PEDIATRICS Vol. 92 No. 5 November 1993, pp. 680-685
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Breast-Feeding and the Risk of Life-Threatening Rotavirus Diarrhea: Prevention or Postponement?

J. Clemens MD1, M. Rao MEng1, F. Ahmed MBBS, MPH2, R. Ward PhD3, S. Huda 4, J. Chakraborty 4, M. Yunus MBBS, MSc4, M. R. Khan 4, M. Ali MSc4, B. Kay DrPH5, F. van Loon MD, PhD6, and D. Sack MD5

1 From the International Centre for Diarrhoeal Disease Research, Bangladesh; National Institute of Child Health and Human Development, Bethesda, MD
2 From the International Centre for Diarrhoeal Disease Research, Bangladesh; National Institute of Child Health and Human Development, Bethesda, MD; Johns Hopkins School of Public Health, Baltimore, MD
3 From the James Gamble Institute of Medical Research, Cincinnati, OH
4 From the International Centre for Diarrhoeal Disease Research, Bangladesh
5 From the International Centre for Diarrhoeal Disease Research, Bangladesh; Johns Hopkins School of Public Health, Baltimore, MD
6 From the International Centre for Diarrhoeal Disease Research, Bangladesh; Centers for Disease Control, Atlanta, GA

Purpose. To assess the relationship between breast-feeding and the risk of life-threatening rotavirus diarrhea among Bangladeshi infants and children younger than 24 months of age.

Design. Case-control study.

Setting. A rural Bangladesh community.

Participants. One hundred two cases with clinically severe rotavirus diarrhea detected in a treatment centerbased surveillance system during 1985 and 1986, and 2587 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 breast-feeding patterns.

Results. Compared with other feeding modes, exclusive breast-feeding of infants was associated with significant protection against severe rotavirus diarrhea (relative risk (RR) = 0.10; 95% confidence interval [CI] = 0.03,0.34). However, during the second year of life, the risk of this outcome was higher in breast-fed than in non-breast-fed children (RR = 2.85; 95% CI = 0.37,21.71), and no overall protection was associated with breast-feeding during the first 2 years of life (RR = 2.61; 95% CI = 0.62,11.02).

Conclusions. Although exclusive breast-feeding appeared to protect infants against severe rotavirus diarrhea, breast-feeding per se conferred no overall protection during the first 2 years of life, suggesting that breast-feeding temporarily postponed rather than prevented this outcome. While not detracting from efforts to promote breast-feeding to alleviate the burden of diarrhea due to nonrotaviral enteropathogens, our findings cast doubt on whether such efforts will impact on the problem of severe rotavirus diarrhea.

Key Words: breast-feeding • rotavirus • diarrhea

Submitted on March 12, 1993
Accepted on May 12, 1993




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