Breast-feeding and bottle-feeding of twins, triplets and higher order multiple births

OBJECTIVE: This study was performed to determine the rates of breast-feeding and/or bottle-feeding in mothers of twins, triplets and higher order multiple births compared to those in mothers of singletons, and identify factors associated with decision as to breast-feed or bottle-feed. METHODS: The subjects were 1,529 mothers of twins aged 6 months-6 years and 258 mothers of triplets and higher order multiple births (higher multiples) aged 6 months-6 years (234 mothers of triplets, 20 mothers of quadruplets, 4 mothers of quintuplets). Also, 1,300 subjects were recruited as a control group from mothers of singletons aged 6 months-6 years. Information regarding feeding methods, including exclusive breast-feeding, mixed-feeding and bottle-feeding with formula milk only, and duration of breast-feeding (in months) was collected. RESULTS: There were significantly higher rates of bottle-feeding in mothers of twins and higher multiples than in mothers of singletons. Duration of breast-feeding in mothers who chose exclusive breast-feeding or mixed-feeding for twins and higher multiples was significantly shorter than those for the singletons. The feeding methods for the twins or higher multiples were not associated with prematurity or low birth weight. However, after adjusting for each associated factor using logistic regression analysis, the decision to bottle-feed was significantly associated with non-cooperation of the husband in childrearing and degree of anxiety that mothers felt when informed of a multiple pregnancy. The odds ratio indicated that mothers who received no cooperation from the husband for childrearing were 1.83 times more likely to choose bottle-feeding as those who received cooperation. Further, the odds ratio indicated that mothers who felt greater anxiety when informed of a multiple pregnancy were 1.73 times more likely to choose bottle-feeding as those who did not feel much anxiety. CONCLUSION: This study found that establishment and continuation of breast-feeding for twins, triplets and higher order multiple births are much more difficult than for singletons. Further, cooperation of the husband in childrearing and the degree of maternal anxiety when informed of a multiple pregnancy are significant factors affecting the decision to breast-feed or bottle-feed for twins, triplets or higher order multiple births.     

Relationship of breast-feeding and hand-washing with dehydration in infants with diarrhoea due to Escherichia coli

This prospective cohort study was carried out in the neonatal unit of the Yangon Children Hospital, Myanmar, to gather more information on the types of feedings and hand-washing practices of mothers as the determinant of severe dehydration in infants with acute diarrhoea due to Escherichia coli. The study subjects included 100 infants with diarrhoea, aged less than 4 months, admitted to the hospital from June 1997 to May 1998. Data on isolation of E. coli from rectal swab samples, types of feedings, hand-washing practices, and dehydration status were collected. Of the 100 cases, E. coli was isolated from rectal swab samples of 48 infants. Of these 48 cases, 28 had some dehydration and 20 had severe dehydration. Exclusive breast-feeding was observed only in the age group < 1 and > 1-2 month(s). The association of the severity of dehydration with other types of feedings compared to exclusive breast-feeding was not statistically significant. In this study, most mothers washed their hands with water only after cleansing their children's defaecation, and before and after feeding their children. The severity of dehydration was statistically significant in hand-washing practices when compared to washing with water only and washing with soap and water. This study has shown the association between types of feedings and hand-washing practices with dehydration in infants with acute diarrhoea due to E. coli. The results of the study suggest that there is a need for appropriate intervention programmes to promote exclusive breast-feeding and hand-washing practices with soap and water after cleansing children's defaecation, and before and after feeding children.     

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004–2014)

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0–23 months of adolescent mothers aged 12–19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2–3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12–18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0–5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.     

Do early infant feeding patterns relate to breast-feeding continuation and weight gain? Data from a longitudinal cohort study

OBJECTIVES: To describe the first-week feeding patterns for breast- vs bottle-fed babies, and their association with sustained breast-feeding and infant weight gain at 6 weeks. DESIGN: A longitudinal cohort study. SETTING: Feeding diaries were completed by mothers in an urban UK community shortly after birth; follow-up weight and feeding data were collected at routine health checks. SUBJECTS: Mothers of 923 full-term infants born during the recruiting period agreed to join the study. In all, 502 usable diaries were returned from 54% of the cohort. RESULTS: Breast-fed infants were fed more frequently (2.71 h between feeds) than bottle-fed infants (3.25 h between feeds) and mixed-fed infants (3.14 h between feeds) (P<0.001) in the first week of life, while duration of feeds was similar. Only exclusive breast-feeding in the first week (P<0.001) and maternal education (P=0.004) were related to continued breast-feeding at 6 weeks. Greater first-week feeding frequency (as measured by feed-to-feed interval, h) was associated with higher weight gain at 6 weeks for breast-feeders, but no analysed factors were associated with higher weight gain for bottle-feeders. CONCLUSIONS: This large-scale study of first-week feeding patterns sheds light on the important and complicated issues of breast-feeding continuation and infant weight gain, with implications for the feeding advice given to mothers. Supplementary bottle feeds were clearly associated with discontinued breast-feeding at 6 weeks. Over that period, higher weight gain was associated with more frequent feeding for breast-fed infants only. SPONSORSHIP: Henry Smith Charity, SPARKS, Child Growth Foundation.     

Feeding practices in 105 counties of rural China

BACKGROUND: China has the largest population in the world with more than 70% of the people living in rural areas. Over 34% of children under the age of 5 years are responded to show moderate or severe growth stunting, so United Nations International Children's Emergency Fund and Chinese Ministry of Health conducted this large-scale survey in China. This study aimed to learn the feeding practice, to find the problems in child-feeding practice and to provide evidence for the government to develop an approach to child malnutrition in rural China. METHODS: A structured questionnaire was used to survey 21,036 mothers of children with age of 0-24 months. RESULTS: Of the 20,915 children, 98.22% were breastfeeding and 24.36% were exclusively breastfeeding. The proportion of children with weekly protein intake was 78.47%. Among the infants under 4 months, the risk of pneumonia in the group of exclusive breastfeeding was 1.69%, while in the group of non-exclusive breastfeeding was 3.63%, showing a statistically significant difference between the two groups. The risk of diarrhoea in the group of exclusive breastfeeding and in the group of non-exclusive breastfeeding among the infants under 4 months was 24.37% and 40.86%, respectively, also showing a statistically significant difference between the two groups. For children with age 4-6 months, the complementary feeding contributed to a higher prevalence of diarrhoea, but not pneumonia. CONCLUSIONS: The breastfeeding was very common, but the exclusive breastfeeding was quite low and the exclusive breastfeeding for children under the age of 4 months decreased the risks of pneumonia and diarrhoea. For children with age 4-6 months, the exclusive breastfeeding could decrease the risk of diarrhoea, too. Protein intake was insufficient for children in rural China. The rural people lacked health knowledge and were greatly influenced by traditional feeding practices.     

Breast-feeding patterns in a rural village in Giza, Egypt.

In a longitudinal study of infant feeding in rural Giza, Egypt, we found that 68.8% of the recruited mothers initiated early suckling of colostrum, but only 51.2% of the infants were exclusively breast-fed in the first week. Solid foods were introduced much earlier than at the recommended age of 4 to 6 months. Sixty percent of the mothers who participated in the study considered breast-feeding plus regular or irregular complementary feeding to be exclusive breast-feeding.     

Breast-feeding counselling in a diarrhoeal disease hospital.

Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.     

2002年北京市2岁以内婴幼儿营养与喂养状况调查

目的了解北京市2岁以内婴幼儿出生时营养、母乳喂养与辅食添加状况,为政府制定儿童营养政策提供依据。方法采取分层整群随机抽样方法,于2002年8至11月在北京市18个区县进行抽样调查。在取得知情同意的情况下,对422名2岁以内婴幼儿的家长进行面对面询问调查。结果北京市平均婴儿出生体重为3325g,低体重出生率和巨大儿出生率分别为2．8％和13．0％;4月龄内婴儿母乳喂养率、混合喂养率和人工喂养率分别为56．6％、33．9％和9．5％,城区混合喂养率明显高于郊区;婴幼儿平均断奶月龄为7．4个月;6月龄及以上婴幼儿的辅食添加率为99．4％,城区和郊区婴幼儿各类辅食的添加顺序一致,但郊区婴幼儿的辅食添加时间晚于城区,且蔬菜水果、水产品、食用油的添加频率低于城区。结论北京地区新生儿体格发育良好,应在社区加强婴幼儿喂养的健康教育,提高母乳喂养率,适当延长母乳喂养时间,并适时添加各类辅食。     

Perceptions of mothers and use of breastmilk substitutes in Dhaka,Bangladesh

To explore the actual practices and perceptions of giving breastmilk and breastmilk substitutes (BMS), this cross-sectional study was conducted among 326 mothers of low (income/month < Tk 4,000, n = 163) and middle (income/month > Tk 4,000, n = 163) socioeconomic status (SES) with infants aged 6-12 months in Dhaka city during February-April 2001. Qualitative data on perceptions of mothers on appropriate breast-feeding practices were also documented through focus-group discussions (FGDs). The prevalence of exclusive breast-feeding was low in both the socioeconomic groups but was comparatively higher among the mothers of middle SES (3.1% vs 12.3%, p < 0.001), although predominant breast-feeding was high among the mothers of low SES. In addition, the use of BMS was higher among the mothers of middle SES than among the mothers of low SES (55.8% vs. 43.5%, p < 0.001). The majority (62.3%) of the mothers mentioned insufficiency of breastmilk as the main reason for introducing BMS. Perception on appropriate feeding practices was also significantly different between the two groups. Approximately, 90% of the mothers of low SES could not differentiate between infant formula and milk powder compared to 70% of the mothers of middle SES (p < 0.001). The findings of FGDs revealed that some middle-class mothers thought that infant formula was the best food for their infants. Programmes to impart proper knowledge on breast-feeding practices should be strengthened.     

河北省城乡地区6~24月龄婴幼儿喂养状况研究

目的 了解河北省城乡地区6~24月龄婴幼儿的喂养状况,并应用婴幼儿喂养指数(infant and child feeding index,ICFI)评价城乡地区不同月龄组婴幼儿的喂养行为,为指导婴幼儿喂养提供科学的参考依据。 方法 数据来自2015年中国居民食物消费状况调查。选取6~24月龄婴幼儿作为研究对象,应用ICFI对喂养行为(24 h母乳喂养、24 h奶瓶喂养、24 h膳食种类、1周辅食添加天数)进行评分。 结果 本研究共纳入婴幼儿861名,ICFI平均得分为(10.58±3.18)分,不同月龄组间ICFI平均得分的差异有统计学意义(F=141.119,P=0.000),在6~8月龄组中,城市ICFI平均得分为(7.61±3.15)分,显著高于农村的(5.44±3.04)分(F=11.859,P=0.001)。喂养总合格率为54.94%(473/861),各月龄组的喂养合格率分别为14.16%、38.78%、66.56%,不同月龄组间喂养合格率的差异均有统计学意义(χ²=124.181,P=0.000)。婴幼儿辅食添加满分率较高的为蛋类、谷薯类、水果、蔬菜,较低的为豆类及其制品、奶类及其制品。 结论 河北省农村地区的低月龄婴幼儿喂养较差,建议加强对辅食添加时间、种类及添加频率等方面婴幼儿喂养知识的宣传。     

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife,Osun State,Nigeria

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.     

武汉市住院婴幼儿医院感染轮状病毒现状及危险因素分析

目的 分析武汉市住院婴幼儿医院感染轮状病毒(RV)的现状及危险因素,为临床诊治和控制医院感染提供科学依据.方法 回顾性收集医院2008年1月-2010年12月住院6月龄～2岁患儿资料5904例,对感染轮状病毒的患儿粪便采用胶体金免疫层析法,进行RV检测,采用单因素分析法分析住院婴幼儿医院感染轮状病毒的相关因素,进一步采用 logistic回归分析确定感染独立危险因素.结果 3年间住院腹泻婴幼儿轮状病毒感染率为25.9％,其中2008-2010年平均感染率分别为26.5％、20.8％和29.8％;轮状病毒感染全年均可发生,其高峰为9-12月份,占阳性总数的62.8％,多因素logistic回归分析结果表明,走廊加床、母乳喂养、呼吸道疾病、住院时间、基础疾病进入回归方程.结论 轮状病毒感染在武汉市住院婴幼儿中较普遍,是引起6月龄～2岁婴幼儿病毒感染性腹泻的主要病原体.新生儿RV感染情况不容忽视,RV腹泻具有明显的季节性,在流行季节应做好预防及保护措施,走廊加床、母乳喂养、呼吸道疾病、住院时间、基础疾病为婴幼儿医院感染轮状病毒的独立影响因素.     

Breastfeeding in Africa: will positive trends be challenged by the AIDS epidemic?

In Africa, more than 95% of infants are currently breastfed, but feeding practices are often inadequate: feeding water, and other liquids, to breastfed infants is a widespread practice. Consequently, the rate of exclusive breast-feeding is low, particularly in West Africa. The rate of bottle-feeding is high in some countries (exceeding 30% in Tunisia, Nigeria, Namibia and Sudan). Nevertheless prolonged breastfeeding is common, and the median duration of breastfeeding ranges between 16 and 28 months. Urbanization and mothers' education are the major factors that tend to shorten breastfeeding. Nevertheless recent trends show an increase in early initiation and in duration of breastfeeding as a result of promotion efforts deployed by WHO and Unicef, local governments, and non-governmental organizations. The importance of breastmilk as a food resource of African countries is generally not recognized. In 31 countries where data on prevalence of breastfeeding are available, consumption of breastmilk by children under three years is estimated at 3.5 million tons per year. The AIDS epidemic could threaten breastfeeding because the virus can be transmitted through breastmilk, as demonstrated by numerous studies. A study suggests that feeding breastmilk and other liquids to infants could be the feeding mode associated with the highest rate of transmission. To prevent mother-to-child transmission of HIV, WHO recommends replacement feeding if it is feasible and safe. Otherwise, mothers are encouraged to practice exclusive breastfeeding for the first months of life followed by early and rapid weaning. The feasibility of replacement feeding with breastmilk substitutes, however, is very uncertain. In a study where free substitutes were given to HIV-positive mothers, the mortality of the formula-fed infants was the same as that of the breastfed infants. HIV-positive mothers may find it difficult to cope with the constraints of replacement feeding, in terms of cost, workload and time, and with the additional health care needs of non-breastfed infants. Exclusive breastfeeding for a few months could carry a lower risk of death than replacement feeding. But success in promoting exclusive breastfeeding has been limited in Africa, and new promotion methods are needed. Infants of all mothers, whether HIV-positive or not, will benefit from improving the rate of exclusive breastfeeding. The major problem is to ensure that early and rapid weaning, between 4 and 6 months, does not have a negative impact on the child's health. Early weaning is known to increase susceptibility to infections and can cause malnutrition. The feasibility and safety of this recommendation will have to be monitored carefully. A strong determination of African governments to promote exclusive breastfeeding among all mothers and to protect prolonged breastfeeding among non-infected mothers will limit the mother-to-child transmission of HIV while preserving the benefits of breastfeeding.     

Infant feeding patterns on Mauritius Island, 1991

The 1991 Mauritius Contraceptive Prevalence Survey (CPS) included a special module on infant feeding patterns in Mauritius. Since 1985, when a similar CPS was conducted, the incidence of breast-feeding has fallen from 86% to 72%. The duration of any breast-feeding among those breast-fed remained constant at 13.6 months. The module allowed for an assessment of the World Health Organization (WHO) breast-feeding indicators on exclusive breast-feeding, timely complementary feeding and continued breast-feeding. Only 16% of infants 0–3 months old are exclusively breast-fed; only 29% of infants 6–9 months old receive breast milk and complementary foods and only 27% of children 12–15 months are still breast-fed. These patterns of limited breast-feeding and early supplementation may signal future declines in breast-feeding for other African and Asian countries. Published by Elsevier Science Ltd     

上海市0~6月龄婴儿母亲纯母乳喂养知信行调查

目的 了解上海市0~6月龄婴儿母亲纯母乳喂养知信行现状。方法 全覆盖问卷调查全市0~6月龄婴儿母亲共5 672名,排除仅进行人工喂养者后进行纯母乳知识、态度和行为情况调查。结果 0~6月龄婴儿纯母乳喂养率为51.34%,与混合喂养组相比,纯母乳喂养组在"正常6个月以内的婴儿食物"（χ2=10.02,P=0.002）和"对婴儿配方奶的看法"（χ2=21.30,P<0.001）等2项母乳喂养知识知晓率、纯母乳喂养信心（χ2=544.57,P<0.001）、母乳喂养方式（χ2=164.97,P<0.001）和维持泌乳方式（χ2=479.33,P<0.001）方面差异有统计学意义。希望通过门诊咨询（母乳喂养咨询室）获得母乳喂养支持的比例最高（56.11%）。结论 纯母乳喂养者的认知、态度和行为较混合喂养者更科学,应开展专业、有效的健康教育,提高纯母乳喂养率。     

Drinking-water quality, sanitation, and breast-feeding: their interactive effects on infant health.

The promotion of proper infant feeding practices and the improvement of environmental sanitation have been two important strategies in the effort to reduce diarrhoeal morbidity among infants. Breast-feeding protects infants by decreasing their exposure to water- and foodborne pathogens and by improving their resistance to infection; good sanitation isolates faecal material from the human environment, reducing exposures to enteric pathogens. Taken together, breast-feeding and good sanitation form a set of sequential barriers that protect infants from diarrhoeal pathogens. As a result, breast-feeding may be most important if the sanitation barrier is not in place. This issue is explored using data from a prospective study of 2355 urban Filipino infants during the first 6 months of life. Longitudinal multivariate analyses are used to estimate the effects of full breast-feeding and mixed feeding on diarrhoeal disease at different levels of sanitation. Breast-feeding provides significant protection against diarrhoeal disease for infants in all environments. Administration of even small portions of contaminated water supplements to fully breast-fed infants nearly doubles their risk of diarrhoea. Mixed-fed and weaned infants consume much greater quantities of supplemental liquids, and as a result, the protective effect of full breast-feeding is greatest when drinking-water is contaminated. Similarly, full breast-feeding has stronger protective effects among infants living in crowded, highly contaminated settings.     

Breast-feeding habits in Ouro Preto, MG, Brazil

OBJECTIVE: To identify the frequency and median duration of breast-feeding in children aged 0-24 months in the city of Ouro Preto, Brazil. METHODS: A cross-sectional study was carried out to identify the median duration of breastfeeding in children aged 0-24 months. A sample of 229 children from 1800 households was drawn by clusters at three different occasions and stratified according to the area (urban or rural). The frequency and median duration of breast-feeding were calculated using the life table technique. RESULTS: A median duration of 198 days was found for breast-feeding as a whole: 71 days for the group of exclusive plus mainly breastfeeding and 17 days for exclusive breastfeeding. CONCLUSION: The current pattern of breast-feeding is of a short-term practice. This evidence suggests the need for intervention programs to promote breast-feeding for longer periods and delay the introduction of food supplementation, preventing the early weaning.     

Exclusive breast-feeding for 6 months, with iron supplementation, maintains adequate micronutrient status among term, low-birthweight, breast-fed infants in Honduras

There is little information on the risk of micronutrient deficiencies during the period of exclusive breast-feeding. We evaluated this among term, low-birthweight (LBW; 1500-2500 g) infants in Honduras. Mother-infant pairs were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, infants were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or be given iron-fortified complementary foods (rice, chicken, fruits, and vegetables) from 4 to 6 mo while continuing to breast-feed (SF, n = 60). Blood samples were collected at 2, 4, and 6 mo and analyzed for hemoglobin (Hb), hematocrit, plasma ferritin, % transferrin saturation, vitamin A, vitamin B-12, folate, zinc, and erythrocyte folate. Infants with Hb < 100 g/L at 2 or 4 mo were given medicinal iron supplements for 2 mo; the proportion administered iron drops did not differ significantly between groups. There was no significant effect of complementary foods on indices of vitamin A, B-12, folate, or zinc status. Among infants not given medicinal iron at 4-6 mo, iron status was higher in the SF group than the EBF group. In those given medicinal iron at 4-6 mo, iron status was higher in the EBF group, suggesting that complementary foods interfered with iron utilization. About half of the infants were anemic by 2 mo, before the age when complementary foods would be recommended. This supports the recommendation that LBW infants should receive iron supplementation in early infancy. Given that infants given iron supplements did not benefit from complementary foods at 4-6 mo, we conclude that exclusive breast-feeding for 6 mo (with iron supplementation) can be recommended for term, LBW infants.     

Assessment of health and nutritional status of infants in relation to breast feeding practices in Karmouz area, Alexandria

Infants are most precious part of nation's life. Infant health is a reflection of the health of the mother and it gives an indication of the health of the adult population of the future. The present work was designed to study the health and nutritional status of infants in Karmouz area in Alexandria as well as the effect of breast feeding practices on the health status of infants. Accordingly, a house to house survey was conducted through cluster sampling technique. The total sample amounted to 396 mothers and 409 infants. Data were collected about infants health status and their feeding practices. Weight and length were measured for all infants. Stool samples were collected and examined. The results revealed that 55.3% of infants had acute respiratory tract infections (ARI); 16.4% had bronchitis and 4.9% had pneumonia, 44% of the infants suffered from diarrhea, 13.2% were infected with parasites, Gardia lamblia was the most commonly found parasite (9.0%). High proportion of infants was found to be stunted (22.7%), 8.6% were wasted and 7.6% were underweight, 40.3% of mothers were in partial practice level. Infants below six months of age who received solid foods at three months or less had a significantly higher percentage of diarrhea (70.6%) compared to 51.5% among those of late weaning (four months or later). The diarrhea was significantly more common among infants aged 12 - < 18 months with about two times of risk relative to those aged < 6 months. A significantly higher risk of diarrhea was found for infants of bottle--or complementary feeding (OR = 2.05, 2.07 respectively, model X2 = 9.71, P < 0.01), in addition the protective effect of breast feeding persisted after adjustment of confounders by multiple logistic regression. High proportion of mothers (63.8%) continued to breast-feed their babies during diarrheal episodes. On the other hand breast-feeding was not significantly protective against the acute respiratory tract infection. Stunting of the infants increases rapidly with age from 12.6% among infants under six months to 30.4% among those aged from 9 - < 12 months. The percentage of stunted infants varied greatly by education of the mothers, it was doubled from 14.7% among those of mothers of high level of education to 28.9% of non educated mothers with a significant high risk of 2.31 times. The repeated attacks of diarrhea throughout the two years of life was still significantly associated with stunting even after adjustment of confounders by multiple logistic regression;, those with three attacks or more had about three times of risk relative to those without the disease (OR = 2.56, 95% CL = 1.12-5.81, model X2 = 19.03, P < 0.01). Health education program should be emphasized to all mothers to improve their knowledge and practice about breast-feeding and its importance in prevention of diarrhea.     

The effects of infant feeding on rotavirus-induced gastroenteritis: a prospective study

The relationship between feeding method and risk of rotavirus infection was studied by following a cohort of 197 infants from low income households through the winter diarrhea season of 1983-84. Fecal specimens were systematically collected and tested for the presence of rotavirus particles by electron microscopy, confirmed by ELISA. The attack rates of rotavirus gastroenteritis were similar for breast-fed and bottle-fed infants (20 per cent, 17 per cent, respectively); however, the clinical course of rotavirus gastroenteritis was quite different. Infants who were breast-fed had illnesses which were characterized by milder symptoms of shorter duration. Of the 10 breast-fed infants who acquired rotavirus gastroenteritis, nine (90 per cent) were classified as mild illnesses while of the 25 bottle-fed infants who acquired rotavirus gastroenteritis, only nine (36 per cent) were classified as having mild illnesses. These data suggest that factors associated with breast-feeding, although not affecting rotavirus infection rates, may moderate the clinical course of rotavirus gastroenteritis.