Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning

BMJ 1996;313:391-394 (17 August)

Papers

Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning

Sandra Costa Fuchs, associate professor,^a Cesar Gomes Victora, professor,^b Jose Martines, medical officer ^c

^a Department of Social Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, R Ramiro Barcelos 2600, sala 415, CEP 90035-003, Porto Alegre, RS, Brazil, ^b Mestrado de Epidemiologia, School of Medicine, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil, ^c Diarrhoeal Diseases Control Programme, Word Health Organisation, Geneva, Switzerland

Correspondence to: Dr Fuchs.

Abstract

Objectives: To investigate risk factors for dehydrating diarrhoeain infants, with special interest in the weaning period.
Design: Case-control study.
Setting: Metropolitan area of Porto Alegre, Brazil.
Subjects: Cases were 192 children aged 0-23 months hospitalisedwith acute diarrhoea and moderate to severe dehydration. Controlswere 192 children matched for age and neighbourhood who didnot have diarrhoea in the previous week.
Main outcome measures: Associations between dehydrating diarrhoeaand child's age, type of milk consumed, time since breast feedingstopped, and breast feeding status.
Results: In infants aged <12 months the risk of dehydratingdiarrhoea was significantly higher in the first 9 months oflife (P<0.001), and in those aged 12-23 months the risk wasagain greater in younger children (12-17 months) (P = 0.03).The type of milk consumed before start of diarrhoea episodewas strongly associated with dehydration independent of socioeconomic,environmental, maternal reproductive, demographic, and healthservices factors. Compared with infants exclusively breast fed,bottle fed infants were at higher risk (odds ratio (95% confidenceinterval) for cow's milk 6.0 (1.8 to 19.8), for formula milk6.9 (1.4 to 33.3)). Compared with those still breast feeding,children who stopped in the previous two months were more likelyto develop dehydrating diarrhoea (odds ratio 8.4 (2.4 to 29.6)).This risk decreased with time since breast feeding stopped.
Conclusion: These results confirm the protective effect of breastfeeding and suggest there is a vulnerable period soon afterbreast feeding is stopped, which may be of relevance for developingpreventive strategies.

Key messages

In this study infants who were exclusively breast fed were six times less likely to have dehydrating diarrhoea than bottle fed infants
Partially breast fed infants were at intermediate levels of risk
Children who were recently weaned showed a higher risk of dehydrating diarrhoea than those who had been weaned for six months or more
Recently weaned children presenting with diarrhoea should receive closer attention from health workers

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