Breast-feeding in a complex emergency: four linked cross-sectional studies during the Bosnian conflict.
OBJECTIVE
To examine changes in breast-feeding and impacts on child health during the Bosnian conflict.


METHODS
Four linked representative cross-sectional household surveys, 1994 to 1997.


METHODS
The countries of former Yugoslavia largely missed the international wave of enthusiasm for breast-feeding of the 1980s and early 1990s. The concern is that breast-feeding deteriorates during humanitarian emergencies, when children need it most.


METHODS
The four surveys visited a random sample of clusters from population registers in the Federation of Bosnia and Herzegovina (BiH) and the Republica Srpska (RS). Interviewers asked about breast-feeding and other factors related to child health, and measured mid upper-arm circumference in 1123 infants aged 1-12 months.


RESULTS
One-fifth of infants were not breast-fed at all (220/1087). Muslim and displaced children were less likely to breast-feed; 59 % of Muslim displaced children never breast-fed. Among infants in sites visited by all four surveys, there was no change in the proportion ever breast-fed and a significant increase in duration of breast-feeding and exclusive breast-feeding between 1994 and 1997. Children were breast-fed for shorter durations in male absent households, in frontline communities, the RS, and households that did not receive remittances from abroad. Non-breast-fed children and those who breast-fed for less than 4 months were more likely to be malnourished, as were those with complementary foods added either before or after their sixth month of life.


CONCLUSIONS
If relief agencies had promoted and supported breast-feeding, this might have avoided some of the increased malnutrition that occurred during the conflict.
Andersson
Neil
N
Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico.
Paredes-Solís
Sergio
S
Legorreta-Soberanis
José
J
Cockcroft
Anne
A
Sherr
Lorraine
L
D000886:Anthropometry; D001835:Body Weight; D017522:Bosnia and Herzegovina / Q000453:epidemiology; D001942:Breast Feeding / Q000453:epidemiology* / Q000706:statistics & numerical data; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology* / Q000209:etiology; D007231:Infant, Newborn; D007514:Islam; D008297:Male; D012042:Registries; D055771:Serbia / Q000453:epidemiology; D014857:Warfare