PROLONGED BREAST-FEEDING, DIARRHEAL DISEASE, AND SURVIVAL OF CHILDRENIN GUINEA-BISSAU

Objective-To analyse the impact of breast feeding on diarrhoeal diseas e and survival in children above 1 year of age in Guinea-Bissau, west Africa. Design-A community study of an open cohort followed up weekly by interviews over 15 months. Data on feeding practices, anthropometry , and survival were recorded for three years. Setting-301 randomly sel ected houses in a semiurban area in the capital, Bissau. Subjects-849 children aged less than 3 years. Main outcome measures-Incidence and d uration of diarrhoea, weight for age, and death of a child. Results-Th e incidence of diarrhoea was higher in weaned children than in partial ly breast fed children, both in 1 year olds (relative risk 1.41; 95% c onfidence interval 1.23 to 1.62) and in 2 year olds (1.67; 1.29 to 2.1 5). The mean duration of an episode of diarrhoea was 5.3 days in breas t fed children compared with 6.3 days in weaned children (P= 0.001). I ndependent of the age of weaning, a similar increase was found in an a nalysis comparing, for each child, the rate and duration of diarrhoea one month before and one month after weaning. Children with low weight for age were breast fed longer than the better nourished children (P= 0.02). Children aged 12-35 months who were not breast fed had a 3.5 ti mes higher mortality (1.4 to 8.3) than breast fed children. Conclusion s-The beneficial effects of breast feeding are not restricted to infan cy. Though children who are partially breast fed after infancy may hav e a lower state of nutrition than the weaned ones, the benefit in term s of lower morbidity may be more important for child survival in place s with a high morbidity from diarrhoea and with high mortality.