Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED

An eight-country cohort study

MAL-ED Network Investigators

Research output: Contribution to journalArticle

Abstract

Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95% confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23,95%CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0-6 months was protective against diarrhea (0-2 months: RR 0.39, 95% CI 0.32, 0.49; 3-5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3-5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.

Original languageEnglish (US)
Pages (from-to)904-912
Number of pages9
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume98
Issue number3
DOIs
StatePublished - Jan 1 2018

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Breast Feeding
Cohort Studies
Diarrhea
Respiratory Tract Infections
Confidence Intervals
Fever
History
Parturition
Diet
Incidence

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases
  • Virology

Cite this

@article{aa29889c12784ca0b3c05df5a454a1c2,
title = "Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED: An eight-country cohort study",
abstract = "Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95{\%} confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23,95{\%}CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0-6 months was protective against diarrhea (0-2 months: RR 0.39, 95{\%} CI 0.32, 0.49; 3-5 months: RR 0.83, 95{\%} CI 0.75, 0.93) and ALRI (3-5 months: RR 0.81, 95{\%} CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.",
author = "{MAL-ED Network Investigators} and Richard, {Stephanie A.} and McCormick, {Benjamin J.J.} and Seidman, {Jessica C.} and Zeba Rasmussen and Margaret Kosek and Rogawski, {Elizabeth T.} and William Petri and Anuradha Bose and Estomih Mduma and Maciel, {Bruna L.L.} and Chandyo, {Ram Krishna} and Zulfiqar Bhutta and Ali Turab and Pascal Bessong and Mustafa Mahfuz and Laura Caulfield and Acosta, {Angel Mendez} and {De Burga}, {Rosa Rios} and Chavez, {Cesar Banda} and Flores, {Julian Torres} and Olotegui, {Maribel Paredes} and Pinedo, {Silvia Rengifo} and Salas, {Mery Siguas} and Trigoso, {Dixner Rengifo} and Vasquez, {Angel Orbe} and Imran Ahmed and Didar Alam and Asad Ali and Shahida Qureshi and Muneera Rasheed and Sajid Soofi and Zaidi, {Anita K.M.} and Ladaporn Bodhidatta and Mason, {Carl J.} and Sudhir Babji and George, {Ajila T.} and Dinesh Hariraju and Jennifer, {M. Steffi} and Sushil John and Shiny Kaki and Gagandeep Kang and Priyadarshani Karunakaran and Beena Koshy and Lazarus, {Robin P.} and Jayaprakash Muliyil and Raghava, {Mohan Venkata} and Monica McGrath and Black, {Robert E} and William Checkley and {Penataro Yori}, Pablo",
year = "2018",
month = "1",
day = "1",
doi = "10.4269/ajtmh.17-0457",
language = "English (US)",
volume = "98",
pages = "904--912",
journal = "American Journal of Tropical Medicine and Hygiene",
issn = "0002-9637",
publisher = "American Society of Tropical Medicine and Hygiene",
number = "3",

}

TY - JOUR

T1 - Relationships among common illness symptoms and the protective effect of breastfeeding in early childhood in MAL-ED

T2 - An eight-country cohort study

AU - MAL-ED Network Investigators

AU - Richard, Stephanie A.

AU - McCormick, Benjamin J.J.

AU - Seidman, Jessica C.

AU - Rasmussen, Zeba

AU - Kosek, Margaret

AU - Rogawski, Elizabeth T.

AU - Petri, William

AU - Bose, Anuradha

AU - Mduma, Estomih

AU - Maciel, Bruna L.L.

AU - Chandyo, Ram Krishna

AU - Bhutta, Zulfiqar

AU - Turab, Ali

AU - Bessong, Pascal

AU - Mahfuz, Mustafa

AU - Caulfield, Laura

AU - Acosta, Angel Mendez

AU - De Burga, Rosa Rios

AU - Chavez, Cesar Banda

AU - Flores, Julian Torres

AU - Olotegui, Maribel Paredes

AU - Pinedo, Silvia Rengifo

AU - Salas, Mery Siguas

AU - Trigoso, Dixner Rengifo

AU - Vasquez, Angel Orbe

AU - Ahmed, Imran

AU - Alam, Didar

AU - Ali, Asad

AU - Qureshi, Shahida

AU - Rasheed, Muneera

AU - Soofi, Sajid

AU - Zaidi, Anita K.M.

AU - Bodhidatta, Ladaporn

AU - Mason, Carl J.

AU - Babji, Sudhir

AU - George, Ajila T.

AU - Hariraju, Dinesh

AU - Jennifer, M. Steffi

AU - John, Sushil

AU - Kaki, Shiny

AU - Kang, Gagandeep

AU - Karunakaran, Priyadarshani

AU - Koshy, Beena

AU - Lazarus, Robin P.

AU - Muliyil, Jayaprakash

AU - Raghava, Mohan Venkata

AU - McGrath, Monica

AU - Black, Robert E

AU - Checkley, William

AU - Penataro Yori, Pablo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95% confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23,95%CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0-6 months was protective against diarrhea (0-2 months: RR 0.39, 95% CI 0.32, 0.49; 3-5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3-5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.

AB - Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident diarrhea after the first 6 months of life (relative risk [RR] 1.10, 95% confidence interval [CI] 1.04, 1.16) and with higher risk of incident ALRI in the 3- to 5-month period (RR 1.23,95%CI 1.03, 1.47). Fever was a consistent risk factor for both diarrhea and ALRI. Exclusive breastfeeding 0-6 months was protective against diarrhea (0-2 months: RR 0.39, 95% CI 0.32, 0.49; 3-5 months: RR 0.83, 95% CI 0.75, 0.93) and ALRI (3-5 months: RR 0.81, 95% CI 0.68, 0.98). Children with recent illness who were exclusively breastfed were half as likely as those not exclusively breastfed to experience diarrhea in the first 3 months of life. Recent illness was associated with greater risk of new illness, causing illnesses to cluster within children, indicating that specific illness-prevention programs may have benefits for preventing other childhood illnesses. The results also underscore the importance of exclusive breastfeeding in the first 6 months of life for disease prevention.

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DO - 10.4269/ajtmh.17-0457

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JF - American Journal of Tropical Medicine and Hygiene

SN - 0002-9637

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