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Initiation of food supplements and stopping of breast-feeding as determinants of weanling shigellosis.

1993; National Institutes of Health; Volume: 71; Issue: 5 Linguagem: Inglês

Faruque Ahmed, J. D. Clemens, Malla Rao, M. R. Khan, Emdadul Haque,

Child Nutrition and Water Access

The association between the period elapsed since weaning and the risk of shigellosis was assessed between 1 November 1987 and 30 November 1989 for a cohort of 1085 Bangladeshi children aged < 3 years. The children were followed for 1 month after exposure to Shigella spp. in their residential neighbourhoods, and the 268 who developed microbiologically confirmed (n = 118) or clinically presumptive (n = 150) shigellosis were compared with the 817 control children who did not develop either syndrome. No increase in risk was noted among breast-fed infants who received food supplements within the previous 3 months compared with those who had received supplements for longer (adjusted odds ratio (OR) = 1.2; 95% confidence interval (CI) = 0.4-3.0). However, compared with breast-fed children, non-breast-fed children had an increased risk (adjusted OR = 2.0; 95% CI = 1.3-2.9; P < 0.001), which was largely attributable to a substantially increased risk in the 3 months after stopping breast-feeding (adjusted OR = 6.6; 95% CI = 2.9-14.6; P < 0.001). The early post-cessation risk was equivalent for confirmed and presumptive shigellosis, but was particularly pronounced among the severely malnourished (adjusted OR = 10.2; 95% CI = 3.1-33.3; P < 0.001). This complex temporal pattern of risk highlights the need for precise definitions of weaning to facilitate identification of children at high risk for invasive diarrhoeal syndromes.Between November 1987 and November 1989, International Centre for Diarrhoeal Disease Research, Bangladesh, (ICDDR,B) scientists followed for 1 month 1085 children, younger than 3 years old, who lived in the Matlab. They compared data on the 268 children who developed microbiologically confirmed on clinically presumptive shigellosis during the 30-day period with data on 817 children who did not develop symptoms of shigellosis. Children who were not breast fed were at greater risk of shigellosis than those who were breast fed (adjusted odds ratio [AOR] = 2; p .001). This risk of shigellosis was much higher during the 1st 3 months after a child stopped breast feeding (AOR = 6.6; p .001) than it was 3 months after cessation of breast feeding (AOR = 1.4). Children who suffered from severe malnutrition were at an especially high post-cessation risk of shigellosis (AOR= 10.2; p .001). These findings show a complex evolution of risk with different stages of weaning, which emphasizes the need for a precise definition of weaning in epidemiologic studies. The limited period of high risk for shigellosis (i.e., the 1st 3 months after breast feeding cessation) and the wide range in ages at which children cease breast feeding elevates the complexity of executing successful vaccination programs against shigellosis, especially live oral vaccines. The vaccines must be administered early in life, before cessation of breast feeding, in order for them to protect against shigellosis. Yet, ingestion of breast milk may reduce the immunogenicity of the vaccines.