RESUMO
OBJECTIVES: To investigate risk factors for dehydrating diarrhoea in infants, with special interest in the weaning period. DESIGN: Case-control study. SETTING: Metropolitan area of Porto Alegre, Brazil. SUBJECTS: Cases were 192 children aged 0-23 months hospitalised with acute diarrhoea and moderate to severe dehydration. Controls were 192 children matched for age and neighbourhood who did not have diarrhoea in the previous week. MAIN OUTCOME MEASURES: Associations between dehydrating diarrhoea and child's age, type of milk consumed, time since breast feeding stopped, and breast feeding status. RESULTS: In infants aged < 12 months the risk of dehydrating diarrhoea was significantly higher in the first 9 months of life (P < 0.001), and in those aged 12-23 months the risk was again greater in younger children (12-17 months) (P = 0.03). The type of milk consumed before start of diarrhoea episode was strongly associated with dehydration independent of socioeconomic, environmental, maternal reproductive, demographic, and health services factors. Compared with infants exclusively breast fed, bottle fed infants were at higher risk (odds ratio (95% confidence interval) for cow's milk 6.0 (1.8 to 19.8), for formula milk 6.9 (1.4 to 33.3)). Compared with those still breast feeding, children who stopped in the previous two months were more likely to develop dehydrating diarrhoea (odds ratio 8.4 (2.4 to 29.6)). This risk decreased with time since breast feeding stopped. CONCLUSION: These results confirm the protective effect of breast feeding and suggest there is a vulnerable period soon after breast feeding is stopped, which may be of relevance for developing preventive strategies.
PIP: Researchers conducted a case control study in Porto Alegre, Brazil, to examine risk factors for dehydrating diarrhea in children 0-23 months old, particularly during the weaning period. There were 192 cases hospitalized with dehydrating diarrhea and 192 age- and neighborhood-matched controls who had no diarrhea in the previous 7 days. Among infants, the risk of developing dehydrating diarrhea was highest during the first 9 months of life, especially at 2-3 months (odds ratio [OR] = 7.1) (p 0.001). For toddlers (12-23 months), the risk was greatest at 12-17 months (OR = 3.7; p = 0.03). Only 8% of cases and 23% of controls were completely breast fed. Children who had not been breast fed faced a higher risk of dehydration than those who had been exclusively breast feed (p = 0.006). The degree of risk depended on the type of breast milk substitute used. Children who consumed cow's milk only and formula only faced the greatest risk of developing dehydrating diarrhea even when adjusted for age and other factors (OR = 6 and 6.9, respectively). Partially breast fed children had intermediate levels of risk (OR = 1.3-2.2). Children who had never breast fed were at low risk of developing dehydrating diarrhea (OR = 0.7), while those who had stopped were at high risk (OR = 6.4) (p 0.001). This increased risk was greatest in the first 2 months after stopping breast feeding (OR = 8.4) and decreased thereafter. These findings support the protective effect of breast feeding. They also point to a vulnerable period soon after termination of breast feeding. Thus, health workers need to pay closer attention to recently weaned children.
Assuntos
Desidratação/etiologia , Diarreia Infantil/etiologia , Desmame , Doença Aguda , Distribuição por Idade , Aleitamento Materno , Estudos de Casos e Controles , Feminino , Humanos , Lactente , Alimentos Infantis , Recém-Nascido , Masculino , Fatores de RiscoRESUMO
PIP: Results of two national surveys were used to study regional patterns of breast feeding and their relationship to birth spacing and infant mortality in Peru. Estimates of the duration of breast feeding were based on the 1984 National Survey of Nutrition and Health. The 1986 Demographic and Family Health Survey (DHS) was the basis for an analysis of factors associated with short durations of breast feeding and of the effect of breast feeding on birth spacing and infant mortality. Mothers who had ever used contraception were excluded from the segments based on the DHS data. Prevalence and life table methods were used to determine regional patterns of breast feeding. The study of risk factors for short duration of breast feeding used a retrospective cohort study comparing infants breast feeding for less than or more than 12 months using bivariate analysis. The effect on birth spacing was assessed using a life table methodology. The infant mortality rate was calculated for the 199 children born between 1980 and 1984 to mothers not using contraception. The duration of breast feeding was relatively short in Lima, perhaps because of the importance of the middle and upper socioeconomic strata. Breast feeding was prolonged in the sierra and of intermediate duration in the lowlands. The coastal area outside of Lima appeared to have an adequate duration of breast feeding. Birth order of 4 or under and urban residence were the only factors significantly related to breast feeding for less than one year. Prolonged lactation was associated with longer birth intervals in women who never used contraception. The median birth interval was increased by around five months according to the life table applied to children born between 1980 and 1984 to women interviewed in the DHS. Prolonged lactation was associated with lower mortality among infants of mothers not using contraception. Infants breast feeding for less than a year had a relative risk of mortality of 3.6 on the coast and 2.7 in the sierra or lowlands. Promotion of breast feeding, it would appear, offers a cost-effective response to the two serious problems of short birth intervals and high infant mortality.^ieng
Assuntos
Intervalo entre Nascimentos , Aleitamento Materno , Demografia , Geografia , Mortalidade Infantil , Inquéritos Nutricionais , População Rural , Fatores de Tempo , População Urbana , América , Países em Desenvolvimento , Serviços de Planejamento Familiar , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Mortalidade , Fenômenos Fisiológicos da Nutrição , Peru , População , Características da População , Dinâmica Populacional , América do SulRESUMO
We conducted a prospective, community-based study of healthy breast-fed Mexican infants to determine the protective effects of anti-Shigella secretory IgA antibodies in milk. Milk samples were collected monthly, and stool culture specimens were obtained weekly and at the time of episodes of diarrhea. Nineteen breast-fed infants were found to have Shigella flexneri, Shigella boydii, or Shigella sonnei in stool samples. Ages of the 10 infants with symptomatic infection and the nine with asymptomatic infection did not differ significantly. Milk samples collected up to 12 weeks before infection were evaluated by enzyme-linked immunosorbent assay for secretory IgA antibodies against lipopolysaccharides of S. flexneri, S. boydii serotype 2, S. sonnei, and virulence plasmid-associated antigens. The geometric mean titers of anti-Shigella antibodies to virulence plasmid-associated antigens in milk received before infection were eightfold higher in infants who remained well than in those in whom diarrhea developed. The significance of milk secretory IgA directed against lipopolysaccharide was less clear. We conclude that human milk protects infants against symptomatic shigella infection when it contains high concentrations of secretory IgA against virulence plasmid-associated antigens.
Assuntos
Antígenos de Bactérias/imunologia , Aleitamento Materno , Disenteria Bacilar/imunologia , Imunoglobulina A Secretora/análise , Leite Humano/imunologia , Plasmídeos/imunologia , Shigella boydii/imunologia , Shigella flexneri/imunologia , Shigella sonnei/imunologia , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Ensaio de Imunoadsorção Enzimática , Fezes/microbiologia , Humanos , Lactente , Recém-Nascido , México/epidemiologia , Prognóstico , Estudos Prospectivos , Estudos Soroepidemiológicos , Shigella boydii/isolamento & purificação , Shigella boydii/patogenicidade , Shigella flexneri/isolamento & purificação , Shigella flexneri/patogenicidade , Shigella sonnei/isolamento & purificação , Shigella sonnei/patogenicidade , População Urbana/estatística & dados numéricos , Virulência/imunologiaRESUMO
To determine whether breast-feeding protects infants against symptomatic and asymptomatic infection by Giardia lamblia, we followed 197 infants in a poor area of Mexico City from birth to 18 months of age; symptoms and feeding status were recorded weekly. Stool specimens were collected every 1 to 2 weeks and tested for Giardia by enzyme-linked immunosorbent assay. A mean of 1.0 Giardia infection per child-year was detected; 94 infants had a total of 139 infections; 17% of infections were symptomatic. Ninety-one percent of infants were breast fed from birth and 38% were breast fed at 1 year of age. Lack of breast-feeding was a significant risk factor for first Giardia infection at all ages. The adjusted incidence rate ratio for first Giardia infection for none versus complete breast-feeding was 5.0 (confidence interval (CI) 1.5 to 16.9; p = 0.009), and for none versus any breast-feeding, 1.8 (CI 1.1 to 2.8; p = 0.013). Symptomatic Giardia infection was also associated with lack of breast-feeding (none vs any: incidence rate ratio = 2.5; CI 0.9 to 6.8; p = 0.077), but breast-feeding did not protect against chronic carriage of Giardia. Other significant risk factors for Giardia infection were presence of animals in the household (p = 0.005) and the use of water or nonmilk liquid for infant feedings (p = 0.035). We conclude that breast-feeding protects infants against Giardia by mechanisms that include preventing the establishment of infection.
PIP: To determine whether breast feeding protects infants against symptomatic and asymptomatic infection by Giardia lamblia, the authors followed 197 infants in a poor area of Mexico City from birth to 18 months of age. Symptoms and feeding status were recorded weekly. Stool specimens were collected every 1-2 weeks and tested for Giardia by an enzyme-linked immunosorbent assay. A mean of 1.0 Giardia infection/child-year was detected; 94 infants had a total of 139 infections and 17% were symptomatic. 91% of the infants were breast fed from birth and 38% were breast fed at 1 year of age. Lack of breast feeding was a significant risk factor for 1st Giardia infection across all ages. The adjusted incidence rate ratio for 1st Giardia infection for none vs. complete breast feeding was 5.0 (confidence interval [CI] 1.5-16.9; p=0.009), and for none vs. any breast feeding, 1.8 (CI 1.1-2.8; p=0.013). Symptomatic Giardia infection was also associated with a lack of breast feeding (none vs. any; incidence rate ratio=2.5; CI 0.9-6.8; p=0.077), but breast feeding did not protect against chronic carrying of the infection. Other significant risk factors for Giardia infection were: presence of animals in household (p=0.005) and the use of water or nonmilk liquid for infant feedings (p-0.035). The authors conclude that breast feeding feeding helps protect infants against Giarda by mechanisms which include the prevention of infection invasion at the outset.
Assuntos
Aleitamento Materno , Giardia lamblia , Giardíase/prevenção & controle , Animais , Estudos de Coortes , Fezes/parasitologia , Feminino , Seguimentos , Giardia lamblia/isolamento & purificação , Giardíase/epidemiologia , Giardíase/parasitologia , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , México , Estudos Prospectivos , Fatores de RiscoRESUMO
PIP: Data from the 1986 Demographic and Health Survey were used to assess the status of breast feeding in the Dominican Republic and to analyze its possible relationship to infant mortality in various population subgroups. The analysis was based on a model that explained infant mortality in the Dominican Republic as a function of eight variables. Care was taken to control for the influence of confounding variables, such as the possible exposure of bottle fed infants to impure water in formula and the possibly shorter birth intervals of women who do not breast feed. Respondents to the Demographic and Health Survey were asked how long their infants born in the previous five years were breast fed. Those infants who were 1 year to five years old at the survey date (and therefore exposed to risk of mortality for at least one year) were included in the study. The statistical technique known as proportional hazard models was selected because of its applicability to lactation, a complex determinant of infant survival because of its dependence on the child's age. Four age ranges were studied: under one month, one to two months, three to six months, and seven to eleven months. Child survival and breast feeding status were established for each age range. The risk of death associated with breast feeding status was thus considered as a function of age. The eight control variables were urban or rural residence, family economic status, maternal education and level of information, source of household water, previous birth interval. Prenatal care, and type of attendance at delivery. The results of the study demonstrated that, when the effects of infants' ages were controlled, breast feeding was an important determinant of infant mortality in the Dominican Republic in the first half of the 1980s. The effect of breast feeding on infant mortality is direct and is not a reflection of any of the other factors. Significant interactions were found between breast feeding and age, and between breast feeding and the household source of water. The risk of death was less for breast fed infants at all ages. The magnitude of the coefficients showed that breast feeding could be crucial during the first month of life. The influence of breast feeding decreased with age, and by 6 months the difference in the risk of death of breast fed and nonbreast fed infants was small. There was no true differential between mortality of breast fed infants who had or did not have potable water in the household. Nonbreast fed infants had a higher risk of death whether or not they lived in households with potable water, but those without potable water were at higher risk. A policy to increase infant survival in the Dominican Republic should promote breast feeding and should work to provide potable water.^ieng
Assuntos
Fatores Etários , Aleitamento Materno , Demografia , Mortalidade Infantil , Mortalidade , Abastecimento de Água , América , Região do Caribe , Conservação dos Recursos Naturais , Países em Desenvolvimento , República Dominicana , Meio Ambiente , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , América do Norte , Fenômenos Fisiológicos da Nutrição , População , Características da População , Dinâmica PopulacionalRESUMO
PIP: Many people including some health workers and physicians believe bottle feeding is just as good as breast feeding, even though bottle feeding poses some dangers to infants. Further, health workers in hospital often are too busy to counsel new mothers in breast feeding or are simply not trained to do so. Moreover, young women often live in areas away from their family and friends thus not living close to women with whom they are familiar and who could guide them in mastering breast feeding skills. So new mothers who want to breast feed have no support, lack confidence, and/or feel they cannot do so because they work or have other responsibilities. Support groups for new breast feeding mothers can provide them with the needed confidence to breast feed by allowing them to discuss concerns with other new mothers and an experienced leader and to learn the advantages of breast feeding, e.g., a breast fed infant is never constipated. A confident experienced woman in breast feeding is best suited to start a support group in a community. She needs to promote the group by talking to health workers and physicians and advertising at maternity hospitals, women's organizations, and health centers. Once the support group has become successful, several mothers can undergo training to start and lead new support groups. If no national breast feeding promotion organization exists to offer advice on starting a support group, the article provides addresses of international organizations. At support group meetings, mothers learn how to breast feed, how to express and store breast milk, breast feed inconspicuously in public, how their bodies work, and about child growth and development. Support group members from the Philippines, Belize, Trinidad and Tobago, Australia, and singapore share their experiences.^ieng
Assuntos
Aleitamento Materno , Estudos de Avaliação como Assunto , Mães , América , Ásia , Sudeste Asiático , Austrália , Belize , Região do Caribe , América Central , Comunicação , Países Desenvolvidos , Países em Desenvolvimento , Processos Grupais , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América do Norte , Fenômenos Fisiológicos da Nutrição , Organização e Administração , Ilhas do Pacífico , Filipinas , Singapura , Trinidad e TobagoRESUMO
PIP: In view of the significant and articulate minority view among pediatricians that breast feeding is not "worth the bother" in developed countries, this review of the literature delves into the evidence from both developed and developing countries for the advantages of breastfeeding, both in infants and for long-term health. Infants in developed settings experience twice the hospitalization rate and more severe illness from lower respiratory tract infection, primarily respiratory syncytial virus. In developing countries the mortality risk is 4-fold. for otitis media, the relative risks were 3.3-4.3 for Finnish infants. Bacterial meningitis and/or bacteremia had a 4-fold risk for hospitalization in a Connecticut study, and a 3-fold relative risk in 2 developing country studies. Human milk was the best preventative for bacteremia and necrotizing enterocolitis in prematures in British neonatal units. A 20-fold reduction in neonatal deaths occurred in Philippine study of breastfeeding, especially in low birth weight babies. Diarrhea causes the most infant mortality in developing nations, where bottle-feeding raises rates 14-fold. In the U.S. estimated relative risks is 3.7 for diarrheal mortality. Sudden infant death is about 1/5 less common in U.S. breast fed babies than in bottle fed. There is evidence for better long-term health after breast feeding in disorders such as celiac disease, Crohn disease, ulcerative colitis, insulin-dependent diabetes mellitus, thyroid disease, malignant lymphoma, chronic liver disease, atopic dermatitis, and food allergies. The design of good studies of protection conferred by breast feeding, and the possible modes of action of breast milk are discussed.^ieng
Assuntos
Aleitamento Materno , Saúde Global , Nível de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Meningite/epidemiologia , Otite Média/epidemiologia , Infecções Respiratórias/epidemiologia , Fatores de Risco , Sepse/epidemiologiaRESUMO
To investigate the role of breast-feeding in preventing diarrhea caused by Campylobacter jejuni, we followed 98 Mexican children prospectively for 2 years beginning at their birth. Attack rates of diarrhea in children less than 6 months of age who were not fed human milk were 2.3 times greater than those in children of the same age who were fed human milk. Breast-fed children remained free of diarrhea for a longer time than non-breast-fed children (p less than 0.0005). The diarrhea attack rate caused by C. jejuni for non-breast-fed infants was significantly greater (p less than 0.005) than that in the breast-fed group. Secretory IgA milk antibody titers against glycine acid-extractable antigen of C. jejuni were high in colostrum, decreased during the first month of breast-feeding, and generally persisted throughout lactation. Human milk consumed by children in whom Campylobacter diarrhea developed did not contain secretory IgA antibodies to the glycine acid-extractable common antigen of Campylobacter. This study shows an association between Campylobacter antibodies in human milk and prevention of diarrhea caused by Campylobacter.
Assuntos
Anticorpos Antibacterianos/fisiologia , Aleitamento Materno , Infecções por Campylobacter/prevenção & controle , Campylobacter fetus/imunologia , Diarreia Infantil/prevenção & controle , Leite Humano/imunologia , Anticorpos Antibacterianos/análise , Infecções por Campylobacter/microbiologia , Campylobacter fetus/isolamento & purificação , Pré-Escolar , Diarreia Infantil/microbiologia , Fezes/microbiologia , Seguimentos , Humanos , Imunoglobulina A Secretora/análise , Lactente , Recém-Nascido , Leite Humano/análise , Probabilidade , Estudos ProspectivosRESUMO
PIP: A survey in Guatemala revealed that 50% of physicians did not know that breast milk provides protection against diarrhea or that it is also an important food after the 1st 6 months of life. Some countries (Indonesia, Thailand, Panama, and the US) have successfully trained health workers in the advantages of breast feeding, but not all training programs have incorporated techniques to help mothers to breast feed, e.g., how to prevent engorgement. Health workers need to show mothers the positioning of the infant which aids breast feeding. Further, some infants do not want to suck or suck ineffectively. Moreover many hospitals need to change their method of managing childbirth. Hospital workers should encourage immediate physical contact between mothers and babies after birth which facilitates breast feeding and babies are more likely to receive the protective colostrum. Similarly they should promote rooming in of newborns with their mothers. In addition, health workers should minimize analgesic use. They should also promote exclusive breast feeding and not give any glucose water or other supplements to newborns which, in addition to other reasons, sends the message that supplemental feedings are fine when indeed they contribute to diarrhea. Moreover, in oral rehydration therapy (ORT) units, oral rehydration solution (ORS) should be spoonfed to diarrhea patients and not given in bottles so mothers will not conclude that the medical community approves of bottle use. Health workers should encourage mothers to spoon feed ORS at home as well. Further, ORT units and inpatient intravenous units should encourage mothers to stay with their infants. Pediatricians should lead the way in promoting breast feeding.^ieng
Assuntos
Publicidade , Aleitamento Materno , Países em Desenvolvimento , Diarreia Infantil , Estudos de Avaliação como Assunto , Hidratação , Pessoal de Saúde , Hospitais , Leite Humano , Apego ao Objeto , Médicos , Ensino , América , Comportamento , Biologia , América Central , Atenção à Saúde , Diarreia , Doença , Economia , Educação , Guatemala , Saúde , Instalações de Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , Relações Interpessoais , Lactação , América Latina , Marketing de Serviços de Saúde , América do Norte , Fenômenos Fisiológicos da Nutrição , Fisiologia , Gravidez , TerapêuticaRESUMO
In a population-based case-control study of infant mortality in two urban areas of southern Brazil, the type of milk in an infant's diet was found to be an important risk factor for deaths from diarrhoeal and respiratory infections. Compared with infants who were breast-fed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhoea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. The risk of death from infections other than diarrhoea or respiratory infection was less clearly associated with breast-feeding (completely weaned, RR = 2.5; partly weaned, RR = 0.4). Cow's and formula milk seemed to be equally hazardous. For deaths due to diarrhoea the increased risk associated with not breast-feeding was greatest in the first two months of life (RR for completely weaned vs breast-fed without supplementary milk = 23.3).
PIP: In a population-based case-control study of infant mortality in 2 urban areas of southern Brazil, the type of milk in an infant's diet was found to be an important risk factor for deaths from diarrheal and respiratory infections. Compared with infants who were breastfed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. The risk of death from infections other than diarrhea or respiratory infection was less clearly associated with breastfeeding (completely weaned, RR=2.5; partly weaned, RR=0.4). Cow's and formula milk seemed to be equally hazardous. For deaths due to diarrhea the increased risk associated with not breastfeeding was greatest in the 1st 2 months of life (RR for completely weaned vs. breastfed without supplementary milk =23.3). (author's modified).
Assuntos
Infecções Bacterianas/prevenção & controle , Aleitamento Materno , Animais , Infecções Bacterianas/mortalidade , Brasil , Bovinos , Diarreia/mortalidade , Diarreia/prevenção & controle , Estudos de Avaliação como Assunto , Alimentos Fortificados , Humanos , Lactente , Alimentos Infantis , Recém-Nascido , Leite , Infecções Respiratórias/mortalidade , Infecções Respiratórias/prevenção & controle , Risco , DesmameRESUMO
PIP: Sociocultural changes in Europe during the Industrial Revolution of the past century resulted in a decline in the practice of breastfeeding. Migration of a large part of the rural population to the city led to a substantial change of life styles, with the health of the population seriously affected. Poor sanitary conditions, deteriorating nutritional status, and other problems became more widespread. Some contemporary reports noted the adverse effects on infant health of the decline in breastfeeding. A researcher in Manchester, Englands found that 60% of infants who were breastfed showed satisfactory growth and nutritional status through 9 months, compared with only 10% of artificially fed infants. In some respects, developments in postwar Latin American reflect trends in Europe a century ago, with rural-urban migration, the incorporation of women into the labor market, the development of food technology, and the use of advertising and propaganda combining to produce a decline in the prevalence of breastfeeding. The proportions of infants breastfed declined from 15% to 6% in Chile between 1960-1968, while in Mexico a parallel but less marked decline in breastfeeding has occurred in both rural and low income urban areas. In 1973, 2/3 of 5000 mothers interviewed breastfed their infants in the 1st month, while by 1979 only 52.8% of a similar sample did so. 3 possible explanations of the decline in breastfeeding see it as a symptom of abandonment of traditional ways by mothers in a process of cultural change; as a decision made without reflection on its consequences for the baby and the family; or as a result of information received by the mother whose interpretation is influenced by her educational level. To understand the phenomenon, breastfeeding must be considered a form of instinctive behavior by which the mother promotes the growth of her baby during a phase of intense nutritional demand, but the practice of breastfeeding is also the result of interaction of the members of the mother's society. Breastfeeding must be considered a cultural trait. Although infant feeding practices have deep cultural roots, the interaction of technologically advanced societies in the western world with underdeveloped societies has produced a process of transculturation in the latter whereby breastfeeding is gradually being displaced. It is probable that only a process of education can combat the decline in breastfeeding.^ieng