RESUMO
OBJECTIVE: To assess the impact of the addition of 12 maternity leave (ML) weeks (2011), a pay for performance (P4P) exclusive breastfeeding (EBF) promotion strategy (2015), and the COVID-19 pandemic in EBF inequalities in Chile. STUDY DESIGN: Interrupted time-series analyses (ITSAs). METHODS: Aggregated national EBF data by municipality and month were collected from 2009 to 2020. We assess the impact of the three events in EBF inequalities using two procedures: 1. ITSA stratified by municipal SES quintiles (Q1-Q5); 2. Calculating the EBF slope index of inequality (SII). RESULTS: The EBF prevalence was higher in lower SES municipalities before and after the three time-events. No impact in EBF inequalities was observed after the extended ML. The P4P strategy increased EBF at six months in all SES quintiles (effect size between 4% and 5%), but in a higher level in poorer municipalities (SII: -0.36% and -1.05%). During COVID-19, wealthier municipalities showed a slightly higher EBF at six months prevalence (SII: 1.44%). CONCLUSION: The null impact of the extended ML in EBF inequalities could be explained by a low access to ML among affiliated to the public health system (20%). The P4P strategy includes multiple interventions that seemed effective in increasing EBF across all SES quintiles, but further in lower quintiles. The restrictions in healthcare access in poorer municipalities could explain EBF inequalities during COVID-19.
Assuntos
Aleitamento Materno , COVID-19 , Feminino , Humanos , Gravidez , Lactente , Chile/epidemiologia , Pandemias , Reembolso de Incentivo , COVID-19/epidemiologia , Emprego , Política Pública , MãesRESUMO
BACKGROUND: Chile has a high prevalence of overweight and obesity and is important to implement and evaluate treatment and control strategies that are effective. OBJECTIVES: To evaluate changes in nutritional status and fasting glucose in overweight women, pre-diabetic and/or pre-hypertension in primary care centers of public health sector. MATERIAL AND METHODS: A retrospective cohort of the universe of women admitted to the program in the participating primary care centers for 18 months was studied. Intervention includes consultations and workshops with doctors, nutritionists, psychologists and physical therapists for 4 months, in primary heath center, promoting healthy eating and increased physical activity, not using drugs. Analysis of causes of admission, dropout, participation in scheduled activities and changes in baseline nutritional status and fasting glucose after 4 months of intervention. RESULTS: 1,528 women 18 to 65 years old, with initial BMI between 25 and 40 were studied and 1,222 completed treatment (71.6%). The median weight change was -3.9% (CI -4.1 to 3.7) of initial weight and -2.0 mg/dl (CI -2.0 to 1.0) of blood glucose. 36.8% of patient decreased ≥ 5% of initial weight, 12.5% of overweight and about one third of obese partly improved or normalized their nutritional status. There was significant reduction in the prevalence of pre-diabetes (16.6 to 8.8%, p < 0.001). CONCLUSION: The intervention was effective for good adhesion and impact in reducing cardiovascular risk factors as BMI, waist circumference and high fasting glucose. One challenge is to keep track of this population to ascertain the impact in the medium and long term.