Breast and complementary feeding practices in relation to morbidity and growth in Malawian infants.
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.
Kalanda
B F
BF
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
Verhoeff
F H
FH
Brabin
B J
BJ
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