Respiratory tract and diarrheal infections of breast-fed infants from birth to 6 months of age in household contexts of an Egyptian village

Abstract

Objective: To investigate the pattern of respiratory tract infections (RTI) and diarrhea among brest-fed infants and the impact of birth weight, maternal diet during lactation, and household socioenvironmental conditions on these illnesses.

Design: A longitudinal household-based study of infant morbidity from birth to 6 months of age.

Setting: Kalama village, Egypt.

Subjects: Morbidity information was obtained for 119 infants; 80 had longitudinal records over the first 6 months of age.

Results: Birth weights were normally distributed and the mean was comparable to the National Center for Health Statistics reference median. Most infants experienced growth faltering and increased illness episodes during 3 to 6 months of age. Infants with RTI during the first 3-month period were at a significantly higher risk of developing subsequent RTI compared with infants without earlier infections (OR = 5.0, chi-square 10.4, P < (0.0001). Similar associations were not observed for diarrhea. Controlling for earlier RTI, lower maternal intakes of vitamin A or C and animal source energy, protein, riboflavin, zinc or calcium were associated with more days sick with RTI in infants during 3-6 months whereas lower birth weight was associated with a longer duration. Among the variables examined poor household sanitation was the only significant predictor of diarrheal illnesses in this population.

Conclusions: Infants living in unsanitary households were the main victims of diarrhea. Duration of RTI was shorter for infants of higher birth weight and sick days were fewer for infants whose mothers consumed more animal source foods, vitamin A or vitamin C.

PIP: In a longitudinal household-based study of infant morbidity from birth to 6 months of age in the village of Kalama, Egypt, morbidity information was obtained for 119 singleton infants from 131 mothers; 80 had longitudinal records and more than 120 days of morbidity recall during the first 6 months of age. Birth weights were normally distributed and the mean was comparable to the National Center for Health Statistics reference median. Most infants experienced growth faltering and increased illness episodes during 3-6 months of age. Infants with respiratory tract infections (RTI) during the first 3-month period were at a significantly higher risk of developing subsequent RTI compared with infants without earlier infections (OR = 5.0, chi-square 10.4, p 0.0001). Similar associations were not observed for diarrhea. A combination of household and maternal variables were tested by multiple regression analysis in 2 samples of 74 and 65 infants, respectively. Poor household sanitation was the only significant predictor of diarrheal illnesses. Controlling for earlier RTI, lower maternal intakes of vitamin A or C and animal source energy, protein, riboflavin, zinc or calcium were associated with more days sick with RTI in infants during 3-6 months, whereas lower birth weight was associated with a longer duration. Among all the illness during the first 6 months of age the most frequent episodes of illness were RTI (39%) and diarrhea (31%), followed by eye infections (18%) and skin conditions (6%). Among the 80 infants 27 (34%) experienced diarrhea during 0-3 months of age and the mean percentage time of being sick was 9.2%; during the second 3 months, 40 infants (50%) were sick 121% of the time. Infants were sick more often with RTI than with diarrhea during both of these periods. RTI episodes were longer during the first 3 months than during the second 3 months.