Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums
Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums
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DOI：
10.1542/peds.108.4.e67
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发表时间：
2001-10-01
期刊：
影响因子：
8
通讯作者：
Becker, S
中科院分区：
文献类型：
--
作者：
Arifeen, S;Black, RE;Becker, S
目标。描述母乳喂养实践并调查婴儿早期纯母乳喂养对婴儿死亡风险的影响，特别是呼吸道感染 (ARI) 和腹泻引起的婴儿死亡风险。方法。对出生在孟加拉国达卡贫民窟地区的 1677 名婴儿进行了一项前瞻性观察研究，并对其从出生到 12 个月大的情况进行了追踪。婴儿出生后入组，到 12 个月大时又接受了 5 次探视。基于结构化调查问卷的口头尸检被用来确定 180 例报告死亡的原因。在考虑了包括出生体重在内的其他变量后，使用比例风险回归模型来估计母乳喂养做法的影响，该模型作为时变变量引入。测量了新生儿、新生儿后和婴儿的总体死亡率，以及急性呼吸道感染和腹泻引起的死亡率。结果。入组时纯母乳喂养的婴儿比例仅为 6%，1 个月时增加至 53%，然后在 6 个月时逐渐下降至 5%。以母乳喂养为主的比例从入组时的 66% 下降到 12 个月时的 4%。很少有婴儿没有接受母乳喂养，而部分母乳喂养的婴儿比例随着年龄的增长而增加。任何年龄段的低出生体重婴儿和正常出生体重婴儿的母乳喂养方法都没有差异。婴儿总体死亡率为每 1000 名活产婴儿中有 114 人死亡。与出生后最初几个月的纯母乳喂养相比，部分母乳喂养或不母乳喂养与婴儿全因死亡风险高出 2.23 倍，因急性呼吸道感染和腹泻导致的死亡风险分别高出 2.40 倍和 3.94 倍。结论。从这一分析中可以清楚地看出，适当的母乳喂养做法对婴儿生存的重要作用。急性呼吸道感染死亡人数的减少凸显了纯母乳喂养在预防传染病方面的广泛有益作用，而不仅仅是减少接触受污染食物的作用，这可能有助于强有力地防止腹泻死亡。
Objectives. To describe breastfeeding practices and investigate the influence of exclusive breastfeeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhea.Methods. A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and followed from birth to 12 months of age. After enrollment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported deaths. Proportional hazards regression models were used to estimate the effect of breastfeeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and diarrhea were measured.Results. The proportion of infants who were breastfed exclusively was only 6% at enrollment, increasing to 53% at 1 month and then gradually declining to 5% at 6 months of age. Predominant breastfeeding declined from 66% at enrollment to 4% at 12 months of age. Very few infants were not breastfed, whereas the proportion of partially breastfed infants increased with age. Breastfeeding practices did not differ between low and normal birth weight infants at any age. The overall infant mortality rate was 114 deaths per 1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold higher risk of infant deaths resulting from all causes and 2.40- and 3.94-fold higher risk of deaths attributable to ARI and diarrhea, respectively.Conclusion. The important role of appropriate breastfeeding practices in the survival of infants is clear from this analysis. The reduction of ARI deaths underscores the broad-based beneficial effect of exclusive breastfeeding in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhea deaths.