Gabriela Buccini

• PhD IBCLC MSc
• Professor (Assistant) at University of Nevada, Las Vegas

Identifying modifiable risk factor for exclusive breastfeeding (EBF) interruption is key for improving child health globally. There is no consensus about the effect of pacifier use on EBF interruption. Thus, the aim of this systematic review was to investigate the association between pacifier use and EBF interruption during the first six month. A s...

Introdução A publicação do Lancet Breastfeeding Series em 2016 reuniu fortes evidências do impacto po-sitivo da amamentação no curto e longo prazos na saúde das crianças e das mulheres que ama-mentam e, também, para a sociedade em países de alta, média e baixa renda 1,2. Tais evidências ratifi cam a proteção e o apoio à amamentação como um direito...

Background: Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF. Objective: This study aimed to fin...

Global efforts to further improve exclusive breastfeeding rates have not been successful, in part because effective scaling-up frameworks and roadmaps have not been developed. The Becoming Breastfeeding Friendly (BBF) toolbox includes an evidence-based index, the BBF Index (BBFI), to guide the development and tracking of large scale, well-coordinat...

Este parecer técnico-científico (PTC) tem como objetivo responder a uma demanda da Coordenação Geral de Saúde da Criança e Aleitamento Materno do Ministério da Saúde (CGSCAM-MS) e do Comitê Nacional de Aleitamento Materno (MS), a fim de oferecer subsídios à implementação do Teste da Linguinha no âmbito do SUS, resultado do Projeto de Lei nº 4.832/1...

Objective Early childhood obesity (ECO) significantly increased in the United States. ECO interventions lack focus on the prevention of ECO for infants under two. Caregiver’s feeding styles (CFS) has shown to affect ECO development, but studies on CFS are limited. This study examined socioecological factors associated with CFS for infants under two...

Promoting child well-being and development requires a multidimensional approach, including the right to adequate food practices. Socially vulnerable children are more exposed to adverse experiences, such as inadequate food consumption due to poverty. In this context, home-visiting programs are an important strategy for nutritional and health care e...

Brazil’s Criança Feliz Program is one of the largest early childhood development home-visiting programs globally. After seven years of scaling up, implementation barriers across diverse municipality settings prevented the program from achieving the intended impact on parenting skills and child development. We conducted a program impact pathway anal...

The influence of family meals on nutrition and health for families has been understudied, especially in low- and middle-income countries. We aimed to analyze associations between regular family meals and body mass index (BMI), food consumption, eating, and sedentary behaviors among Brazilian schoolchildren and their caregivers. A cross-sectional st...

Food insecurity (FI) has short‐ and long‐term effects on maternal and child health, with persistent inequities within under‐resourced communities of colour (e.g., Hispanic and Non‐Hispanic Black). Interventions to mitigate maternal–child FI must engage the voices of under‐resourced communities of colour to improve implementation and tackle socio‐ec...

OBJECTIVE To confirm the diagram of the program’s impact pathways and Estratégia Amamenta e Alimenta Brasil (EAAB - Brazilian Breastfeeding and Complementary Feeding Strategy) core functions, and to determine indicators for evaluating EAAB. METHODS This is a qualitative study within the field of implementation research. Data collection included tw...

Household food insecurity (HFI) has been related to adverse maternal‐child health outcomes and mental health worsening during pregnancy. Few studies evaluated the temporal association between HFI and anxiety and depressive symptoms in pregnant women, and this association remains not completely understood. This study aimed to systematically review t...

Background During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for ev...

Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Foll...

Background Zip codes classified by the Food Insecurity Index with moderate and high food insecurity (FI) risk can be a threat to the health and well-being of children during the first 1,000 days (from pregnancy to 2 years). The presence of nurturing care assets (i.e., stable environments that promote health and nutrition, learning opportunities, se...

This compendium report showcases a diverse set of case studies from various countries, which address different aspects of NCD prevention and control, and mental health conditions. The report highlights country experiences in developing multisectoral action plans or strategies and implementing multisectoral actions. These case studies illustrate the...

Background Postpartum depression affects 13% of women after childbirth in the United States. Mothers who experience depression are less likely to breastfeed than those who do not experience depression. On the other hand, breastfeeding may have a positive effect on maternal mental health. Research aim We aimed to analyze whether breastfeeding cessa...

Household food insecurity (HFI) during childhood is associated with poor dietary diversity and malnutrition, placing children's growth at risk. Children with growth disorders, such as stunting, are more likely to have poor cognition and educational performance, lower economic status, and an increased risk of nutrition‐related chronic diseases in ad...

Background In 2016, Brazil scaled up the Criança Feliz Program (PCF, from the acronym in Portuguese), making it one of the largest Early Childhood Development (ECD) programs worldwide. However, the PCF has not been able to achieve its intended impact. We aimed to identify barriers and facilitators to achieving the PCF implementation outcomes across...

O editorial destaca a importância da Ciência da Disseminação e Implementação (D&I) em países de língua portuguesa, abordando desafios na incorporação de evidências científicas na prática. Pesquisas indicam que o conhecimento científico pode levar até 17 anos para ser adotado nos serviços de saúde, atingindo apenas 14% da população-alvo. A D&I busca...

Objective To systematically map implementation research focusing on interventions aimed at early childhood development, its main characteristics and implementation strategies. Methods A scoping review of the global literature was planned and performed in accordance with recommendations of the Joanna Briggs Institute. The search was carried out in n...

Resident physicians have completed medical school and are undergoing specialized training in a specific area of medicine. The demanding workload of residency, high levels of responsibility, and exposure to traumatic events can lead to chronic stress and fatigue, which can increase the risk of developing burnout syndrome, a psychological state chara...

Malnutrition in all its forms has risen on global agendas due to the recognition of its magnitude and consequences for a wide range of human, social, and economic outcomes. Implementing strategies and programs with the needed scale and quality is a major challenge. The Brazilian National Survey on Child Nutrition (ENANI-2019) pointed out several ad...

Introduction Studies in Latin America have focused either on analyzing factors associated with exclusive breastfeeding (EBF) or infant formula (IF). Purpose Analyze the association between economic, sociodemographic, and health factors with EBF, mixed milk feeding (MixMF), and exclusive use of IF in three Latin American and Caribbean countries in...

The authors would like to make the following corrections to this paper [...]

Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. A...

Investing in early childhood programs such as Brazil’s Criança Feliz Program (PCF) to support low-income families in providing a nurturing care environment is critical to ensure that children reach their full developmental potential. We aimed to analyze the influence of the PCF on the nurturing care environment provided by families enrolled in the...

Background: Effective scale-up of multisectoral strategies aimed to prevent and treat childhood obesity has been a challenge in Brazil, the largest country in Latin America. Implementation Science methods, such as Net-Map, can identify key actors and opinion leaders (OLs) to advance the implementation and promote sustainability. Objectives: This...

Background Pacifier use can interfere with nurturing care practices such as breastfeeding, soothing, and sleeping. Due to contradicting beliefs, recommendations, and the high frequency of pacifier use, understanding its associations may support shaping equitable public health recommendations. This study explored the socio-demographic, maternal, and...

Background: The Brazilian Breastfeeding and Complementary Feeding Strategy (Estratégia Amamenta e Alimenta Brasil-EAAB) aims to improve Primary Health Care (PHC) workers' counseling skills to promote and support infant and young children feeding (IYCF). However, the maintenance and scaling up of the EAAB has been challenging. The theory-driven Pro...

Objectives In Brazil, there have been different strategies for preventing childhood obesity and caring for children with obesity. However, scaling up the impact of these strategies to effectively reduce this condition is challenging. We aimed to map and describe the influence level (i.e., power) of key actors at the federal and local levels to impl...

We aimed to identify whether single mother in poverty is a risk factor for household food insecurity, anxiety, and poor quality of life and whether extreme poverty modifies this association. The study included 545 pregnant women or mothers with a monthly per capita income less than half the minimum wage. Single mother is associated with anxiety and...

Background Early introduction of liquid/solid food before 6 months of age is one of the major barriers to exclusive breastfeeding. Our objective was to analyze the evolution of infant feeding practices for infants under 6 months of age in Latin American and Caribbean countries in the decades of 1990, 2000 and 2010. Method Cross-sectional time seri...

Background: The Brazilian Breastfeeding and Complementary Feeding Strategy-Estratégia Amamenta e Alimenta Brasil (EAAB) aims to promote optimal breastfeeding (BF) and complementary feeding (CF) practices through the training of primary health professionals. Competition among health priorities and programs is one of the organizational contextual ba...

Background Holistic attention to adolescent health is needed to sustain the benefits of investment in early childhood development. Any such interventions must make sure to address the needs of adolescent and young adult parents. This study explored the social and demographic maternal variables associated with risk of early childhood development (EC...

The Brazilian Early Childhood Friendly Municipal Index (IMAPI) is a population-based approach to monitor the nurturing care environment for early childhood development (ECD) using routine information system data. It is unknown whether IMAPI can be applied to document metropolitan urban territorial differences in nurturing care environments. We used...

Key messages There is a dearth of indicators and management information systems to assess early childhood nurturing care environments. The Brazilian Early Childhood Care Friendly Municipal Index (IMAPI) is a robust tool to assess nurturing care environments at the local level. IMAPI was able to detect nurturing care inequities within and across reg...

Selecting indicators to monitor nurturing care (NC) environments that support decision‐making and guide the implementation of integrated early childhood development (ECD) programmes has become a priority globally. Several population‐based approaches have been attempted to create a set of indicators or a composite index methodology to measure the NC...

This exploratory qualitative study aimed to identify sociocultural and intergenerational aspects of perception and practices in child feeding among quilombola women, members of maroon communities in Brazil. A focus group with 12 mothers and another group with four grandmothers of children under five years of age were conducted in a rural quilombola...

O Manual de Apoio ao Tutor da EAAB foi desenvolvido com o objetivo de orientar e fortalecer o seu papel de tutor, trazendo sugestões de atividades que possam ser conduzidas para efetivamente apoiar os profissionais da Atenção Primária à Saúde (APS) na implementação da EAAB.

Background: The World Health Organization set a global nutrition target to increase the rate of exclusive breastfeeding (EBF) among infants younger than 6 months to at least 50% by the year 2025. Yet, the early introduction of solid food (before 6 months of age) occurs in approximately one in three infants, making it a major barrier to EBF. The aim...

Livro de acesso aberto e gratuito. Conteúdo pode ser acessado em: https://repositorio.ufms.br/handle/123456789/3866 Esta obra visa a ajudar os profissionais da saúde a melhor implementar evidências científicas consagradas para benefício da saúde populacional. Estima-se que o tempo médio para que uma evidência científica seja usada rotineiramente n...

Providing an enabling nurturing care environment for early childhood development (ECD) that cuts across the five domains of the Nurturing Care Framework (i.e., good health, adequate nutrition, opportunities for early learning, security and safety and responsive caregiving) has become a global priority. Brazil is home to approximately 18.5 million c...

Objective To determine if household food insecurity (HFI) is associated with risk of developmental delays. Design Cross-sectional study of a representative sample of children under 2 years old. Risk of developmental delays was assessed with the Denver Developmental Screening Test II. HFI was measured with the Brazilian Food Insecurity Measurement...

The Nurturing Care Framework (NCF) calls for establishing a global monitoring and accountability systems for early childhood development (ECD). Major gaps to build low‐cost and large‐scale ECD monitoring systems at the local level remain. In this manuscript, we describe the process of selecting nurturing care indicators at the municipal level from...

To address inequities that prevent socioeconomically vulnerable young children from reaching their full developmental potential, Brazil implemented Programa Criança Feliz (PCF) (“Happy Child” early childhood development program) in 2934 of its 5570 municipalities. A qualitative case study was carried out on the basis of in‐depth interviews with 22...

Background Optimal early child development (ECD) is fundamental for every child to achieve their developmental potential and thrive. Household food insecurity (HFI) is a risk factor for suboptimal development, but there is still a need to better understand the pathways that explain this relationship. Objective To evaluate whether maternal mental h...

Objective To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). Methods This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reli...

In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of infant and young children counseling provided by primary healthcare teams to ultimately improving infant feeding practices. • A Manual to Support EAAB Tutors (the Manual) was developed following a problem-based learning methodology. • This study aimed to eval...

Objective: To analyse the determinants of exclusive breast-feeding (EBF) discontinuation in southeastern Brazil between 2008 and 2013. Design: Secondary cross-sectional data were analysed from three waves of child feeding surveys conducted in the city of Marília, São Paulo, Brazil, in 2008, 2011 and 2013 (n 1645 children under 6 months). Multiva...

Background Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary h...

Objective To analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breast-feeding during the first hour of life (BFFHL) and reducing late neonatal mortality. Design Cost-effectiveness economic assessment from the health system perspective, preceded by a prospective cohort of mother–baby followed from birth to 6 mo...

Objectives Early inequities in Early Childhood Development (ECD) are linked to inequalities across the five regions and within the 5570 municipalities in Brazil. We aimed to operationalize an index (IMAPI) to assess and monitor the enabling environment for nurturing care at the regional and municipal level in Brazil using existing national database...

Objectives The aim of the study was to evaluate whether maternal mental health and infant's diet mediate the association between Household Food Insecurity (HFI) and Early Child Development (ECD) using Structural Equation Modeling (SEM). We hypothesized a priori that both maternal mental health and infant's diet would mediate the association between...

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used th...

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross‐sectional study included 468 mother–infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early...

Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendl...

Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To in...

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta‐analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old....

Evidence on the Nurturing Care Framework underlies the critical role of governments investing in integrated Early Childhood Development (ECD) systems to ensure that vulnerable children will survive and thrive. Brazil has endemic inequalities, poverty, and food insecurity across the 5,570 municipalities. This study aims to assess the municipality’s...

Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospec...

Objective: To evaluate the implementation of the Tutor Support Manual of Estratégia Amamenta e Alimenta (EAAB) – the "Manual", developed to support continuing education activities (CEA) in primary health care. Methods: Evaluative research with a quantitative and qualitative approach. The evaluated intervention consisted of the use of the Manual by...

Introduction While the Government of Mozambique has galvanized action around exclusive breastfeeding (EBF) as a national priority, only 43% of Mozambican children under six months of age are exclusively breastfed. In the absence of skilled lactation support, challenges mothers experience with breastfeeding may inhibit initiation, exclusivity and du...

Objective To identify modifiable risk factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Colombia. Design Cross-sectional study from the 2010 Colombia nationally representative Demographic Health Survey (DHS). Studied exposures were categorized into five hierarchical blocks of increasing proximity...

Objective To analyze the prevalence of ultra‐processed food intake among children under one year of age and to identify associated factors. Methods A cross‐sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Brazil....

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...

Objectives The objectives of this implementation science study are to 1) identify problems and challenges with exclusive breastfeeding (EBF) experienced by mothers in Nampula, Mozambique, 2) gain an understanding of the quality and type of counseling on breastfeeding problems and challenges provided by facility and community-based health providers...

The WHO recommends exclusive breastfeeding of infants for the first 6 mo of life (EBF-6). We reviewed the evidence behind concerns related to this recommendation. The risk of iron deficiency among EBF-6 infants can be significantly reduced if delayed cord clamping is performed in all newborns. At the moment there is no population-level evidence ind...

Background: Investing in maternity protection for working women is an important social equity mechanism. Addressing the maternity leave needs of women employed in the informal sector economy should be a priority as more than half of women in Latin America, South Asia, and sub-Saharan Africa are employed in this sector. Objective: To develop a co...

Background Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown. Research aim Quantify the p...

Becoming Breastfeeding Friendly (BBF) is an initiative designed to track country readiness and progress to effectively scale up breastfeeding programs. BBF includes a policy toolbox that has three components: the Becoming Breastfeeding Friendly Index (BBFI), case studies, and a 5‐meeting process. Mapping pathways of how BBF was implemented and util...

Background: Since the 1980s, Brazil has implemented several initiatives to support breastfeeding. Maternity leave, paid in full for 16 weeks, has been available since 1988. However, few studies in Brazil have analyzed the impacts of maternity leave on breastfeeding using population-based indicators. Research aim: The aim was to analyze the associa...

Promoting exclusive breastfeeding (EBF) is a highly feasible and cost‐effective means of improving child health. Regulating the marketing of breastmilk substitutes is critical to protecting EBF. In 1981, the World Health Assembly adopted the WHO International Code of Marketing of Breastmilk Substitutes (the Code), prohibiting the unethical advertis...

Scaling up breastfeeding programmes has not been highly prioritized despite overwhelming evidence that breastfeeding benefits the health of mothers and children. Lack of evidence‐based tools for scaling up may deter countries from prioritizing breastfeeding. To fill this gap, Becoming Breastfeeding Friendly (BBF) was developed to guide countries in...

Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from...

Background: The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (...

Breastfeeding is one of the most feasible and cost-effective maternal-child health interventions. Currently, global investments needed to achieve the WHO global nutrition target for exclusive breastfeeding (EBF) do not meet the recommended standards for economic investment and implementation of policies supporting mothers to breastfeed. Estimating...

Objetivo: Descrever e analisar as práticas de aleitamento materno exclusivo entre mulheres trabalhadoras com creche no local de trabalho. Métodos: O estudo foi realizado em um Centro de Convivência Infantil, vinculado a uma Instituição de Ensino Superior. Para coleta de dados utilizou-se um questionário estruturado. Realizou-se análise múltipla de...

Strategies to tackle stunting, obesity, and micronutrient deficiencies must take into account the inequities in which these diseases are rooted, argue Rafael Perez-Escamilla and colleagues

Objective: To analyze the prevalence of ultra-processed food intake among children under one year of age and to identify associated factors. Methods: A cross-sectional design was employed. We interviewed 198 mothers of children aged between 6 and 12 months in primary healthcare units located in a city of the metropolitan region of São Paulo, Bra...

Matéria sobre os primeiros 1,000 dias de vida

Objectives To describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. Methods This was a cross‐sectional study with data extracted from th...

Purpose: to identify the prevalence of pacifier use as well as the reasons for introducing a pacifier and to analyze factors associated with this practice among children of working women with childcare in the workplace. Methods: a cross-sectional study was conducted with 46 women working at a higher education institution that offered childcare in...

Objectives: To describe the profile of women with children aged under 4 months living in the Brazilian state capitals and in the Federal District according to their working status and to analyze the influence of maternity leave on exclusive breastfeeding (EBF) among working women. Methods: This was a cross-sectional study with data extracted fro...