Original Article
European Journal of Clinical Nutrition (2006) 60, 401–407. doi:10.1038/sj.ejcn.1602330; published online 23 November 2005
Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants
Guarantor: BJ Brabin.
Contributors: The study was designed and planned by FHV and BJB. FHV was responsible for data collection and BFK and BJB for data analysis and for writing the paper.
B F Kalanda1,2, F H Verhoeff1,4 and B J Brabin1,3,4
- 1Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
- 2College of Medicine, University of Malawi, Blantyre, Malawi
- 3Emma Kinderziekenhuis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- 4Royal Liverpool Childrens Hospital, NHS Trust, Alder Hey, Liverpool, UK
Correspondence: Professor BJ Brabin, Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, England, UK. E-mail: b.j.brabin@liverpool.ac.uk
Received 4 February 2005; Revised 19 August 2005; Accepted 14 September 2005; Published online 23 November 2005.
Abstract
Objectives:
The objective of this study was to compare growth, morbidity incidence and risk factors for undernutrition between infants receiving complementary feeding early, before 3 months of age, with those receiving complementary foods after 3 months in a poor rural Malawian community.
Methods:
A cohort of babies was enrolled at birth for follow-up to 12 months of age. Weight, length, morbidity and feeding patterns were recorded at 4 weekly intervals from birth to 52 weeks.
Results:
Mean age at introduction of water was 2.5 months (range 0–11.8), complementary foods 3.4 months (range, 1.0–10.7) and solids 4.5 months (range 1.2–13.8). Over 40% of infants had received complementary foods by 2 months and 65% by 3 months. The proportion of exclusively breast-fed infants, which included those receiving supplemental water, was 13% at 4 months, 6.3% at 5 months and 1.5% at 6 months. Infants with early complementary feeding had lower weight for age at 3 and 6 months (P<0.05), and at 9 months (P=0.07) and at 2 months they were approximately 200 g lighter. Early complementary feeding was significantly associated with increased risk for respiratory infection (P<0.05), and marginally increased risk for eye infection and episodes of malaria. Maternal illiteracy was associated with early complementary feeding (OR=2.1, 95% CI 1.3, 3.2), while later complementary feeding was associated with reduced infant morbidity and improved growth.
Conclusion:
Breast-feeding promotion programmes should target illiterate women. Greater emphasis is required to improve complementary feeding practices.
Keywords:
breastfeeding, complementary feeding, morbidity, illiteracy, growth
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