title: Drinking-water quality, sanitation, and breast-feeding: their interactive effects on infant health.
abstract: The promotion of proper infant feeding practices and the improvement of environmental sanitation have been two important strategies in the effort to reduce diarrhoeal morbidity among infants. Breast-feeding protects infants by decreasing their exposure to water- and foodborne pathogens and by improving their resistance to infection; good sanitation isolates faecal material from the human environment, reducing exposures to enteric pathogens. Taken together, breast-feeding and good sanitation form a set of sequential barriers that protect infants from diarrhoeal pathogens. As a result, breast-feeding may be most important if the sanitation barrier is not in place. This issue is explored using data from a prospective study of 2355 urban Filipino infants during the first 6 months of life. Longitudinal multivariate analyses are used to estimate the effects of full breast-feeding and mixed feeding on diarrhoeal disease at different levels of sanitation. Breast-feeding provides significant protection against diarrhoeal disease for infants in all environments. Administration of even small portions of contaminated water supplements to fully breast-fed infants nearly doubles their risk of diarrhoea. Mixed-fed and weaned infants consume much greater quantities of supplemental liquids, and as a result, the protective effect of full breast-feeding is greatest when drinking-water is contaminated. Similarly, full breast-feeding has stronger protective effects among infants living in crowded, highly contaminated settings.
authors.affiliation: University of Texas-Houston, School of Public Health, MPH Program at El Paso 79968-0642.
authors.forename: J
authors.initials: J
authors.lastname: VanDerslice
authors.forename: B
authors.initials: B
authors.lastname: Popkin
authors.forename: J
authors.initials: J
authors.lastname: Briscoe
mesh_terms: D000328:Adult; D001942:Breast Feeding; D015331:Cohort Studies; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D007229:Infant Welfare; D007231:Infant, Newborn; D010679:Philippines / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012499:Sanitation / Q000592:standards*; D012959:Socioeconomic Factors; D014876:Water Pollution / Q000009:adverse effects; D014881:Water Supply / Q000592:standards*