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Does breastfeeding influence mortality in children hospitalized with diarrhoea?
H P Sachdev1, S Kumar, K K Singh
1Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Insights
Breastfeeding significantly reduces mortality risk in hospitalized children with diarrhea. This protective effect is evident across all age groups and is particularly strong in vulnerable infants.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Diarrheal diseases remain a leading cause of mortality in young children globally.
- Hospitalization for diarrhea indicates severe illness, necessitating investigation into protective factors.
- Understanding factors influencing mortality in hospitalized children is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between breastfeeding and mortality in children hospitalized for diarrhea.
- To quantify the protective effect of breastfeeding against death in this vulnerable population.
- To identify specific subgroups of children who may benefit most from breastfeeding during hospitalization.
Main Methods:
- Prospective study involving 309 children under 18 months hospitalized for diarrhea.
- Multivariate logistic regression analysis comparing deceased cases (36) with discharged controls (273).
- Adjustment for confounding variables including nutritional status, illness chronicity, and co-infections.
Main Results:
- Breastfeeding demonstrated a strong protective effect against mortality (adjusted OR 2.7; 95% CI 2.1-3.6).
- The protective effect was significant across age intervals: 0-6 months (OR 6.0), 7-12 months (OR 2.6), and 13-18 months (OR 1.8).
- Greater benefits were observed in children with severe wasting, stunting, protracted illness, or diarrhea as the sole condition.
Conclusions:
- Breastfeeding provides substantial protection against death in children up to 18 months hospitalized with diarrhea.
- The findings underscore the importance of continued breastfeeding, even during hospitalization for severe illness.
- Public health strategies should promote and support breastfeeding for hospitalized infants to reduce mortality.
Abstract:
The association between breastfeeding and mortality in children hospitalized for diarrhoea was investigated in a prospective manner in 309 subjects below 18 months of age. In multivariate logistic regression analysis, 36 cases who died were compared with 273 controls who were discharged in a satisfactory condition. Breastfeeding had a strong protective effect against mortality even after allowance was made for confounding variables (including nutritional status, chronicity of illness, associated non-enteral infections) and a possible bias of interruption of breastfeeding as an early consequence of the terminal illness. The adjusted odd's ratio (OR) and 95 per cent confidence intervals (95 per cent CI) for the protective effect were 2.7 and 2.1-3.6, respectively. The adjusted OR's (95 per cent CI's) were 6.0 (3.6-10.2), 2.6 (2.0-3.4), and 1.8 (1.4-2.5) for the age intervals 0-6, 7-12, and 13-18 months, respectively (P less than 0.001, less than 0.01, and less than 0.05, respectively). Further stratified analyses suggested a greater benefit in children with severe wasting, severe stunting, protracted illness, and diarrhoea as the sole illness. It is concluded that in children up to 18 months of age, breastfeeding offers substantial protection against death in children hospitalized with diarrhoea.