Infant feeding patterns and risks of death and hospitalization in the first half of infancy : multicentre cohort study

To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. This paper is based on a secondary analysis of data from a...

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Published in:	Bulletin of the World Health Organization Vol. 83; no. 6; pp. 418 - 426
Main Authors:	BAHL, Rajiv, FROST, Chris, KIRKWOOD, Betty R, EDMOND, Karen, MARLINES, Jose, BHANDARI, Nita, ARTHUR, Paul
Format:	Journal Article
Language:	English
Published:	Genève Organisation mondiale de la santé 01-06-2005 World Health Organization The World Health Organization
Subjects:	Age Alimentos infantiles: Conducta alimentaria Babies Biological and medical sciences Bottle Feeding - utilization Breast feeding Breast Feeding - statistics & numerical data Breastfeeding Breastfeeding & lactation Causa de muerte Causes of Children & youth Clinical trials Cohort analysis Demographics Diarrea Disease transmission Estudios de cohortes Estudios multicéntricos Feeding Behavior Feeding patterns Female General aspects Ghana Ghana - epidemiology Health aspects Health Policy & Services HIV HIV infection in children Hospitalización Hospitalization Hospitalization - statistics & numerical data Human immunodeficiency virus Humans Immunization India India - epidemiology Infant Infant mortality Infant Mortality - trends Infant Nutritional Physiological Phenomena Infant, Newborn Infecciones del tracto respiratorio Infections Infectious diseases Intervention Lactancia materna Lactante Male Medical sciences Miscellaneous Morbidity Mortalidad infantil Mothers Multicenter Studies as Topic Multicentre Nutrición infantil Patient admissions Peru Peru - epidemiology Perú Poverty Areas Proportional Hazards Models Prospective Studies Public health. Hygiene Public health. Hygiene-occupational medicine Randomized controlled trials Randomized Controlled Trials as Topic Risk Factors Towns Vitamin A South America Asia Africa America Ghana Peru India Human Nutrition Upper respiratory tract Multicenter study Mortality Diarrhea Infant Hospitalization Breast feeding Epidemiology Feeding Infection Cohort study Cause Risk factor Breast Digestive diseases Intestinal disease Death Tropical medicine Mammary gland Public health Mortalidad infantil Alimentos infantiles: Conducta alimentaria Lactancia materna Multicenter studies Cause décès Infant nutrition Pérou Respiratory tract infections Voies aériennes supérieures, Infection Nutrición infantil Estudios de cohortes Cohort studies Diarrea Infecciones del tracto respiratorio Etude multicentrique Hospitalisation Causa de muerte Feeding behavior Inde Mortalité nourrisson Allaitement au sein Diarrhée Ghana Estudios multicéntricos Infant mortality Nutrition nourrisson Cause of death Hospitalización India Lactante Comportement alimentaire Nourrisson Perú Etude cohorte Peru
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Summary:	To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation. Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana. Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru. At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week. Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months. The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions. There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86). Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001). There are two major implications of these findings. First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants. Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0042-9686 1564-0604
DOI:	10.1590/S0042-96862005000600009