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

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.

Relation of maternal zinc nutriture to pregnancy outcome and infant development in an Egyptian village

Zinc nutriture of women living in a periurban Egyptian village was examined over the last 6 mo of pregnancy and the first 6 mo of lactation as one of several potential determinants of pregnancy outcome and infant development. Estimated bioavailable zinc intake was approximately 2 mg/d from diets high in phytate and fiber. Among numerous variables analyzed by multiple regression, early pregnancy weight (3 mo) and plasma zinc concentrations in the second trimester formed the best predictor model of birth weight, accounting for 39% of the variance. Bioavailable zinc intake during pregnancy was part of a profile of micronutrient intakes related to neonatal habituation behavior, a measure of early information processing. Performance on the Bayley motor test at 6 mo of age was negatively related to maternal intakes of plant zinc, phytate, and fiber, suggesting that zinc bioavailability was involved. Maternal dietary intake explained most of the variance observed in infant motor performance; however, predictive variance was amplified by the psychosocial context.

Diet during lactation associated with infant behavior and caregiver-infant interaction in a semirural Egyptian village

Potential processes through which nutritional and non-nutritional factors can relate to infant state and behavior and mother-infant interactions were examined in 41 mother-infant pairs from semirural Egyptian households. All infants were breast-fed, and breast milk was the main source of their nutrient intake. Median birth weight was close to reference median; however, most infants showed growth faltering when they were 3-6 mo of age. Among the infant behavioral and state variables, only drowsiness (a proxy for activity and alertness) was significantly associated with the nutritional and non-nutritional factors examined. Among these factors, mothers' intakes of animal source foods and certain B vitamins were the strongest predictors of drowsiness. The nature of the association between maternal diet and drowsiness, examined by multiple regression analysis, showed clearly that inadequate diet of the mother was the major risk factor. Alertness of infants was further compromised when there were several children in the households. The small, less vocal and less alert infants received less vocalization from their mothers. In this environment, infants of undernourished mothers may not receive the extra care and stimulation needed and are at risk for subsequent developmental disabilities.

Determinants of pregnancy outcome and newborn behavior of a semirural Egyptian population

Several potential determinants of birth weight and neonatal behavioral organization, ie, maternal anthropometry, food intake (energy, protein, and plant- and animal-source foods), morbidity, and household socioeconomic status, were followed systematically in a semirural Egyptian population during greater than or equal to 6 mo of pregnancy. In early pregnancy mothers were generally normal weight to moderately overweight. Their mean energy intake, largely from plant sources, was approximately 8.37 MJ/d (2000 kcal/d) during trimesters 2 and 3. Early (3 mo) pregnancy weight and weight gain during trimesters 2 and 3 were significantly positively related to birth weight Z scores. The best predictor model examined for birth weight included early pregnancy weight, weight gain, and length of gestation (R2 = 0.45). Early pregnancy weight and maternal intake of animal-source foods were significant positive predictors of the newborn's orientation and habituation behavior, respectively. Habituation and orientation measures assess the infant's early ability to process information.