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espanolIntroduccion. En Colombia la practica de la lactancia materna exclusiva es baja y, pese a las estrategias implementadas para promoverla, aun falta mucho para cumplir con la meta establecida por la Organizacion Mundial de la Salud (OMS). Objetivo. Describir la situacion actual de la consejeria en lactancia materna exclusiva (CLME) en Instituciones Amigas de la Mujer y la Infancia (IAMI) de Bogota D.C., Colombia. Materiales y metodos. Estudio descriptivo transversal. La muestra estuvo constituida por 76 consejeros (miembros del personal en salud) de 12 IAMI, a quienes se les aplico una encuesta semiestructurada con preguntas cerradas y abiertas. Para el analisis de las variables numericas y categoricas se empleo estadistica descriptiva y para analizar las respuestas obtenidas mediante preguntas abiertas se uso el software N-Vivo version 10. Resultados. Los enfermeros y los auxiliares de enfermeria fueron los consejeros que tuvieron mayor contacto con las madres lactantes (84% y 42% respectivamente). El 91% de los participantes no contaba con formacion en CLME segun los lineamientos de la OMS, mientras que para el 60% la consejeria significaba ensenar o brindar informacion a las madres sobre como lactar. Conclusion. La formacion en consejeria en lactancia materna se centra en brindar informacion sobre como lactar, mas no en desarrollar habilidades de consejeria; ademas, no hay un consenso entre el personal de salud que se desempena como consejero en lactancia materna sobre lo que significa la CLME. EnglishIntroduction: Exclusive breastfeeding is still limited in Colombia. Despite the strategies implemented to promote it, the goal established by the World Health Organization (WHO) regarding this practice is far from being achieved. Objective: To describe the current situation of exclusive breastfeeding counseling at Women and Children Friendly Institutions (WCFI) of Bogota D.C., Colombia. Materials and methods: Cross-sectional descriptive study conducted in a sample of 76 counselors from 12 WCFI institutions who were administered a semi-structured questionnaire with open and closed questions. Descriptive statistics were used to analyze the numerical and categorical variables, and the NVivo 10 software was used to analyze the answers obtained through open questions. Results: Qualified nurses and nursing assistants had the most contact with breastfeeding mothers (84% and 42% respectively). 91% of the participants had not been trained in exclusive breastfeeding counselling according to the WHO guidelines, while 60% of the sample considered that counseling only meant teaching and providing information to mothers on how to breastfeed. Conclusion: Breastfeeding counseling training is focused on providing information on how to breastfeed, but not on developing counseling skills. Furthermore, there is no consensus among health staff that works as breastfeeding counselors about what exclusive breastfeeding counseling is.

The aim of the study was to use linear programming (LP) analyses to adapt New Complementary Feeding Guidelines (NCFg) designed for infants aged 6 to 12 months living in poor socioeconomic circumstances in Bogota to ensure dietary adequacy for young children aged 12 to 23 months.A secondary data analysis was performed using dietary and anthropometric data collected from 12-month-old infants (n = 72) participating in a randomized controlled trial. LP analyses were performed to identify nutrients whose requirements were difficult to achieve using local foods as consumed; and to test and compare the NCFg and alternative food-based recommendations (FBRs) on the basis of dietary adequacy, for 11 micronutrients, at the population level.Thiamine recommended nutrient intakes for these young children could not be achieved given local foods as consumed. NCFg focusing only on meat, fruits, vegetables, and breast milk ensured dietary adequacy at the population level for only 4 micronutrients, increasing to 8 of 11 modelled micronutrients when the FBRs promoted legumes, dairy, vitamin A-rich vegetables, and chicken giblets. None of the FBRs tested ensured population-level dietary adequacy for thiamine, niacin, and iron unless a fortified infant food was recommended.The present study demonstrated the value of using LP to adapt NCFg for a different age group than the one for which they were designed. Our analyses suggest that to ensure dietary adequacy for 12- to 23-month olds these adaptations should include legumes, dairy products, vitamin A-rich vegetables, organ meat, and a fortified food.

Objetivo: Describir la situación actual de la consejería en lactancia materna como apoyo para el inicio y mantenimiento de la lactancia materna exclusiva hasta los seis meses, en el Hospital de Engativá. Métodos: Estudio descriptivo de corte transversal, con diseño cuantitativo y cualitativo, realizado en el Hospital de Engativá. La muestra estuvo constituida por 13 profesionales de la salud. Se presentan los resultados preliminares de esta institución, que forma parte de la muestra de la primera parte de la tesis doctoral titulada “Experiencia de la consejería en el apoyo para el inicio y mantenimiento de la lactancia materna exclusiva hasta los seis meses de edad”, de la primera autora de este artículo. Resultados: 77 % (10/13) de las participantes no están formadas como consejeras en lactancia materna; 69 % (9/13) de las participantes tiene contacto con la misma madre en más de una oportunidad; para el 69 % de las participantes, la consejería en lactancia materna significa educar a la madre en lactancia materna. La consejería en lactancia materna llevada a cabo por el 85 % de las participantes se traduce en realizar actividades educativas que buscan informar y enseñar a la madre sobre lactancia. El 54 % de ellas entrega material, como cartillas y folletos. Los temas centrales de la educación son: beneficios de la lactancia materna (85 %), técnica de lactancia materna (69 %) y técnicas de extracción, almacenamiento y transporte de leche materna (38 %). Sin embargo, no se centran en la principal duda que tienen las madres, reconocida por las participantes de este estudio, relacionada con la inseguridad hacia la producción de la leche. Conclusión: No hay claridad sobre el acompañamiento que debe realizarse para promover la lactancia materna y el enfoque de la consejería en lactancia materna por el personal de salud. Es necesario profundizar en lo que significa la consejería en lactancia materna, la metodología y el seguimiento, para promover el inicio de la lactancia y su mantenimiento hasta los seis meses de forma exclusiva.

The optimal age for introducing complementary feeding to breast-fed infants may differ depending on the setting. Prolonged exclusive breast-feeding (EBF) protects against infection but may increase the risk of iron deficiency (ID)/anaemia (IDA) in vulnerable infants. The aim of the present study was to compare haemoglobin (Hb), serum ferritin (SF), anaemia (Hb 11 g/L), ID (SF 12 μg/L) and IDA (Hb 10.5 g/dL + Hct 33% + ID) using observational analyses in 6-month old infants from Bogota, Colombia who were EBF for 4 to 5 versus 6 months or older, and examine predictors.Infant feeding was recorded, anthropometry performed, and blood obtained for Hb and SF at 6 months in healthy term infants (birth weight 2500 g), all EBF for ≥4 months.One hundred eight infants (54% boys) were recruited; 46% EBF for 4 to 5 months, 54% EBF at 6 months. Prevalence of anaemia, ID, and IDA was 20%, 10%, and 5%, with no significant difference between EBF4-5 and EBF6 groups. In multivariate models, anaemia/ID were predicted by greater weight gain from 0 to 6 months, and anaemia also by caesarean delivery; Hb was lower in infants with higher intake of cows' milk; SF was lower in boys and those with greater weight gain. EBF4-5 versus EBF6 was not a significant predictor of any outcome.Anaemia and ID were common at 6 months but were not affected by EBF for 4 to 5 versus 6 months, suggesting 6 months EBF is safe in this population. Further research is, however, required to examine effects on later iron status. The findings highlight the need to emphasise avoidance of cow's milk before 12 months.

Introduction: In Colombia, despite the implementation of initiatives such as breastfeeding counseling, exclusive breastfeeding rates are low. Objective: To understand the experience of a group of nursing mothers regarding the exclusive breastfeeding counseling they were provided with at Women and Children Friendly Institutions (WCFI) in Bogota D.C., Colombia. Materials and methods: Qualitative research with a phenomenological approach. In-depth interviews were administered to 19 breastfeeding mothers who were provided with exclusive breastfeeding counseling at 3 WCFI between August 2016 and January 2017. Units of meaning (UM) were identified through a comprehensive analysis based on the reading of the textual transcripts of the interviews and the identification of essential structures in the mothers’ narratives associated with the experience they had while being counseled in three moments (gestation, delivery/immediate postpartum and puerperium). The analysis was performed using the N-Vivo version 10 software Results: The average age was 23 years. Only 37% of the mothers exclusively breastfed their children until they were 4 months. Nine UM were identified. During gestation and the immediate postpartum period, participants were given instructions on how to breastfeed, but they were not provided with exclusive breastfeeding counseling by healthcare staff. During the puerperium, the mothers' families and support networks provided them with help and guidance regarding breastfeeding. Conclusion: It is possible that the legal provisions on breastfeeding counseling and initiatives such as the WCFI are not being complied with in the country, since there are obstacles that hinder their proper execution; thus, it is necessary to propose and develop effective strategies for the training of breastfeeding counselors among health personnel.

Son reconocidos los beneficios de la lactancia materna en la salud del binomio madre-hijo; sin embargo, pese a las estrategias para promover su práctica, esta sigue siendo corta. La Encuesta Nacional de Situación Nutricional en Colombia 2010 reportó una prevalencia de lactancia materna exclusiva del 42.8%, cifra que aún está lejos de cumplir la meta establecida por la Organización Mundial de la Salud de exclusividad hasta los seis meses de edad y complementaria hasta los dos años.En los últimos 20 años se han puesto en marcha intervenciones como la consejería en lactancia materna. En Colombia, la formación del personal de salud en este tema inició a principios de los años 90; pero, en la actualidad, existen varias dificultades para llevar a la práctica la consejería en lactancia en mujeres gestantes y madres en periodo de lactancia en las diferentes instituciones de salud del país. Como consecuencia, la consejería se enfoca en apoyar a la mujer en las dificultades que se presentan en el acto de amamantar desde el aspecto fisiológico, sin centrarse en la mujer.El conocimiento de las bases teóricas de la consejería permite orientar el acompañamiento a la madre para promover el inicio de la lactancia materna y la exclusividad hasta los seis meses de edad. Del mismo modo, es necesario tener en cuenta los retos que conlleva el pasar de la teoría a la práctica en el contexto colombiano. The benefits of breastfeeding in terms of health for both mother and child are well known. However, despite the different strategies to promote its practice, breastfeeding practice still remains low. In Colombia, the 2010 ENSIN (Spanish acronym for National Survey on Nutritional Status) reported an exclusive breastfeeding prevalence of 42.8%, an amount still far from achieving the target set by the World Health Organization on breastfeeding exclusivity until the child is six months old and complementary breastfeeding up to two years old.During the last 20 years interventions such as breastfeeding counseling have been set in motion. In Colombia, training of health personnel in breastfeeding counseling began in the early 90s, somehow, currently there are several difficulties to implement breastfeeding counseling in pregnant women and mothers in breastfeeding stage attending health institutions in the country. As a result, counseling focuses on supporting women regarding the difficulties that arise when breastfeeding from the physiological aspect, but it does not focus on women at all.Knowledge on counseling theoretical bases allows orienting the mother to promote breastfeeding and its exclusivity in children until they are six years old. Likewise, it is necessary to take into account the challenges that arise when moving from theory to practice in the Colombian context.