 |
|
Viewpoint Indian Pediatrics 2001; 38: 381-384 |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Impact
of Breastfeeding on Weight Gain and Incidence of Diarrhea |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
In India, Low Birth Weight (LBW) constitutes about 30% of all live births(1). LBW babies are considered to be at risk for poor child survival. Studies have shown that they have higher risk of diarrhea and longer duration of suffering than their normal birth weight (NBW) counterparts(2-4). It is well documented that exclusive breastfeeding for the first 4-6 months of life, protects infants from diarrhea(5) whereas, non breastfed infants have 30 times greater risk of attacks of severe diarrhea(6). We, therefore, undertook an observational study on the breastfeeding pattern and its impact on weight gain and diarrhea in LBW infants in an urban slum of Calcutta.
Study Population A community based observational study was conducted between April 98 and March 99, on a birth cohort of fifty LBW (<2500 g) babies, identified from the slum area situated in east Calcutta with a population of about 10,000. Fifty NBW newborn babies selected from the same area and matched for age and sex served as controls. Both the groups were prospectively followed upto the age of four completed months. Birth weights were recorded from hospital discharge certificates. As the mothers could not specify the exact data of LMP (last menstrual period), it was not possible to categorize the children according to their gestational ages. Study Design Once a child was included in the study, a standardized pre-designed questionnaire was used to obtain family details including basic demographic and socio-epidemiological data. Weekly surveillance was carried out for detection of diarrhea, by locally recruited, resident female workers who were trained in home management of diarrhea and also acted as depot holders for ORS. Regular field visits for further data collection and supervision, was made by an epidemiological team headed by a physician. Their observations were noted in Individual Child Health Cards with details of infant feeding practices. Weight of each infant was measured once every month on the birth date of the child or within subsequent 2 days, using the standard beam balance type of weighing machine (to the nearest 10 g). Details of each reported episode of diarrhea were noted and the mother advised to continue breastfeeding, if her child was still being breastfed, or alternatively, give plenty of fluids and ORS. Treatment was given where necessary. Individual forms were scrutinized for accuracy and consistency and data were subsequently fed into personal computer in database package. The data were validated by logical and range check and analyzed using SPSSPC+ 4.0 and Epi Info Version 5.0. Analysis of Variance (ANOVA) was used to compare the differences in mean proportional weight gain among the four different groups and if significant, then Scheffes multiple comparison test was applied. Definitions Diarrhea was defined as passage of three or more watery stools in 24 hours. For exclusively breastfed infants, a change in consistency of stool with increased frequency, which was of concern to the mother, was regarded as diarrhea. Exclusively breastfed (EBF) babies were those who received only breast-milk. Early weaned infants were those who received supplementary feeds before 4 months of age.
Incidence of diarrhea among early weaned group
Final weight birth weight
The LBW and NBW groups were comparable for socio-economic status, availability of safe water supply (about 30%), disposal of childs faeces and handwashing habits. Proportion of EBF in both LBW and NBW groups gradually declined over age and by four months of age it was 76% among LBW and 70% among NBW babies. Table 1 compares the proportional weight gain in the two groups of infants. It depicts that in both LBW and NBW groups, the EBF babies showed significantly higher propor-tional weight gain per cent (p <0.001) than the early weaned infants.
From Table II it is evident that in the LBW group, early weaned infants had significantly higher risk of occurrence of diarrhea (IRR = 8.9, 95% CI = 3.6-22.4) than the EBF infants and also in the NBW group, the early weaned infants were at higher risk (IRR = 2.7, 95% CI = 0.9-8.0). The EBF infants had similar diarrhoeal incidence in both LBW and NBW groups but more importantly, the early weaned children with low birth weight, had 3 times more risk of developing diarrhea (95% CI 1.3-7.2) than those with normal birth weight.
The study clearly showed that inspite of adverse social and environmental conditions, the LBW babies who were on EBF showed remarkable catch-up growth. Analysis of the proportional weight gain of the two groups of infants showed that although the LBW babies suffered from an initial handicap of birth weight, EBF upto 4 months of age could provide the necessary protection with regard to weight gain. Proportional weight gain of LBW babies might well be higher than the NBW babies as their base is of lower magnitude, but the fact remains that only those LBW babies, who were on EBF, had significantly better weight gain than the NBW babies, in the same category. It may thus be commented that the LBW babies are more benefited in the form of weight gain when they are exclusively breastfed. Similar findings were also observed in another study(7) which showed that EBF was sufficient for LBW babies to gain normal weight and no supplementary feeding was necessary. In this study, the EBF infants were found to experience fewer episodes of diarrhea as compared to those weaned early. Further, infants who had low birth weight and were weaned early, suffered from significantly higher incidence of diarrhea as compared to their normal birth weight counterparts. It is apparent that the risk of infection to LBW babies is greatly enhanced if they are not exclusively breastfed as shown in other studies also(8,9). Thus the present study reiterates the protective effect of exclusive breastfeeding even under adverse socioenvironmental situations currently existing in urban slums. It further indicates that promotion of exclusive breastfeeding should give special emphasis on LBW babies as they are more vulnerable to malnutrition and risk of infections such as diarrhea. Contributors: DS co-ordinated the study (especially designing and analysis) and drafted the paper; she will act as the guarantor for the paper. PGS, SKM and DNG helped in planning and implementation of the study, as well as data collection, entry and analysis and also in drafting of the paper. SG and BM helped in designing, analysis and interpretation of the study. Funding: None.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
