VanDerslice J, Popkin B, Briscoe J
University of Texas-Houston, School of Public Health, MPH Program at El Paso 79968-0642.
Bull World Health Organ. 1994;72(4):589-601.
The promotion of proper infant feeding practices and the improvement of environmental sanitation have been two important strategies in the effort to reduce diarrhoeal morbidity among infants. Breast-feeding protects infants by decreasing their exposure to water- and foodborne pathogens and by improving their resistance to infection; good sanitation isolates faecal material from the human environment, reducing exposures to enteric pathogens. Taken together, breast-feeding and good sanitation form a set of sequential barriers that protect infants from diarrhoeal pathogens. As a result, breast-feeding may be most important if the sanitation barrier is not in place. This issue is explored using data from a prospective study of 2355 urban Filipino infants during the first 6 months of life. Longitudinal multivariate analyses are used to estimate the effects of full breast-feeding and mixed feeding on diarrhoeal disease at different levels of sanitation. Breast-feeding provides significant protection against diarrhoeal disease for infants in all environments. Administration of even small portions of contaminated water supplements to fully breast-fed infants nearly doubles their risk of diarrhoea. Mixed-fed and weaned infants consume much greater quantities of supplemental liquids, and as a result, the protective effect of full breast-feeding is greatest when drinking-water is contaminated. Similarly, full breast-feeding has stronger protective effects among infants living in crowded, highly contaminated settings.
推广正确的婴儿喂养方法和改善环境卫生，一直是降低婴儿腹泻发病率工作中的两项重要策略。母乳喂养可减少婴儿接触水传和食源性病原体的机会，并提高其抗感染能力，从而保护婴儿；良好的环境卫生可将粪便与人类环境隔离开来，减少接触肠道病原体的机会。母乳喂养和良好的环境卫生共同构成了一系列保护婴儿免受腹泻病原体侵害的屏障。因此，如果卫生屏障未到位，母乳喂养可能最为重要。本文利用对2355名菲律宾城市婴儿出生后头6个月进行的一项前瞻性研究的数据，探讨了这一问题。采用纵向多变量分析来估计在不同卫生水平下，纯母乳喂养和混合喂养对腹泻疾病的影响。母乳喂养在所有环境中都能为婴儿提供显著的腹泻疾病防护。即使给纯母乳喂养的婴儿少量喂食受污染的水补充剂，其腹泻风险也几乎会增加一倍。混合喂养和断奶婴儿摄入的补充液体量要多得多，因此，当饮用水受污染时，纯母乳喂养的保护作用最为显著。同样，纯母乳喂养对生活在拥挤、污染严重环境中的婴儿具有更强的保护作用。
