J. Vanderslice et al., DRINKING-WATER QUALITY, SANITATION, AND BREAST-FEEDING - THEIR INTERACTIVE EFFECTS ON INFANT HEALTH, Bulletin of the World Health Organization, 72(4), 1994, pp. 589-601
The promotion of proper infant feeding practices and the improvement o
f environmental sanitation have been two important strategies in the e
ffort to reduce diarrhoeal morbidity among infants. Breast-feeding pro
tects infants by decreasing their exposure to water- and foodborne pat
hogens and by improving their resistance to infection; good sanitation
isolates faecal material from the human environment, reducing exposur
es to enteric pathogens. Taken together breast-feeding and good sanita
tion form a set of sequential barriers that protect infants from diarr
hoeal pathogens. As a result, breast-feeding may be most important if
the sanitation barrier is not in place. This issue is explored using d
ata from a prospective study of 2355 urban Filipino infants during the
first 6 months of life. Longitudinal multivariate analyses are used t
o estimate the effects of full breast-feeding and mixed feeding on dia
rrhoeal disease at different levels of sanitation. Breast-feeding prov
ides significant protection against diarrhoeal disease for infants in
all environments. Administration of even small portions of contaminate
d wafer supplements to fully breast-fed infants nearly doubles their r
isk of diarrhoea. Mixed-fed and weaned infants consume much greater qu
antities of supplemental liquids, and as a result, the protective effe
ct of full breast-feeding is greatest when drinking-water is contamina
ted. Similarly, full breast-feeding has stronger protective effects am
ong infants living in crowded, highly contaminated settings.