Effectiveness of an Educational Manual to Promote Infant Feeding Practices in Primary Health Care

Objective: To test the hypothesis that a continuing educational strategy (ie, "the manual") in primary health-care improves infant feeding practices among infants under 1 year of age. Methods: A before and after study was conducted at primary health-care units in Embu das Artes, Brazil. The intervention was the use of a manual created to supporting continuing educational activities on breastfeeding and complementary feeding to be performed by tutors of Estrategia Amamenta e Alimenta Brasil with health-care teams, in a period of 8 months. Five hundred sixty-one mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis. Results: Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices. Conclusions: The manual is a continuing educational strategy that improved complementary feeding practices in primary health care.