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American Journal of Clinical Nutrition. 2003 Aug; 78(2):291-295.Background: Opinions and recommendations about the optimal duration of exclusive breastfeeding have been strongly divided, but few published studies have provided direct evidence on the relative risks and benefits of different breastfeeding durations in recipient infants. Objective: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding. Design: We conducted an observational cohort study nested within a large randomized trial in Belarus by comparing 2862 infants exclusively breastfed for 3 mo (with continued mixed breastfeeding through = 6 mo) with 621 infants who were exclusively breastfed for = 6 mo. Regression to the mean, within-cluster correlation, and cluster- and individual-level confounding variables were accounted for by using multilevel regression analyses. Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent. Conclusions: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life. (author's)
Epidemiology of an outbreak of cholera in Senegal (West Africa) in 1985: modes of transmission and mortality.
[Unpublished] . 24,  p.A cholera outbreak in villages under demographic surveillance by a team of ORSTOM researchers in the center part of Senegal during the first three months of 1985 is described. Health authorities started a vaccination campaign and disinfection of the wells. The ORSTOM team helped to treat cholera cases and a house-to-house survey of the area was started immediately. All cases of cholera-like diarrhea and vomiting that occurred during January-March 1985 in the villages were recorded on special forms. Most cases (63%) and most deaths occurred in January. The epidemic reached a peak during the fourth week of January, then plunged. Interventions started at the end of the third week with a mass vaccination campaign, chlorinization of wells, treatment of cases with oral rehydration therapy (ORT) and tetracycline (4 x 500 mg per day for 2 days), and chemoprophylaxis of cholera patient contacts with sulfadoxine. The pattern of the disease transmission was clearly identified from retrospective interviews in 4% of all cases. Among the 102 identified cases, 56% showed evidence of primary contamination at a funeral ceremony and 44% were secondary cases within the household caused by person-to-person cholera transmission. 70% of adults were contaminated at a burial ceremony and 82% of children inside the compound. 31% of all cholera patients were below 15 years of age (more than 44% of the total population), while 28% of all cholera cases were among the population aged over 50 (14% of the population). During these 3 months, 235 cases of cholera with 44 deaths were recorded. The overall attack rate was 1.9/100 population, and the global lethality rate was 18.7%. However, below age 50 the case-fatality rate was 10%, and after age 50 it rose to 40%. 24.7% of males vs. 14.5% of females were at risk of dying. The drop from a peak of 43% lethality to less than 10% a week later was most probably attributable to ORT and tetracycline treatment.