Skip to main content
Top
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: a prospective cohort study

Authors: Sarah Hanieh, Tran T. Ha, Julie A. Simpson, Tran T. Thuy, Nguyen C. Khuong, Dang D. Thoang, Thach D. Tran, Tran Tuan, Jane Fisher, Beverley-Ann Biggs

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Acute respiratory infections and diarrhea remain the leading causes of infant morbidity and mortality, with a high burden of both pneunomia 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 pneumomia (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.
Literature
1.
go back to reference Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77. Epub 2013/06/12.CrossRefPubMed Bhutta ZA, Das JK, Rizvi A, Gaffey MF, Walker N, Horton S, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–77. Epub 2013/06/12.CrossRefPubMed
2.
go back to reference Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151–61. Epub 2012/05/15.CrossRefPubMed Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012;379(9832):2151–61. Epub 2012/05/15.CrossRefPubMed
3.
go back to reference Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008;37(4):816–30. Epub 2008/06/24.CrossRefPubMedPubMedCentral Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol. 2008;37(4):816–30. Epub 2008/06/24.CrossRefPubMedPubMedCentral
4.
go back to reference Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011;378(9799):1325–38. Epub 2011/09/29.CrossRefPubMed Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011;378(9799):1325–38. Epub 2011/09/29.CrossRefPubMed
5.
go back to reference Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012;12:220. Epub 2012/03/23.CrossRefPubMedPubMedCentral Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health. 2012;12:220. Epub 2012/03/23.CrossRefPubMedPubMedCentral
6.
go back to reference Rudan I, El Arifeen S, Black RE, Campbell H. Childhood pneumonia and diarrhoea: setting our priorities right. Lancet Infect Dis. 2007;7(1):56–61. Epub 2006/12/22.CrossRefPubMed Rudan I, El Arifeen S, Black RE, Campbell H. Childhood pneumonia and diarrhoea: setting our priorities right. Lancet Infect Dis. 2007;7(1):56–61. Epub 2006/12/22.CrossRefPubMed
10.
go back to reference Vietnam Academy of Social Science. Vietnam Poverty Update: Poverty and poverty reduction in Vietnam 1993–2004. Vietnamese Academy of Social Sciences: Hanoi, Vietnam; 2006. Vietnam Academy of Social Science. Vietnam Poverty Update: Poverty and poverty reduction in Vietnam 1993–2004. Vietnamese Academy of Social Sciences: Hanoi, Vietnam; 2006.
11.
go back to reference General Statistics Office of Vietnam. Statistical Year Book of Vietnam. Hanoi: Statistical Publishing House; 2011. General Statistics Office of Vietnam. Statistical Year Book of Vietnam. Hanoi: Statistical Publishing House; 2011.
12.
go back to reference Hengstermann S, Mantaring 3rd JB, Sobel HL, Borja VE, Basilio J, Iellamo AD, et al. Formula feeding is associated with increased hospital admissions due to infections among infants younger than 6 months in Manila, Philippines. J Hum Lact. 2010;26(1):19–25.CrossRefPubMed Hengstermann S, Mantaring 3rd JB, Sobel HL, Borja VE, Basilio J, Iellamo AD, et al. Formula feeding is associated with increased hospital admissions due to infections among infants younger than 6 months in Manila, Philippines. J Hum Lact. 2010;26(1):19–25.CrossRefPubMed
13.
go back to reference United Nations Children's Fund. Composition of a Multimicronutrient Supplement to be used in Pilot Programmes among Pregnant Women in Developing Countries: Report of a UNICEF/WHO/UNU Workshop. UNICEF: New York; 1999. United Nations Children's Fund. Composition of a Multimicronutrient Supplement to be used in Pilot Programmes among Pregnant Women in Developing Countries: Report of a UNICEF/WHO/UNU Workshop. UNICEF: New York; 1999.
14.
go back to reference Hanieh S, Ha TT, Simpson JA, Casey GJ, Khuong NC, Thoang DD, et al. The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Viet Nam: a cluster randomised trial. PLoS Med. 2013;10(6), e1001470. Epub 2013/07/16.CrossRefPubMedPubMedCentral Hanieh S, Ha TT, Simpson JA, Casey GJ, Khuong NC, Thoang DD, et al. The effect of intermittent antenatal iron supplementation on maternal and infant outcomes in rural Viet Nam: a cluster randomised trial. PLoS Med. 2013;10(6), e1001470. Epub 2013/07/16.CrossRefPubMedPubMedCentral
15.
go back to reference WHO. Integrated Management of Childhood Illness. WHO: Geneva; 2008. WHO. Integrated Management of Childhood Illness. WHO: Geneva; 2008.
16.
go back to reference Tran TD, Tran T, La B, Lee D, Rosenthal D, Fisher J. Screening for perinatal common mental disorders in women in the north of Vietnam: a comparison of three psychometric instruments. J Affect Disord. 2011;133(1–2):281–93. Epub 2011/05/03.CrossRefPubMed Tran TD, Tran T, La B, Lee D, Rosenthal D, Fisher J. Screening for perinatal common mental disorders in women in the north of Vietnam: a comparison of three psychometric instruments. J Affect Disord. 2011;133(1–2):281–93. Epub 2011/05/03.CrossRefPubMed
17.
go back to reference Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case–control study. Bmj. 1999;318(7194):1316–20.CrossRefPubMedPubMedCentral Cesar JA, Victora CG, Barros FC, Santos IS, Flores JA. Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case–control study. Bmj. 1999;318(7194):1316–20.CrossRefPubMedPubMedCentral
18.
go back to reference Hipgrave DB, Assefa F, Winoto A, Sukotjo S. Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr. 2012;15(2):307–15. Epub 2011/03/24.CrossRefPubMed Hipgrave DB, Assefa F, Winoto A, Sukotjo S. Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr. 2012;15(2):307–15. Epub 2011/03/24.CrossRefPubMed
19.
go back to reference Creek TL, Kim A, Lu L, Bowen A, Masunge J, Arvelo W, et al. Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. J Acquir Immune Defic Syndr. 2010;53(1):14–9.CrossRefPubMed Creek TL, Kim A, Lu L, Bowen A, Masunge J, Arvelo W, et al. Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. J Acquir Immune Defic Syndr. 2010;53(1):14–9.CrossRefPubMed
20.
go back to reference Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet. 2013;381(9875):1417–29. Epub 2013/04/16.CrossRefPubMed Bhutta ZA, Das JK, Walker N, Rizvi A, Campbell H, Rudan I, et al. Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost? Lancet. 2013;381(9875):1417–29. Epub 2013/04/16.CrossRefPubMed
21.
go back to reference Dey SK, Chisti MJ, Das SK, Shaha CK, Ferdous F, Farzana FD, et al. Characteristics of diarrheal illnesses in non-breast fed infants attending a large urban diarrheal disease hospital in Bangladesh. PloS one. 2013;8(3), e58228. Epub 2013/03/23.CrossRefPubMedPubMedCentral Dey SK, Chisti MJ, Das SK, Shaha CK, Ferdous F, Farzana FD, et al. Characteristics of diarrheal illnesses in non-breast fed infants attending a large urban diarrheal disease hospital in Bangladesh. PloS one. 2013;8(3), e58228. Epub 2013/03/23.CrossRefPubMedPubMedCentral
22.
go back to reference Abdel-Hafeez EH, Belal US, Abdellatif MZ, Naoi K, Norose K. Breast-feeding protects infantile diarrhea caused by intestinal protozoan infections. Korean J Parasitol. 2013;51(5):519–24. Epub 2013/12/12.CrossRefPubMedPubMedCentral Abdel-Hafeez EH, Belal US, Abdellatif MZ, Naoi K, Norose K. Breast-feeding protects infantile diarrhea caused by intestinal protozoan infections. Korean J Parasitol. 2013;51(5):519–24. Epub 2013/12/12.CrossRefPubMedPubMedCentral
23.
go back to reference Prameela KK, Vijaya LR. The importance of breastfeeding in rotaviral diarrhoeas. Malays J Nutr. 2012;18(1):103–11. Epub 2013/05/30.PubMed Prameela KK, Vijaya LR. The importance of breastfeeding in rotaviral diarrhoeas. Malays J Nutr. 2012;18(1):103–11. Epub 2013/05/30.PubMed
24.
go back to reference Lopez-Alarcon M, Villalpando S, Fajardo A. Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age. J Nutr. 1997;127(3):436–43. Epub 1997/03/01.PubMed Lopez-Alarcon M, Villalpando S, Fajardo A. Breast-feeding lowers the frequency and duration of acute respiratory infection and diarrhea in infants under six months of age. J Nutr. 1997;127(3):436–43. Epub 1997/03/01.PubMed
25.
go back to reference Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108(4), E67. Epub 2001/10/03.CrossRefPubMed Arifeen S, Black RE, Antelman G, Baqui A, Caulfield L, Becker S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics. 2001;108(4), E67. Epub 2001/10/03.CrossRefPubMed
26.
go back to reference Lauer JA, Betran AP, Barros AJ, de Onis M. Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment. Public Health Nutr. 2006;9(6):673–85.CrossRefPubMed Lauer JA, Betran AP, Barros AJ, de Onis M. Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment. Public Health Nutr. 2006;9(6):673–85.CrossRefPubMed
27.
go back to reference Agostoni C, Axelsson I, Goulet O, Koletzko B, Michaelsen KF, Puntis JW, et al. Preparation and handling of powdered infant formula: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2004;39(4):320–2.CrossRefPubMed Agostoni C, Axelsson I, Goulet O, Koletzko B, Michaelsen KF, Puntis JW, et al. Preparation and handling of powdered infant formula: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2004;39(4):320–2.CrossRefPubMed
28.
go back to reference Noriega FR, Kotloff KL, Martin MA, Schwalbe RS. Nosocomial bacteremia caused by Enterobacter sakazakiki and Leuconostoc mesenteroides resulting from extrinsic contamination of infant formula. Pediatr Infect Dis Js. 1990;9(6):447–9.CrossRef Noriega FR, Kotloff KL, Martin MA, Schwalbe RS. Nosocomial bacteremia caused by Enterobacter sakazakiki and Leuconostoc mesenteroides resulting from extrinsic contamination of infant formula. Pediatr Infect Dis Js. 1990;9(6):447–9.CrossRef
29.
go back to reference Lakshman R, Ogilvie D, Ong KK. Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Arch Dis Child. 2009;94(8):596–601.CrossRefPubMedPubMedCentral Lakshman R, Ogilvie D, Ong KK. Mothers’ experiences of bottle-feeding: a systematic review of qualitative and quantitative studies. Arch Dis Child. 2009;94(8):596–601.CrossRefPubMedPubMedCentral
30.
go back to reference Rinne MM, Gueimonde M, Kalliomaki M, Hoppu U, Salminen SJ, Isolauri E. Similar bifidogenic effects of prebiotic-supplemented partially hydrolyzed infant formula and breastfeeding on infant gut microbiota. FEMS Immunol Med Microbiol. 2005;43(1):59–65.CrossRefPubMed Rinne MM, Gueimonde M, Kalliomaki M, Hoppu U, Salminen SJ, Isolauri E. Similar bifidogenic effects of prebiotic-supplemented partially hydrolyzed infant formula and breastfeeding on infant gut microbiota. FEMS Immunol Med Microbiol. 2005;43(1):59–65.CrossRefPubMed
31.
go back to reference Langhendries JP, Detry J, Van Hees J, Lamboray JM, Darimont J, Mozin MJ, et al. Effect of a fermented infant formula containing viable bifidobacteria on the fecal flora composition and pH of healthy full-term infants. J Pediatr Gastroenterol Nutr. 1995;21(2):177–81.CrossRefPubMed Langhendries JP, Detry J, Van Hees J, Lamboray JM, Darimont J, Mozin MJ, et al. Effect of a fermented infant formula containing viable bifidobacteria on the fecal flora composition and pH of healthy full-term infants. J Pediatr Gastroenterol Nutr. 1995;21(2):177–81.CrossRefPubMed
32.
go back to reference Gribble KD. Mechanisms behind breastmilk's protection against, and artificial baby milk's facilitation of, diarrhoeal illness. Breastfeed Rev. 2011;19(2):19–26.PubMed Gribble KD. Mechanisms behind breastmilk's protection against, and artificial baby milk's facilitation of, diarrhoeal illness. Breastfeed Rev. 2011;19(2):19–26.PubMed
33.
go back to reference Le Huerou-Luron I, Blat S, Boudry G. Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev. 2010;23(1):23–36. Epub 2010/05/11.CrossRefPubMed Le Huerou-Luron I, Blat S, Boudry G. Breast- v. formula-feeding: impacts on the digestive tract and immediate and long-term health effects. Nutr Res Rev. 2010;23(1):23–36. Epub 2010/05/11.CrossRefPubMed
34.
go back to reference Prameela Jr KK, Mohamed AK. Breast milk immunoprotection and the common mucosal immune system: a review. Malays J Nutr. 2010;16(1):1–11.PubMed Prameela Jr KK, Mohamed AK. Breast milk immunoprotection and the common mucosal immune system: a review. Malays J Nutr. 2010;16(1):1–11.PubMed
35.
go back to reference Thu HN, Eriksson B, Khanh TT, Petzold M, Bondjers G, Kim CN, et al. Breastfeeding practices in urban and rural Vietnam. BMC Public Health. 2012;12:964. Epub 2012/11/13.CrossRefPubMedPubMedCentral Thu HN, Eriksson B, Khanh TT, Petzold M, Bondjers G, Kim CN, et al. Breastfeeding practices in urban and rural Vietnam. BMC Public Health. 2012;12:964. Epub 2012/11/13.CrossRefPubMedPubMedCentral
36.
go back to reference National Institute of Nutrition, UNICEF. Nutrition Surveillance 2010: Vietnam Nutrition profile 2010. UNICEF: Hanoi; 2011. National Institute of Nutrition, UNICEF. Nutrition Surveillance 2010: Vietnam Nutrition profile 2010. UNICEF: Hanoi; 2011.
37.
go back to reference Dibley MJ, Roy SK, Senarath U, Patel A, Tiwari K, Agho KE, et al. Across-country comparisons of selected infant and young child feeding indicators and associated factors in four South Asian countries. Food Nutr Bull. 2010;31(2):366–75. Epub 2010/08/17.CrossRefPubMed Dibley MJ, Roy SK, Senarath U, Patel A, Tiwari K, Agho KE, et al. Across-country comparisons of selected infant and young child feeding indicators and associated factors in four South Asian countries. Food Nutr Bull. 2010;31(2):366–75. Epub 2010/08/17.CrossRefPubMed
38.
go back to reference Senarath U, Dibley MJ, Agho KE. Factors associated with nonexclusive breastfeeding in 5 east and southeast Asian countries: a multilevel analysis. J Hum Lact. 2010;26(3):248–57. Epub 2010/01/30.CrossRefPubMed Senarath U, Dibley MJ, Agho KE. Factors associated with nonexclusive breastfeeding in 5 east and southeast Asian countries: a multilevel analysis. J Hum Lact. 2010;26(3):248–57. Epub 2010/01/30.CrossRefPubMed
39.
go back to reference Nguyen PH, Keithly SC, Nguyen NT, Nguyen TT, Tran LM, Hajeebhoy N. Prelacteal feeding practices in Vietnam: challenges and associated factors. BMC Public Health. 2013;13:932.CrossRefPubMedPubMedCentral Nguyen PH, Keithly SC, Nguyen NT, Nguyen TT, Tran LM, Hajeebhoy N. Prelacteal feeding practices in Vietnam: challenges and associated factors. BMC Public Health. 2013;13:932.CrossRefPubMedPubMedCentral
Metadata
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
Authors
Sarah Hanieh
Tran T. Ha
Julie A. Simpson
Tran T. Thuy
Nguyen C. Khuong
Dang D. Thoang
Thach D. Tran
Tran Tuan
Jane Fisher
Beverley-Ann Biggs
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2431-9

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue