantial public health gains. Breastfeeding has a larger impact on women's health than previously appreciated.