Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study.

OBJECTIVE--To determine the effect of breast feeding on the risk of xerophthalmia in children aged 6 months to 3 years attending a diarrhoea treatment centre in Bangladesh. DESIGN--Case-control study based on stratified analysis (Mantel-Haenszel) and multivariate analysis (logistic regression) of data from a treatment centre based surveillance system. SETTING--A large diarrhoea treatment centre in Dhaka, Bangladesh. PATIENTS--2687 children aged 6 months to 3 years representing a 4% systematic sample of all children in this age group treated yearly at the centre over three consecutive years. 66 of the children were cases of xerophthalmia (that is, they had Bitot''s spots or corneal lesions or night blindness or night blindness plus conjunctival xerosis or any combination of these) and the remaining 2621 did not have signs or symptoms of vitamin A deficiency. This second group served as controls. MAIN OUTCOME MEASURE--Xerophthalmia and breast fed at onset of diarrhoea or presentation. RESULTS--The odds ratio relating breast feeding to vitamin A deficiency after adjustment for a large number of confounding variables (0.26 (95% confidence interval 0.14 to 0.49); p less than 0.001) reflected a 74% reduction in the risk of vitamin A deficiency among breast fed children. The estimated reduction of risk did not decline with age, and some 49% of children aged 24-35 months were still being breast fed. The odds ratio relating breast feeding to xerophthalmia in the third year of life (0.35 (95% confidence interval 0.35 to 0.86) reflected a 65% reduced risk of vitamin A deficiency. Other important risk factors or prognostic indicators for xerophthalmia as identified by multivariate analysis were recent measles, prolonged diarrhoea, severe protein energy malnutrition, and poor socioeconomic state. CONCLUSIONS--These results indicate that breast feeding was associated with a substantial reduction of the risk of vitamin A deficiency extending to the third year of life and support the recommendation that mothers in developing countries should be advised to breast feed for as long as possible.     

Prolonged breast feeding,diarrhoeal disease,and survival of children in Guinea-Bissau.

OBJECTIVE--To analyse the impact of breast feeding on diarrhoeal disease and survival in children above 1 year of age in Guinea-Bissau, west Africa. DESIGN--A community study of an open cohort followed up weekly by interviews over 15 months. Data on feeding practices, anthropometry, and survival were recorded for three years. SETTING--301 randomly selected houses in a semiurban area in the capital, Bissau. SUBJECTS--849 children aged less than 3 years. MAIN OUTCOME MEASURES--Incidence and duration of diarrhoea, weight for age, and death of a child. RESULTS--The incidence of diarrhoea was higher in weaned children than in partially breast fed children, both in 1 year olds (relative risk 1.41; 95% confidence interval 1.23 to 1.62) and in 2 year olds (1.67; 1.29 to 2.15). The mean duration of an episode of diarrhoea was 5.3 days in breast fed children compared with 6.3 days in weaned children (P = 0.001). Independent of the age of weaning, a similar increase was found in an analysis comparing, for each child, the rate and duration of diarrhoea one month before and one month after weaning. Children with low weight for age were breast fed longer than the better nourished children (P = 0.02). Children aged 12-35 months who were not breast fed had a 3.5 times higher mortality (1.4 to 8.3) than breast fed children. CONCLUSIONS--The beneficial effects of breast feeding are not restricted to infancy. Though children who are partially breast fed after infancy may have a lower state of nutrition than the weaned ones, the benefit in terms of lower morbidity may be more important for child survival in places with a high morbidity from diarrhoea and with high mortality.     

Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study

ObjectiveTo determine whether breast feeding protects infants against pneumonia and whether the protection varies with age.DesignNested case-control study.SettingPelotas, southern Brazil.SubjectsCases were 152 infants aged 28-364 days who had been admitted to hospital for pneumonia. Controls were 2391 cases in a population based case-control study.ResultsInfants who were not being breast fed were 17 times more likely than those being breast fed without formula milk to be admitted to hospital for pneumonia (95% confidence interval 7.7 to 36.0). This relative risk was 61 (19.0 to 195.5) for children under 3 months old, decreasing to 10 (2.8 to 36.2) thereafter. Supplementation with solids was associated with a relative risk of 13.4 (7.6 to 23.5) for all infants and 175 (21.8 to 1405.1) for those under 3 months old.ConclusionBreast feeding protects young children against pneumonia, especially in the first months of life. These results may be used for targeting intervention campaigns at the most vulnerable age groups.

Key messages

• Pneumonia is the leading cause of death in children under 5 years old across the world
• In Brazil infants who were not breast fed were 17 times more likely than those receiving breast milk alone to be admitted for pneumonia
• The relative risk of admission was 61 for children under 3 months of age, decreasing to 10 thereafter
• Supplementation with solids was associated with a relative risk of 13.4 for all infants
• Mothers must be encouraged to breast feed very young infants and be advised of the right time to introduce supplementary foods

     

Breast-feeding, diarrhoea and sanitation as components of infant and child health: a study of large scale survey data from Ghana and Nigeria

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.     

Haem iron intake in 12-36 month old children depleted in iron: case-control study.

OBJECTIVE: To compare the intakes of haem and non-haem iron in iron depleted and iron replete children. DESIGN: Case-control study. SETTING: Early Childhood Centres and a long day care centre in Sydney, Australia. SUBJECTS: Children aged 12-36 months depleted in iron and controls matched for age and sex. MEAN OUTCOME MEASURES: Iron status by using plasma ferritin concentration. A three day weighed dietary intake record completed by the parents. Risk factors for iron deficiency assessed by questionnaire. RESULTS: Fifty six iron depleted and 68 iron replete children participated. The average daily intake of haem iron was significantly lower in the iron depleted group (t = 2.392, P = 0.018); there was a tendency towards a lower average daily intake of non-haem iron (t = 1.724, P = 0.086) and vitamin C (t = 1.921, P = 0.057) for iron depleted children. Low intake of haem iron (< 0.71 mg/day) was significantly associated with iron depletion with an odds ratio fo 3.0 (P = 0.005). The proportion of iron depleted children who were given whole cows'' milk before 12 months of age was almost double that of iron replete children; multivariate analysis showed that both haem iron intake and age of introduction of cows'' milk were independently associated with iron depletion. CONCLUSIONS: The results of this study show that, in young children in developed countries, a lower haem iron intake is a major risk factor for iron depletion; the introduction of whole cows'' milk before 12 months is further confirmed as a risk factor. Parental education on nutrition should now focus on these two aspects of nutrition for infants and young children.     

Poor Adherence to National and International Breastfeeding Duration Targets in an Australian Longitudinal Cohort

Objectives

To report on the proportion and characteristics of Australian infants who are fed, and mothers who feed, in accordance with the national and international breastfeeding duration targets of six, 12 and 24 months. Furthermore, to examine the longitudinal breastfeeding duration patterns for women with more than one child.

Methods

Breastfeeding duration data for 9773 children have been self-reported by a national sample of 5091 mothers aged 30–36 years in 2009, participating in the Australian Longitudinal Study on Women’s Health.

Results

Only 60% of infants received the minimum recommended 6 months of breast milk, irrespective of breastfeeding exclusivity. Less than 30% of infants received any breast milk at 12 months, and less than 3% were breastfed to the international target of 24 months. Young, less educated, unmarried or low-income women were at an increased risk of premature breastfeeding cessation. For women with three or more children, nearly 75% of women who breastfed their first child for at least six months reached this breastfeeding duration target for their next two children.

Conclusion

While national breastfeeding rates are typically evaluated in relation to the infant, a novel component of our study is that we have assessed maternal adherence to breastfeeding duration targets and the longitudinal feeding practices of women with more than one child. Separate evaluations of maternal and infant breastfeeding rates are important as they differ in their implications for public health policy and practice.     

Breast feeding and lower respiratory tract illness in the first year of life. Group Health Medical Associates.

OBJECTIVE--To assess the relation between breast feeding and subsequent experience of lower respiratory tract illness. DESIGN--Prospective (from well child visits) and retrospective (from maternal recall) study of breast feeding and prospective assessment by paediatricians of lower respiratory tract illness in infants during first year of life. SETTING--Health maintenance organisation. PARTICIPANTS--Over 1000 infants who were healthy at birth and whose parents used the paediatricians of a local health maintenance organisation. MAIN OUTCOME MEASURES--Duration of breast feeding and type of lower respiratory tract illness (wheezing and non-wheezing) at different age intervals during the first year of life. RESULTS--Breast feeding was associated with a decreased incidence of wheezing illnesses only in the first four months of life. Interactions existed between breast feeding and sharing a room, being Mexican American, and being a boy. Multivariate techniques showed that after controlling for a variety of factors children who received minimal breast milk had a greater risk of early wheezing illnesses; the risk was further increased by simultaneous exposure to sharing a room. CONCLUSION--Breast feeding seems to protect against wheezing respiratory tract illnesses in the first four months of life, particularly when other risk factors are present.     

Influence of maternal diet during lactation and use of formula feeds on development of atopic eczema in high risk infants.

OBJECTIVE--To examine the effects of maternal diet during lactation and the use of formula feeds on the development of atopic eczema in infants at risk. DESIGN--Mothers who planned to breast feed exclusively were randomly allocated to either a restricted diet (avoiding milk and other dairy products, eggs, fish, peanuts, and soybeans) or a diet without restrictions. Mothers who did not plan to breast feed were randomly allocated to using one of three formula feeds. SETTING--Child health centre in Canada. SUBJECTS--97 Mothers who chose to breast feed and 124 mothers who did not. INTERVENTIONS--Restricted diet for 49 mothers who breast fed. Casein hydrolysate formula, soy milk formula, or cows'' milk formula for infants not breast fed. MAIN OUTCOME MEASURE--Development of eczema in babies. RESULTS--Infants were followed up over 18 months and examined for eczema. Eczema was less common and milder in babies who were breast fed and whose mothers were on a restricted diet (11/49 (22%) v 21/48 (48%)). In infants fed casein hydrolysate, soy milk, or cows'' milk 9/43 (21%), 26/41 (63%), and 28/40 (70%), respectively, developed atopic eczema. CONCLUSIONS--In families with a history of atopic disease [corrected] mothers who breast feed should avoid common allergenic foods during lactation. If they choose not to breast feed a hydrolysate formula should be used.     

Continuous Intragastric Milk Feeds in Infants of Low Birth Weight

In a feeding trial 66 infants of low birth weight received continuous intragastric milk feeds from the fourth hour of life, starting with 60 ml/kg/24 hr and reaching a maximum of 300 ml/kg/24 hr on the ninth day. Each infant received only full-strength milk, which was either expressed human breast milk or SMA-S26 (a proprietary low-protein adapted cows'' milk) or half-cream Regal milk (partly-skimmed evaporated cows'' milk). For various reasons 10 babies had to be withdrawn, and the final assessment was made on the 56 who completed the trial successfully.Persistent vomiting was a problem in only four infants. In two of them the trial was continued after gastric lavage and in the other two vomiting stopped when the volume was reduced. Despite a careful search no evidence was found of aspiration of feeds in any infant. Continuous intragastric milk infusion was shown to be a safe method of feeding infants of low birth weight and SMA-S26 was almost as well tolerated as human milk. Because of the high-protein content of half-cream cows'' milk preparations and the resultant high plasma amino-acid levels when they are given in these large volumes they should be avoided for this type of feeding although they produce better weight gains in the first week of life.     

Impact of massive dose of vitamin A given to preschool children with acute diarrhoea on subsequent respiratory and diarrhoeal morbidity.

OBJECTIVE--To assess the impact of vitamin A supplementation on morbidity from acute respiratory tract infections and diarrhoea. DESIGN--Double blind randomised placebo controlled field trial. SETTING--An urban slum area in New Delhi, India. SUBJECTS--900 children aged 12-60 months attending a local health facility for acute diarrhoea of less than seven days'' duration randomly allocated to receive vitamin A 200,000 IU or placebo. MAIN OUTCOME MEASURES--Incidence and prevalence of acute lower respiratory tract infections and diarrhoea during the 90 days after termination of the enrolment diarrhoeal episode measured by twice weekly household surveillance. RESULTS--The incidence (relative risk 1.07; 95% confidence interval 0.92 to 1.26) and average number of days spent with acute lower respiratory tract infections were similar in the vitamin A supplementation and placebo groups. Among children aged 23 months or less there was a significant reduction in the incidence of measles (relative risk 0.06; 95% confidence interval 0.01 to 0.48). The incidence of diarrhoea was also similar (relative risk 0.95; 0.86 to 1.05) in the two groups. There was a 36% reduction in the mean daily prevalence of diarrhoea associated with fever in the vitamin A supplemented children older than 23 months. CONCLUSIONS--Results were consistent with a lack of impact on acute lower respiratory tract related mortality after vitamin A supplementation noted in other trials and a possible reduction in the severity of diarrhoea.     

Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study.

OBJECTIVE: To investigate the relation of infant feeding practice to childhood respiratory illness, growth, body composition, and blood pressure. DESIGN: Follow up study of a cohort of children (mean age 7.3 years) who had detailed infant feeding and demographic data collected prospectively during the first two years of life. SETTING: Dundee. SUBJECTS: 674 infants, of whom 545 (81%) were available for study. Data on respiratory illness were available for 545 children (mean age 7.3 (range 6.1-9.9) years); height for 410 children; weight and body mass index for 412 children; body composition for 405 children; blood pressure for 301 children (mean age 7.2 (range 6.9-10.0) years). MAIN OUTCOME MEASURES: Respiratory illness, weight, height, body mass index, percentage body fat, and blood pressure in relation to duration of breast feeding and timing of introduction of solids. RESULTS: After adjustment for the significant confounding variables the estimated probability of ever having respiratory illness in children who received breast milk exclusively for at least 15 weeks was consistently lower (17.0% (95% confidence interval 15.9% to 18.1%) for exclusive breast feeding, 31.0% (26.8% to 35.2%) for partial breast feeding, and 32.2% (30.7% to 33.7%) for bottle feeding. Solid feeding before 15 weeks was associated with an increased probability of wheeze during childhood (21.0% (19.9% to 22.1%) v 9.7% (8.6% to 10.8%)). It was also associated with increased percentage body fat and weight in childhood (mean body fat 18.5% (18.2% to 18.8%) v 16.5% (16.0% to 17.0%); weight standard deviation score 0.02 (-0.02 to 0.06) v -0.09 (-0.16 to 0.02). Systolic blood pressure was raised significantly in children who were exclusively bottle fed compared with children who received breast milk (mean 94.2 (93.5 to 94.9) mm Hg v 90.7 (89.9 to 91.7) mm Hg). CONCLUSIONS: The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for 15 weeks and no solid foods are introduced during this time. Breast feeding and the late introduction of solids may have a beneficial effect on childhood health and subsequent adult disease.     

Prevalence of anemia among James Bay Cree infants of northern Quebec

BACKGROUND: Anemia is common among First Nation infants in Canada, often as a result of iron deficiency, which places them at risk for psychomotor impairment. Prevalence data are unavailable, and the risk factors are unknown. This study assessed the prevalence of anemia and associated risk factors among 9-month-old Cree infants in northern Quebec. METHODS: Between January 1995 and October 1998, 6 of 9 Cree villages in the James Bay region adopted a screening protocol for anemia in 9-month-old infants. Cross-sectional data were obtained from medical charts. The data for babies of very low birth weight and those with fever or infection were excluded. Among the 386 babies whose hemoglobin concentration was known, the type of milk consumed at the time of screening was known for 354. Associations between hemoglobin concentration and mean cell volume at 9 months, and milk type and weight gain since birth were analysed. RESULTS: The mean hemoglobin concentration of the 386 infants was 114.1 (standard deviation [SD] 10.6) g/L. The prevalence of anemia was 31.9% (95% confidence interval [CI] 27.2%-36.7%) with a hemoglobin cutoff value of 110 g/L, 17.6% 95% CI 13.9%-21.7%) with a cutoff value of 105 g/L, and 7.8% (95% CI 5.3%-10.9%) with a cutoff value of 100 g/L. Babies exclusively fed formula at 9 months had a higher mean hemoglobin concentration (118.5 [SD 9.9] g/L) than those exclusively fed breast milk (109.9 [SD 10.0] g/L), cow''s milk (112.5 [SD 10.1] g/L) or more than one type of milk (112.0 [SD 10.8] g/L) (p < 0.05). Compared with formula, the odds ratio (OR) for anemia was 7.9 (95% CI 3.4-18.2) for breast milk, 5.0 (95% CI 2.0-12.7) for cow''s milk and 5.2 (95% CI 1.9-14.6) for mixed milks. Infants fed formula and those fed cow''s milk had significantly greater weight gains since birth, by 724 g and 624 g respectively, than breast-fed infants (p < 0.05). When milk type was controlled for, weight gain since birth was significantly associated with the presence of microcytic erythrocytes (OR comparing highest tertile of weight gain to lowest tertile 2.9, 95% CI 1.2-6.6). INTERPRETATION: Iron-deficiency anemia is highly prevalent among James Bay Cree infants. Measures to increase iron intake are required.     

Reasons given by mothers for discontinuing breastfeeding in Iran

Background

We have previously shown that in Iran, only 28% of infants were exclusively breastfed at six months, despite a high prevalence of breastfeeding at two years of age. The primary aim of this study was to investigate the reasons women discontinued exclusive breastfeeding.

Method

This retrospective study was based on questionnaires and interviews with 63,071 mothers of infants up to 24?months of age, divided into two populations: infants younger than six months and six months or older. The data were collected in 2005?C2006 from all 30 provinces of Iran.

Results

Only 5.3% of infants less than six months of age stopped breastfeeding (mean age of 3.2?months); more commonly in urban than rural areas. The most frequently cited reasons mothers gave for discontinuing exclusive breastfeeding were physicians?? recommendation (54%) and insufficient breast milk (self-perceived or true, 28%). Breastfeeding was common after six months of age: only 11% of infants discontinued breastfeeding, at a mean of 13.8?months. The most common reason for discontinuation at this age was insufficient breast milk (self-perceived or true, 45%). Maternal illness or medication (10%), infant illness (6%), and return to work (3%) were uncommon causes. Use of a pacifier was correlated with breastfeeding discontinuation. Maternal age and education was not associated with duration of breastfeeding. Multivariate analysis showed that using a pacifier and formula or other bottle feeding increased the risk of early cessation of breastfeeding.

Conclusions

Physicians and other health professionals have an important role to play in encouraging and supporting mothers to maintain breastfeeding.     

The social origins of infantile colic: questionnaire study covering 76,747 infants.

OBJECTIVE: To describe risk factors for infantile colic. DESIGN: Questionnaire administered by health visitors. SETTING: Sheffield. SUBJECTS: Mothers of 76,747 infants born between 1 August 1975 and 31 May 1988, interviewed when the infant was 1 month old. MAIN OUTCOME MEASURES: Reporting of infantile colic and its duration; weight of infant leeding, state of the home, socioeconomic characteristics of the parents, parents'' age, and mother''s parity. RESULTS: The odds of reporting infantile colic were increased with breast feeding (odds ratio of breast v bottle feeding 1.35 (95% confidence interval 1.28 to 1.43)), increasing parental age, lower parity, increasing parental age at leaving full time education, and more affluent homes and districts of residence. In a logistic regression analysis, mother''s age and parity and socioeconomic factors remained the most important risk factors for the reporting of infantile colic (each P < 0.005), and the effect of breast feeding was attenuated (odds ratio of breast v bottle feeding 1.09 (1.02 to 1.15)). CONCLUSION: At a population level, dietary factors contribute little to mothers'' reporting of infantile colic, and dietary change should not be the primary intervention.     

Egg and cows' milk hypersensitivity in exclusively breast fed infants with eczema,and detection of egg protein in breast milk.

Forty nine eczematous infants who were still solely and exclusively breast fed and who had never received anything but breast milk were studied for evidence of sensitisation to foods. Thirty four similar infants without eczema formed a control group. The eczematous infants were divided into three groups according to clinical criteria: (1) definite atopic eczema; (2) possible atopic eczema; (3) atopic eczema unlikely. Twenty three infants showed cutaneous hypersensitivity to foods, usually egg and cows'' milk. Seven of 14 infants in group 1 and nine of 20 in group 2 were sensitised compared with four of 15 in group 3 and three of 34 controls (p less than 0.01). Ovalbumin was detected in breast milk from 14 of 19 mothers tested after ingestion of egg, the concentrations being the same for mothers feeding eczematous and normal infants. Breast fed babies developing eczema may be sensitised by foods eaten by their mothers.     

Improvement of Expressed Breast Milk in Mothers of Preterm Infants by Recording Breast Milk Pumping Diaries in a Neonatal Center in China

Objectives

Because inadequate expression of human milk (EBM) in mothers of hospitalized infants were noticed in a neonatal center of our hospital, family education program was carried out to increase the EBM.

Methods

A breast milk pumping diary was introduced to the mothers with preterm infant(s) admitted in the NICU. The ratios of EBM (days of EBM to NICU/hospitalized days), breast milk feeding (BMF) (days of infants fed with exclusive human milk/hospitalized days), mixed feeding (MF) (days of infants fed with partial breast milk and partial formula/hospitalized days), and formula feeding (FF) (days of infants fed with preterm formula/hospitalized days) were evaluated.

Results

During January to April, 2014, the ratios of EBM to the NICU, BMF, MF and FF were 28.11%, 6.6%, 32.8% and 60.6%, respectively. After the introduction of breast milk pumping diary to the mothers from May 2014, the ratio of EBM to the NICU increased significantly to 53.3% (p<0.01) within the following eight months. Both the ratios of BMF and MF also rose to 23.8% and MF 55.3%, respectively. Consequently, the ratio of FF was reduced to 20.9%. Exclusive breast milk feeding also significantly reduce the duration of nil per oral (NPO) of the very low birth weight infants during hospital stay as compared to those fed with mixed feeding and formula feeding.

Conclusion

The introduction of a breast milk pumping diary was associated with a significant increase in the intake of EBM of the hospitalized preterm newborns.     

A physiological role of breast milk leptin in body weight control in developing infants

Objective: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk. The aim of this study was to determine whether milk leptin concentration is correlated with maternal circulating leptin and BMI and with body weight gain of infants. Research Methods and Procedures: A group of 28 non‐obese women (BMI between 16.3 and 27.3 kg/m²) who breast‐fed their infants for at least 6 months and their infants were studied. Venous blood and milk samples were obtained from mothers at 1, 3, 6, and 9 months of lactation, and leptin concentration was determined. Infant body weight and height were followed until 2 years of age. Results: During the whole lactation period, milk leptin concentration correlated positively with maternal plasma leptin concentration and with maternal BMI. In addition, milk leptin concentration at 1 month of lactation was negatively correlated with infant BMI at 18 and 24 months of age. A better negative correlation was also found between log milk leptin concentration at 1 and at 3 months of lactation and infant BMI from 12 to 24 months of age. Discussion: We concluded that, in a group of non‐obese mothers, infant body weight during the first 2 years may be influenced by milk leptin concentration during the first stages of lactation. Thus, moderate milk‐borne maternal leptin appears to provide moderate protection to infants from an excess of weight gain. These results seem to point out that milk leptin is an important factor that could explain, at least partially, the major risk of obesity of formula‐fed infants with respect to breast‐fed infants.     

Inappropriate infant feeding practices of HIV-positive mothers attending PMTCT services in Oromia regional state,Ethiopia: a cross-sectional study

Background

Inappropriate infant feeding affects the probability of mother-to-child transmission of HIV and HIV-free survival of infants. However, in Ethiopia limited evidence exists regarding the infant feeding practice of mothers who are HIV-positive. The aim of this study was to determine the prevalence and predictors of inappropriate infant feeding among HIV-positive mothers attending the prevention of mother-to-child transmission (PMTCT) service in Adama and Bushoftu towns, Oromia, central Ethiopia.

Methods

A cross-sectional study was conducted in ten PMTCT service providing health facilities in the towns; 283 mother-infant pairs were enrolled. Appropriate infant feeding practice was defined as exclusive breastfeeding in the first six months of age. Logistic regression was employed to analyze the data and the outputs are presented using adjusted odds ratio (AOR) with 95% confidence intervals (CI).

Results

One hundred thirty of the infants were aged below six months, 103 between 6 and 11 months and 50 were older than 12 months. The prevalence of inappropriate infant feeding was 14.5% (95% CI 10.6, 18.7). About 6.3% and 8.3% practiced exclusive replacement feeding and mixed feeding respectively, in the first six months. Only 1.8% ever expressed their breast milk to feed their baby and none practiced wet nursing. Among 38 mothers who already discontinued breastfeeding 52.6% did so before 12 months of age. Mothers who were HIV-positive and had received antenatal (AOR?=?0.05: 0.01, 0.30) and postnatal visits (AOR?=?0.18: 0.04, 0.81); received infant feeding counseling (AOR?=?0.18: 0.06, 0.55); and disclosed their HIV status to their partners (AOR?=?0.28: 0.12, 0.63), showed a reduction of practicing inappropriate infant feeding. Mothers having breast problems (AOR?=?4.89: 1.54, 15.60) and infants with mouth ulcers (AOR?=?6.41: 2.07, 19.85) were more likely to practice inappropriate feeding.

Conclusion

Prompt management of breast complaints in mothers and mouth ulcer in infants; and provision of nutrition counseling to HIV-positive mothers, especially during antenatal and postnatal care, may help to improve the infant feeding practices for HIV exposed infants.

     

Anthropometry and body composition of 18 year old men according to duration of breast feeding: birth cohort study from Brazil

Objective To assess the association between duration of breast feeding and measures of adiposity in adolescence.Design Population based birth cohort study.Setting Pelotas, a city of 320 000 inhabitants in a relatively developed area in southern Brazil.Participants All newborn infants in the city''s hospitals were enrolled in 1982; 78.8% (2250) of all male participants were located at age 18 years when enrolling in the national army.Main outcome measures Weight, height, sitting height, subscapular and triceps skinfolds, and body composition (body fat, lean mass).Results Neither the duration of total breast feeding nor that of predominant breast feeding (breast milk plus non-nutritive fluids) showed consistent associations with anthropometric or body composition indices. After adjustment for confounding factors, the only significant associations were a greater than 50% reduction in obesity among participants breast fed for three to five months compared with all other breastfeeding categories (P = 0.007) and a linear decreasing trend in obesity with increasing duration of predominant breast feeding (P = 0.03). Similar significant effects were not observed for other measures of adiposity. Borderline direct associations also occurred between total duration of breast feeding and adult height (P = 0.06).Conclusions The significant reduction in obesity among children breast fed for three to five months is difficult to interpret, as no a priori hypothesis existed regarding a protective effect of intermediate duration of breast feeding. The findings indicate that, in this population, breast feeding has no marked protective effect against adolescent adiposity.     

Infant feeding practices: 1984-85 versus 1977-78.

In 1979 and 1980 the Canadian Paediatric Society''s Nutrition Committee published guidelines for professionals counselling mothers of infants on feeding practices. The practices in 1984-85 of mothers in Toronto were determined for comparison with the practices identified in a similar study conducted in Toronto and Montreal in 1977-78 to ascertain if practices had changed in favour of the recommendations. Between July 1984 and February 1985, 404 metropolitan Toronto mothers of infants were interviewed. Compared with the 1977-78 group of mothers, more of the 1984-85 mothers had chosen to breast-feed and fewer had stopped breast-feeding in the first month. As well, fewer of the 1984-85 infants had been fed unmodified cow''s milk in the first 6 months of life and introduced to solid foods before 4 months of age. We conclude that major changes in infant feeding practices had occurred since 1977-78 and that the 1984-85 practices corresponded closely to the infant feeding guidelines.