Breastfeeding and the risk of hospitalization for respiratory disease in infancy: a meta-analysis.

OBJECTIVE: To examine breastfeeding and the risk of hospitalization for lower respiratory tract disease in healthy full-term infants with access to modern medical care. DATA SOURCES: MEDLINE, personal communication with researchers, the OVID databases, Dissertation Abstracts Online, and BIOSIS. STUDY SELECTION: The titles, abstracts, and text of studies from developed countries were explored for breastfeeding exposure measures and lower respiratory tract disease hospitalization rates. For summary statistics, we required 3 inclusion criteria: (1) a feeding contrast of a minimum of 2 months of exclusive breastfeeding (no formula supplementation) vs no breastfeeding and (2) study populations that excluded sick, low birth weight or premature infants and (3) reflected affluent regions; 27% of studies met these criteria. DATA EXTRACTION: We abstracted data from all relevant reports. DATA SYNTHESIS: Data from all primary material (33 studies) indicated a protective association between breastfeeding and the risk of respiratory disease hospitalization. Nine studies met all inclusion criteria, and 7 cohort studies were pooled. The feeding contrasts in these 7 studies were 4 or more months of exclusive breastfeeding vs no breastfeeding. The summary relative risk (95% confidence interval) was 0.28 (0.14-0.54), using a random-effects model. This effect remained stable and statistically significant after adjusting for the effects of smoking or socioeconomic status. CONCLUSION: Among generally healthy infants in developed nations, more than a tripling in severe respiratory tract illnesses resulting in hospitalizations was noted for infants who were not breastfed compared with those who were exclusively breastfed for 4 months.

Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica.

OBJECTIVE: To study the knowledge, attitudes, and practices of caregivers in Kingston, Jamaica, regarding childhood diarrhea and dehydration in order to determine if limited caregiver knowledge about the prevention and treatment of diarrhea and dehydration puts children at increased risk of presenting at the hospital for these concerns. METHODS: The study was an observational case-control study conducted between February 1997 and May 1997 at Bustamante Hospital for Children in Kingston. Convenience sampling was used and data were collected by face-to-face interviews with two groups of caregivers of children under 5 years of age. One group (n = 117) presented with children with acute gastroenteritis, and the other group (n = 98) presented with acute concerns unrelated to gastroenteritis. While 197 of the 215 caregivers interviewed were the mother of a child, there were also 9 guardians, 5 fathers, and 4 grandmothers in the sample. RESULTS: The mean caregiver age, level of education, and socioeconomic status were similar for the two groups. The caregivers in the gastroenteritis group were more likely to present with younger children and to have less convenient access to running water or a refrigerator. Children of caregivers who had never heard of oral rehydration therapy were at increased risk of presenting with gastroenteritis and dehydration (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.8-11.7), as were children of caregivers with low knowledge scores about the prevention and treatment of diarrhea and dehydration (OR, 3.7; 95% CI, 1.6-8.8). Another independent risk factor was a caregiver's poor sense of self-reliance in managing a child's diarrhea (OR, 2.3; 95% CI, 1.1-4.9). CONCLUSIONS: These findings highlight a need to enhance educational efforts that will empower caregivers to protect their children from diarrhea-associated morbidity and mortality.

Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica / Conocimientos, actitudes y prácticas de los cuidadores hacia la diarrea infantil y la deshidratación en Kingston, Jamaica

Objective. To study the knowledge, attitudes, and practices of caregivers in Kingston, Jamaica, regarding childhood diarrhea and dehydration in order to determine if limited caregiver knowledge about the prevention and treatment of diarrhea and dehydration puts children at increased risk of presenting at the hospital for these concerns. Methods. The study was an observational case-control study conducted between February 1997 and May 1997 at Bustamante Hospital for Children in Kingston. Convenience sampling was used and data were collected by face-to-face interviews with two groups of caregivers of children under 5 years of age. One group (n = 117) presented with children with acute gastroenteritis, and the other group (n = 98) presented with acute concerns unrelated to gastroenteritis. While 197 of the 215 caregivers interviewed were the mother of a child, there were also 9 guardians, 5 fathers, and 4 grandmothers in the sample. Results. The mean caregiver age, level of education, and socioeconomic status were similar for the two groups. The caregivers in the gastroenteritis group were more likely to present with younger children and to have less convenient access to running water or a refrigerator. Children of caregivers who had never heard of oral rehydration therapy were at increased risk of presenting with gastroenteritis and dehydration (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.8­11.7), as were children of caregivers with low knowledge scores about the prevention and treatment of diarrhea and dehydration (OR, 3.7; 95% CI, 1.6­8.8). Another independent risk factor was a caregiver's poor sense of self-reliance in managing a child's diarrhea (OR, 2.3; 95% CI, 1.1­4.9). Conclusions. These findings highlight a need to enhance educational efforts that will empower caregivers to protect their children from diarrhea-associated morbidity and mortality

Objetivos. Estudiar los conocimientos, actitudes y prácticas de los cuidadores hacia la diarrea infantil y la deshidratación en Kingston, Jamaica, con el fin de determinar si sus escasos conocimientos sobre la prevención y el tratamiento de la diarrea y la deshidratación hacen que los niños corran mayor riesgo de hospitalización por estos problemas. Métodos. Se realizó un estudio observacional de casos y controles entre febrero y mayo de 1997 en el Hospital Infantil Bustamante de Kingston. Se usó una muestra de conveniencia de niños de menos de 5 años y los datos fueron recogidos mediante entrevistas personales con los cuidadores de los dos grupos de niños. Un grupo estaba formado por 117 niños con gastroenteritis aguda, y el otro por 98 niños con problemas agudos no relacionados con la gastroenteritis. De los 215 cuidadores entrevistados, 197 eran las madres, 9 eran tutores, 5 eran los padres y 4 eran las abuelas. Resultados. La media etaria de los cuidadores, su nivel educacional y su estatus socioeconómico eran similares en los dos grupos. Los cuidadores del grupo de niños con gastroenteritis tenían niños más pequeños y menos acceso al agua corriente y a frigoríficos. Los niños cuyos cuidadores nunca habían oído hablar de la rehidratación oral tenían mayor riesgo de presentar gastroenteritis y deshidratación [razón de posibilidades (odds ratio: OR): 4,6; intervalo de confianza del 95% (IC95): 1,8­11,7], al igual que los niños cuyos cuidadores tenían escasos conocimientos sobre la prevención y el tratamiento de la diarrea y la deshidratación (OR: 3,7; IC95: 1,6­8,8). Otro factor de riesgo independiente fue la poca confianza del cuidador en su propia capacidad para tratar la diarrea del niño (OR: 2,3; IC95: 1,1­4,9). Conclusiones. Estos resultados destacan la necesidad de incrementar los esfuerzos informativos que les permitan a los cuidadores proteger a los niños de la morbilidad y la mortalidad relacionadas con la diarrea.

Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica

Objective. To study the knowledge, attitudes, and practices of caregivers in Kingston, Jamaica, regarding childhood diarrhea and dehydration in order to determine if limited caregiver knowledge about the prevention and treatment of diarrhea and dehydration puts children at increased risk of presenting at the hospital for these concerns. Methods. The study was an observational case-control study conducted between February 1997 and May 1997 at the Bustamante Hospital for Children in Kingston. Convenience sampling was used and data were collected by face-to-face interviews with two groups of caregivers of children under 5 years of age. One group (n=117) presented with children with acute gastroenteritis, and the other group (n=98) presented with acute concerns unrelated to gastroenteritis. While 197 of the 215 caregivers interviewed were the mother of a child, there were also 9 guardians, 5 fathers, and 4 grandmothers in the sample. Results. The mean caregiver age, level of education, and socioeconomic status were similiar for the two groups. The caregivers in the gastroenteritis group were more likely to present with younger children and to have less convenient access to running water or a refrigerator. Children of caregivers who had never heard of oral rehydration therapy were at increased risk of presenting with gastroenteritis and dehydration (odds ratio [OR], 4.6; 95 percent confidence interval [CI], 1.8-11.7), as were children of caregivers with low knowledge scores about the prevention and treatment of diarrhea and dehydration (OR, 3.7; 95 percent CI, 1.6-8.8). Another independent risk factor was a caregiver's poor sense of self-reliance in managing a child's diarrhea (OR, 2.3; 95 percent CI, 1.1-4.9). Conclusions. These findings highlight a need to enhance educational efforts that will empower caregivers to protect their children from diarrhea-associated morbidity and mortality (AU)