Abstract
Research has not provided unequivocal support for the recommendation to continue breastfeeding until children reach at least age 24 months. In many circumstances, breastfeeding duration is chosen or conditioned by factors other than scientific evidence and recommendations. Even in communities where breastfeeding into the second year is the nom, a significant number of toddlers are weaned before the recommended age. The research reported here was conducted in a rural community of western Kenya. We prospectively followed a cohort of 264 children for 6 months (mean age at baseline, 14.1± 2.4 months) to examine the effect of variable breastfeeding duration on length and weight gain. We found that breastfeeding was positively associated with growth in a manner that we inferred to be causal, the effect being stronger on linear growth than on weight gain. This was despite the fact that in a cohort where 95% were breastfeeding at baseline, the prevalence of stunting (height-for-age below -2 standard deviations of the WHO-NCHS reference) was already 48%. The present paper examines the socioeconomic characteristics, sanitation, morbidity, and complementary feeding practices that define the context of this apparently contradictory relationship. The population was poor, no household had running water, and malaria is endemic in the study area. Complementary feeding was initiated for 93% of the cohort before age 3 months. The weaning diet was bulky (77% energy from carbohydrate), and high in phytate content ([phytate]:[zinc] molar ratio, 28). Diet quality, judged by diversity and animal source food intake, was low. Several micronutrient intakes were below current recommendations, including riboflavin (63%), niacin equivalents (64%), calcium (72%), iron (74%) and zinc (33%). Based on a locally defined socioeconomic status scale, children in higher SES households were breastfed for a shorter duration than were children from poorer households. Sanitation and water consumption modified the effect of breastfeeding duration on growth: the effect was stronger in the absence of a pit latrine and at low water consumption. Our results support the recommendation to sustain breastfeeding in the second year, particularly in economically depressed environments with inadequate sanitation and water supplies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Caulfield LE, Bentley ME, Ahmed S. Is prolonged breastfeeding associated with malnutrition? Evidence from nineteen Demographic and Health Surveys. Int J Epidemiol 1996;25:693–703.
World Health Organization. The World Health Organization’s infant feeding recommendation. Wkly Epidemiol Rec 1995;70:119–120.
Victora CG, Vaughan JP, Martines JC, Barcelos LB. Is prolonged breast feeding associated with malnutrition? Am J Clin Nutr 1984;39:307–314.
Ng’andu NH, Watts TEE. Child growth and duration of breast feeding in urban Zambia. J Epidemiol Comm Hlth 1990;44:281–285.
Taren D, Chen J. A positive association between extended breast feeding and nutritional status in rural Hubei Province, People’s Republic of China. Am J Clin Nutr 1993;58:862–67.
Nube M, Asenso-Okyere WK. Large differences in nutritional status between fully weaned and partially breast fed children beyond the age of 12 months. Euro J Clin Nutr Euro J Clin Nutr 1996;50:171–177.
Prentice A. Regional variations in the composition of human milk. In Jensen R. G. (Ed) Handbook of Milk Composition. New York: Academic Press 1995.
Torun B, Davies PSW, Livingstone MBE, Paolisso M, Sackett R, Spurr GB. Energy requirements and dietary energy recommendations for children and adolescents 1 to 18 years old. Euro J Clin Nutr, 1996;50(Suppl. 1) S37–S81.
Dewey KG, Beaton G, Fjeld C, Lonnerdal B, Reeds P. Protein requirements for infants and children. Euro J Clin Nutr 1996;50(Suppl. 1) S119–S150.
FAO/WHO. Requirements of Vitamin A, Iron, Folate and Vitamin B12 Report of a Joint FAO/WHO Expert Consultation. FAO Food and Nutrition Series No. 23. Rome: FAO, 1988.
World Health Organization. Trace Elements in Human Nutrition. Geneva: WHO, 1996.
Walker AF. The contribution of weaning foods to protein-energy malnutrition. Nutr Res Rev 1990;3:25–47.
Huffman SL, Martin LH. First feedings: optimal feeding of infants and toddlers. Nutr Res 1994;14:127–159.
Onyango A, Koski KG, Tucker KL. Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. Int J Epidemiol 1998;27:484–489
Neumann CG, Harrison GG. Onset and evolution of stunting in infants and children. Examples from the Human Nutrition Collaborative Research Support Program. Kenya and Egypt studies. Euro J Clin Nutr 1994;48(Suppl.1):S90–S102.
Murphy SP, Beaton GH, Calloway DH. Estimated mineral intakes of toddlers: predicted prevalence of inadequacy in village populations in Egypt, Kenya and Mexico. Am J Clin Nutr 1992;56:565–572.
Gibson RS. Zinc nutrition in developing countries. Nutr Res Rev 1994;7:151–173.
Marquis GS, Habicht J-P, Lanata CF, Black RE, Rasmussen KM. Breast milk or animalproduct foods improve linear growth of Peruvian toddlers consuming marginal diets. Am J Clin Nutr 1997;66:1102–1109.
Kaplan RM, Toshima MT. Does a reduced fat diet cause retardation in child growth? Preventive Medicine 1992;21:33–52.
Allen LH, Backstrand JR, Stanek III EJ, Pelto GH, Chavez A, Molina E, et al. The interactive effects of dietary quality on the growth and attained size of young Mexican children. Am J Clin Nutr 1992;56:353–364.
Molbak K, Jakobsen M, Sodemann M, Aaby P. Is malnutrition associated with prolonged breastfeeding? Int J Epidemiol 1997;26:458–59.
Hoyle B, Yunus MD, Chen LC. Breast feeding and food intake among children with acute diarrhoeal disease. Am J Clin Nutr 1980;33:2365–71.
Brown KH, Stallings RY, Creed de Kanashiro H., Lopez de Romana G. & Black R. Effects of common illnesses on infants’ energy intakes from breast milk and other foods during longitudinal community-based studies in Huascar (Lima), Peru. Am J Clin Nutr 1990;52:1005–13.
Launer LJ, Habicht J-P, Kardjati S. Breast feeding protects infants in Indonesia against illness and weight loss due to illness. Am J Epidemiol 1990;131:322–31.
Dickin KL, Brown K, Fagbule D, et al. Effect of diarrhoea on dietary intake by infants and young children in rural villages of Kwara State, Nigeria. Euro J Clin Nutr 1990;44:307–17.
Butz WP, Habicht J-P, DaVanzo J. Environmental factors in the relationship between breastfeeding and infant mortality: The role of sanitation and water in Malaysia. Am J Epidemiol 1984;119:516–525.
Esrey SA, Habicht J-P, Casella G. The complementary effect of latrines and increased water usage on the growth of infants in rural Lesotho. Am J Epidemiol 1992:135:659–66.
Cairncross S, Cliff JL. Water use and health in Mueda, Mozambique. Trans R Soc Trop Med and Hyg 1987;81:51–54.
Fawzi WW, Herrera MG, Nestel P, Amin A, Mohamed KA. A longitudinal study of prolonged breastfeeding in relation to child undernutrition. Int J Epidemiol 1998, 27:255–260.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2002 Kluwer Academic Publishers
About this chapter
Cite this chapter
Onyango, A.W. (2002). Breastfeeding and Growth in Rural Kenyan Toddlers. In: Koletzko, B., Michaelsen, K.F., Hernell, O. (eds) Short and Long Term Effects of Breast Feeding on Child Health. Advances in Experimental Medicine and Biology, vol 478. Springer, Boston, MA. https://doi.org/10.1007/0-306-46830-1_13
Download citation
DOI: https://doi.org/10.1007/0-306-46830-1_13
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-306-46405-8
Online ISBN: 978-0-306-46830-8
eBook Packages: Springer Book Archive