DRINKING-WATER QUALITY, SANITATION, AND BREAST-FEEDING - THEIR INTERACTIVE EFFECTS ON INFANT HEALTH

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.