Dojčenie a hnačky

30. januára 2016

Dojčenie a hnačky

Výsledky početných štúdii sa zhodujú v tom, že výživa materským mliekom dojčatá účinne chráni pred hnačkami vyvolanými baktériami ako aj vírusmi. Častosť, závažnosť priebehu a úmrtnosť na hnačky je u dojčených detí podstatne nižšia ako u ich rovesníkov kŕmených umelými mliekami. Svetová zdravotnícka organizácia predpokladá, že v krajinách tzv. tretieho sveta umrie každoročne 1.5 milióna detí na následky umelej výživy (t.j. v prvom rade na hnačky s následnou dehydratáciou a rozvratom vnútorného prostredia). Ochranný efekt dojčenia je však zrejmý aj v rozvinutých krajinách s dobrým hygienickým štandardom. Bez ohľadu na socio-ekonomické postavenie rodiny je riziko hnačkových ochorení u dojčených detí podstatne menšie. Ochranný účinok materského mlieka sa uplatňuje nielen pri výlučnom ale aj čiastočnom dojčení (t.j. u detí, ktoré sú zčasti dojčené a zčasti dokrmované umelým mliekom). V takomto prípade je efekt dojčenia priamo úmerný podielu materského mlieka vo výžive. Privčasné zavádzanie príkrmov (pred 6 mesiacom veku) je takisto spojené s častejším výskytom hnačiek. Najmä u detí žijúcich v zlých hygienických podmienkach sa odporúča dojčenie aj po prvom roku života.

 
Pediatrics, Vol. 99 No. 6 June 1997, p. e5
A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States
Paula D. Scariati*Laurence M. Grummer-StrawnDagger and Sara Beck Fein
Background:  Studies on the health benefits of breastfeeding in developed countries have shown conflicting results. These studies often fail to account for confounding, reverse causality, and dose-response effects. We addressed these issues in analyzing longitudinal data to determine if breastfeeding protects US infants from developing diarrhea and ear infections.  Methods: Mothers participating in a mail panel provided information on their infants at ages 2, 3, 4, 5, 6, and 7 months. Infants were classified as exclusively breastfed; high, middle, or low mixed breast- and formula-fed; or exclusively formula-fed. Diarrhea and ear infection diagnoses were based on mothers’ reports. Infant age and gender; other liquid and solid intake; maternal education, occupation, and smoking; household size; family income; and day care use were adjusted for in the full models. Results:  The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7). Conclusions:  Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she will develop diarrhea or ear infection. longitudinal analysis, diarrhea, ear infection, breastfeeding.
Am J Public Health 1999 Jan;89(1):25-30
Breast-feeding and infant illness: a dose-response relationship?
Raisler J, Alexander C, O’Campo P
Nurse-Midwifery Program, University of Michigan School of Nursing, Ann Arbor 48109-0482, USA. jraisler@umich.edu
OBJECTIVES: The purpose of this study was to determine whether breast-feeding has a dose-related protective effect against illness and whether it confers special health benefits to poor infants. METHODS: The association between breast-feeding dose and illnesses in the first 6 months of life was analyzed with generalized estimating equations regression for 7092 infants from the National Maternal and Infant Health Survey. Breast-feeding dose (ratio of breast-feedings to other feedings) was categorized as full, most, equal, less, or no breast-feeding. RESULTS: Compared with no breast-feeding, full breast-feeding infants had lower odds ratios of diarrhea, cough or wheeze, and vomiting and lower mean ratios of illness months and sick baby medical visits. Most breast-feeding infants had lower odds ratios of diarrhea and cough or wheeze, and equal breast-feeding infants had lower odds ratios of cough or wheeze. Full, most, and equal breast-feeding infants without siblings had lower odds ratios of ear infections and certain other illnesses, but those with siblings did not. Less breast-feeding infants had no reduced odds ratios of illness. Findings did not vary by income. CONCLUSIONS: Full breast-feeding was associated with the lowest
illness rates. Minimal (less) breast-feeding was not protective. Breast-feeding conferred similar health benefits in all economic groups.
J Epidemiol Community Health 1998 Jul;52(7):451-8
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Inequality in infant morbidity: causes and consequences in England in the 1990s. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.
Baker D, Taylor H, Henderson J
Department of Child Health, University of Bristol.
STUDY OBJECTIVE: To examine the effect of deprivation, crowding, maternal smoking, and breast feeding on morbidity from wheeze and diarrhoea in the first six months after birth. DESIGN: A geographically located population survey using maternal responses on self completion questionnaires. SETTING: The three health districts of Bristol. SUBJECTS: 8501 infants from the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) in which all women expecting a baby between April 1991 and December 1992 in Bristol were invited to participate. MAIN OUTCOME MEASURES: The prevalence and severity of wheeze at six months after birth. The prevalence of diarrhoea and the duration of the worst bout at six months after birth. RESULTS: Logistic regression analyses using a conceptual hierarchical framework showed that wheeze was significantly more likely to be reported for infants if they lived in rented accommodation (OR = 1.20, 95% CI = 1.04, 1.39), if they lived in crowded housing conditions (OR = 1.26, 95% CI = 1.06, 1.49), if they were one of a number of siblings (OR = 1.78, 95% CI = 1.52, 2.07), and if their mothers smoked (OR = 1.38, 95% CI = 1.21, 1.58). They were significantly less likely to have wheeze if they were breast fed (OR = 0.68, 95% CI = 0.59, 0.79). Each of these factors was independently related to the prevalence of wheeze. For infants with wheeze those who were breast fed for three or more months were significantly less likely to have three or more episodes in the first six months after birth (OR = 0.76, 95% CI = 0.58, 0.99). A higher prevalence of diarrhoea in infancy was associated with living in rented accommodation (OR = 1.25, 95% CI = 1.10, 1.41) and lower maternal education (OR = 0.76, 95% CI = 0.69, 0.84) and a lower prevalence with breast feeding (OR = 0.42, 95% CI = 0.37, 0.48). An episode of diarrhoea was significantly less likely to last for six or more days if an infant lived in mortgaged accommodation (OR = 1.34 95% CI = 1.03, 1.75) and was breast fed for three or more months (OR = 1.34 95% CI = 1.03, 1.75). CONCLUSION: Deprivation was associated with heightened morbidity from common conditions such as wheeze and diarrhoea for this geographical cohort of infants in England in the 1990s. Results supported evidence suggesting that breast feeding is protective against such conditions and is particularly associated with reduced severity and duration. Implications for future research and policy are discussed.
Early Hum Dev 1997 Oct 29;49 Suppl:S83-103
Gastroenteritis, diarrhoea and breast feeding.
Golding J, Emmett PM, Rogers IS
Unit of Paediatric and Perinatal Epidemiology, University of Bristol, UK.
In this paper we review the literature in regard to possible relationships between breast feeding and diarrhoea or gastroenteritis. We show that in the developed as well as the developing world, there is consistent evidence of a protective effect of exclusive breast feeding in the first 4-6 months of life. The odds ratios were generally in excess of 3.0 for non-breast milk feeds. The relationship was not consistent for rotavirus infections but was consistently strong for non-viral pathogens. There are a number of indicators that suggest biological plausibility, in both the developing and developed world. The triple indicators of consistency and strength of the epidemiological associations, together with biological plausibility are major arguments for believing that there is a causal sequence involved.
Public Health 1997 Jul;111(4):239-43
The associations between feeding modes and diarrhoea among urban children in a newly developed country.
al-Ali FM, Hossain MM, Pugh RN
Department of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
The protective effect of breastfeeding against infantile diarrhoea may be less pronounced in areas with modern water supply and sanitation facilities. This finding raises the question whether protection by breastfeeding against infantile diarrhoea in developing countries will decline with improvement in water supply and sanitation. To address this question a historical cohort study of the associations between feeding modes and diarrhoea incidence and severity in children aged 0-14 months at baseline was done in Al Ain city, United Arab Emirates. In this city in a newly developed country, modern water supply and sanitation facilities have become available to everyone during the last two decades. During three months of follow-up of 249 children, the nonbreastfed had more diarrhoea than did the partly breastfed, who in turn had more diarrhoea than did the fully breastfed. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrhoeal morbidity in each child: occurrence or non-occurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the nonbreastfed and fully breastfed subgroups. These results indicate that in Al Ain, despite the universal access to modern water supply and sanitation facilities, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhoea. This observation is particularly important given the growing concern that, as an unwanted effect of ‘modernisation’, breastfeeding is on the decline in Al Ain and comparable populations elsewhere.
Am J Epidemiol 1999 Oct 1;150(7):770-7
Epidemiology of rotavirus diarrhea in Egyptian children and implications for disease control.
Naficy AB, Abu-Elyazeed R, Holmes JL, Rao MR, Savarino SJ, Kim Y, Wierzba TF, Peruski L, Lee YJ, Gentsch JR, Glass RI, Clemens JD
Epidemiology Branch, National Institute of Child Health and Human Development, Bethesda, MD 20852, USA.
Reliable epidemiologic data are essential for formulating effective policy to control rotavirus disease through immunization. The objective of this study was to describe the epidemiology of rotavirus diarrhea in a population-based cohort of children under 3 years of age residing in Abu Homos, Egypt, in 1995-1996. Rotavirus diarrhea incidence rates (episodes per person-year) were 0.13 for infants aged <6 months, 0.61 for those aged 6-11 months, 0.17 for those aged 12-23 months, and 0.15 for those aged 24-35 months. Fifty-six percent of children with rotavirus diarrhea had clinical dehydration; 90% of rotavirus diarrheal episodes occurred between July and November. In infants under 1 year of age, receipt of breast milk was associated with a lower incidence of rotavirus diarrhea. No other sociodemographic or environmental factor was found to be significantly associated with rotavirus diarrhea. Of 46 rotavirus isolates with strains identified, 41 (89%) were G serotypes 1 and 2. Rotavirus diarrhea was a major cause of morbidity in this cohort. Promotion of breastfeeding may exert a protective effect in young infants in this setting, but improvements in water and sanitation are unlikely to be effective preventive measures. The use of effective immunization against rotavirus in early infancy should be considered a public health priority.
Lancet 1998 Apr 18;351(9110):1160-4
Role of human-milk lactadherin in protection against symptomatic rotavirus infection.
Newburg DS, Peterson JA, Ruiz-Palacios GM, Matson DO, Morrow AL, Shults J, Guerrero ML, Chaturvedi P, Newburg SO, Scallan CD, Taylor MR, Ceriani RL, Pickering LK
Shriver Center for Mental Retardation, Waltham, MA 02254, USA. dnewburg@shriver.org
BACKGROUND: Human milk contains a 46 kDa mucin-associated glycoprotein, lactadherin, which binds specifically to rotavirus and inhibits its replication. This study tested the hypothesis that lactadherin protects against symptoms of rotavirus infection. METHODS: 200 infants in Mexico City were recruited at birth and monitored by regular stool EIA for rotavirus, serology, and recording of feeding and stool patterns. Milk samples were obtained from the mothers weekly until 4 weeks post partum then monthly. The sample taken immediately before an infant’s episode of rotavirus infection was assayed for lactadherin, butyrophilin, mucin, and secretory IgA. An infection was defined as symptomatic if diarrhoea occurred in the 5 days before or after detection of the virus. FINDINGS: 31 infants developed rotavirus infection; 15 were symptomatic and 16 had no symptoms. The median concentration of lactadherin in the milk samples (obtained 4-41 days [median 13] before the infection) was 48.4 (range 5.6-180) microg/mL in the asymptomatic group and 29-2 (6.2-103-4) microg/mL in the symptomatic group. Although these medians did not differ significantly, in logistic regression analysis adjusted for age at infection and secretory IgA concentration there was a significant difference between the groups (p=0O01). No association between symptom status and concentrations of butyrophilin, mucin, or secretory IgA was found. INTERPRETATION: Protection against rotavirus by human milk is associated with the glycoprotein lactadherin. This association is independent of products of the secretory immune system.
Salud Publica Mex 1999 Jul-Aug;41(4):263-70
The impact of infant feeding patterns on infection and diarrheal disease due to enterotoxigenic Escherichia coli.
Long K, Vasquez-Garibay E, Mathewson J, de la Cabada J, DuPont H
Departamento de Nutricion y Salud del Nino, Instituto Nacional de Salud Publica, Cuernavaca, Morelos, Mexico.
OBJECTIVE: Determine the impact of dietary risk factors on patterns of infection by heat labile toxin-producing Escherichia coli (LT-ETEC). MATERIALS AND METHODS: Ninety-eight infants were followed from birth for one year in Guadalajara, Mexico, beginning in august of 1986. Stool and breast milk samples were collected weekly from infants and their mothers, respectively. Mothers were also interviewed on a weekly basis regarding the health of the infants. Parametric hazard models were fit to durations of different LT-ETEC disease states determined through the analysis of stools. The child’s consumption of supplemental foods and liquids as well as specific levels of LT-ETEC-specific breast milk antibodies were included in each model as time-varying covariates. RESULTS: The hazard of LT-ETEC asymptomatic infection increased 400 percent among children who received oats gruel (hazard rate = 4.01; 95% CI 2.77-5.24). The duration of infection was reduced if the child had had a previous LT-ETEC diarrheal episode (2.12; 95% CI 1.74-2.49) but was prolonged if the child consumed herbal teas (0.53; 95% CI 0.27-0.7). Herbal teas and high LT-ETEC-specific breast milk antibody levels each reduced the hazard of symptomatic infection by ninety percent. Symptomatic episodes became asymptomatic more rapidly if a child was given rice water. CONCLUSIONS: Specific weaning foods increase the risk of infection. Breastmilk antibodies and liquid infusions reduce diarrheal disease and infection duration.
Kansenshogaku Zasshi 1999 May;73(5):451-6
Detection of bactericidal antibody in the breast milk of a mother infected with enterohemorrhagic Escherichia coli O157:H7.
Adachi E, Tanaka H, Toyoda N, Takeda T
Department of Infectious Diseases Research, National Children’s Medical Research Center.
A 21 years-old pregnant woman developed diarrhea, fresh bloody stools and abdominal pain on April 6th 1997 at 32 weeks of gestation, and was admitted to the hospital on April 11th. The stool culture on admission was positive for enterohemorrhagic Escherichia coli (EHEC) O157:H7 (Stx1 and 2). Clinical laboratory data during admission showed only slight elevation of beta-microglobulin and N-acetyl glucosaminidase in the urine, and no neurological or hemolytic symptoms were seen. After the antibiotic and lactobacillus administration, all her symptoms were relieved and no abnormal findings in pregnancy were observed. She delivered a baby girl normally on May 30th. Serum (between 41 and 120 days from the onset) and milk (between 4 and 64 days post partum) samples from the mother, and serum (64 days of age) from a baby and cord blood were obtained to monitor the immune status against EHEC O157:H7 and against Shiga toxins (Stx). Anti-E. coli O157 LPS antibodies (IgA, G and M) were assayed by the ELISA method. Neutralizing anti-Stx antibodies were measured by using ACHN cell cytotoxicity assay. In the colostrum and mature milk, high levels of IgA and IgM, and no IgG antibodies against EHEC O157 LPS were detected. In one of the control colostrum samples obtained from 4 healthy mothers IgA antibody against EHEC O157 LPS was detected. To assess the potency of protection against EHEC O157:H7 by the breast milk, we monitored it by the bactericidal activity for the organism under complement-coincubation experiment, and by the neutralization test for the Stx cytotoxicity. As a result, breast milk samples (both colostrum and mature milk) from a patient were demonstrated to kill the organisms. One of 4 healthy milk samples, showed bactericidal activity though it was negative in O157-LPS antibody. This bactericidal activity seen in one healthy colostrum is possibly due to a nonspecific reaction caused by non-O157 E. coli infection. From these observations, it was suggested that the bactericidal activity was due to the IgM class antibody against EHEC O157:H7. However, the neutralizing antibody against Stx1 and 2 could not be detected in any sample. EHEC infection at late gestation did not cause adverse effects to a fetus, and breastfeeding may have advantage for the protection of a baby against EHEC infection.
J Diarrhoeal Dis Res 1997 Jun;15(2):53-8
Human colostrum IgA antibodies reacting to enteropathogenic Escherichia coli antigens and their persistence in the faeces of a breastfed infant.
Carbonare SB, Silva ML, Palmeira P, Carneiro-Sampaio MM
Instituto Butantan, Universidade de Sao Paulo, Brazil.
IgA antibodies reacting to enteropathogenic Escherichia coli (EPEC) antigens in human colostrum and their role in the inhibition of EPEC adherence to HEp-2 cells were studied. Colostrum IgA was isolated with a Sepharose anti-IgA column. IgA-depleted colostrum lost its inhibitory effect on EPEC adhesion, while the IgA-enriched eluate was a potent adherence inhibitor. The same eluate showed a significant loss of inhibitory activity after absorption with an EPEC strain showing localised adherence (LA+), but no alteration after absorption with an LA- strain. No bands were observed in Western blot analysis with LA+ absorbed eluate and with a crude extract of the EPEC strain, but the eluate absorbed with LA- showed a strong recognition of a 94-kDa band, a molecular weight equivalent to that of intimin. Colostrum antibodies reacting to non-protein antigens were not detected by Western blot analysis. The persistence of anti-EPEC IgA in the gastrointestinal tract was shown by the strong reactivity to the 94-kDa band in Western blot analysis of one mother’s colostrum and her infant’s faeces. These data confirm the role of colostrum antibodies in protecting the neonate against infections due to EPEC.
Curr Med Chem 1999 Feb;6(2):117-27
Human milk glycoconjugates that inhibit pathogens.
Newburg DS
Shriver Center for Mental Retardation 200 Trapelo Road, Waltham, Massachusetts 02452 USA.
Breast-fed infants have lower incidence of diarrhea, respiratory disease, and otitis media. The protection by human milk has long been attributed to the presence of secretory IgA. However, human milk contains large numbers and amounts of complex carbohydrates, including glycoproteins, glycolipids, glycosaminoglycans, mucins, and especially oligosaccharides. The oligosaccharides comprise the third most abundant solid constituent of human milk, and contain a myriad of structures. Complex carbohydrate moieties of glycoconjugates and oligosaccharides are synthesized by the many glycosyltransferases in the mammary gland; those with homology to cell surface glycoconjugate pathogen receptors may inhibit pathogen binding, thereby protecting the nursing infant. Several examples are reviewed: A fucosyloligosaccharide inhibits the diarrheagenic effect of stable toxin of Escherichia coli. A different fucosyloligosaccharide inhibits infection byCampylobacter jejuni. Binding of Streptococcus pneumoniae and of enteropathogenic E. coli to their respective receptors is inhibited by human milk oligosaccharides. The 46-kD glycoprotein, lactadherin, inhibits rotavirus binding and infectivity. Low levels of lactadherin in human milk are associated with a higher incidence of symptomatic rotavirus in breast-fed infants. A mannosylated glycopeptide inhibits binding by enterohemorrhagic E. coli. A glycosaminoglycan inhibits binding of gp120 to CD4, the first step in HIV infection. Human milk mucin inhibits binding by S-fimbriated E. coli. The ganglioside, GM1, reduces diarrhea production by cholera toxin and labile toxin of E. coli. The neutral glycosphingolipid, Gb3, binds to Shigatoxin. Thus, many complex carbohydrates of human milk may be novel antipathogenic agents, and the milk glycoconjugates and oligosaccharides may be a major source of protection for breastfeeding infants.
Acta Paediatr Suppl 1999 Aug;88(430):110-26
Nutritional effects and management of diarrhoea in infancy.
Gracey M
School of Public Health, Curtin University, Perth, Australia. michael.gracey@health.wa.gov.au
The interactions between diarrhoeal disease and nutritional status are complex and synergistic. These are serious issues globally because they affect hundreds of millions of young children and annually cause > 3 million deaths in children aged under 5 y. Despite intensive field-based and laboratory studies over three decades, many questions remain unanswered about the causes, pathophysiology and best approaches to management and prevention of this “diarrhoea-malnutrition” syndrome. Oral rehydration therapy (ORT) has been a major advance and has saved many lives from acute diarrhoea. However, persistent diarrhoea is now a major problem and is very significant because of its strong negative impacts on nutritional status and because persistent diarrhoea and dysentery are now major causes of infant and young child deaths. ORT provides clear and practical methods for replacement of fluid and electrolyte losses during diarrhoea. Rehydration salts can be made available as (i) a simple, easy-to-use package, complete with user instructions; (ii) cereal-based formulae based on widely available ingredients that can be prepared domestically or commercially; and (iii) home-made mixtures of sugar and salt which should be simple to prepare but are risky because of inadequate understanding about their preparation at home and the chance of mixing the ingredients inaccurately and giving them wrongly.Continuation and encouragement of breastfeeding is an important strategy to prevent and control diarrhoea and as part of its management. Early refeeding during diarrhoea is another important principle to help to reduce its duration, severity and its nutritional impacts. Supplementation with specific dietary ingredients, such as vitamin A, zinc and folate, is rather contentious and drug therapy is of little value unless specifically indicated. Some patients may require enteral nutrition or parenteral nutrition but these require specialized equipment and skills that are usually beyond the reach of developing countries and infants and children who live in remote areas.
Pediatrics 1999 Jul;104(1):e3
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Early initiation of breastfeeding and the risk of infant diarrhea in rural Egypt.
Clemens J, Elyazeed RA, Rao M, Savarino S, Morsy BZ, Kim Y, Wierzba T, Naficy A, Lee YJ
National Institute of Child Health and Human Development, Bethesda, Maryland 20892, USA. clemensj@exchange.nih.gov
BACKGROUND: Initiation of breastfeeding shortly after delivery may enhance breastfeeding’s protective effect against diarrhea because of the protective properties of human colostrum contained in early breast milk. OBJECTIVE: To evaluate whether initiation of breastfeeding within the first 3 days of life, when breast milk contains colostrum, was associated with a lower rate of diarrhea in rural Egyptian infants during the first 6 months of life. METHODS: Infants initially breastfed (n = 198) were monitored prospectively with twice-weekly home visits to ascertain dietary practices and diarrheal illnesses. RESULTS: The burden of diarrhea during the first 6 months of life in the cohort was high: seven episodes per child-year of follow-up. Only 151 (76%) infants initiated breastfeeding during the first 3 days of life (“early initiation”). Infants in whom breastfeeding was initiated early had a 26% (95% CI: 2%,44%) lower rate of diarrhea than those initiated late. The protective association between early initiation and diarrhea was independent of the pattern of postinitiation dietary practices and was evident throughout the first 6 months of life. CONCLUSIONS: Early initiation of breastfeeding was associated with a marked reduction of the rate of diarrhea throughout the first 6 months of life, possibly because of the salutary effects of human colostrum. These data highlight the need for interventions to encourage early initiation of breastfeeding in less developed settings.
Am J Epidemiol 1996 Jun 1;143(11):1142-8
Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines.
Yoon PW, Black RE, Moulton LH, Becker S
Department of International Health, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
The effects of not breastfeeding on mortality due to diarrhea and acute lower respiratory infection (ALRI) in children under 2 years of age were examined using data from a 1988-1991 longitudinal study of 9,942 children in Metro Cebu, The Philippines. Cox regression methods were used to study the magnitude of the risks, possible interactions with birth weight and nutritional status, and the effect of additional confounding factors. Not breastfeeding had a greater effect on diarrheal mortality than on ALRI mortality. In the first 6 months of life, failing to initiate breastfeeding or ceasing to breastfeed resulted in an 8- to 10-fold increase in the rate of diarrheal mortality. The rate of mortality associated with both ALRI and diarrhea was increased nearly six times by not breastfeeding, but the rate of ALRI mortality alone was not increased. The data also suggested that the risk of mortality associated with not breastfeeding was greater for low birth weight infants and infants whose mothers had little formal education. After age 6 months, the protective effects of breastfeeding dropped dramatically. These findings underscore the importance of promoting breastfeeding, especially during the first 6 months of life, and of targeting high risk groups such as low birth weight babies and those of low socioeconomic status.
Southeast Asian J Trop Med Public Health 1999 Jun;30(2):299-306
Dietary management during pregnancy, lactation and common childhood illnesses in rural Bangladesh.
Piechulek H, Aldana JM, Engelsmann B, Hasan MN
ICFHDP, GTZ Office, Gulshan, Dhaka, Bangladesh.
Data were collected on nutritional aspects of women in general and during special time frames such as pregnancy, lactation and common childhood illnesses (diarrhea, acute respiratory infections and measles) from rural areas in Bangladesh. A distinctive gender bias was evident regarding decision making and food allocation within the household. Inadequate feeding practices were observed during diarrhea with 22.2% of the mothers discontinuing breast-feeding. Breast-feeding and nutritional support were comparatively better during ARI and measles. When the children were ill, 97% of the mothers administered a special diet with a variety of food preferences, which were perceived to improve the symptoms of the respective illness. Maternal education influenced both the occurrence of diarrhea and the nutritional management of diarrhea and measles significantly. Therefore, community health education should focus on the importance of breast-feeding and continued nutritional support during illnesses. In order for this health education to be effective, traditional beliefs noted in this study have to be incorporated.
Acta Paediatr 1996 Sep;85(9):1070-5
Risk factors for deaths in under-age-five children attending a diarrhoea treatment centre.
Teka T, Faruque AS, Fuchs GJ
International Centre for Diarrhoeal Disease Research, Bangladesh.
Few case-control studies have examined possible risk factors for diarrhoeal deaths in under-age-five children in the developing countries. We analysed data from the surveillance system of our diarrhoea treatment centre/hospital for the period 1990-94 on 928 children less than 5 years of age. In univariate analysis, 11factors were significantly associated with death: lack of breastfeeding, severe malnutrition, complicated diarrhoea, pneumonia, xerophthalmia, duration of diarrhoea 7-14 days, moderate or severe dehydration, recent history of measles, Shigella flexneri infection, maternal illiteracy, and very low household income. Rotavirus diarrhoea was negatively associated with fatal outcome. In the assessment of severe malnutrition, weight-for-height measurement discriminated mortality risk better than weight-for-age or height-for-age indices. Only two factors retained their significance, severe malnutrition and non-breastfeeding in the multivariate analysis with adjusted odds ratio (95% confidence interval) of 84.2 (9.1, 775.9) and 4.2 (1.3, 13.2) respectively.
J Trop Pediatr 1996 Jun;42(3):170-2
Early complementary feeding is associated with low nutritional status of young infants recovering from diarrhoea.
Haider R, Islam A, Kabir I, Habte D
International Centre for Diarrhoeal Disease Research, Bangladesh.
Young infants admitted to hospital for diarrhoea were studied to identify and understand the reasons for early complementary feeding and to examine its effect on nutritional status. Of 132 infants, 71 percent were being breastfed, 24 percent had already stopped, and 5 percent had never been breastfed. Complementary feeds were started by the mothers when infants’ median age (range) was 27 (1-180) days. Mothers’ perceptions regarding breastmilk being insufficient (53 per cent) or causing diarrhoea (19 percent), were the major reasons for complementary feeding. The mean weight-for-age of the infants given complementary feeds before the age of 2 months was 72 percent of the National Centre for Health Statistics (NCHS) standards, compared to 82 percent in those starting after 2 months of age (P = 0.01). Similarly, the mean weight-for-length in these two groups were 86 and 91 percent, respectively (P = 0.04). Initiation of early complementary feeding is associated with infant malnutrition and this alarming trend should be strongly discouraged.
Acta Paediatr 1996 Oct;85(10):1159-62
Occurrence of diarrhoeal diseases in relation to infant feeding practices in a rural community in West Bengal, India.
Mondal SK, Gupta PG, Gupta DN, Ghosh S, Sikder SN, Rajendran K, Saha MR, Sircar BK, Bhattacharya SK
Department of Epidemiology, National Institute of Cholera and Enteric Diseases, Calcutta, India.
In a rural community-based prospective study, diarrhoea in relation to the feeding patterns of a cohort of infants was studied. A total of 148 infants between the ages of 0 and 2 months were enrolled and followed until the completion of 1 year of age. Survival analysis showed that by the fourth month of age exclusive breastfeeding dropped by 75%. The proportion of complementary breastfeeding increased from 18.6 to 52.9% during the same period and to 83.7% by the eighth month. This study clearly highlights the tendency for early switch over from exclusive breastfeeding to complementary breastfeeding. Early weaning was associated with an incidence rate ratio (IRR) of 3.02 (95% CI 1.043-8.802). The IRR of 3.02 and its confidence limits (1.043-8.02) suggest a significant protective effect of exclusive breastfeeding against diarrhoea in infants. The results of this study indicate that promotion of exclusive breastfeeding has a potential role to reduce the incidence of diarrhoea amongst infants. The findings of this study will be useful for Diarrhoeal Disease Control Programme in reducing diarrhoeal morbidity.
Indian Pediatr 1997 Nov;34(11):995-1001
A prospective cohort study on the survival experience of under five children in rural western India.
Hirve S, Ganatra B
K.E.M. Hospital Research Center, Rasta Peth, Pune.
OBJECTIVE: To study the role of birth weight, nutrition, immunization and other medical as well as social factors in determining child survival. DESIGN: A prospective cohort study. SETTING: 45 villages in Shirur Development Block in Pune District in Maharashtra. METHODS: A cohort of 4129 children were followed from birth till 5 years of age. Weight and length/height of the child was measured at birth and at 3 monthly home visits. Information was also obtained on common childhood morbidities, immunization status and other bio-medical factors. Cause of death was ascertained by verbal autopsy. RESULTS: The neonatal, infant and underfive mortality was rates were estimated to be 37, 60 and 79 per 1000 live births, respectively. Diarrhea and ARI contributed to the major mortality burden. The Kaplan Meier Survival curve showed a sharp fall in the neonatal period, a less rapid decline in the post-neonatal period followed by a marginal fall in the post-infancy period till 5 years age. Girls had a better survival in the early neonatal period but the trend reversed in the late neonatal period. Normal birth weight children had better survival curves compared to low birth weight children. Survival improved with increasing birth order. Multivariate analysis revealed that birth weight, immunization status, and mother’s and child’s nutritional status influenced infant and under five mortality. CONCLUSION: Birth weight continues to exert its influence not only on survival/mortality in early life but even as late as 5 years of age. Strategies to improve child survival should include immunization and breastfeeding.
J Trop Pediatr 1999 Apr;45(2):115-8
The impact of breastfeeding practices on respiratory and diarrhoeal disease in infancy: a study from Sri Lanka.
Perera BJ, Ganesan S, Jayarasa J, Ranaweera S
Lady Ridgeway Hospital for Children, Colombo, Sri Lanka.
A hospital-based descriptive recall study was conducted to assess the relationship, if any, between breastfeeding practices and morbidity from respiratory and diarrhoeal diseases in infants. A total of 343 infants (285 admitted patients and 58 controls) were recruited. Clinical and sociodemographic data and details regarding breastfeeding practices, timing of the first respiratory or diarrhoeal illness, and the timing of the first admission for a respiratory or diarrhoeal illness, were carefully documented. Three broad groups of those who were exclusively breastfed for 3 months or less, 4 months or more, and those who were never breastfed were identified. There was no significant difference in the numbers of infants who developed a respiratory or diarrhoeal illness or were admitted to hospital with a respiratory or diarrhoeal illness during the period of exclusive breastfeeding, irrespective of the period of exclusive breastfeeding. However, significant numbers of patients who were breastfed for 3 months or less developed the first respiratory infection, the first episode of diarrhoea, and the first hospital admission for respiratory or diarrhoeal disease during the first 3 months following the introduction of other foods and in the subsequent 3 months following this period. Those who were never breastfed showed the worst results. Significantly fewer of those who were breastfed for 4 months or more fulfilled the same criteria. Identical findings were noted whether the additional feeds used to terminate exclusive breastfeeding were water, herbal tea, native medicines, or formula milk. Similar results were obtained in the control group. This study reiterates the extended protective effects of exclusive breastfeeding for periods of over 4 months against respiratory and diarrhoeal diseases using a novel set of outcome measures.
J Adv Nurs 1999 Mar;29(3):721-6
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The relationship between infant feeding practices and diarrhoeal infections.
Ziyane IS
Faculty of Health Sciences (Midwifery Department), University of Swaziland, Mbabane, Southern Africa.
To determine the relationship between infant feeding practices and diarrhoeal infections, a descriptive survey was conducted on infants aged between 6 and 12 months of age. A guided interview was conducted with 105 mothers of infants who attended the health facilities of Mbabane, Swaziland. The results showed that breast feeding was routinely practised by the majority of mothers, although exclusive breast feeding was very low. Supplementary feeds in the form of formula or solids were introduced by the majority of respondents within the first 3 months of life. Infants who were given colostrum and breast milk had fewer diarrhoeal attacks. Other factors, for example education and cultural factors, influenced the feeding practices and number of diarrhoeal attacks. It is recommended that breast feeding should be promoted as an important intervention in the control of diarrhoea.
Am J Trop Med Hyg 1999 Jan;60(1):167-71
Management of childhood diarrhea and use of oral rehydration salts in a suburban West African community.
Sodemann M, Jakobsen MS, Molbak K, Martins C, Aaby P
Projecto de Saude de Bandim, Bissau, Guinea-Bissau.
In a household survey in Guinea-Bissau, 319 episodes of diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient. Mothers with no knowledge of ORS did not use it during the observed attack of diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of ORS, good knowledge of ORS, and having ORS sachets at home. Multivariate Cox regression analyses showed that the presence of ORS sachets at home at the onset of diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and address mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.
J Biosoc Sci 2000 Jan;32(1):47-61
Breast-feeding, diarrhoea and sanitation as components of infant and child health: a study of large scale survey data from Ghana and Nigeria.
Ahiadeke C
Population Dynamics Unit, ISSER, University of Ghana, Legon, Ghana.
Using Demographic and Health Survey datasets from Ghana and Nigeria, this study examined whether the protective effects of breast-feeding are greatest where the poorest sanitation conditions prevail. It was found that mixed-fed infants aged between 0 and 11 months tend to have a higher risk of diarrhoea than fully breast-fed children, while the risk of diarrhoea among weaned infants is twice that of mixed-fed infants. The probit regression models employed in the analysis were used to predict the probability of diarrhoea associated with each breast-feeding pattern for both ‘poor’ and ‘good’ sanitation areas. It was found that the risk of diarrhoea among mixed-fed infants in the poor sanitation areas tends to be high while the same risk among fully breast-fed infants tends to be minimal. In essence, the health risks of mixed feeding are real, particularly for infants aged less than 7 months, and are even worse for those weaned before 6 months of age.
Ann Trop Paediatr 1999 Dec;19(4):371-6
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The impact of breastfeeding on serum electrolytes in infants hospitalized with severe dehydrating diarrhoea in Yemen.
Banajeh SM, Hussein RF
Department of Paediatrics, Sana’a University, Yemen. shaithami@unicef.org
The effect of breastfeeding on serum electrolytes and case fatality was studied in a group of 430 children admitted with severe dehydrating diarrhoea. Hyponatraemia and hypokalaemia were significantly more prevalent in infants who were exclusively bottle-fed (37.3% and 46.3%) compared with exclusively breastfed (12.2% and 16.7%) and among bottle-fed weaning children (46.3% and 62.6%) compared with weaning children who continued to breastfeed (24.7% and 36.7%, respectively). Mortality was lower in exclusively breastfed children (4.4%) than in those receiving formula feeds (16.4%); it was also lower in weaning children who continued to receive breast-milk (6%) than in bottle-fed weaning children (13.8%). Breastfeeding significantly reduces case fatality and the likelihood of electrolyte disturbances among infants hospitalized with severe dehydrating diarrhoea.
Eur J Epidemiol 1999 Nov;15(10):907-12
Maternal knowledge and environmental factors associated with risk of diarrhea in Israeli Bedouin children.
Bilenko N, Fraser D, Naggan L
S. Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Diarrhea is still a major cause of morbidity and mortality among children in developing countries. As it is due to multiple causative agents including viruses, bacteria and parasites, biological interventions are not currently available to markedly reduce incidence and severity. We examined maternal knowledge and reported behavior during diarrheal episodes, as well as environmental factors to determine their association with diarrhea. The children and mothers were from a Bedouin township in southern Israel, which has developed preventive and curative health care facilities. The Bedouin population in Israel is in transition from a nomadic to a settled life style. While almost all mothers exhibited good knowledge regarding food storage and prevention of diarrhea episodes in the children, the rate of illness in the children remained relatively high (two episodes per child year of observation). In a multivariate analysis, cessation of breastfeeding during diarrhea, child sleeping with siblings and lack knowledge about risk factors, were the major risk factors for illness with odds ratios (OR): 4.6, p = 0.02, 5.6, p = 0.03 and 1.7, p = 0.06, respectively. These data indicate that even in this population with free access to preventive medical care, greater efforts should be made to educate mothers regarding risk factor for diarrheal disease identification and the benefits of maintaining breastfeeding during diarrhea episodes.
J Nutr 2000 Mar;130(3):546-52
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Growth faltering is prevented by breast-feeding in underprivileged infants from Mexico City.
Villalpando S, Lopez-Alarcon M
Unidad de Investigacion Medica en Nutricion, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, D.F.
This study was designed to test whether breast-feeding protects infants reared in unfavorable environments from growth-stunting by averting acute infections. The body weight and length, feeding mode and morbidity of 170 healthy infants were assessed at 15-d intervals from birth to 6 mo. Birth weight and length were not different between groups, but at 6 mo, breast-fed infants were heavier and tended to be taller (P = 0.1) than infants fed formula. Relative to NCHS values, infants had lower mean birth weights than a sample of American and European BF infants. At 6 mo, the weight of BF infants caught up to the weight of NCHS standards, while infants fed formula fell to around -1 NCHS-Z-score for weight and length. The cumulative 6-mo weight increments were negatively related to the number of episodes of diarrhea, and positively to duration of lactation (P = 0.03, R(2) = 0.17). The 6-mo length gain was negatively related to infections but not to duration of lactation (P = 0.004, R(2) = 0.19). Never-ill infants attained a better weight (P = 0.04) and length (P = 0.02) than infants who suffered one or more episodes of diarrhea. Weight and length gain of infants suffering at least one episode of diarrhea was positively related to breast-feeding and socioeconomic status. Weight increments of 15-d were positively related to breast-feeding and negatively to the introduction of solids. In conclusion, breast-feeding positively affected the growth performance of the recipient infants by averting infections and possibly by improving nutrient intake during infections.
Acta Paediatr 1999 Oct;88(10):1101-6
Effect of breastfeeding and morbidity on the development of low birthweight term babies in Brazil.
Morris SS, Grantham-McGregor SM, Lira PI, Assuncao AM, Ashworth A
International Food Policy Research Institute, Washington, DC, USA.
Low birthweight (LBW) occurs in 17% of births in developing countries and many of them are full term. The subsequent development of LBW term infants is poorer than higher birthweight children and more likely to be affected by poor social circumstances. We investigated the effects of morbidity and breastfeeding on the development of these LBW term infants. Two parallel cohorts (n = 131 + 131) of LBW term (1500-2499 g) and higher birthweight (3000-3499 g) infants were recruited from six maternity centers in northeast Brazil. The longitudinal prevalence of morbidity and the frequency of breastfeeding over the first 6 mo of life were assessed. The infants’ development was assessed on the Bayley Scales at 6 and 12 mo, and we previously reported that the low birthweight group had lower scores than the higher birthweight group. Hospitalizations in the first 6 mo were negatively associated with 6-mo and 12-mo Bayley scores in both groups. Among LBW infants, but not higher birthweight infants, there were significant associations between the prevalence of diarrhea and mental and motor development at 6 mo and mental development at 12 mo. Breastfeeding frequency in the first 4 wk of life was positively associated with mental development in both birthweight groups at 6 mo but not at 12 mo. Breastfeeding beyond 4 wk was not associated with the children’s development. We conclude that low birthweight infants are especially vulnerable to the effects of diarrhea, and the greater frequency and differential effect of diarrhea partly explains their poorer development.
J Nutr 1997 Mar;127(3):436-43
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Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age.
Lopez-Alarcon M, Villalpando S, Fajardo A
Unidad de Investigacion en Nutricion, Hospital de Pediatria, Mexico, D.F.
It remains unclear whether breast-feeding protects infants against acute respiratory infection (ARI). To determine if breast-feeding protects against ARI as it does against diarrhea, 170 healthy newborns were followed for 6 mo. Feeding mode, incidence and duration of ARI and diarrhea were recorded biweekly. Infants were classified as fully or partially breast-fed, or formula-fed. Incidence and prevalence were computed monthly. The effects of duration of breast-feeding and potential confounders were analyzed by multiple and logistic regression analyses. Incidence and prevalence of ARI were significantly lower in fully breast-fed infants than in formula-fed infants from birth up to 4 mo, as was the mean duration of individual episodes (5.1 +/- 3.5 vs. 6.4 +/- 3.6 d, respectively). Incidence of ARI was negatively associated with duration of breast-feeding and positively associated with the presence of siblings (P < 0.05). The prevalence of ARI was associated only with the duration of breast-feeding (P < 0.05). Infants that were never breast-fed and that had one or more siblings were more likely to have an episode of ARI than those fully breast-fed for at least 1 mo. Incidence, prevalence, and duration of individual episodes of diarrhea were also lower in breast-fed infants. Incidence (r = -0.17, P < 0.02) and prevalence (r = -0.19, P < 0.008) were negatively associated with duration of full breast-feeding. Introduction of solid food was not associated with further episodes of diarrhea. The present results demonstrate protection against ARI as a result of breast-feeding similar to that for diarrhea, i.e., lower incidence and percentage of days ill, and episodes of shorter duration.
Am J Clin Nutr 1997 Nov;66(5):1102-9
Breast milk or animal-product foods improve linear growth of Peruvian toddlers consuming marginal diets.
Marquis GS, Habicht JP, Lanata CF, Black RE, Rasmussen KM
Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA. gmarquis@uab.edu

Although breast-feeding is widely accepted as important for infant health, its benefits during the second year of life have been questioned. We analyzed data from 107 breast-fed and weaned Peruvian children living in a periurban community to determine whether breast milk contributed to improved linear growth between 12 and 15 mo of age. Breast-feeding frequency was self-reported; intakes of complementary foods and animal products were estimated from a food-frequency survey. Multivariate-linear-regression analysis was used to predict the length of the children at 15 mo of age. Determinants of length included length and weight-for-length at 12 mo of age (US National Center for Health Statistics standards), interval between 12- and 15-mo measurements, breast-feeding frequency, incidence of diarrhea, and intakes of complementary and animal-product foods. Complementary foods, animal-product foods, and breast milk all promoted toddlers’ linear growth. In subjects with low intakes of animal-product foods, breast-feeding was positively associated (P < 0.05) with linear growth. There was a 0.5-cm/3 mo difference in linear growth between weaned toddlers and children who consumed the average number of feedings of breast milk. Linear growth was also positively associated with intake of animal-product foods in children with low intakes of complementary foods. The negative association between diarrhea and linear growth did not occur in subjects with high complementary-food intakes. When the family’s diet is low in quality, breast milk is an especially important source of energy, protein, and accompanying micronutrients in young children. Thus, continued breast-feeding after 1 y of age, in conjunction with feeding of complementary foods, should be encouraged in toddlers living in poor circumstances.

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