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. 2015 Jul-Sep;13(3):435–440. doi: 10.1590/S1679-45082015RW3107

Chart 3. Analysis of references according to objectives and results, 1992-2011.

Reference Objective Results
Post et al.(10) To investigate possible prognostic factors for hospital mortality in children under one year of age living in the metropolitan area of Rio de Janeiro, who died between May 1986 and April 1987, with diarrhea or pneumonia as the underlying cause of death. There was no association between breastfeeding and hospital mortality from diarrhea, and breastfeeding frequencies up to 1 month of age were very similar between cases (60%) and the control group (59%).
Bittencourt et al.(11) To evaluate whether, during the first 6 months of life, there was a differential effect of diarrhea upon the monthly weight and height growth rates between breastfed children and fully weaned children. Weaned children showed delayed height and weight growth rates due to higher incidence and higher prevalence of diarrhea. Breastfeeding effectively mitigates the adverse effect of diarrhea upon monthly weight rates.
Fuchs and Victoria(12) To evaluate the effect of demographic, socioeconomic, environmental, maternal reproductive, dietary and nutritional variables upon the risk and prognosis of diarrhea, using hierarchical analysis. Low birth weight, height-to-age deficit and lack of breastfeeding were risk and prognostic factors for diarrhea.
Barros et al.(13) To evaluate the prevalence of breastfeeding, morbidity and the nutritional status of a group of children, some of whom had attended lactation centers and the others not. A greater proportion of children accompanied at lactation centers had been exclusively breastfed; children who attended the lactation centers had less diarrhea in the two weeks prior to the study than those who did not attend, and their weight was more appropriate for age.
Escuder et al.(14) To study the impact of breastfeeding on death rate reduction. The preventable mortality fraction from respiratory infection varied between 33 and 72%, according to municipality and age group. For diarrhea, the variation was between 35 and 86%. Breastfeeding in the first year of life may be the most feasible strategy to reduce post-neonatal mortality beyond the levels already achieved in the municipalities of São Paulo.
Vieira et al.(15) To assess the protective effects of breastfeeding against diarrhea in children under 1 year. The occurrence of diarrhea was high (11.6%), more frequently after the age of 6 months (63.3 %). Non-breastfed children younger than 6 months had a 64.0% (95% CI: 1.07- 2.51) greater chance for diarrhea (p<0.02) than breastfed children. When compared to exclusively breastfed children, this chance increased to 82.0% (95% CI: 1.11-3.01) among non-breastfed children.
Vanderlei and Silva(16) To assess the mothers’ awareness about causes, signs of dehydration and management of acute diarrhea, as well as the occurrence of hospitalization for complications of this disease in their children under two years. Association between hospitalization for acute diarrhea in children under 2 years and precarious living conditions, lack of breastfeeding and malnutrition.
Vitolo et al.(17) To assess the impact of the application of the nutritional guidelines for children under 2 years of age established by the General Coordination of Food and Nutrition Policy of the Ministry of Health, through a randomized intervention study. The intervention was associated with a higher proportion of exclusive breastfeeding at 4 months (RR=1.58; 95% CI: 1.21-2.06), at 6 months (RR=2.34; 95% CI: 1.37-3.99), and breastfeeding at 12 months (RR=1.26; 95% CI: 1.02-1.55); it was also associated with a lower proportion of children with diarrhea (RR=0.68; 95% CI: 0.51-0.90), respiratory problems (RR=0.63; 95% CI: 0.46-0.85 ), medication use (RR=0.56; 95% CI: 0.34-0.91), and dental caries (RR=0.56; 95% CI: 0.32-0.96) in the age group of 12 to 16 months.
Brandão et al.(18) To describe the clinical and epidemiological characteristics of children with acute diarrhea and shock admitted to the pediatric intensive care unit, and compare the clinical outcomes between death and survival groups, identifying factors associated with death. In 53/61 children, the duration of exclusive breastfeeding was less than three months, and only 8/61 were breastfed at admission. No association was found between sex (p=0.78), age (p=0.07) and lactation (p=0.63) and progression to death. Acute diarrhea with shock preferably affects artificially fed young infants, with a high mortality rate.
Boccolini and Boccollini(19) To evaluate the relation between breastfeeding and admissions for diarrheal diseases in children aged under 1 year, in Brazilian capital cities and the Federal District, in 2008. In 2008, both exclusive breastfeeding (tax rate=0.76; 95% CI: 0.61-0.94) and breastfeeding in children up to 9-12 months of age (tax rate=0.72; 95% CI: 0.52-0.99) managed to reduce hospitalization rates for diarrheal diseases in the studied population.
Bernardi et al.(20) To assess the impact of the program Ten steps to a healthy diet: ood guide for children under 2 years of age upon the duration of exclusive breastfeeding and to reduce the occurrence of diarrhea and symptoms of respiratory morbidity in children aged 6 to 9 months. A longer duration of exclusive breastfeeding age (p=0.02) was observed in the intervention group, but no statistically significant changes were observed in the prevalence of diarrhea and symptoms of respiratory morbidity. Further analysis showed that the duration of exclusive breastfeeding was higher in the group of children with no occurrence of diarrhea (p=0.001) and without symptoms of respiratory morbidity (p=0.03). These results suggest that the strategy was not enough to interfere in the occurrence of morbidities, but it was effective in increasing exclusive breastfeeding time.

CI 95%: confidence interval; RR: relative risk.