Abstracts

This longitudinal study examines the value of breastfeeding on growth during the second year of life. A cohort of 264 children were followed for 6 months. The baseline age range was 8 to 18 months. At base line 14% of children had been weaned and 65.5% were breastfeeding at follow-up. Using multivariate analysis, children in the group of longest breastfeeding duration gained 3.4cm and 370g more than those in the shortest duration group.

The studied identified some aspects of breastfeeding and household sanitation factors that could influence growth. The strongest association between breastfeeding and linear growth was observed in households that had no latrine and daily water use was less than 10L per person.

The authors concluded that their results support the WHO recommendation of breastfeeding for two years and beyond, especially in settings of poor sanitation.

In light of the HIV transmission from mother to child important questions have been raised about the safety of artificial feeding in environments of economic deprivation in making recommendations regarding infant feeding in areas where HIV is pandemic. In addition assessing the varying levels of protection during the first year of life is important in determining the risk of mortality of not breastfeeding.

The Study Team compiled datasets, including a MEDLINE search of studies carried out over the past 20 years using the key words "breastfeeding" and "mortality" that might provide information on the risk of infant and childhood mortality according to infant feeding practices. Six available data sets met the researchers criteria. The leading causes of death associated with not breastfeeding were diarrheal disease and acute respiratory illness. The protective effect of breastfeeding against all infant deaths were the greatest in Pakistan, intermediate in Brazil and the lowest in the Philippines. Protection was slightly greater for girls than for boys. During the first 6 months of life, protection against diarrhea was substantially greater than against acute respiratory illness.

In summary, the analysis showed that infants who are not breastfed have a six-fold greater risk of dying from infectious diseases within the first two months of life than those who are breastfed. The protection that breastfeeding provides decreases steadily with age, and is likely due to lower intakes of breastmilk by older infants who also receive complementary foods. The authors suggest that this data be taken into account in assessing the risk of withholding breastfeeding by HIV positive mothers and the relative weight of infectious diseases in overall infant and young child mortality should be taken into account.

Implementation of the current UNAIDS recommendations on infant feeding poses many practical difficulties for us. How many individual decisions are made by choice or by necessity? The decision to breastfeed or formula feed can result in considerable uncertainty and anguish for mothers. A mere change of emphasis in the current guidelines is needed, in that women who have no other option but breastfeeding should be encouraged and supported to practice exclusive breastfeeding. Although more work is required we should not delay the implementation of this recommendation."