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Weaning practices of the Makushi of Guyana and their relationship to infant and child mortality: A preliminary assessment of international recommendations.
American Journal of Human Biology. 2006 May-Jun; 18(3):312-324.The World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life, primarily because of potential immunological benefits which are deemed to outweigh nutritive costs for infants. This recommendation is controversial, as studies of the relationship between the term of EBF and infant and child health have produced conflicting results. The purpose of this paper is to evaluate the relationship between the term of EBF and infant and child mortality among a group of swidden-horticulturalists in lowland South America. Consistent with the WHO, we hypothesized that EBF < 6 months will compromise the survival of the infant or child. This relationship was assessed via recall data generated in 2001 in structured interviews with 60 Makushi Amerindian women in Guyana's North Rupununi region. The data were analyzed with t-tests, Fisher's exact test, and logistic regression. The results do not support our hypothesis; the term of EBF is not found to be related to infant or child mortality. This is surprising given the potential for contamination in nonbreast-milk foods in this environment. Notably, this is occurring among mothers who are not energetically stressed. We propose that the apparent lack of benefit of EBF = 6 months is due to insufficient energy supply from breast milk alone, which may predispose the child to morbidity when subsequently stressed. This study concurs with others which revealed no significant benefits to the infant of EBF > 6 months, and the recognition that universal recommendations must be situated within local ecological contexts. (author's)
Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?
AIDS. 2003 Apr 11; 17(6):879-885.Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV. (author's)
Dietary management of young children with acute diarrhoea: a manual for managers of health programmes. 2nd ed.
Geneva, Switzerland, World Health Organization, 1991. iii, 29 p.This WHO manual is appropriate for use by managers of health programs in controlling the dietary intake of young children with acute diarrhea. diarrhea is a major cause of malnutrition because of the low food intake during the illness, reduced nutrient absorption, and increased nutrient needs from the infection. Those most at risk are young infants 4-6 months old, who are not breastfed, and older infants and children (4-6 months to 2 years old). The introduction presents the causes of diarrhea, causes of malnutrition, and recent findings on nutrition in young children and mothers and on the digestion and absorption of nutrients during diarrhea. The selection of foods to be given during and after diarrhea is discussed in terms of the following variables which affect the choice of foods: age of the child, availability of foods, resources needed for food preparation, nutritional value of food, stage of illness, consistency of food, and frequency of feeding. The role that traditional beliefs and practices play in treatment is also mentioned as is the nature of the beliefs. Foods are classified as food and nonfood, appropriate and inappropriate foods, cultural superfood, special occasion foods, and foods related to ideas concerning physiology. Common treatments for diarrhea are starving the child for a short time; partial food restriction; continuation or restriction of breastfeeding; the feeding of certain foods, at certain times, and in specified amounts; the administration of herbal drinks and plant infusions; and the use of purgatives, emetics, or magical potions. It is important to collect information from several sources in communities and to gather data from discussions, written records, and observation. Methods to prevent diarrhea include following good feeding practices, washing hands after defecation, and keeping the children clean. Monitoring children on a growth chart to diagnose specific nutrient deficiencies, particularly of vitamin A and iron, helps in determining malnutrition. The multimix principle in introducing weaning foods is given, and a table provides a list of important nutrients as well as a list of foods rich in these nutrients. It is of particular importance during diarrhea to consume potassium-rich foods, carotene-rich foods, and milk and to avoid sweetened drinks.
DIALOGUE ON DIARRHOEA. 1991 Sep; (46):4.Artificial feeds constituted with contaminated water and unclean bottles are the leading cause of diarrhea in infants. Companies market artificial feeds globally as infant formula (a substitute for breast milk) and follow-up formula (a complement to breast milk). Breast milk is best for all 0-12 month old infants. Breast-fed infants do not need any formula even follow-up formula. Indeed >6-month old infants require solid healthful foods and breast milk. Like infant formulas, follow-up formula made with contaminated water or bottles can cause the infant to become ill with an infection, and offering follow-up formulas to infants impedes weaning and is costly. Follow-up formulas do not complement breast milk, but instead tend to replace it. The 1986 WHO World Health Assembly has even declared that, in some countries, provision of follow-up formula is not necessary. WHO fears mothers could use follow-up formula instead of infant formula because it has a higher protein and mineral content thus increasing the risk of dehydration during diarrhea. Follow-up formula can result in an unbalanced diet. Since the International Code of Marketing of Breastmilk Substitutes does not address formulas marketed as a complement to breast milk, formula companies market follow-up formulas in both developed and developing countries. Most mothers do not know the risks of using follow-up formulas, however. Governments have several alternatives to stop the marketing of these formulas. They can design and implement a code that defines breast-milk substitutes as any formula perceived and used as a breast milk option even if promoted as a breast-milk complement. They can also amend an existing code. WHO offers technical assistance to any member government who wishes to design, implement, and monitor such a code.
ANNUAL REVIEW OF PUBLIC HEALTH. 1989; 10:221-44.Globally 4.5 million small children died because of infections in 1982. Diarrheal diseases, respiratory infections, and malnutrition are predisposing factors to infections. Diarrhea can be watery and dysenteric causing loss of body water. Oral rehydration therapy (ORT) prevented 700,000 deaths in 1986 period. Improved case management can prevent deaths: nutrition both during and after an episode of diarrhea, appropriate use of medications, antimicrobial agents in cholera, and factors that protect against enteric infections (gastric acid). Antibiotic use during an epidemic of verotoxin-producing strain of E. coli increased that risk of death. 330 million packets of oral rehydration salt (ORS) were produced around the work in 1987. Continuation of breast feeding and nutrient rich, food-based oral rehydration therapy (ORT) is vital. ORT benefit illnesses caused by Shigella, Salmonella, or campylobacter. Hand washing with soap and water reduces the incidence of dysentery. Chemotherapy can control chronic diarrhea, while malnutrition prolongs diarrhea. Among antidiarrhea drugs berberine and bismuth subsalicylate are effective. Typhoid vaccine TY 21a, a killed oral cholera vaccine with rotavirus, protects against Shigellae. Social mobilization efforts relying on mass media include the Child Survival and Development Revolution (CSDR) of UNICEF, Expanded Program for Immunization (EPI), and Control of Diarrheal Diseases (CDD). Promotion of breast feeding reduced 8-20% of diarrhea-related morbidity and 24-27% of mortality up to 6 months of age. Improved weaning practices by education cut mortality by 2-12% for under fives. A rotavirus immunization program could slash the 6% incidence of diarrhea and 20% of deaths in children under 5. Cholera immunization with efficacy of 70% could eliminate the .4% of diarrhea episodes and 8% of diarrhea deaths caused by cholera. Measles immunization coverage of 60% would reduce diarrhea morbidity by 1.8% and mortality by 13% in children under 5. Improved water supply and sanitation lowered morbidity by 22%, hand washing with soap and water cut diarrhea by 14-48%, secondary Shigella Cases by 35%, and all diarrhea episodes by 37%. Sustainability suffers from inadequate planning. The integration of CDD with primary health care is shown by the example of Thailand where the rural health network was expanded. The World Health Organization has developed a framework for local problem solving. Advances have been made in the past few years, but 3 million children are still dying from preventable diarrheal disease.
IN POINT OF FACT 1990 Sep; (70):1-4.About 50% of children <1 year old in developing countries die during the 1st month of life, and 97% of all infant deaths occur in developing countries. Major factors contributing to these deaths are the mother's poor health before and during pregnancy, unhygienic childbirth practices, and inadequate care after delivery. Low birth weight, linked to mother's health, is considerably related to survival and development and growth. >500,000 women in developing countries die annually due to pregnancy and childbirth. Maternal mortality risk in the poorest countries can be 200 times that of developed countries. Inappropriate timing and spacing, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery contribute to high maternal mortality in developing countries. Mothers <18 years old are at the highest risk of pregnancy complications, delivering a premature infant, and/or death. Postponement of marriage and better access to family planning would improve their and their infants chances of survival. Access to and acceptability of family planning promotes the health of women and children. Literate women and their children are healthier than those of illiterate women. A trained person attends only 20% of births in developing countries. Increasing the number of deliveries with a trained attendant and increasing immunizations of mothers with the tetanus toxoid will greatly reduce mortality. Infants leaving the uterus experience a drop in ambient temperature from 37 to 20 degrees Celsius. If they are not dried off, covered in a dry cloth, and/or allowed to be in physical contact quickly, they can experience considerable heat loss or even death. Further all infants should be exclusively breastfed for 4-6 months to ensure healthy growth and development and to provide protection against infections.
ACTA PAEDIATRICA SCANDINAVICA. 1988 Mar; 77(2):183-90.The acceptance of the World Health Organization (WHO) International Code for Marketing of Breastmilk Substitutes has stimulated governments to design programs for the more energetic promotion of breastfeeding, but promotional efforts in developing nations may not be getting through to the mothers or may not be designed to meet their specific needs. In a prospective study in Istanbul, it was observed that all infants, whether delivered in a hospital or at home, received not only mixtures of sugar and water and other mixtures soon after birth and for about 1 week thereafter, but also complementary foods now and then until this became a regular practice. This pattern can be defined as regular complementary feeding or partial breastfeeding. Yet, the mothers described it as exclusive breastfeeding. The early and haphazard introduction of water and food in those environments where contamination is common exposes the infants to concentrated amounts of microorganisms which may overwhelm the immunological protection provided by breastmilk and also reduces the milk supply through insufficient stimulation of the breast. Exclusive breastfeeding should be encouraged, and irregular complementary feedings during the early weeks of life should be strongly discouraged, unless there is a medical indication. When exclusive breastfeeding is no longer sufficient, i.e., at the age of about 5 months, complementary feeding should be promoted. Programs for the promotion of breastfeeding have been criticized for devoting too much attention to the infant and little or no attention to the needs of the mother. In a given society, it may be difficult to promote breastfeeding if women regard it as a means of preventing them from improving their socioeconomic situation. Women who want to breastfeed their children should not be prevented from doing so by their working conditions.
In: Programmes to promote breastfeeding, edited by Derrick B. Jelliffe and E. F. Patrice Jelliffe. Oxford, England, Oxford University Press, 1988. 235-47.The work of the WHO in promoting, monitoring, researching, and regulating breastfeeding and infant nutrition is reviewed. WHO has always fostered infant nutrition, but took up the subject of breastfeeding in 1974 at its 27th World Health Assembly with an expression of concern for decline of the practice. Breastfeeding is a learned behavior in humans that must be supported and reinforced: secular factors are converging to decrease breastfeeding in most of the world. The 1974 assembly set up a working group to initiate research, to collect data on infant nutrition and breastfeeding practices, composition of breast milk in different socioeconomic milieu, methods of conducting controlled studies on mortality in relation to feeding, and effects of hormonal contraceptives on lactation. 3 distinct patterns of feeding were found, among the urban poor, economically advantaged, and rural mothers. A 1979 meeting concluded that monitoring of feeding practices is necessary to set up national programs Training workshops were held and instructive materials were developed. Papers presented at the meeting were published. WHO with UNICEF are promoting the health and social status of mothers, such as nutrition, maternity protection, and support of women's organizations. WHO is collaborating with the International Labor Office (ILO) to survey maternity protection in 129 countries. A final issue being addressed is the infant food industry. In 1985, the World Health Assembly reported that the International Code of Marketing, involving labeling, marketing and regulation of infant foods, has been adopted wholly or in part by 141 countries.
In: Proceedings of the International Conference on Oral Rehydration Therapy, June 7-10, 1983, Washington, D.C., edited by Richard Cash. Washington, D.C., Agency for International Development [AID], Bureau for Science and Technology, 1983. 8-13. (International Conference on Oral Rehydration Therapy, 1983, proceedings)The worst economic setbacks since the 1930s do not augur well for the 100s and millions of children already trapped in the day-to-day silent emergency resulting from the conjunction of extreme poverty and underdevelopment which contributes so greatly to the death and disability toll which afflict over 40,000 small children per day. In the absence of special measures to accelerate health progress significantly, millions more children and mothers in low income areas are likely to die in the decade ahead. This meeting on promoting oral rehydration therapy is a concrete reminder that the key to the effectiveness in improving children's conditions is a refusal to accept a limitation upon what can be done with the available resources. In September, 1982, UNICEF invited a group of experts drawn from international agencies and nongovernmental groups involved in improving the lives of children to meet and discuss the problem. They recognized that certain elements of the primary health care strategy, including oral rehydration therapy, could greatly contribute to the realization of the health for all goal. They focused on community-based services and primary health care and how to improve health services. The improved techniques and technologies, the increased acceptance of the primary health care approach, and a new capacity of social organization for reaching low-income families could save a high proportion of children's lives. Nutritional surveillance, oral rehydration, breastfeeding and better weaning practices, immunization, family spacing, food supplements, and health education will contribute to the health of millions of mothers and families. Everyone is urged to make a commitment to strive for the health for all goal. The media, private organizations and ministeries of health must all join in the effort.
Proceedings of the International Conference on Actions Needed to Improve Maternal and Infant Nutrition in Developing Countries held at the Silahis International Hotel, Metropolitan Manila, Philippines, February 8-12, 1982.
Makati, Philippines, National Nutrition Council, 1983 Mar. 258 p.This document contains the proceedings of an international conference which underscored the seriousness of malnutrition in the developing countries and the determination of the 3rd World to find a solution to that problem. It stresses the value of a concerted approach by both international and national organizations in all regions. Conference participants represented 33 countries--primarily developing nations, and included pediatricians, anthropologists, nutrition planners, professors, medical epidemiologists, and social scientists. The conference was comprised of 6 plenary sessions and 6 workshops. A 1-day site visit was taken to the environs of Metro Manila, the Philippines. The participants observed how the local level responds to the national government's concerns to improve the nutritional status of the respective communities. This document is divided into 4 parts. Part 1 contains the summarized proceedings of the conference. Abstracts of technical papers presented at each of the 6 plenary sessions (Maternal Nutrition and Child Development, Breast Feeding Practices and Trrends; Strategies to Encourage Breast Feeding; Physiological Basis for Supplementary Feeding; Traditional Weaning Proctices; and Policies and Programs to Improve Supplementary Feeding) are provided. The complete, edited texts of the technical papers are in Part 2. Summaries of the principal objectives, conclusions, and recommendations of each of the 6 workshops that followed the plenary sessions are offered in Part 3. The open forums which concluded each plenary session provided an opportunity for participants to discuss specific issues related to the problems of maternal and infant nutrition in the 3rd Worldd. The edited remarks of participants in these discussions are included in Part 4. Appendices are attached.