Infant care in rural Malawi. A prospective study of morbidity and growth in relation to environmental factors

Abstract

In connection with the introduction of piped surface water delivered by community taps in a rural area of Malawi, 46 infants were studied prospectively during a 10-month period to monitor infant care and health. Compared with the reference population, newborn infants generally weighed less and were shorter. Breastfeeding was universal and appeared adequate for catch-up in weight during the 1st 3 months. Growth faltering occurred from the age of 3 months when the prevalence of infectious diseases gradually increased and suitable supplementary foods were lacking. Babies were given highly contaminated water from the 1st days of life, but, in spite of this, diarrhoea was infrequent during the 1st 5 months when respiratory tract infections and episodes of fever were the most common symptoms of disease. Diarrhoea became a problem from the age of 5-6 months. No differences in morbidity or growth patterns were observed between infants using piped and traditional water sources. Thus, the quality of drinking water seemed to have no substantial effect on the health of the studied infants during the 1st months of life.

PIP: All 36 children (18 boys and 18 girls) born in 539 households from October 31, 1984, to February 28, 1985, were studied prospectively. In January 1985, 10 children (7 girls and 3 boys) born between January and April 1984 were also included. During visits, the mother was asked about disease during the preceding month and about feeding practices. The children had a clinical examination and nutritional assessment at each visit. 34 of 36 children began breast feeding within an hour of delivery. At 4 months, all 33 surviving children were still breast-fed. A thin maize gruel was introduced from as early as 2 days to as late as 4.5 months of age. At about 3 months, a thick maize porridge was started, and by 7 months 50% of the infants received this porridge. By May 1985, about 50% of the families (18/34) used piped water. During the first 6 months, the fever reported was significantly related to spleen size at the end of that month (p 0.05), suggesting malaria. Diarrhea gradually increased to an average of about 2 days per month by the age of 5-6 months and reached a peak of 4-5 days per month at the age of 11-12 months. During the first year of life, at least one symptom of disease was reported on 6 days per month on average. During the first 6 months, there was no difference in morbidity prevalence between infants whose families used piped water and infants whose families drew water from traditional sources. The growth rate during the first 6 months was significantly correlated with total morbidity, respiratory tract infections, diarrheal diseases and fever during the month (p 0.05). Four of the newborn children, 1 boy and 3 girls, died during the follow-up period of 7-10 months, giving an estimated probability of dying before 6 months of age of 112 per 1000. Further research is needed why, under apparently similar conditions, some children survive and others do not.