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Title: Prolonged breast-feeding: no association with increased risk of clinical malnutrition in young children in Burkina Faso.
Author: Cousens S, Nacro B, Curtis V, Kanki B, Tall F, Traore E, Diallo I, Mertens T.
Journal: Bull World Health Organ; 1993; 71(6):713-22. PubMed ID: 8313489.
Abstract:
Reported are our findings from a case-control study of the association between prolonged breast-feeding and clinical malnutrition in an urban setting in West Africa. The cases were children aged 12-36 months who had been hospitalized with a diagnosis of clinical malnutrition. Children of a similar age who lived in neighbouring courtyards were recruited as controls. For 152 case-control pairs in which both children were receiving solid foods, non-breast-feeding was associated with an increased risk of clinical malnutrition (crude odds ratio = 2.37; 95% confidence interval = 1.24, 4.55). This association remained statistically significant after controlling for various potentially confounding variables (P = 0.03). Our findings suggest that either prolonged breast-feeding may offer substantial protection against clinical malnutrition in the study population or malnutrition leads mothers to stop breast-feeding. These results are inconsistent with those of a number of workers who have reported that prolonged breast-feeding is associated with an increased risk of malnutrition. This inconsistency might have arisen because of differences in the definition of malnutrition used or because of variations in the quantity and quality of weaning foods available in different settings. We found no evidence to support the hypothesis that prolonged breast-feeding may be detrimental to children. This case control study includes all children aged 12-36 months admitted to the pediatric unit of Sanou Souro Hospital for clinical malnutrition in Bobo-Biolasso, Burkina Faso in 1990 and early 1991. Cases numbered 273 persons, and matched controls numbered 173. 75% of cases have a diagnosis of marasmus, 10% have a diagnosis of kwashiorkor, and 15% have a diagnosis of marasmic kwashiorkor, Mortality includes 50% (14 cases) of the kwashiorkor cases and 30% of each of the other types of malnutrition. All cases show a poor anthropometric status (-4.2 among marasmus cases, -2.75 among kwashiorkor cases, and -3.80 among marasmic kwashiorkor cases). Only 2% show clinical malnutrition. The primary diagnoses are for diarrhea (78%), vomiting (46%), hepatomegaly (25%), dyspnoea (14%). and lymphadenopathy (14%). 35% are aged 12-17 months, 38% are aged 18-23 months, 18% are aged 24-29 months, and 9% are aged 30-36 months. 53% are male. 72% are in receipt of home follow-up visits. Of the 77 not followed up, 30 died. Cases and controls are grouped by feeding patterns (solid foods without breast milk, solid foods and breast milk and without or without porridge, and no solid foods). More malnutrition cases occur among children in the group with no solid food (11 with breast milk and/or other milk or porridge and 7 with porridge only). Those eating solid food with breast milk have a reduced odds of malnutrition. The case-control analysis indicates that more malnutrition occurs among those receiving breast milk or other milk. But with controls for age and supplementation the results indicate that children not receiving breast milk are twice as likely to suffer clinical malnutrition (odds ratio of 2.37), and the occurrence varies with age. Logistic regressions with control for confounding factors indicate that children without breast milk have three times the risk of malnutrition. Prolonged breast feeding and solid food supplements are associated with a 70% reduction in the rate of clinical malnutrition. Caution is urged in accepting wholly the findings due to the potential for reverse causality.

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