Determinants of infant growth in the slums of Dhaka: size and maturity at birth, breastfeeding and morbidity

Objective: To investigate the influences of size at birth, breastfeeding an d morbidity on growth during infancy in poor areas of urban Bangladesh. Design: This was a prospective observational study of a cohort of newborn i nfants followed until 12 months of age. Setting: Slum areas of Dhaka City in Bangladesh. Subjects: A total of 1654 newborn infants were enrolled at birth, and follo w-up was completed for 1207 infants. Repeated anthropometric measurements a nd interviews of caretakers on infant feeding and morbidity were conducted. A mixed effects regression method was used for modeling infant growth. Results: After adjusting for other variables, mean differences in body weig ht by birth weight and length, small-for-gestational age and prematurity ca tegories remained relatively constant throughout infancy. A positive impact of exclusive breastfeeding in the first 3 - 5 months on infant growth was detectable at 12 months of age. Although the bigger babies in the sample te nded to grow relatively even bigger; exclusive breastfeeding appeared to co unteract this pattern. Reported diarrhoea was associated with lower body we ights and lengths even after adjusting for feeding patterns. Conclusions: Size at birth has an important role in determining growth duri ng infancy. Effective strategies for improving birth weight, poorly address ed till now in Bangladesh, are needed. The sustained effect on growth and t he even more beneficial effect in lighter infants are compelling reasons fo r promotion of exclusive breastfeeding in early infancy.