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PEDIATRICS Vol. 100 No. 6 December 1997, p. e2

ELECTRONIC ARTICLE:
Breastfeeding and the Risk of Life-threatening Enterotoxigenic Escherichia coli Diarrhea in Bangladeshi Infants and Children

Received Oct 3, 1996; accepted Jul 7, 1997.

John D. Clemens*, Dagger , Malla R. Rao*, Dagger , J. Chakraborty*, Mohammed Yunus*, Mohammed Ali*, Bradford Kay*, par , Frederick P. L. van Loon*, par , Abdullah NaficyDagger , and David A. Sack*, §

From the * International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh; Dagger  National Institute of Child Health and Human Development, Bethesda, Maryland; § Johns Hopkins School of Public Health, Baltimore, Maryland; and par  Centers for Disease Control and Prevention, Atlanta, Georgia.

Objective.  To assess the relationship between breastfeeding and the risk of life-threatening enterotoxigenic Escherichia coli (ETEC) diarrhea among Bangladeshi infants and young children <36 months of age.

Design.  Case-control study.

Setting.  A rural Bangladesh community.

Participants.  A total of 168 cases with clinically severe ETEC diarrhea detected in a treatment center-based surveillance system during 1985 to 1986 and 3679 controls selected in three surveys of the same community during the same calendar interval.

Outcomes.  Cases and controls were compared for the frequency of antecedent breastfeeding patterns.

Results.  Compared with other feeding modes, exclusive breastfeeding of infants was associated with significant protection against severe ETEC diarrhea (relative risk [RR] = 0.51; 95% confidence interval [CI]: 0.28,0.96). However, during the second and third years of life, the risk of this outcome was similar in both breastfed and nonbreastfed children (RR = 0.98; 95% CI: 0.45,2.12), and no significant overall protective association between breastfeeding and severe ETEC diarrhea was evident during the first 3 years of life (RR = 0.86; 95% CI: 0.43,1.74).

Conclusions.  Exclusive breastfeeding appeared to protect infants against severe ETEC diarrhea, but breastfeeding was not associated with protection after infancy, nor was it associated with a major overall reduction of severe ETEC disease during the first 3 years of life. Although not diminishing the importance of breastfeeding, our findings suggest that other interventions, such as immunization and education about proper food hygiene, may also be required in efforts to prevent this major pediatric disease.

Key words: enterotoxigenic Escherichia coli, breastfeeding, diarrhea.


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