Characteristics of Diarrheal Illnesses in Non-Breast Fed Infants Attending a Large Urban Diarrheal Disease Hospital in Bangladesh

Sanjoy Kumer Dey,Sumon Kumar Das,Mohammod Jobayer Chisti,Shahnawaz Ahmed,Fahmida Dil Farzana,Mohammad Abdul Malek,Mohammed Abdus Salam,Abu Syed Golam Faruque,Chandan Kumar Shaha,Tahmeed Ahmed,Farzana Ferdous

doi:10.1371/journal.pone.0058228

Abstract

BackgroundLack of breast feeding is associated with higher morbidity and case-fatality from both bacterial and viral etiologic diarrheas. However, there is very limited data on the characteristics of non–breastfed infants attending hospital with diarrheal illnesses caused by common bacterial and viral pathogens. Our objective was to assess the impact of lack of breast feeding on diarrheal illnesses in infants living in urban Bangladesh.MethodsWe extracted data of infants (0–11 months) for analyses from the data archive of Diarrheal Disease Surveillance System (DDSS) of the Dhaka Hospital of icddr,b for the period 2008–2011.ResultsThe prevalence of breastfeeding in infants attending the hospital with diarrhea reduced from 31% in 2008 to 17% in 2011, with corresponding increase in the prevalence of non-breastfed (chi square for trend <0.001). Among breastfed infants, the incidence of rotavirus infections was higher (43%) among the 0–5 months age group than infants aged 9–11 months (18%). On the other hand, among non-breastfed infants, the incidence of rotavirus infections was much higher (82%) among 9–11 months old infants compared to those in 0–5 months age group (57%) (chi square for trend <0.001). Very similar trends were also observed in the incidence of cholera and ETEC diarrheas among different age groups of breastfed and non-breastfed infants (chi square for trend 0.020 and 0.001 respectively). However, for shigellosis, the statistical difference remained unchanged among both the groups (chi square for trend 0.240).Conclusion and SignificanceWe observed protective role of breastfeeding in infantile diarrhea caused by the major viral and common bacterial agents. These findings underscore the importance of promotion and expansion of breastfeeding campaigns in Bangladesh and elsewhere.

Highlights

In developing countries, diarrheal diseases, as a group, remains the leading cause of illness and the second leading cause of death among young children, during the first two years of their lives
Ethical Statement The Diarrhoeal Disease Surveillance System of icddr,b is a routine activity of the Dhaka Hospital, which has been approved by the Research Review Committee (RRC) and Ethical Review Committee (ERC) of icddr,b and this study has been approved by the RRC and ERC of icddr,b
The proportion of breast-fed infants gradually fell from 31% in 2008 to 17% in 2011, with gradual increase in the proportion of non-breast-fed infants from 69% to 83% during the same time period (Figure 1)

Summary

Introduction

Diarrheal diseases, as a group, remains the leading cause of illness and the second leading cause of death among young children, during the first two years of their lives. Children are exposed to a wide range of enteric bacterial pathogens even at a very early age and suffer from frequent episodes of diarrheal illnesses. The diarrheagenic Escherichia coli, Shigella spp., Campylobacter spp., and Vibrio are the common bacterial pathogens causing diarrhea in young children in developing countries, including Bangladesh [3]. Rotavirus is one of the most common causes of dehydrating gastroenteritis among children younger than two years, which accounts for one-third of all hospitalizations for diarrhea and an estimated 500,000 deaths each year [4]. There is very limited data on the characteristics of non–breastfed infants attending hospital with diarrheal illnesses caused by common bacterial and viral pathogens.

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Discussion

Conclusion