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  • Title: Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning.
    Author: Fuchs SC, Victora CG, Martines J.
    Journal: BMJ; 1996 Aug 17; 313(7054):391-4. PubMed ID: 8761225.
    Abstract:
    OBJECTIVES: To investigate risk factors for dehydrating diarrhoea in infants, with special interest in the weaning period. DESIGN: Case-control study. SETTING: Metropolitan area of Porto Alegre, Brazil. SUBJECTS: Cases were 192 children aged 0-23 months hospitalised with acute diarrhoea and moderate to severe dehydration. Controls were 192 children matched for age and neighbourhood who did not have diarrhoea in the previous week. MAIN OUTCOME MEASURES: Associations between dehydrating diarrhoea and child's age, type of milk consumed, time since breast feeding stopped, and breast feeding status. RESULTS: In infants aged < 12 months the risk of dehydrating diarrhoea was significantly higher in the first 9 months of life (P < 0.001), and in those aged 12-23 months the risk was again greater in younger children (12-17 months) (P = 0.03). The type of milk consumed before start of diarrhoea episode was strongly associated with dehydration independent of socioeconomic, environmental, maternal reproductive, demographic, and health services factors. Compared with infants exclusively breast fed, bottle fed infants were at higher risk (odds ratio (95% confidence interval) for cow's milk 6.0 (1.8 to 19.8), for formula milk 6.9 (1.4 to 33.3)). Compared with those still breast feeding, children who stopped in the previous two months were more likely to develop dehydrating diarrhoea (odds ratio 8.4 (2.4 to 29.6)). This risk decreased with time since breast feeding stopped. CONCLUSION: These results confirm the protective effect of breast feeding and suggest there is a vulnerable period soon after breast feeding is stopped, which may be of relevance for developing preventive strategies. Researchers conducted a case control study in Porto Alegre, Brazil, to examine risk factors for dehydrating diarrhea in children 0-23 months old, particularly during the weaning period. There were 192 cases hospitalized with dehydrating diarrhea and 192 age- and neighborhood-matched controls who had no diarrhea in the previous 7 days. Among infants, the risk of developing dehydrating diarrhea was highest during the first 9 months of life, especially at 2-3 months (odds ratio [OR] = 7.1) (p 0.001). For toddlers (12-23 months), the risk was greatest at 12-17 months (OR = 3.7; p = 0.03). Only 8% of cases and 23% of controls were completely breast fed. Children who had not been breast fed faced a higher risk of dehydration than those who had been exclusively breast feed (p = 0.006). The degree of risk depended on the type of breast milk substitute used. Children who consumed cow's milk only and formula only faced the greatest risk of developing dehydrating diarrhea even when adjusted for age and other factors (OR = 6 and 6.9, respectively). Partially breast fed children had intermediate levels of risk (OR = 1.3-2.2). Children who had never breast fed were at low risk of developing dehydrating diarrhea (OR = 0.7), while those who had stopped were at high risk (OR = 6.4) (p 0.001). This increased risk was greatest in the first 2 months after stopping breast feeding (OR = 8.4) and decreased thereafter. These findings support the protective effect of breast feeding. They also point to a vulnerable period soon after termination of breast feeding. Thus, health workers need to pay closer attention to recently weaned children.
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