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J Pediatr (Rio J). 2013 Sep-Oct;89(5):477-84. doi: 10.1016/j.jped.2013.02.018. Epub 2013 Jul 18.

Degree of compliance with the ten steps of the Breastfeeding Friendly Primary Care Initiative and its association with the prevalence of exclusive breastfeeding.

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PhD in Women's and Children's Health, Departamento de Nutrição e Dietética, Escola de Nutrição Emília de Jesus Ferreiro, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil. Electronic address:



To analyze the association between the degree of compliance with the ten steps of the Breastfeeding-Friendly Primary Care Initiative (BFPCI) and the prevalence of exclusive breastfeeding (EBF) in infants younger than six months in the city of Rio de Janeiro.


This was a cross-sectional study conducted in a representative sample of 56 primary health care units of this municipality. The assessment of compliance with the ten steps of the BFPCI was carried out by interviewing health care professionals, pregnant women, and mothers; the generated performance scores were classified into tertiles. To obtain the outcome, i.e., the EBF, a data collection questionnaire was applied to mothers of children younger than six months who were followed up at these units in November of 2007. Prevalence ratios were obtained for the EBF using Poisson regression with robust variance.


The prevalence of EBF was 47.6%. In the multivariate analysis, the upper tertile of performance showed a 34% higher prevalence of EBF (PR=1.34, 95% CI: 1.24 to 1.44) and the second tertile was 17% higher (PR=1.17, 95% CI: 1.08 to 1.27) than the first tertile. Mothers who did not work outside home had a 75% higher prevalence of EBF (PR=1.75, 95% CI: 1.53 to 2.01); assistance in a basic health unit, as opposed to a family health unit, implied a 10% higher prevalence (PR=1.10, 95% CI: 1.03 to 1.19). The prevalence of EBF decreased 1% for each day of the infant's life (PR=0.993, 95% CI: 0.992 to 0.993).


Given the contribution of BFPCI to the practice of EBF, a greater investment in the expansion and sustainability of this initiative is recommended, as well as its association with other strategies to promote, protect, and support breastfeeding.


Aleitamento materno; Atenção básica à saúde; Avaliação de programas e projetos de saúde; Breastfeeding; Cross-sectional studies; Estudos transversais; Evaluation of health programs and projects; Primary health care

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