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  • Original Article
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Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants

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.

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Acknowledgements

We are grateful for support received from staff at Chikwawa and Montfort Hospitals and to B Makwiza, S Mlanga, V Nakoma, M Gwaza and H Banda and to laboratory technicians for technical support. Financial support was provided by the Gates Malaria Partnership (GMP) and the European Commission Programme for Life Sciences and Technologies for Developing Countries (Contract. T53* CT92-0083).

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Correspondence to B J Brabin.

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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.

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Kalanda, B., Verhoeff, F. & Brabin, B. Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants. Eur J Clin Nutr 60, 401–407 (2006). https://doi.org/10.1038/sj.ejcn.1602330

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