Meira Camila Abadia Rodrigues, Azeredo Catarina Machado, Rinaldi Ana Elisa Madalena
Universidade Federal de Uberlândia, Uberlândia, Brasil.
Universidade Federal de Viçosa, Viçosa, Brasil.
Cad Saude Publica. 2024 Nov 25;40(10):e00007024. doi: 10.1590/0102-311XPT007024. eCollection 2024.
This study aimed to verify the association between gross domestic product values - purchasing power parity (GDP PPP) and scores of the World Breastfeeding Trends Initiative (WBTi) tool. This is an ecological study carried out with 98 low-income (n = 43), middle-income (n = 27), and high-income (n = 28) countries. The evaluation of pro-breastfeeding actions was obtained from the WBTi and the GDP PPP from the World Bank. The mean and standard deviation (SD) of the total and each item WBTi scores were estimated. ANOVA and Tukey's test were used to compare the means of the WBTi tool according to the countries' GDP PPP. The association between GDP PPP and total and individual WBTi scores was analyzed by linear regression. Higher WBTi scores were identified for the items health and nutrition care system (item 5: mean = 6.4; SD: ±2.0) and Information Support (item 7: mean = 6.4; SD: ±2.5). The means of the total score and of items 3 (implementation of the code of marketing of breast-milk substitutes), 7 (information support), 9 (infant feeding during emergencies) and 10 (mechanisms of monitoring and evaluating systems) were higher in low- and middle-income countries, while item 4 (maternity protection in the workplace) presented a high mean in high-income countries (p < 0.05). We observed a negative association between GDP PPP and the total tool score (β = -2.67; 95%CI: -5.06; -0.29), item 3 (β = -0.50; 95%CI: -0.91; -0.08), item 7 (β = -0.67; 95%CI: -1.07; -0.27), item 8 (infant feeding and HIV; β = -0.59; 95%CI: -1.07; -0.11), and item 9 (β = -0.91; 95%CI: -1.34; -0.48). We observed a positive association between GDP PPP and item 4 (maternity protection in the workplace; β = 0.63; 95%CI: 0.24; 1.02). Countries with lower GDP PPP presented higher scores of the tool, with the exception of item 4, which had higher scores in countries with higher GDP PPP.
本研究旨在验证国内生产总值（购买力平价）（GDP PPP）与世界母乳喂养趋势倡议（WBTi）工具得分之间的关联。这是一项对98个低收入国家（n = 43）、中等收入国家（n = 27）和高收入国家（n = 28）开展的生态学研究。对支持母乳喂养行动的评估来自WBTi，而GDP PPP数据来自世界银行。估算了WBTi总分及各项目得分的均值和标准差（SD）。采用方差分析和Tukey检验，根据各国的GDP PPP比较WBTi工具的均值。通过线性回归分析GDP PPP与WBTi总分及各项目得分之间的关联。健康与营养护理系统项目（项目5：均值 = 6.4；SD：±2.0）和信息支持项目（项目7：均值 = 6.4；SD：±2.5）的WBTi得分较高。低收入和中等收入国家的总分以及项目3（母乳代用品销售守则的实施）、项目7（信息支持）、项目9（紧急情况下的婴儿喂养）和项目10（监测和评估系统机制）的均值较高，而项目4（工作场所的产假保护）在高收入国家的均值较高（p < 0.05）。我们观察到GDP PPP与工具总分（β = -2.67；95%CI：-5.06；-0.29）、项目3（β = -0.50；95%CI：-0.91；-0.08）、项目7（β = -0.67；95%CI：-1.07；-0.27）、项目8（婴儿喂养与艾滋病毒；β = -0.59；95%CI：-1.07；-0.11）和项目9（β = -0.91；95%CI：-1.34；-0.48）之间存在负相关。我们观察到GDP PPP与项目4（工作场所的产假保护；β = 0.63；95%CI：0.24；1.02）之间存在正相关。GDP PPP较低的国家工具得分较高，但项目4除外，该项目在GDP PPP较高的国家得分较高。
