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

Beriberi (Thiamine Deficiency) and High Infant Mortality in Northern Laos

<div><p>Background</p><p>Infantile beriberi (thiamine deficiency) occurs mainly in infants breastfed by mothers with inadequate intake of thiamine, typically among vulnerable populations. We describe possible and probable cases of infantile thiamine deficiency in northern Laos.</p><p>Methodology/Principal Findings</p><p>Three surveys were conducted in Luang Namtha Province. First, we performed a retrospective survey of all infants with a diagnosis of thiamine deficiency admitted to the 5 hospitals in the province (2007–2009). Second, we prospectively recorded all infants with cardiac failure at Luang Namtha Hospital. Third, we further investigated all mothers with infants (1–6 months) living in 22 villages of the thiamine deficiency patients’ origin. We performed a cross-sectional survey of all mothers and infants using a pre-tested questionnaire, physical examination and squat test. Infant mortality was estimated by verbal autopsy. From March to June 2010, four suspected infants with thiamine deficiency were admitted to Luang Namtha Provincial hospital. All recovered after parenteral thiamine injection. Between 2007 and 2009, 54 infants with possible/probable thiamine deficiency were diagnosed with acute severe cardiac failure, 49 (90.2%) were cured after parenteral thiamine; three died (5.6%). In the 22 villages, of 468 live born infants, 50 (10.6%, 95% CI: 8.0–13.8) died during the first year. A peak of mortality (36 deaths) was reported between 1 and 3 months. Verbal autopsy suggested that 17 deaths (3.6%) were due to suspected infantile thiamine deficiency. Of 127 mothers, 60 (47.2%) reported edema and paresthesia as well as a positive squat test during pregnancy; 125 (98.4%) respected post-partum food avoidance and all ate polished rice. Of 127 infants, 2 (1.6%) had probable thiamine deficiency, and 8 (6.8%) possible thiamine deficiency.</p><p>Conclusion</p><p>Thiamine deficiency may be a major cause of infant mortality among ethnic groups in northern Laos. Mothers’ and children’s symptoms are compatible with thiamine deficiency. The severity of this nutritional situation requires urgent attention in Laos.</p></div

Characteristics of infants with suspected thiamine deficiency admitted to the 5 hospitals 2007–2009.

<p>*Age at death was: 8 days, 4 and 5 months</p><p>Mean and (95% confidence interval)</p><p>Characteristics of infants with suspected thiamine deficiency admitted to the 5 hospitals 2007–2009.</p

Flow chart of the thiamine deficiency survey in northern Laos.

<p>Flow chart of the thiamine deficiency survey in northern Laos.</p

Socio-demographic characteristics of mothers in 22 villages of North Laos.

<p>Numbers and (percentages). Median and interquartile. Mean and (95% CI interval).</p><p>1 US dollars ~ 8000 kip</p><p>Socio-demographic characteristics of mothers in 22 villages of North Laos.</p

Characteristics of examined infants (0–6 months) in 22 villages of North Laos.

<p>Median age and (Interquartile range)</p><p>* One (0.8%) in health centre; 14 (11%) in provincial hospital; 18 (14.1%) in district hospitals</p><p>Characteristics of examined infants (0–6 months) in 22 villages of North Laos.</p

Infantile mortality in 22 villages from northern Laos.

<p>Infantile mortality in 22 villages from northern Laos.</p

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

<p>95% Confidence Interval.</p

Knowledge of and feeding BMS to infants less than 6 months in Laos^£.

<p>*Mean age and 95% confidence interval,</p>£<p>knows at least one BMS in the category.</p><p>The following questions were asked: Did you give this product to your baby? If yes, How old was your child when you started giving this product to her/him (month).</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