| Abstract | Cilj: Analizirati dostupne podatke o dojenju u Hrvatskoj iz rutinskih (obveznih) javnozdravstvenih statističkih izvještaja u razdoblju od 2005. do 2015. godine, prikazati trend dojenja te opisati proces prikupljanja, evidentiranja i prijavljivanja podataka o dojenju nadležnim tijelima u Hrvatskoj. -----
Materijal i metode: Korišteni su podaci o prehrani novorođenčadi koji se prikupljaju u rodilištima i podaci o prehrani dojenčadi iz djelatnosti zdravstvene zaštite dojenčadi i male djece i obiteljske medicine u razdoblju od 2005. do 2015. godine. Za analizu podataka i prikaz trenda dojenja koristila se deskriptivna statistika. Kako bi se dobio dublji uvid u proces prikupljanja, evidentiranja i prijavljivanja podataka o dojenju, proveden je polu-strukturirani nestandardizirani intervju na namjernom prigodnom uzorku pedijatara i patronažnih sestara. -----
Rezultati: Prema podacima o dojenju iz hrvatskih rodilišta u promatranom razdoblju je više od 85% novorođenčadi isključivo dojeno, s time da od 2013. godine dolazi do pada isključivog dojenja ispod 80%. U istom razdoblju raste udio novorođenčadi na dvovrsnoj prehrani kojih je do 2012. godine oko 10%, ali u razdoblju od 2013. do 2015. godine slijedi porast 13,3%-17,7%. Od 2013. godine raste i udio nepoznatih podataka o dojenju s prosječnih 1,5% od 2005. do 2012. godine na 2,2%-2,8% u razdoblju od 2013. do 2015. godine. Udio novorođenčadi hranjene zamjenom za majčino mlijeko je kontinuirano ispod 2%. Podaci o dojenju iz primarne zdravstvene zaštite (PZZ) prikazuju uglavnom rast udjela prehrane samo dojenjem do 2011. godine u dobi od 0-2 i 3-5 mjeseci, nakon čega slijedi pad u 2013. godini. Od 2012. godine pedijatrijski timovi imali su obvezu priključivanja na Centralni zdravstveni informacijski sustav (CEZIH), ali elektroničke poruke ne sadržavaju podatke o prehrani dojenčadi kao ni većinu drugih pokazatelja iz sistematskih pregleda. Ručno vođene evidencije o dojenju i drugim pokazateljima sistematskih pregleda od 2013. godine više nisu pouzdan izvor informacija, jer pedijatri ne dostavljaju podatke o dojenju za oko 30% dojenčadi obuhvaćene sistematskim pregledima. Rezultati intervjua pokazali su kako postoji visoko razvijena svijest o važnosti prikupljanja podataka o dojenju među anketiranim pedijatrima i patronažnim sestrama pri čemu su pedijatri iskazali nezadovoljstvo računalnom aplikacijom koja ne omogućava bilježenje i praćenje javnozdravstvenih pokazatelja rasta i razvoja dojenčadi i predškolske djece na razini ordinacije. ----- Zaključak: Rutinski prikupljeni podaci o dojenju u Hrvatskoj ne dozvoljavaju donošenje zaključaka o trendu dojenja obzirom na uočene razlike u definicijama pokazatelja dojenja, probleme u prikupljanju rutinskih zdravstveno-statističkih podataka o dojenju iz primarne zdravstvene zaštite nakon uvođenja CEZIH-a otkad raste udio nepoznatih podataka u evidencijama iz primarne zdravstvene zaštite. Osim toga, nije moguće evaluirati ostvarenje mjera za promicanje dojenja određenih Nacionalnim programom za zaštitu i promicanje dojenja, jer ne postoji obveza dostave pokazatelja o njihovu provođenju niti ishodima. Kako bi se unaprijedio proces prikupljanja, evidentiranja i prijavljivanja podataka o dojenju, potrebno je sustavno primjenjivati definicije Svjetske zdravstvene organizacije o dojenju te promjenama u nacionalnom zdravstvenom informacijskom sustavu omogućiti precizno evidentiranje na razini rodilišta i primarne zdravstvene zaštite te dostavu ovih podataka za javnozdravstvene potrebe praćenja i evaluacije dojenja. Osim evaluacije dojenja prema podacima rutinskih zdravstveno-statističkih izvještaja, potrebno je evaluirati i mjere koje provode udruge civilnog društva za zaštitu i promicanje dojenja da bi mogli procijeniti koliko su njihove intervencije bile uspješne i kako ih dalje planirati i provoditi. |
| Abstract (english) | Aim: The aim is to analyse available breastfeeding data in Croatia from routine (compulsory) public health reports during the period from 2005 to 2015 and to show the trend of breastfeeding. Moreover, the object is to describe the process of gathering, collecting, recording and reporting of breastfeeding data to the official institutions in Croatia. -----
Materials and Methods: Infant nutrition data collected at maternity wards and infant nutrition data from primary health care units (paediatrics and family medicine) during the period from 2005 to 2015 have been used. Descriptive statistics have been used to analyse the data and to show the trend of breastfeeding. In order to gain a deeper insight into the process of gathering, collecting, recording and reporting of breastfeeding data, a semi-structured non-standardized interview was conducted on a deliberate sample of paediatricians and community nurses. -----
Results: According to the breastfeeding data from Croatian maternity wards, more than 85% of newborn infants had been exclusively breastfed. After 2013 there has been a significant decrease of exclusive breastfeeding shares to less than 80%. In the same period, the share of newborns on mixed feeding (combining breastfeeding and bottle feeding) has grown (10% in 2012), but in the period from 2013 to 2015 there had been an increase from 13.3% to 17.7%. Since 2013 the share of unknown breastfeeding data has risen from an average of 1.5% between 2005 and 2012 to 2.2% - 2.8% during the period from 2013 to 2015. The share of infants fed with formula is continuously below 2%. When it comes to data on breastfeeding from primary health care, we can see a mainly growth of exclusive breastfeeding by 2011, followed by a fall in 2013. Since 2012 paediatric teams have an obligation to join the Croatian Central Healthcare Information System of the Republic of Croatia (CEZIH), but electronic messages do not contain infant nutrition information, as well as most other indicators of systematic examinations. Manually recorded breastfeeding records and other public health indicators obtained from systematic examinations from 2013 are no longer a reliable source of information because paediatricians do not provide breastfeeding data for about 30% of infants covered by systematic examinations. The results of the interviews show that there is a well-developed awareness of the importance of collecting data on breastfeeding among surveyed paediatricians and community nurses. Also, the results show that paediatricians are dissatisfied with computer application and a generally unscheduled system in monitoring public health indicators of growth and development of infants and preschool children. -----
Conclusion: The routinely collected data on breastfeeding do not allow to reach the conclusion of the breastfeeding trend in the Republic of Croatia. The reasons for that lies in a view of the observed problems in the difference of the applied definitions, as well as the problems in collecting routine health statistical data on breastfeeding from primary health care after joining the Central Healthcare Information System of the Republic of Croatia (CEZIH), especially after the share of unknown data in the records of the primary health care has increased. Therefore, it is impossible to evaluate the implementation of breastfeeding measures promoted by the National Program for the Protection and Promotion of Breastfeeding because there is no obligation to provide indicators on their implementation or outcome. In order to improve the process of collecting, recording and reporting breastfeeding data, the WHO definitions of breastfeeding should be applied. Furthermore, the national health information system should provide precise recording and documenting on both level, at the maternity wards and primary health care, as well as to secure the delivery of these data for monitoring and evaluating breastfeeding practices. Beside the evaluation of breastfeeding practices according to routine health statistics reports, there is a necessity to evaluate programs which promote and support breastfeeding by the non-government organizations. It is necessary to analyse how much their interventions have been successful and how to plan and implement those interventions for further actions. |
