Comportamiento de algunos factores biosociales en la lactancia materna en los menores de un año / Behavior of some biosocial factors related to breastfeeding in babies aged less than 1 year

INTRODUCCIÓN: El abandono progresivo de la lactancia materna se ha considerado una nueva enfermedad propia de los siglos XX y XXI, en la cual han influido una serie de factores de muy diversa Índole. OBJETIVO: Caracterizar el comportamiento de los factores biosociales en la lactancia materna en los menores de un año. MÉTODOS: Se realizó un estudio descriptivo de corte transversal, en un universo de 158 nacimientos ocurridos en el 2008 del Área de salud Aleida Fernández Chardiet . Se empleó el estudio bibliográfico, documental y la contrastación de criterios de diferentes autores como procedimiento teórico, además de procedimientos empíricos. RESULTADOS: Solo en el 55,7 por ciento de los lactantes estudiados, se logró una lactancia materna exitosa, cifras por debajo de las recomendaciones internacionales. El destete precoz ocurrió en el 44,3 por ciento y el motivo más frecuente fue la hipogalactia materna. CONCLUSIONES: El motivo más frecuente del destete precoz, fue sustentado por el criterio de las madres de que era insuficiente la producción y obtención de leche

INTRODUCTION: The progressive neglect of breastfeeding has been considered a new disease own of XX and XXI centuries where a series of very diverse factors have been influenced. OBJECTIVE: To characterize the behavior of biosocial factors related to breastfeeding in babies aged less than 1 year. METHODS: A cross-sectional and descriptive study was conducted in 158 births occurred in 2008 in Aleida Chardiet health area. Authors used the bibliographic, documentary study and the criteria contrast from different authors as a theoretical procedure, in addition to the empirical ones. RESULTS: Only in the 55.7 percent of study infants it was possible to achieve a successful breastfeeding, figures under the international recommendations. The early wean occurred in the 44.3 percent and the more frequent reason was the mother hypogalactia. CONCLUSIONS: The more frequent reason for the early wean was supported by the mother criterion related to a insufficient milk production and obtaining

Breastfeeding is not related to postpartum relapses in multiple sclerosis.

OBJECTIVE: To assess the relationship between breastfeeding and risk of puerperal relapses in a large cohort of patients with multiple sclerosis (MS). METHODS: We prospectively followed-up pregnancies occurring between 2002 and 2008 in women with MS, recruited from 21 Italian MS centers, and gathered data on breastfeeding through a standardized interview. The risk of relapses after delivery was assessed using the Cox regression analysis. RESULTS: A total of 302 out of 423 pregnancies in 298 women resulted in full-term deliveries. Patients were followed up for at least 1 year after delivery. The time-dependent profile of the relapse rate before, during, and after pregnancy did not differ between patients who breastfed and patients who did not. In the multivariate analysis, adjusting for age at onset, age at pregnancy, disease duration, disability level, and relapses in the year prior to pregnancy and during pregnancy, treatment with disease-modifying drugs (DMDs), and exposure to toxics, the only significant predictors of postpartum relapses were relapses in the year before pregnancy (hazard ratio [HR] = 1.5; 95%confidence interval [CI] 1.3-1.9; p < 0.001) and during pregnancy (HR = 2.2; 95% CI 1.5-3.3; p < 0.001). CONCLUSIONS: In our sample, postpartum relapses were predicted only by relapses before and during pregnancy. Therefore, the reported association between breastfeeding and a lower risk of postpartum relapses may simply reflect different patient behavior, biased by the disease activity. Our results can assist neurologists facing the breastfeeding issue in mother counseling and shared decision-making. Especially, among patients with high risk of postpartum relapses, breastfeeding may not be feasible and early postpartum treatment should be an option.

Waist-to-hip ratio and woman's education level as predictors of breastfeeding duration.

The possible existence of a relationship between breastfeeding duration, educational status and waist-hip ratio (WHR) as a measure of fertility and biological fitness in a sample of the Polish population is examined in this article. Data on age, height, weight, waist and hip circumferences, educational level (as a proxy for socio-economic status), and duration of breast feeding were collected for women using questionnaires in 11 outpatients' surgeries for healthy children, and in 5 general practices in three districts of Wroclaw, Poland. An ordinal multinominal linear model with logit link was used to determine the extent to which duration of lactation was influenced by maternal WHR and level of education. The best single predictor for the duration of lactation was WHR. While WHR decreases according to increasing duration of lactation for mothers with university or high school education, no such differences were observed among women at the lowest level of education. This study confirms the greater biological fitness of women with low WHR in the Polish population, and shows that this is mediated by level of educational attainment of the women.

Comparison of the concentrations of polychlorinated biphenyls and dioxins in mothers affected by the Yusho incident and their children.

Accumulated maternal dioxins are passed onto the fetus and neonate via the placenta and maternal milk. In Japan in 1968, an accidental human exposure to rice oil contaminated with polychlorinated biphenyls (PCBs) and other dioxin-related compounds, such as polychlorinated dibenzofurans (PCDFs), led to development of Yusho oil disease. We investigated differences in blood dioxin concentrations in mother-children pairs affected by the Yusho incident. From 2002 to 2008, blood samples were collected from 26 pairs of Yusho mothers and their children (19 mothers, 26 children). Specific congeners of seven polychlorinated dibenzo-p-dioxins (PCDDs), ten PCDFs, and four non-ortho PCBs were analyzed. The children had significantly lower TEQ concentrations of PCDDs, PCDFs, and coplanar PCBs compared to their mothers. The mother-child difference in blood concentrations varied with the congeners; the largest for 2,3,4,7,8-pentaCDF and the smallest for 1,2,3,4,6,7,8-heptaCDD. The level for 2,3,4,7,8-pentaCDF, which characterizes Yusho oil disease, was approximately 17-30 times higher in the mothers than in the general population, whereas there were no significant differences between children in the formula-fed group and the general population. In contrast, the mean level for 2,3,4,7,8-pentaCDF in the breast-fed group was approximately 1.5 times, (range 0.5-6.5 times) higher than that in the general population. Over 30 years after the Yusho incident, the mean blood dioxin levels in the offspring were only a fraction of the levels in their mothers. This is more consistent with exposure via breast milk than via transplacental transfer in the Yusho incident.

Determinants of early child-feeding practices among HIV-infected and noninfected mothers in rural Kenya.

Quantitative and qualitative data were collected from mothers with children aged 4 to 24 months to examine the determinants of child-feeding practices among HIV-infected and noninfected mothers in the rural parts of Kisumu District in Kenya. More than 40% of children had received other foods or drinks by 3 months of age. Home-based births, perceived small child size at birth, and larger household size were associated with significantly higher risks of premature cessation of exclusive breastfeeding. Maternal HIV infection, overweight/obesity, and having multiple "under-2's" were associated with higher risks of overall breastfeeding cessation. Higher socioeconomic status was associated with significantly lower risks of premature cessation of exclusive breastfeeding. Child-feeding decisions were often made postpartum. Mothers were more likely to discuss feeding methods with their partners only if they were HIV infected. Poverty was identified as a barrier to exclusive breastfeeding in the first 6 months.

Initiation and duration of breastfeeding in an aboriginal community in south western Sydney.

The Gudaga Study is a prospective, longitudinal birth cohort study of Australian urban Aboriginal children. Mothers of Aboriginal infants were recruited using a survey of all mothers admitted to the maternity ward of an outer urban hospital in Sydney. These data established initiation rates among Gudaga infants and those of non-Aboriginal infants born locally (64.7% and 75.2%, respectively) and factors associated with breastfeeding. Older (relative risk, 1.24; confidence interval, 1.01-1.44), more educated (relative risk, 1.30; confidence interval, 1.11-1.48) mothers who intended to breastfeed (relative risk, 2.22; confidence interval, 2.12-2.3) were more likely to breastfeed. Smokers (relative risk, 0.72) and mothers of Aboriginal infants (relative risk, 0.78) were less likely to initiate breastfeeding. Breastfeeding rates for Gudaga infants dropped rapidly, with 26.3% breastfeeding at 2 months. Local health services providers can benefit from such information as they target relevant prenatal, perinatal, and postnatal services for Aboriginal mothers and their infants.

Factors associated with duration of breastfeeding in ireland: potential areas for improvement.

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Relationship between level of education and breastfeeding duration depends on social context: breastfeeding trends over a 40-year period in Spain.

This article presents trends of breastfeeding in Spain from the 1960s to the end of the century, analyzing the relationship between level of education and breastfeeding duration. A sample of 666 adult women provided data about breastfeeding practices for children born between 1958 and 2002. Joinpoint regression models for breastfeeding duration for the firstborn child throughout these years show a U-shaped curve, with a sharp decrease at the beginning of the 1970s (-17.2%) and a gradual increase toward the end of the century (1.9%). However, the trend for women with primary studies shows a constant decrease throughout the whole period (-7.4%), while higher education levels relate to a positive trend from the 1970s onward (3.4%). The authors conclude that in the Spanish context, maternal level of education is not associated with breastfeeding duration in the same direction or with the same magnitude across time. Factors related to breastfeeding should be studied, taking into account social context.

The effect of maternity leave length and time of return to work on breastfeeding.

OBJECTIVE: We investigated the effect of maternity leave length and time of first return to work on breastfeeding. METHODS: Data were from the Early Childhood Longitudinal Study-Birth Cohort. Restricting our sample to singletons whose biological mothers were the respondents at the 9-month interview and worked in the 12 months before delivery (N = 6150), we classified the length of total maternity leave (weeks) as 1 to 6, 7 to 12, ≥ 13, and did not take; paid maternity leave (weeks) as 0, 1 to 6, ≥ 7, and did not take; and time of return to work postpartum (weeks) as 1 to 6, 7 to 12, ≥ 13, and not yet returned. Analyses included χ(2) tests and multiple logistic regressions. RESULTS: In our study population, 69.4% initiated breastfeeding with positive variation by both total and paid maternity leave length, and time of return to work. In adjusted analyses, neither total nor paid maternity leave length had any impact on breastfeeding initiation or duration. Compared with those returning to work within 1 to 6 weeks, women who had not yet returned to work had a greater odds of initiating breastfeeding (odds ratio [OR]: 1.46 [1.08-1.97]; risk ratios [RR]: 1.13 [1.03-1.22]), continuing any breastfeeding beyond 6 months (OR: 1.41 [0.87-2.27]; RR: 1.25 [0.91-1.61]), and predominant breastfeeding beyond 3 months (OR: 2.01 [1.06-3.80]; RR: 1.70 [1.05-2.53]). Women who returned to work at or after 13 weeks postpartum had higher odds of predominantly breastfeeding beyond 3 months (OR: 2.54 [1.51-4.27]; RR: 1.99 [1.38-2.69]). CONCLUSION: If new mothers delay their time of return to work, then duration of breastfeeding among US mothers may lengthen.

Gene polymorphisms, breast-feeding, and development of food sensitization in early childhood.

BACKGROUND: The effect of breast-feeding on the development of allergic disease is uncertain. There are no data that show whether this relationship varies by individual genotypes. OBJECTIVE: We sought to evaluate the effect of breast-feeding and gene-breast-feeding interactions on food sensitization (FS) in a prospective US birth cohort. METHODS: This study included 970 children who were prospectively followed since birth. Breast-feeding history was obtained from a standardized questionnaire interview. FS was defined as a specific IgE level of 0.35 kU(A)/L or greater to any of 8 common food allergens. Eighty-eight potentially functional single nucleotide polymorphisms (SNPs) were genotyped from 18 genes involved in innate immunity or T(H)1/T(H)2 balance. Logistic regression models were used to test the effects of breast-feeding and gene-breast-feeding interactions on FS, with adjustment for pertinent covariates. RESULTS: Children who were ever breast-fed (n = 739), including exclusively breast-fed children, were at a 1.5 (95% CI, 1.1-2.1; P = .019) times higher risk of FS than never breast-fed children (n = 231). This association was significantly modified by rs425648 in the IL-12 receptor ß1 gene (IL12RB1; P for interaction = .0007): breast-feeding increased the risk of FS (odds ratio, 2.0; 95% CI, 1.4-3.1; P = .0005) in children carrying the GG genotype but decreased the risk (odds ratio, 0.6; 95% CI, 0.3-1.4; P = .252) in children carrying the GT/TT genotype. Similar interactions were observed for SNPs in the Toll-like receptor 9 (TLR9; rs352140) and thymic stromal lymphopoietin (TSLP; rs3806933) genes. The interaction between the combined genotypes of the 3 SNPs and breast-feeding on FS was even stronger (P for interaction < 10⁻5). CONCLUSION: Our data suggest that the effect of breast-feeding on FS was modified by SNPs in the IL12RB1, TLR9, and TSLP genes both individually and jointly. Our findings underscore the importance of considering individual genetic variations in assessing this relationship.

Factores socioculturales y psicológicos vinculados a la lactancia materna exclusiva / Sociocultural and psychological factors linked to exclusive breastfeeding

Introducción: la lactancia materna ha sido la forma de alimentación más segura para el ser humano en toda su historia. Esta leche es la única que asegura al niño pequeño una alimentación adecuada y le protege de las infecciones. Objetivo: determinar el comportamiento de los principales factores socioculturales y psicológicos vinculados a la práctica y abandono de la lactancia materna exclusiva y su repercusión en el estado de salud de los lactantes. Métodos: se realizó un estudio descriptivo de corte transversal, en el municipio Diego Ibarra, Estado de Carabobo, en el año 2008. La muestra estuvo conformada por 96 lactantes cuyas madres dieron su consentimiento informado para participar en este. Resultados: se observó un predominio de las madres adolescentes asociado al abandono de la lactancia materna antes de los 4 meses, la secundaria fue el nivel escolar más frecuente en la serie, sin embargo, el predominio de la categoría de obrera o técnica se asoció a una lactancia menor de 4 meses. Conclusiones: al nacimiento predominó la lactancia materna mixta, con una tendencia progresiva al uso de la lactancia artificial a partir del cuarto mes. Se encontró mayor frecuencia de madres con conocimientos deficientes sobre la lactancia materna, y fueron estas las que lactaron a sus bebés por menor tiempo. Más de las tres cuartas partes de las mujeres refirieron como causa de abandono de la lactancia materna exclusiva, que el niño se quedaba con hambre y la insuficiente disponibilidad de leche en las mamas.

Introduction: the breastfeeding has been the more safe feeding way for human being in all its history. This type of milk is the only assuring the infant a proper feeding while protecting him of infections. Objective: to determine the behavior of main sociocultural and psychological factors linked to practice and giving up of the exclusive breastfeeding and its repercussion on infant health status. Methods: a cross-sectional and descriptive study was conducted in "Diego Ibarra" municipality of Carabobo State during 2008. Sample included 96 infants whose mothers gave its informed consent to participate in this study. Results: there was predominance of adolescents mothers associated with breast feeding giving up before four months; the more frequent schooling was of secondary one, however, predominance of working or technique was associated with a breastfeeding during less than four months. Conclusions: at birth there was predominance of mixed breastfeeding, with a progressive trend to use of artificial breastfeeding from the fourth month. There was a great frequency of mothers with poor knowledge of breastfeeding and they were those that breastfeed during a minor time. More of the three quarter of women recounted as exclusive breastfeeding giving up cause hat infants starved and the enough availability of breast milk.

Breastfeeding prevalence and distribution in the USA and Appalachia by rural and urban setting.

INTRODUCTION: Breastfeeding provides health benefits to infants and mothers, yet many women decide against breastfeeding. This study examined differences in the prevalence of breastfeeding among national, urban, rural, and Appalachian regions of the USA. METHODS: Secondary data analysis of the US 2007 National Survey of Children's Health (n=27 388) data were completed for prevalence, insurance coverage, and medical home (a source of comprehensive primary care) determinations according to rural or urban location. RESULTS: The weighted US and Appalachian prevalences of breastfeeding were 0.755 (CI 0.743-0.767) and 0.683 (CI 0.672-0.694). National and Appalachian urban prevalences were 0.770 (CI 0.757-0.784) and 0.715 (CI 0.702-0.728). Rural areas had a significantly lower prevalence of breastfeeding of 0.687 (CI 0.661-0.713). Appalachia was significantly lower than the national rural level at 0.576 (CI 0.554-0.598). Women with Medicaid/State Children's Health Insurance Program (SCHIP) had an odds ratio of 1.79 of not breastfeeding compared with privately insured women. Nationally, 26.6% (CI 24.5-28.7) of children of women who did not breastfeed did not have a medical home. CONCLUSIONS: Anticipatory guidance about breastfeeding with culturally sensitive awareness programs and interventions directed at rural populations, especially in high risk geographic areas such as Appalachia, may be needed. Healthcare professionals have a unique opportunity to provide anticipatory guidance to pregnant women by discussing the benefits of breastfeeding during visits. High school health educational programs should address the benefits of breastfeeding with rural females.

Unilateral breastfeeding: an unusual practice that might be the reason for future development of contralateral breast disease.

BACKGROUND: A significant number of mothers have breastfed their babies from one breast only or from one breast more than the other. They presented to the breast clinic with complaints that mainly involve the breast that was not used or less used for breastfeeding. METHODS: The database of the Breast Unit at King Fahd Hospital, Jeddah, Saudi Arabia, was reviewed from April 1998 to March 2010. The lactation history of any patient coming to the breast clinic was documented, including number of children, duration of lactation, and the way they performed breastfeeding. RESULTS: During the study period, 54 patients have breastfed their babies exclusively from one breast (Group 1), and 21 have breastfed from one breast more than the other (Group 2). Patients gave different reasons for this practice, with nipple retraction being the commonest. In Group 1, 46 of 54 (85%) presented with complaints in the breast that was not used for breastfeeding (unsuckled), and only eight of 54 (15%) presented with complaints in the used (suckled) breast (p = 0.000). In Group 2, 13 of 21 (62%) presented with complaints in the breast that was less used for breastfeeding (less suckled), five of 21 (24%) presented with complaints in the breast more used for breastfeeding (more suckled), and three of 21 (14%) presented with complaints in both breasts equally (p = 0.418). CONCLUSION: Mothers who practice unilateral breastfeeding are candidates for future development of different breast problems in the unsuckled/less suckled breast.

Levels of persistent organic pollutant and their predictors among young adults.

Exposure to persistent organic pollutants (POPs), such as polychlorinated biphenyls (PCBs), dichlorodiphenyldichloroethane (p,p'-DDE), and hexachlorobenzene (HCB) continues to be of concern due to their ubiquitous distribution and high persistence. Current toxicant body burden is still a primary concern within the Akwesasne Mohawk Nation since other studies conducted within the community have shown relationships between these POPs and endocrine disruption. In this article we describe the levels of these toxicants in young adults of the Akwesasne Mohawk Nation between the ages of 17 and 21 years of age (mean age 18.1 years), and investigate potential influences of their current body burden. Seventeen congeners in fourteen chromatographic peaks were detected in 50% or more of the individuals sampled (geometric mean [GM] of the sum of these congeners=0.43 ppb). Congeners 118, 138[+163+164] and 153 had the highest rate of detection (≥98%) within the Akwesasne young adults. Of the other organochlorines, HCB (GM=0.04 ppb) and p,p'-DDE (GM=0.38 ppb) were found in 100% and 99% of the sample respectively. Significantly higher levels of PCBs were found among individuals who were breastfed as infants, were first born, or had consumed local fish within the past year. When compared to levels of p,p'-DDE, HCB, and 13 specific congeners reported by the CDC for youth between the ages of 12 and 19 years, the geometric means of several congeners (CBs 99, 105, 110, and 118) among the Akwesasne were higher than the reported CDC 90th percentile. In contrast, levels of CB 28 in Akwesasne young adults were ~50% or less than those of the CDC cohort. p,p'-DDE and HCB levels were generally higher in the CDC cohort (GM of 0.516 and 0.065 ppb, respectively for Mohawks vs. 2.51 and 0.123, respectively, for CDC). Concentrations of non-persistent PCBs among this sample of Akwesasne young adults were higher than those reported by the CDC suggesting continued exposure, but lower than those associated with severe contamination. Additional research into the concentration trends of individual PCB congeners within Akwesasne youth and young adults is warranted to further improve our insight into the determinants and influences of organochlorine concentrations within members of the Akwesasne community.

Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants.

OBJECTIVE: To identify the inpatient maternal and neonatal factors associated to the weaning of very low birth weight (VLBW) infants. METHODS: One hundred nineteen VLBW (<1500 g) infants were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB), and 66 (75%) were weaned (partial breastfeeding or formula feeding). RESULTS: Univariate analysis found an association between weaning and lower birth weight, longer stays in the neonatal intensive care unit (NICU), and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. CONCLUSION: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants.

PCDD, PCDF, PCB and PBDE concentrations in breast milk of mothers residing in selected areas of Slovakia.

The concentrations of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), dioxin-like polychlorinated biphenyls (dl-PCBs) and polybrominated diphenylethers (PBDEs) in 33 breast milk samples collected in 2006-2007 from primipara mothers close to four industrial areas of Slovak Republic were determined. The total PCDDs/PCDFs and dl-PCBs expressed as TEQ based on WHO TEFs 1998 in breast milk samples varied from 5.0 to 51.8 pg g(-1) fat (median: 13.1 pg g(-1) fat; mean: 18.0 pg g(-1) fat). The measurements of seven PBDE congeners (IUPAC No. 28, 47, 99, 100, 153, 154, and 183) were performed for the first time in human milk from Slovakia. PBDE levels ranged between 0.22 and 1.62 ng g(-1) fat, with median and mean value of 0.43 ng g(-1) fat and 0.57 ng g(-1) fat respectively. No statistically significant differences were observed between studied areas in total PBDE concentrations. Furthermore, this study presents first results concerning the daily intake (DI) of PCDDs/PCDFs and dioxin-like compounds for the most vulnerable breast-fed infant population in Slovakia. The total PCDD/PCDF and dl-PCB DI for an infant during the first 2 months of life was estimated in a range from 14.4 to 230 pg TEQ kg(-1)b.w., with a median value of 58.9 pg TEQ kg(-1)b.w.. The DI values substantially exceeded the tolerable daily intake (TDI) 1-4 pg TEQ kg(-1)b.w. recommended by WHO. The dietary infant intake concerning PBDEs was estimated to be between 0.69 and 7.1 ng kg(-1)b.w.d(-1), with median value of 1.7 ng kg(-1)b.w.d(-1).

Healthcare professionals' and mothers' perceptions of factors that influence decisions to breastfeed or formula feed infants: a comparative study.

AIM: This article is a report of a study comparing healthcare professionals' and mothers' perceptions of factors that influence the decision to breastfeed or formula feed an infant. BACKGROUND: The World Health Organisation recommends that mothers should breastfeed exclusively for the first 6 months of age and then continue to do so alongside complementary foods for the first 2 years and beyond. However, levels of breastfeeding in the United Kingdom are below the recommended targets. Low levels of actual or perceived professional support and understanding are associated with formula use. METHODS: Twenty professionals working closely with mothers of young infants completed a semi-structured interview exploring the reasons they believed mothers chose to use formula milk. Twenty-three mothers with an infant aged 6-12 months also reflected on their experiences of milk feeding. The data were collected during 2007-2008. RESULTS: Professionals described a range of influences on maternal decisions to breastfeed or formula feed including lack of knowledge, support and help with difficulties. These were strongly echoed in the reasons mothers gave for formula use, suggesting clear professional understanding of the challenges relating to breastfeeding. Although keen to give further support, professionals raised issues of lack of time and resources to support mothers. CONCLUSION: Contrary to maternal beliefs of poor professional understanding, professionals had a clear perception of influences affecting early milk feeding choice. Further resources and recognition are needed for healthcare professionals working with new mothers to enable them to offer increased support, with the aim of increasing breastfeeding duration.

Breast milk lead and cadmium levels from suburban areas of Ankara.

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 µg/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (> 5 µg/l). Breast milk Cd levels were > 1 µg/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 µg/l; p=0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 µg/l, respectively; p=0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 µg/l, p=0.023; vitamin: 0.78, 0.00 µg/l, p=0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r=-0.257, p=0.041 and r=-0.251, p=0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study.

Protective efficacy of co-trimoxazole prophylaxis against malaria in HIV exposed children in rural Uganda: a randomised clinical trial.

OBJECTIVE: To evaluate the protective efficacy of co-trimoxazole prophylaxis against malaria in HIV exposed children (uninfected children born to HIV infected mothers) in Africa. DESIGN: Non-blinded randomised control trial SETTING: Tororo district, rural Uganda, an area of high malaria transmission intensity PARTICIPANTS: 203 breastfeeding HIV exposed infants enrolled between 6 weeks and 9 months of age INTERVENTION: Co-trimoxazole prophylaxis from enrollment until cessation of breast feeding and confirmation of negative HIV status. All children who remained HIV uninfected (n = 185) were then randomised to stop co-trimoxazole prophylaxis immediately or continue co-trimoxazole until 2 years old. MAIN OUTCOME MEASURE: Incidence of malaria, calculated as the number of antimalarial treatments per person year. RESULTS: The incidence of malaria and prevalence of genotypic mutations associated with antifolate resistance were high throughout the study. Among the 98 infants randomised to continue co-trimoxazole, 299 malaria cases occurred in 92.28 person years (incidence 3.24 cases/person year). Among the 87 infants randomised to stop co-trimoxazole, 400 malaria cases occurred in 71.81 person years (5.57 cases/person year). Co-trimoxazole prophylaxis yielded a 39% reduction in malaria incidence, after adjustment for age at randomisation (incidence rate ratio 0.61 (95% CI 0.46 to 0.81), P = 0.001). There were no significant differences in the incidence of complicated malaria, diarrhoea, pneumonia, hospitalisations, or deaths between the two treatment arms. CONCLUSIONS: Co-trimoxazole prophylaxis was moderately protective against malaria in HIV exposed infants when continued beyond the period of HIV exposure despite the high prevalence of Plasmodium genotypes associated with antifolate resistance. Trial registration Clinical Trials NCT00527800.