title: Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: a prospective cohort study.
abstract: BACKGROUND
  Acute respiratory infections and diarrhea remain the leading causes of infant morbidity and mortality, with a high burden of both pneumonia and diarrhea in South-East Asia. The aim of the study was to determine antenatal and early infant predictive factors for severe morbidity episodes during the first 6 months of life in Ha Nam province, Vietnam.
  
  
  METHODS
  A prospective cohort study of 1049 infants, born to women who had previously participated in a cluster randomized controlled trial of antenatal micronutrient supplementation in rural Vietnam, was undertaken between 28th September 2010 and 8th Jan 2012. Infants were followed until 6 months of age, and the outcome measure was inpatient admission for suspected pneumonia or diarrheal illness during the first 6 months of life. Risk factors were assessed using univariable logistic regression and multiple logistic regression.
  
  
  RESULTS
  Of the 1049 infants seen at 6 months of age, 8.8 % required inpatient admission for suspected pneumonia and 4 % of infants required inpatient admission for diarrheal illness. One third of infants (32.8 %) were exclusively breast fed at 6 weeks of age. Exclusive breast feeding at 6 weeks of age significantly reduced the odds of inpatient admission for suspected pneumonia (Odds Ratio (OR) 0.39, 95 % Confidence Interval (CI) 0.20 to 0.75) and diarrheal illness (OR 0.37, 95 % CI 0.15 to 0.88).
  
  
  CONCLUSIONS
  Exclusive breast feeding in early infancy reduces the risk of severe illness from diarrhea and suspected pneumonia. Public health programs to reduce the burden of inpatient admission from diarrheal and respiratory illness in rural Vietnam should address barriers to exclusive breast feeding.
authors.affiliation: Department of Medicine, University of Melbourne, Doherty Institute, Parkville, VIC, 3050, Australia. shanieh@unimelb.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hanieh
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam. hatran2004@gmail.com.
authors.forename: Tran T
authors.initials: TT
authors.lastname: Ha
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia. julieas@unimelb.edu.au.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Simpson
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam. thuytranrtccd@gmail.com.
authors.forename: Tran T
authors.initials: TT
authors.lastname: Thuy
authors.affiliation: Provincial Centre of Preventive Medicine, Hanam Province, Vietnam. khuongdichte@gmail.com.
authors.forename: Nguyen C
authors.initials: NC
authors.lastname: Khuong
authors.affiliation: Provincial Centre of Preventive Medicine, Hanam Province, Vietnam. thoangyt@yahoo.com.
authors.forename: Dang D
authors.initials: DD
authors.lastname: Thoang
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam. indthach@gmail.com.|The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia. indthach@gmail.com.
authors.forename: Thach D
authors.initials: TD
authors.lastname: Tran
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam. trantuanrtccd@gmail.com.
authors.forename: Tran
authors.initials: T
authors.lastname: Tuan
authors.affiliation: The Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia. jane.fisher@monash.edu.
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Department of Medicine, University of Melbourne, Doherty Institute, Parkville, VIC, 3050, Australia. babiggs@unimelb.edu.au.|The Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, 3052, Australia. babiggs@unimelb.edu.au.
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
mesh_terms: D000328:Adult; D001942:Breast Feeding; D003967:Diarrhea / Q000517:prevention & control; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D016015:Logistic Models; D016017:Odds Ratio; D011014:Pneumonia / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D012720:Severity of Illness Index; D014744:Vietnam; D055815:Young Adult