Skip to main content
NCBI home page
The BMJ logoLink to The BMJ
. 1991 Aug 31;303(6801):493–496. doi: 10.1136/bmj.303.6801.493

Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study.

D Mahalanabis 1
PMCID: PMC1670801  PMID: 1912858

Abstract

OBJECTIVE--To determine the effect of breast feeding on the risk of xerophthalmia in children aged 6 months to 3 years attending a diarrhoea treatment centre in Bangladesh. DESIGN--Case-control study based on stratified analysis (Mantel-Haenszel) and multivariate analysis (logistic regression) of data from a treatment centre based surveillance system. SETTING--A large diarrhoea treatment centre in Dhaka, Bangladesh. PATIENTS--2687 children aged 6 months to 3 years representing a 4% systematic sample of all children in this age group treated yearly at the centre over three consecutive years. 66 of the children were cases of xerophthalmia (that is, they had Bitot's spots or corneal lesions or night blindness or night blindness plus conjunctival xerosis or any combination of these) and the remaining 2621 did not have signs or symptoms of vitamin A deficiency. This second group served as controls. MAIN OUTCOME MEASURE--Xerophthalmia and breast fed at onset of diarrhoea or presentation. RESULTS--The odds ratio relating breast feeding to vitamin A deficiency after adjustment for a large number of confounding variables (0.26 (95% confidence interval 0.14 to 0.49); p less than 0.001) reflected a 74% reduction in the risk of vitamin A deficiency among breast fed children. The estimated reduction of risk did not decline with age, and some 49% of children aged 24-35 months were still being breast fed. The odds ratio relating breast feeding to xerophthalmia in the third year of life (0.35 (95% confidence interval 0.35 to 0.86) reflected a 65% reduced risk of vitamin A deficiency. Other important risk factors or prognostic indicators for xerophthalmia as identified by multivariate analysis were recent measles, prolonged diarrhoea, severe protein energy malnutrition, and poor socioeconomic state. CONCLUSIONS--These results indicate that breast feeding was associated with a substantial reduction of the risk of vitamin A deficiency extending to the third year of life and support the recommendation that mothers in developing countries should be advised to breast feed for as long as possible.

Full text

PDF
493

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Becroft T. C. Child-rearing practices in the highlands of New Guinea: general features. Med J Aust. 1967 Oct 28;2(18):810–813. doi: 10.5694/j.1326-5377.1967.tb74274.x. [DOI] [PubMed] [Google Scholar]
  2. Brown K. H., Black R. E., Becker S., Nahar S., Sawyer J. Consumption of foods and nutrients by weanlings in rural Bangladesh. Am J Clin Nutr. 1982 Nov;36(5):878–889. doi: 10.1093/ajcn/36.5.878. [DOI] [PubMed] [Google Scholar]
  3. Cohen N., Jalil M. A., Rahman H., Matin M. A., Sprague J., Islam J., Davison J., Leemhuis de Regt E., Mitra M. Landholding, wealth and risk of blinding malnutrition in rural Bangladeshi households. Soc Sci Med. 1985;21(11):1269–1272. doi: 10.1016/0277-9536(85)90276-x. [DOI] [PubMed] [Google Scholar]
  4. Gebre-Medhin M., Vahlquist A., Hofvander Y., Uppsäll L., Vahlquist B. Breast milk composition in Ethiopian and Swedish mothers. I. Vitamin A and beta-carotene. Am J Clin Nutr. 1976 Apr;29(4):441–451. doi: 10.1093/ajcn/29.4.441. [DOI] [PubMed] [Google Scholar]
  5. MANTEL N., HAENSZEL W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959 Apr;22(4):719–748. [PubMed] [Google Scholar]
  6. Sinha D. P., Bang F. B. Seasonal variation in signs of vitamin-A deficiency in rural West Bengal children. Lancet. 1973 Aug 4;2(7823):228–230. doi: 10.1016/s0140-6736(73)93133-4. [DOI] [PubMed] [Google Scholar]
  7. Sommer A., Tarwotjo I., Djunaedi E., West K. P., Jr, Loeden A. A., Tilden R., Mele L. Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial. Lancet. 1986 May 24;1(8491):1169–1173. doi: 10.1016/s0140-6736(86)91157-8. [DOI] [PubMed] [Google Scholar]
  8. Sommer A., Tarwotjo I., Hussaini G., Susanto D. Increased mortality in children with mild vitamin A deficiency. Lancet. 1983 Sep 10;2(8350):585–588. doi: 10.1016/s0140-6736(83)90677-3. [DOI] [PubMed] [Google Scholar]
  9. Stoll B. J., Glass R. I., Huq M. I., Khan M. U., Holt J. E., Banu H. Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh. Br Med J (Clin Res Ed) 1982 Oct 23;285(6349):1185–1188. doi: 10.1136/bmj.285.6349.1185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Tarwotjo I., Sommer A., Soegiharto T., Susanto D., Muhilal Dietary practices and xerophthalmia among Indonesian children. Am J Clin Nutr. 1982 Mar;35(3):574–581. doi: 10.1093/ajcn/35.3.574. [DOI] [PubMed] [Google Scholar]
  11. Vis H. L., Hennart P., Ruchababisha M. Some issues in breast-feeding in deprived rural areas: maternal nutrition and breast-feeding in the Kivu, Zaire. Assignment Child. 1981 Feb;55-56:183–200. [PubMed] [Google Scholar]
  12. West K. P., Jr, Chirambo M., Katz J., Sommer A. Breast-feeding, weaning patterns, and the risk of xerophthalmia in Southern Malawi. Am J Clin Nutr. 1986 Nov;44(5):690–697. doi: 10.1093/ajcn/44.5.690. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES