Breast-feeding, infections and infant outcomes: an international perspective

Abstract

Most rural mothers from Puriscal, a typical transitional population in Costa Rica, breastfeed their infants; more than one half breast-feed beyond 6 months. This situation was brought about by commencement of rooming-in and promotion of breast-feeding in the maternity where most Puriscal infants are delivered. Before such interventions were implemented, most infants were not breast-fed or were nursed for a few months only. In addition, feeding pooled human colostrum and milk to "high-risk" neonates was followed by a marked decrease in incidence of early neonatal infections. Exclusive breast-feeding for at least the first month of life was associated with optimal infant growth, regardless of degree of maturity at birth. Breast-fed infants grew better than non-breast-fed infants. Periods of weight loss or growth arrest were relatively uncommon in Puriscal, and when occurred, they were associated to infectious diseases, and, to a lesser degree, child neglect, abuse or deficient home technology. These observations were contrasted with a previous study in the Indian village of Cauque, in Guatemala, where optimal child growth was observed in breast-fed infants during the first semester of life, despite marked socioeconomic deprivation. Beyond this period, however, growth faltering was considerably more common in Cauque rather than in Purisal as a result of a greater incidence of infectious diseases and poorer home technologies in Cauque. Infections resulted in diminished calorie intake, nutrient wastage, weight loss, growth arrest and premature death. These studies show that the control and prevention of malnutrition and premature death lies in great part in the success to control and prevent infectious disease, more than in correcting whatever deficiencies appear in the village diet. This predicate does not apply to situations in which there is evident food shortage.