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      Lactancia materna, alimentación complementaria y malnutrición infantil en los Andes de Bolivia Translated title: Breastfeeding, complimentary feeding practices and childhood malnutrition in the Bolivian Andes

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          Abstract

          El Norte de Potosí es una de las partes más pobres de Bolivia, contiene los indicadores más altos de pobreza rural desnutrición e inseguridad alimentaria de los Andes bolivianos. El propósito fue caracterizar los niveles de desnutrición y las prácticas de alimentación de infantes para desarrollar un programa de intervenciones efectivas, sensibles al género y culturalmente relevantes, fomentando las buenas prácticas de alimentación infantil. Para la toma de los datos antropométricos se usó métodos estándares. Se tomaron el peso y la talla de 400 niños/as menores de cinco años de 30 comunidades. En seis de estas comunidades, se usaron entrevistas y discusiones con grupos focales con 33 madres y otros familiares, además de observaciones en los hogares para describir las prácticas de alimentación de los infantes. Casi el 20% de los niños/as son de bajo peso; además los niños/as tienen altos niveles de retraso en la talla. El 38% de las mamás empezaron la lactancia materna después de 12 horas. El 39% inició la alimentación complementaria, en los primeros tres meses. El tipo de alimento complementario que se da al infante en general fue inadecuado. Con este estudio se pudo ver que las deficiencias nutricionales a menudo empiezan cuando la madre inicia la lactancia materna y cuando introduce por primera vez la alimentación complementaria. Para las intervenciones que estén destinadas a mejorar la nutrición materno-infantil se requerirá cambios en el comportamiento personal, un mayor reconocimiento y apoyo comunitario; estrategias para llegar a la gente joven, hacer participar a los hombres y una mayor disponibilidad de servicios de calidad.

          Translated abstract

          Northern Potosí is one of the poorest parts of Bolivia with the highest indicators of rural poverty, malnutrition and food insecurity in the Bolivian Andes. The objective of this research was to characterize the levels of malnutrition and describe infant feeding practices in Potosi, Bolivia and use this information to develop an effective, gender sensitive and culturally relevant intervention encouraging good infant feeding practices. Standard methods were used to collect anthropometric data. Weight and height data were collected for 400 children under five years of age from 30 communities. In six of these communities, interviews and focus group discussions were conducted with 33 mothers and other families in addition to household observational data that were collected to describe infant feeding practices. Nearly 20% of children were underweight; stunting was widespread as well. 38% of mothers initiated breastfeeding 12 hours or more after birth. 39% of mothers initiated complementary feeding in the first three months following birth. The type of complementary food given to children was usually inadequate. With this research we could see that nutritional deficiencies often begin when the mother starts breastfeeding and when first introduced complementary feeding. Interventions aimed at improving maternal and child nutrition will require changes in parents’ behavior, greater recognition and community support of the importance of child feeding, and the inclusion of strategies to reach young people, involve men, and make high quality nutrition promotion more widely available in the communities.

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              Breastfeeding and maternal and infant health outcomes in developed countries.

              We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries. We searched MEDLINE(R), CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were searched through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts. We included systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding and relevant outcomes published in the English language. Included studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. The studies were graded for methodological quality. We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear. A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes. For future studies, clear subject selection criteria and definition of "exclusive breastfeeding," reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help. Sibling analysis provides a method to control for hereditary and household factors that are important in certain outcomes. In addition, cluster randomized controlled studies on the effectiveness of various breastfeeding promotion interventions will provide further opportunity to investigate any disparity in health outcomes as a result of the intervention.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                alan
                Archivos Latinoamericanos de Nutrición
                ALAN
                Sociedad Latinoamericana de Nutrición (Caracas )
                0004-0622
                March 2010
                : 60
                : 1
                : 7-14
                Affiliations
                [1 ] Cornell University E.E.U.U
                Article
                S0004-06222010000100002
                7d4c4f3d-f565-476d-9694-ff195c8e158a

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0622&lng=en
                Categories
                NUTRITION & DIETETICS

                Nutrition & Dietetics
                Breast feeding,feeding practices,malnutrition,Bolivia,Lactancia materna,prácticas alimentación,desnutrición

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