BREAST-FEEDING AND THE RISK OF LIFE-THREATENING ENTEROTOXIGENIC ESCHERICHIA-COLI DIARRHEA IN BANGLADESHI INFANTS AND CHILDREN

Objective. To assess the relationship between breastfeeding and the ri sk of life-threatening enterotoxigenic Escherichia coli (ETEC) diarrhe a among Bangladeshi infants and young children < 36 months of age. Des ign. Case-control study. Setting. A rural Bangladesh community. Partic ipants. A total of 168 cases with clinically severe ETEC diarrhea dete cted in a treatment center-based surveillance system during 1985 to 19 86 and 3679 controls selected in three surveys of the same community d uring the same calendar interval. Outcomes. Cases and controls were co mpared for the frequency of antecedent breastfeeding patterns. Results . Compared with other feeding modes, exclusive breastfeeding of infant s was associated with significant protection against severe ETEC diarr hea (relative risk [RR] = 0.51; 95% confidence interval [CI]: 0.28,0.9 6). However, during the second and third years of life, the risk of th is outcome was similar in both breastfed and nonbreastfed children (RR = 0.98; 95% CI: 0.45,2.12), and no significant overall protective ass ociation between breastfeeding and severe ETEC diarrhea was evident du ring the first 3 years of life (RR = 0.86; 95% CI: 0.43,1.74). Conclus ions. Exclusive breastfeeding appeared to protect infants against seve re ETEC diarrhea, but breastfeeding was not associated with protection after infancy, nor was it associated with a major overall reduction o f severe ETEC disease during the first 3 years of life. Although not d iminishing the importance of breastfeeding, our findings suggest that other interventions, such as immunization and education about proper f ood hygiene, may also be required in efforts to prevent this major ped iatric disease.