Infant Feeding Patterns and Risks of Death and Hospitalization in the First Half of Infancy
Article: Bahl et al. 2005;83:418-26
5 September 2005 - I would like to submit my comments on the article by R. Bahl et al. titled "Infant feeding patterns and risks of death and hospitalization in the first half of infancy: multicentre cohort study", published in the June 2005 issue of the Bulletin (1).
This study comes to two major conclusions:
- "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.” Before pronouncing this far reaching conclusion, it should have been mentioned that this is true only in the resource crunched areas.
- "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 available literature indicates contrary to this. The Zvitambo study (2) explicitly concludes that the risk of Predominant Breastfeeding over Exclusive Breastfeeding varied from 1.6 to 2.7 over the 18-month period, reaching statistical significance at 12 months. These findings indicate that the early introduction of non-human milks and solid foods conveys an especially high risk, but that even non-milk liquids are likely to increase the risk. Therefore, the more strictly HIV positive mothers are able to breastfeed exclusively, the lower the risks of HIV or death will be for their infants.
Since, papers published in the Bulletin of WHO have a great impact on the policy makers and planners, there is an urgent need to clarify these issues.
J.P. Dadhich, New Delhi.
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.
- Peter J. Iliffa, Ellen G. Piwozb, Naume V. Tavengwa et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 2005, 19:699–708.
Dr J.P. Dadhich. Coordinator, Breastfeeding Promotion Network of India. BP -33 , Pitampura, New Delhi 110088, India (email: jpdadhich@ibfan-asiapacific.org).