BREAST-FEEDING AND THE RISK OF LIFE-THREATENING ROTAVIRUS DIARRHEA - PREVENTION OR POSTPONEMENT

Purpose. To assess the relationship between breast-feeding and the ris k of life-threatening rotavirus diarrhea among Bangladeshi infants and children younger than 24 months of age. Design. Case-control study. S etting. A rural Bangladesh community. Participants. One hundred two ca ses with clinically severe rotavirus diarrhea detected in a treatment center-based surveillance system during 1985 and 1986, and 2587 contro ls selected in three surveys of the same community during the same cal endar interval. Outcomes. Cases and controls were compared for the fre quency of antecedent breast-feeding patterns. Results. Compared with o ther feeding modes, exclusive breast-feeding of infants was associated with significant protection against severe rotavirus diarrhea (relati ve risk (RR) = 0.10; 95% confidence interval [CI] = 0.03, 0.34). Howev er, during the second year of life, the risk of this outcome was highe r in breast-fed than in non-breast-fed children (RR = 2.85; 95% CI = 0 .37, 21.71), and no overall protection was associated with breast-feed ing during the first 2 years of life (RR = 2.61; 95% CI = 0.62, 11.02) . Conclusions. Although exclusive breast-feeding appeared to protect i nfants against severe rotavirus diarrhea, breast-feeding per se confer red no overall protection during the first 2 years of life, suggesting that breast-feeding temporarily postponed rather than prevented this outcome. While not detracting from efforts to promote breast-feeding t o alleviate the burden of diarrhea due to nonrotaviral enteropathogens , our findings cast doubt on whether such efforts will impact on the p roblem of severe rotavirus diarrhea.