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Infant feeding and risk of severe diarhoea in Basrah City, Iraq - A case-control study

Author: Mahmood DA et al. Bull WHO
Year: 1989
Resource type: Article

Mahmood DA, Feachem RG, Huttly SRA. Infant feeding and risk of severe diarrhoea in Basrah City, Iraq: A case-control study. Bull WHO 1989;67(6):701–6.

Country: Iraq, Setting: Urban

Design: Case-control: cases (n = 597) were infants hospitalized with diarrhea at local health clinics; controls (n = 723) were infants brought in for routine immunizations with no recent history of hospitalization

Outcome measure: Risk of hospitalization with diarrhea.

Results: Diarrhea was affected significantly by infant feeding mode. Exclusive breastfeeding was used as the reference category. Infants aged 2-3 months who were partially breastfed had a relative risk of 6.2, and infants who were not breastfed had a relative risk of 36.7. Infants aged 3-4 months who were partially breastfed had a relative risk of 2.9, and infants who were not breastfed had a relative risk of 23.8. Sterilization of bottles as opposed to no sterilization had no effect on hospitalisation for diarrhea. Among older infants, partial breastfeeding was used as the reference category. The relative risk of hospitalization for nonbreastfed infants aged 6-7 months was 3.9. Among infants 8-11 months, there was no protective effect of breastfeeding.

It was estimated that 60% of all cases of hospitalized diarrhea could be prevented if optimal infant feeding practices were observed (e.g., exclusive breastfeeding for all infants < 6 months of age and partial breastfeeding and food thereafter).

METHODOLOGICAL ISSUES:

The study addressed the problem of reverse causality, controlled for a number of other potentially confounding variables, and calculated population attributable risk. Breastfeeding and outcome measures were clearly defined.

Abstract: The relationship between infant feeding practices and nutritional status was investigated in 557 randomly selected infants attending maternal-child health clinics in Basrah City, Iraq, in 1983-84. A socioeconomic scoring system was developed based on variables such as maternal and paternal education, place of residence, father's occupation, and home and car ownership. 91.3% of infants were breastfed after birth, with no differences in terms of sex or socioeconomic status (SES). However, over the 1st 6 months of life, there was a steady decline in the prevalence of breastfeeding, to 75% among infants of low SES and 57% among those of high SES. In the 2-3-month age group, 55% of high SES infants and 35% of low SES infants who were still being breastfed were also being bottle-fed. The proportions of infants at various ages receiving food were significantly higher in the high rather than low SES group. About 90% of the infants' weight-for-age score fell within + or - 2 standard deviations of the median reference weight utilized by WHO. Age and feeding mode were significantly associated with weight-for-age, while sex and SES were not. Exclusively breastfed infants had the highest weight-for-age scores and non-breastfed infants had the lowest, with partially breastfed infants occupying an intermediate position. Also, while weight faltering with age was observed among partially breastfed and non-breastfed infants in the 1st 6 months of life, no such pattern occurred among exclusively breastfed babies. It could not be determined whether there were genuine nutritional indications (e.g., inadequate breast milk due to maternal malnutrition) for the high frequency of early supplementation of breastfed infants with bottle feeding identified in this study.

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Mahmood DA et al. Bull WHO (1989). Infant feeding and risk of severe diarhoea in Basrah City, Iraq - A case-control study. www.ennonline.net/iycfdiarhoeairaq