Resumo em Espanhol:

En el presente estudio se reanalizaron los datos de la Encuesta Nacional de Salud de la República Dominicana, realizada en 1991, con el fin de identificar las características sociodemográficas, de la atención médica, del embarazo y el niño que influyen sobre la duración de la lactancia materna total (DLMT). Se estudió una muestra de 1 984 parejas madre-hijo representativa de la población nacional. De los hijos de cada madre, solo se incluyó al último niño nacido vivo, que era amamantado y menor de 3 años de edad en el momento de la encuesta. Los datos sobre la DLMT y los factores estudiados se recabaron entrevistando a las madres (incluidos la edad, tipo de residencia, paridad, nivel socioeconómico, educación, empleo y deseo de procrear de la madre, tipo de parto y lugar en que se produjo, tipo de trabajador de la salud que lo atendió, sexo y peso al nacer del hijo, tiempo transcurrido entre el parto y el inicio de la lactancia materna, y edad del niño al cesar la lactancia y en el momento de realizarse la encuesta). El riesgo de haber sido destetado a distintas edades se calculó por el método de la tabla de vida y el efecto independiente de cada variable de interés se estimó por medio de un modelo de regresión de Cox. La duración mediana de la lactancia materna total fue 7 meses y la tasa relativa de destete (TRD) fue más alta en los niños ablactados (TRD = 8,56; IC95%: 4,25-17,20), los de madres universitarias (TRD = 1,48; IC95%: 1,24-1,77), los que comenzaron a mamar tardíamente (TRD = 1,25; IC95%: 1,11-1,40), los que nacieron en instituciones públicas (TRD = 1,62; IC95%: 1,24-2,11) y privadas (TRD = 2,19; IC95%: 1,65-2,91), y en los de madres primíparas de nivel socioeconómico bajo (TRD = 1,80; IC95%: 1,45-2,24). Los programas de lactancia materna del país deben prestar especial atención a las madres con educación universitaria, a las que dan a luz en hospitales privados y a las primíparas de nivel socioeconómico bajo, ya que estas mujeres tienden a amamantar a sus hijos durante períodos relativamente cortos. Dentro de las estrategias de los programas de promoción de la lactancia materna habría que subrayar la importancia que reviste el retraso de la ablactación, pues este parece ser el factor que mayor impacto ejerce en la duración de la lactancia materna.

Resumo em Inglês:

The study reported here explored the influence of maternal, health care, pregnancy, and child-related factors upon the duration of total breast-feeding (DTBF) in the Dominican Republic. The data for the study, which included 1984 mother-child pairs representative of the Dominican population, came from the National Health Survey of 1991. The child in each of the mother-child pairs was the mother's last-born child who had been breast-fed and was less than 3 years of age at the time of the survey. Interviews with the mothers were used to collect information about the duration of breast-feeding and the factors studied (including maternal age, urban/rural residence, parity, mother's socioeconomic status, maternal education, maternal employment, mother's desire for pregnancy, type of delivery, place of delivery, the type of health worker attending the delivery, the child's sex, the child's birth weight, the time elapsed between delivery and initiation of breast-feeding, the child's age at complete weaning, and the child's age at the time of the survey). The child's risk of complete weaning at different ages was calculated using the life table method, and the independent effect of each of the study variables was estimated using Cox's regression model. The median DTBF was 7 months. The risk that a child would be completely weaned (the relative rate of complete weaning, or RRCW) was found to be higher among children who received foods other than breast milk and water while still breast-feeding (RRCW = 8.56; 95% CI = 4.25-17.20), whose mothers had some university education (RRCW = 1.48; 95% CI = 1.24-1.77), who began breast-feeding a day or more after delivery (RRCW = 1.25; 95% CI = 1.11-1.40), who were born in either public health institutions (RRCW = 1.62; 95% CI = 1.24-2.11) or private health institutions (RRCW = 2.19; 95% CI = 1.65-2.91), and who were the first-born of mothers with low socioeconomic status (RRCW = 1.80; 95% CI = 1.45-2.24). According to the study results, the country's breast-feeding programs should give special attention to mothers with university educations, those giving birth in private health facilities, and those with low socioeconomic status giving birth to their first child, since these groups tended to breast-feed their children for relatively short periods of time. Also, breast-feeding promotion strategies should stress the importance of delaying the introduction of foods other than breast milk into the child's diet, as this appears to be the one factor having the greatest adverse effect on the duration of breast-feeding.

Resumo em Português:

Este é um estudo descritivo, efetuado com base em dados oficiais sobre mortalidade por cirrose hepática para o ano de 1989. Os seus objetivos são: a) descrever a mortalidade por cirrose hepática em adultos brasileiros; b) estimar os anos produtivos de vida perdidos (APVP) precocemente (entre 20 e 59 anos) e c) determinar possiveis diferenças regionais na mortalidade e nos anos produtivos de vida perdidos. Os dados brutos foram ajustados por idade e sexo, tomando como padrão a população brasileira para o ano de 1980. Os APVP basearam-se na fórmula de Romeder e McWhinnie para anos potenciais de vida perdidos, modificados pela autora para anos produtivos de vida perdidos. As taxas brutas de mortalidade foram mais elevadas no Sudeste e Norte, e em todas as regiões predominou no sexo masculino, com razões homem/mulher para o país de 4,5 e variações regionais dos coeficientes de mortalidade para o sexo masculino de 14,37 (Centro-Oeste) a 35,86/100 000 (Sudeste), e para o sexo feminino de 3,49 (Centro-Oeste) a 8,5/100 000 (Norte). As curvas etárias de mortalidade para os homens, exceto os da região Norte, mostram tendência ao declinio ou estabilização a partir dos 60 anos. Para os homens do Norte, a curva é continuamente ascendente, atingindo 86,37/100 000 habitantes a partir dos 70 anos. As mulheres também apresentam curvas ascendentes, muito expressivas no Norte e Nordeste. As taxas ajustados por idade mostram uma redução para as mulheres do Sudeste, mantendo-se mais elevada no Norte. A mortalidade proporcional por cirrose hepática em relação ao aparelho digestivo chegou aos 48,7% para os homens e 24,1% para as mulheres. Dos 138 860 APVP por cirrose hepática em 1989, 83,2% foram no sexo masculino, mas as médias de APVP para o país, em torno de 15,5 anos, foram semelhantes para os sexos. Todavia, as médias de APVP para homens e mulheres do Norte e mulheres do Centro-Oste foram muito mais elevadas do que nas demais regiões. Os dados sugerem que a cirrose hepática entre os homens de todas as regiões, exceto os da região Norte, é possivelmente determinada pelo alcoolismo, enquanto entre homens nortistas existem fortes evidências da co-existencia de cirrose hepática de etiologia viral (vírus B e C da hepatite). Para as mulheres, as evidências apontam também para o predomínio da cirrose de etiologia viral.

Resumo em Inglês:

This descriptive study was done using official data on mortality from cirrhosis of the liver for the year 1989. Its objectives are: (a) to describe mortality from cirrhosis of the liver in Brazilian adults; (b) to estimate the productive years of life lost (PYLL) prematurely (between 20 and 59 years of age) from this cause; and (c) to show any regional differences in cirrhosis mortality or PYLL. The raw data were adjusted by age and sex, using the 1980 population of Brazil as the standard. Calculation of PYLL was based on the formula of Romeder and McWhinnie for years of potential life lost, modified by the author to express productive years of life lost. The crude death rates from cirrhosis were higher in the Southeast and North, and in all regions they were higher in males, the countrywide male/female ratio being 4.5. Cirrhosis mortality among males ranged from a low of 14.37 deaths per 100 000 in the Center-West to a high of 35.86 per 100 000 in the Southeast; for females the rates ranged from 3.49 deaths per 100 000 in the Center-West to 8.5 deaths per 100 000 in the North. The cirrhosis mortality curves by age for men showed a leveling off or decline after age 60, except in the North where the curve continued to rise. Like this latter curve, the cirrhosis mortality curves for women also kept rising progressively with increasing age, most markedly in the North and Northeast. Overall, mortality from cirrhosis of the liver accounted for 48.7% of the deaths from digestive system disorders among men and for 24.1% of such deaths among women. Of the 138 860 PYLL from cirrhosis of the liver in 1989, 83.2% were lost by males; but the average loss per person dying of cirrhosis nationwide, around 15.5 years, was similar for both sexes. Regionally, the average PYLL per affected person was higher for men and women in the North and for women in the Center-West than it was in the other regions. The data suggest that cirrhosis of the liver among men in all the regions, except the North, is probably attributable largely to alcoholism. Among males from the North, there is strong evidence that cirrhosis with a viral etiology (hepatitis B and C viruses) is also important. For women, the evidence suggests that cirrhosis of viral etiology predominates.