Breast-feeding, weaning patterns, and the risk of xerophthalmia in Southern Malawi

Abstract

A case-control study of breast-feeding and weaning patterns associated with xerophthalmia was conducted among children aged 24-71 mo in Southern Malawi in 1983. One hundred fifty-two children with active xerophthalmia were compared to 151 clinically normal children matched on age (+/- 12 mo), sex, and village of residence. All children were initially breast-fed; however, children with xerophthalmia began weaning onto porridge (p = 0.05) and ceased breast-feeding earlier (p less than 0.01 for 24-47 mo olds), had a shorter weaning interval (p less than 0.005), and were fully weaned from the breast for a longer duration (p less than 0.025) than the controls. The association between earlier cessation of breast-feeding and subsequent xerophthalmia was strongest during the immediate post-weaning years. These findings imply a protective role for breast-feeding against xerophthalmia in early childhood.

The role of vitamin A in reducing child mortality and morbidity and improving growth

“…These findings are consistent with earlier reports that observed a protective effect of breast feeding against severe VAD, even after the first year of life. 54,55 Dewan et al 56 in a RCT of children admitted with acute diarrhea of less than 3 days also found that vitamin A supplementation reduced the duration and severity of that episode, but only among children with clinical or subclinical VAD based on conjunctival impression cytology >3/5. Walser et al 57 also reported reductions of about 3 days in the duration of a diarrheal episode among children who were "historically at risk of persistent diarrhea," in a study in Brazil using a prepost design (3 months before and after administration of vitamin A).…”

Infant feeding practices reflect antecedent risk of xerophthalmia in Nepali children

“…Xerophthalmic children in Malawi were reported to have begun the weaning process, on average, one month earlier than non-xerophthalmic controls (3 vs 4 months of age) (West et al, 1986). The infant feeding process can be divided into different stages, each associated with patterns of feeding and interaction between care giver and child.…”

Vitamin A Deficiency

“…Among healthy women, mature breast milk contains 600-700 µg of vitamin A per liter [36,43], which, at an intake of about 725 mL per day, provides a breastfed infant with 435-500 µg dietary vitamin A [43], an amount considered adequate during infancy [34]. In undernourished settings, breast milk can contain half this concentration [43,44] but still provides clinically protective amounts to infants and toddlers [45,46]. Provitamin A carotenoids represent the major source of dietary vitamin A in the developing world, among which β-carotene is the most ubiquitous and bioavailable [16,19,20].…”