Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums
Arifeen, S.; Black, R.E.; Antelman, G.; Baqui, A.; Caulfield, L.; Becker, S.
Pediatrics 108(4): E67
2001
ISSN/ISBN: 0031-4005 PMID: 11581475 DOI: 10.1542/peds.108.4.e67Document Number: 216674
Objectives: To describe breast feeding practices and investigate the influence of exclusive breast feeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhoea. Methods: A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and followed from birth to 12 months of age. After enrolment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported deaths. Proportional hazards regression models were used to estimate the effect of breast feeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and diarrhoea were measured. The proportion of infants who were breast fed exclusively was only 6% at enrolment, increasing to 53% at one month and then gradually declining to 5% at 6 months of age. Predominant breast feeding declined from 66% at enrolment to 4% at 12 months of age. Very few infants were not breast fed, whereas the proportion of partially breast fed infants increased with age. Breast feeding practices did not differ between low and normal birth weight infants at any age. The overall infant mortality rate was 114 deaths/1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold higher risk of infant deaths resulting from all causes and 2.40- and 3.94-fold higher risk of deaths attributable to ARI and diarrhoea, respectively. The important role of appropriate breast feeding practices in the survival of infants is clear from this analysis. The reduction of ARI deaths underscores the broad-based beneficial effect of exclusive breastfeeding in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhoea deaths.