Breast-Milk Substitutes: A New Old-Threat for Breastfeeding Policy in Developing Countries. A Case Study in a Traditionally High Breastfeeding Country

Background: Developing countries with traditionally breastfeeding are now experiencing the increasing pressure of formula milk marketing. This may endanger lives and undermine the efforts of national policies in achieving the objectives of the Millennium Development Goals. We examined the use of, and factors for use, of all available breast-milk substitutes (BMS) in a country with a traditionally high rate of breastfeeding. Methods: Randomised multi-stage sampling surveys in 90 villages in 12/17 provinces in Laos. Participants: 1057 mothers with infants under 24 months of age. Tools: 50-query questionnaire and a poster of 22 BMS (8 canned or powdered milk; 6 non-dairy; 6 formulas; 2 non-formulas). Outcome measures included: prevalence of use and age of starting BMS in relation to socio-demographic characteristics and information sources, by univariate and multivariate analyses

Childhood dysglycemia: prevalence and outcome in a referral hospital.

INTRODUCTION: Hypoglycemia is a defining feature of severe malaria and several other infectious diseases in children but the prevalence, significance, and prognosis of abnormal blood glucose, including hyperglycemia, have rarely been addressed in severely ill children in non-malaria endemic areas. METHODS: In Madagascar, consecutive children (1 month-15 years) admitted to the pediatric ward of a referral hospital, were categorized using the integrated management of childhood illness (IMCI). Samples were taken once on admission for measuring blood glucose concentration. Glycemia levels (hypoglycemia <2.2 mmol/l; low glycemia: 2.2-4.4 mmol/l; normoglycemia >4.4-8.3 mmol/l; and hyperglycemia >8.3 mmol/l) were related to the IMCI algorithm and case fatality. Factors associated with blood glucose concentration and case fatality were analysed using univariate and multivariate analysis. RESULTS: Of 420 children, 48.1% (n = 202) were severely ill; 3.1% (n = 13) had hypoglycemia; 20.0% (n = 84) low glycemia; 65.9% (n = 277) normoglycemia; and 10.9% (n = 46) hyperglycemia. In univariate analysis, hypoglycemia and hyperglycemia both showed significant increase in the risk of death, as compared to normal blood glucose (RR: 12.2, 95% CI: 6.2-23.7 and RR: 2.5, 95% CI: 1.0-6.2, respectively). Children with low glycemia had no increased risk of death (RR: 1.2, 95% CI: 0.4-3.2) despite a poorer IMCI status on admission. After logistic regression, hypoglycemia (RR: 19.4, 95% CI: 5.0-.74.7, hepatomegaly (RR: 12.2, 95% CI: 3.3-44.9) and coma (RR: 4.8, 95% CI: 1.3-17.6) were the features on admission associated with an increased risk of death. CONCLUSIONS: Dysglycemia in non-neonates is associated with increased mortality. These findings underline the need for the use of rapid screening tests to initiate early treatment. Alternative treatments such as oral or sublingual administration of glucose should be developed in structures with limited resources

Socio-demographic characteristics of children on admission in Pediatrics.

<p>Mean and [95% confidence interval (95% CI)].</p

Case fatality according to blood glucose concentration of 420 admitted to Pediatrics.

<p>Mean and [95% confidence interval (95% CI)].</p>*<p>Died during hospitalization or left critically ill and expected to died.</p>**<p>Children were transferred to nutrition rehabilitation centre after improvement of acute status, 7 children left the hospital without notice, their outcome is unknown.</p

Medical characteristics of children according to IMCI algorithm.

<p>IMCI: integrated management of childhood illness.</p>*<p>Weight for height, or height for age, or weight for age ≤3 Standard Deviation (WHO 2006) among children less than 59 months.</p><p>14 had kwashiorkor (1 hypo, 2 low glycemia, 10 normoglycemia, 1 hyperglycemia, 1 hyperglycemia had marastic-kwashiorkor).</p

Baseline glycemia and children features and in-hospital mortality (univariate analysis)^*.

*<p>Only significant factors, Fischer's exact test when expected value of cell value is <5. CI: confidence interval.</p

Enrolment flow chart.

<p>Enrolment flow chart.</p

Main reasons for giving BMS to infants before 6 months of age among users.

£<p>The following question was asked: Why do you feed your baby this product?</p><p>*Of 207 users before 6 months, 203 users ‘responses available.</p><p>**Rich with vitamins, similar to rice, good for children.</p><p>***1.4% of 1057 mothers reported that they could not breastfeed.</p

Factors associated with the use of BMS before 6 months of age in Laos (multivariate analysis).

<p>95% Confidence Interval.</p

Main source of information on breast milk substitute (BMS).

£<p>The following questions were asked: How did you hear about these products? (many answers possible), if the answer was TV: Which channels?</p>££<p>The following question was asked: Which of the above mentioned sources of information do you trust the most for your family?</p