title: Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants.
abstract: OBJECTIVE
  The objective of this study was to compare growth, morbidity incidence and risk factors for undernutrition between infants receiving complementary feeding early, before 3 months of age, with those receiving complementary foods after 3 months in a poor rural Malawian community.
  
  
  METHODS
  A cohort of babies was enrolled at birth for follow-up to 12 months of age. Weight, length, morbidity and feeding patterns were recorded at 4 weekly intervals from birth to 52 weeks.
  
  
  RESULTS
  Mean age at introduction of water was 2.5 months (range 0-11.8), complementary foods 3.4 months (range, 1.0-10.7) and solids 4.5 months (range 1.2-13.8). Over 40% of infants had received complementary foods by 2 months and 65% by 3 months. The proportion of exclusively breast-fed infants, which included those receiving supplemental water, was 13% at 4 months, 6.3% at 5 months and 1.5% at 6 months. Infants with early complementary feeding had lower weight for age at 3 and 6 months (P<0.05), and at 9 months (P=0.07) and at 2 months they were approximately 200 g lighter. Early complementary feeding was significantly associated with increased risk for respiratory infection (P<0.05), and marginally increased risk for eye infection and episodes of malaria. Maternal illiteracy was associated with early complementary feeding (OR=2.1, 95% CI 1.3, 3.2), while later complementary feeding was associated with reduced infant morbidity and improved growth.
  
  
  CONCLUSIONS
  Breast-feeding promotion programmes should target illiterate women. Greater emphasis is required to improve complementary feeding practices.
authors.affiliation: Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: B F
authors.initials: BF
authors.lastname: Kalanda
authors.forename: F H
authors.initials: FH
authors.lastname: Verhoeff
authors.forename: B J
authors.initials: BJ
authors.lastname: Brabin
mesh_terms: D000328:Adult; D000367:Age Factors; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D001942:Breast Feeding / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006128:Growth / Q000502:physiology; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000706:statistics & numerical data*; D041943:Infant Formula; D007226:Infant Mortality; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn / Q000254:growth & development*; D008295:Malawi; D008297:Male; D009035:Mothers / Q000193:education*; D012307:Risk Factors; D012423:Rural Health; D014886:Weaning