ABSTRACT
The protective effect of breastfeeding against infantile diarrhoea may be less pronounced in areas with modern water supply and sanitation facilities. This finding raises the question whether protection by breastfeeding against infantile diarrhoea in developing countries will decline with improvement in water supply and sanitation. To address this question a historical cohort study of the associations between feeding modes and diarrhoea incidence and severity in children aged 0-14 months at baseline was done in Al Ain city, United Arab Emirates. In this city in a newly developed country, modern water supply and sanitation facilities have become available to everyone during the last two decades. During three months of follow-up of 249 children, the nonbreastfed had more diarrhoea than did the partly breastfed, who in turn had more diarrhoea than did the fully breastfed. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrhoeal morbidity in each child: occurrence or non-occurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the nonbreastfed and fully breastfed subgroups. These results indicate that in Al Ain, despite the universal access to modern water supply and sanitation facilities, breastfeeding plays an important role in reducing the incidence and severity of infantile diarrhoea. This observation is particularly important given the growing concern that, as an unwanted effect of 'modernisation', breastfeeding is on the decline in Al Ain and comparable populations elsewhere.
PIP: Since the protective effect of breast feeding against infantile diarrhea may be less pronounced in areas with modern water supply and sanitation facilities, this effect may decline as developing countries make improvements in these areas. This possibility was addressed in a historical cohort study of the association between feeding modes and diarrhea incidence and severity in 249 children from Al Ain city, United Arab Emirates, who were 0-14 months of age at baseline. During the past two decades, a modern water supply and sanitation facilities have become universally available in this newly developed country. During 3 months of follow-up, 69 (28%) of the 249 children had at least 1 diarrhea episode. The 61 non-breast-fed infants had more diarrhea than the 45 partially breast-fed infants, who in turn had more diarrhea than the 143 fully breast fed ones. After multivariate adjustment, this dose-response effect was consistent for three measures of diarrheal morbidity in each child: occurrence or nonoccurrence of incidence episodes, number of episodes, and total severity score. However, significant differences were seen only between the non-breast-fed and fully breast-fed infants. These findings indicate that breast feeding remains a critical child health intervention, even in areas with universal access to modern water supply and sanitation facilities.
