Initiation of food supplements and stopping of breast-feeding as determinants of weanling shigellosis.
The association between the period elapsed since weaning and the risk of shigellosis was assessed between 1 November 1987 and 30 November 1989 for a cohort of 1085 Bangladeshi children aged < 3 years. The children were followed for 1 month after exposure to Shigella spp. in their residential neighbourhoods, and the 268 who developed microbiologically confirmed (n = 118) or clinically presumptive (n = 150) shigellosis were compared with the 817 control children who did not develop either syndrome. No increase in risk was noted among breast-fed infants who received food supplements within the previous 3 months compared with those who had received supplements for longer (adjusted odds ratio (OR) = 1.2; 95% confidence interval (CI) = 0.4-3.0). However, compared with breast-fed children, non-breast-fed children had an increased risk (adjusted OR = 2.0; 95% CI = 1.3-2.9; P < 0.001), which was largely attributable to a substantially increased risk in the 3 months after stopping breast-feeding (adjusted OR = 6.6; 95% CI = 2.9-14.6; P < 0.001). The early post-cessation risk was equivalent for confirmed and presumptive shigellosis, but was particularly pronounced among the severely malnourished (adjusted OR = 10.2; 95% CI = 3.1-33.3; P < 0.001). This complex temporal pattern of risk highlights the need for precise definitions of weaning to facilitate identification of children at high risk for invasive diarrhoeal syndromes.
Ahmed
F
F
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka.
Clemens
J D
JD
Rao
M R
MR
Khan
M R
MR
Haque
E
E
D001459:Bangladesh / Q000453:epidemiology; D001903:Bottle Feeding / Q000009:adverse effects*; D001942:Breast Feeding; D016022:Case-Control Studies; D002675:Child, Preschool; D016001:Confidence Intervals; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000150:complications; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D014886:Weaning