Infant Feeding Patterns and Risks of Death and Hospitalization in the First Half of Infancy

Article: Bahl et al. 2005;83:418-26

1 July 2005 -- Dear Bulletin: I would like to comment on Rajiv Bahl et al, "Infant Feeding Patterns and Risks of Death and Hospitalization in the First Half of Infancy: Multicentre Cohort Study," Bulletin of the World Health Organization, June 2005, 83(6), pp. 418-426.

This study comes to two major conclusions. The first one says, “the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants.” There are not extremely high risks of infant mortality associated with not being breastfed in all settings. If this conclusion was to be understood as applying to resource-poor settings, it should have said so.

The second conclusion was "the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed” and this “suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding."

The study monitored health outcomes only until the infants were six months of age. This study does not provide an adequate basis for reaching this conclusion. Other readily available literature clearly supports the view that infants have better health outcomes when they are exclusively breastfed than when they are mixed fed.

At the very least, this conclusion should have specified that it was speaking only about the risks of death in the first six months, and it should have acknowledged that substantial differences in mortality and morbidity were likely to appear at later times.

Also, the second conclusion, like the first, should have said that it applies only to resource-poor settings.

Finally, it appears that the cases studied were not ones in which the mother was diagnosed as HIV-positive. The stated objective of the study makes no reference to HIV.

The literature on infant feeding in the context of maternal HIV infection generally is based on the premise that the effects of breastfeeding by HIV-positive mothers on their infants’ health is likely to be different from what it would be if the mother was not HIV infected. To help guide choices with regard to methods of feeding, studies are needed on infant feeding patterns and mortality and morbidity outcomes for HIV-infected mothers. The relevance of studies with mothers who are not known to be infected is highly questionable.

Aloha, George Kent.

REFERENCES:

• Rajiv Bahl, Chris Frost, Betty R. Kirkwood et al. Infant Feeding Patterns and Risks of Death and Hospitalization in the First Half of Infancy: Multicentre Cohort Study. Bulletin of the World Health Organization 2005;83:418-26.

Professor George Kent. Department of Political Science, University of Hawai'i, Honolulu, Hawai'i 96822 USA (email: kent@hawaii.edu).