Appendix B

Appendix B presents a compilation of abstracts of studies that address relationships of the mode of infant feeding with the infant's subsequent survival in developing countries. Abstracts are presented in either tabular or narrative form and are arranged chronologically.

ABSTRACT B-1A Death Rate and Relative Risk (RR) of Death by Feeding Method from Birth Among Infants Born in 11 Villages of the Ludhiana District, Punjab, India, 1955 to 1959a

 

 

Death Rate/1,000 and RR, During First Year of Life

 

 

0-28 days

2-11 mo

Feeding Method at Birth

Sample Size

Number of Deaths/1,000

RR

Number of Deaths/1,000

RR

Breast

739

46

1.00

74

1.00

Bottle

20

750

16.30

200

2.70

a From Gordon et al. (1963).



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Nutrition During Lactation Appendix B Appendix B presents a compilation of abstracts of studies that address relationships of the mode of infant feeding with the infant's subsequent survival in developing countries. Abstracts are presented in either tabular or narrative form and are arranged chronologically. ABSTRACT B-1A Death Rate and Relative Risk (RR) of Death by Feeding Method from Birth Among Infants Born in 11 Villages of the Ludhiana District, Punjab, India, 1955 to 1959a     Death Rate/1,000 and RR, During First Year of Life     0-28 days 2-11 mo Feeding Method at Birth Sample Size Number of Deaths/1,000 RR Number of Deaths/1,000 RR Breast 739 46 1.00 74 1.00 Bottle 20 750 16.30 200 2.70 a From Gordon et al. (1963).

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Nutrition During Lactation ABSTRACT B-1B Mortality from Diarrheal Disease Among Children Breastfed at Birtha   Breastfed Only Weaned During This Period Previously Weaned Age, mo Sample Size Cases of Diarrhea/ 100/yrb Diarrheal Deaths/ 1,000/yr Sample Size Cases of Diarrhea/ 100/yr Diarrheal Deaths/ 1,000/yr Sample Size Cases of Diarrhea/ 100/yr Diarrheal Deaths/ 1,000/yr 0–-2 524 136   3 267   NAc NA NA 3–5 380 124   4 100   3 267   6–8 196 184   8 350   4 100   9–11 91 128   11 291   7 171   0–11     23.5     0     (˜1,000.0)d                     12–14 31 90   3 240   11 218   15–17 17 118   31 168   40 150   18–20 3 133   79 213   61 230   21–23 1 NRe   39 154   138 151   12–23     153.8     0     48                     24–26 1 NR   34 165   87 138   27–29 0 NR   21 133   120 87   24–29     NA     0     10 a From Gordon et al. (1963). b The same child may have diarrhea more than one time during the year. c NA = Not applicable. d Four deaths occurred during 3.5 person-years of observation. e NR = Not reported. COMMENTS: Deaths for partially breastfed infants were not presented. Diarrhea increased with the initiation of supplemental foods among breastfed infants in 11 villages in Punjab, India, from 1955 to 1959. "No deaths occurred among cases in the immediate weaning period; fatalities occurred in cases of the late post weaning period. … The explanation would appear to be in the nutritional state of the child" (Gordon et al., 1963, p. 368).

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Nutrition During Lactation ABSTRACT B-2 Comparison of Feeding Methods Used for Jamaican Children Who Died Between the Ages of 6 and 36 Months, 1962 to 1963a Feeding Method Deathsb Random Controlsc Number % of Total Number % of Total Never fully breastfed 4 2.9 7 5.2 Fully breastfed <3 mo 37 27.0 24 17.9 Fully breastfed 3–6 mo 73 53.3 69 51.5 Fully breastfed >6 mo 23 16.8 34 25.4 Unknown 11 d 14 d a From McKenzie et al. (1967). b Random sample of deaths (N = 285); completed questionnaires concerning infant feeding were available for 72%. c Random sample of controls (N = 275); completed questionnaires were available for 56%. d Children whose feeding method was unknown were excluded from the analysis. COMMENTS: Relative risk of death was 1.42 for infants breastfed less than 3 months compared with those breastfed longer. Relative risk was calculated from authors' data. ABSTRACT B-3 Ratios of Observed to Expected Deaths Among 8,456 Births in Rural Senegal, 1962 to 1968, by Breastfeeding Status and Agea   Currently Breastfeeding Weaned Age, mo Number of Observed Deaths Number of Expected Deaths Ratio Number of Observed Deaths Number of Expected Deaths Ratio 0–11 455 460 0.99 9 4 2.25 12–23 360 351 1.03 36 45 0.80 24–35 64 59 1.08 181 186 0.97 a From Cantrelle and Leridon (1971).

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Nutrition During Lactation ABSTRACT B-4 Death Rates and Relative Risk (RR) Among 1,283 Infants in 15 Rural Communities in Chile, by Feeding Methoda   Death Rate/1,000b and RR, by Feeding Method     Bottle Mixed Age, mo Breast, Number of Deaths/1,000 Number of Deaths/1,000 RRc Number of Deaths/1,000 RR 1 29.2 60.5 2.07 56.0 1.92 3 13.8 38.7 2.80 37.5 2.72 6 10.0 19.9 1.99 14.0 1.40 a From Plank and Milanesi (1973), obtained in a survey of 1,712 women aged 15 to 44 in 1969 and 1970. b Death rate for infants between specified age and age 1 year. c Relative risk for breastfeeding = 1.0. COMMENTS: The increase in mortality associated with bottle feeding was less than when supplemental foods were given (but was not lower when infants were partially breastfed). ABSTRACT B-5 Percentage of Infants Breastfeeding in Total Study Sample and Among Those Who Died, and the Relative Risk (RR) of Death for Short-Term Breastfeedinga   Percentage of Infants Breastfed, by Study Population and Breastfeeding Duration   All Infants Infants Who Died RRb of Death for Breastfeeding for <6 mo Study Area <6 mo ≥6 mo <6 mo ≥6 mo El Salvador 20 80 78.0 22.0 14.2 Kingston, Jamaica 51 49 87.4 12.6 7.1 Medellin, Colombia 61.8 31.2 91.3 8.8 6.4 Sao Paolo, Brazil 77.2 22.8 95.9 4.1 6.8 a From Wray (1978), who analyzed data for deaths from Puffer and Serrano (1973) and for rate of breastfeeding among survivors in El Salvador (Menchu et al., 1972), Kingston (Grantham-MacGregor and Back, 1970), Medellin (Oberndorfer and Mejia, 1968), and Sao Paolo (Iunes et al., 1975). b Relative risk for breastfeeding for ≥6 mo = 1.0.

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Nutrition During Lactation ABSTRACT B-6 Mortality and Relative Risk (RR) of Death Among Breastfed and Bottle-Fed Infants in One Australian Aboriginal Settlement, 1953 to 1972a   Breastfed Infantsb Bottle-Fed Infants Age, mo Number of Deaths Sample Size Mortality Rate/1,000 Number of Deaths Sample Size Mortality Rate/1,000 RRc 1–3 3 547 5.5 4 525 7.6 1.38 4–6 0 99 0 11 705 15.6 d 7–12 0 20 0 9 1,588 5.7 d a From Dugdale (1980). b It was unclear whether breastfeeding included mixed feeding. c Relative risk for breastfed infants = 1.0. d Cannot be estimated.

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Nutrition During Lactation ABSTRACT B-7 Case Fatality and Relative Risk (RR) for Death from Measles Among 602 Breastfed and Weaned Children in Guinea-Bissau (West Africa), 1979a   Breastfed Infants Weaned Infants Age, mo Number of Cases Case Fatality, % Number of Cases Case Fatality, % RRb 0–11 71 28 1 0 c 12–23 43 37 16 25 0.68 24–35 14 14 42 26 1.86 36–71 2 0 112 11 c a From Aaby et al. (1981). Data on feeding were obtained 2 months before a measles epidemic. b Relative risk for breastfed infants = 1.0. c Cannot be estimated. ABSTRACT B-8 Postneonatal Mortalitya and Relative Risk (RR) Among Breastfed and Never Breastfed Infants in Six Guatemalan Villages, 1960 to 1974b       Postneonatal Mortality Rates/1,000, by Feeding Method Period of Birth Sample Size Never Breastfed Infants, %c Ever Breastfed Infants Never Breastfed Infants RRd Before 1960 1,128 6.3 75 375 5.0 1960–1968 1,985 6.5 47 193 4.1 1969–1974 1,442 4.9 39 189 4.8 a Postneonatal mortality = number of deaths between ages 28 days and 1 year per 1,000 live births. b Based on unpublished data from del Pinal (1981). c The low proportions of infants never breastfed suggest that illness may have prevented breastfeeding. d Relative risk for ever breastfed infants = 1.0.

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Nutrition During Lactation ABSTRACT B-9 Relative Risk (RR) of Survival by Duration of Breastfeeding Among the Last Child Born to Each of 2,907 Women at Three Hospitals in Cairo, Egypt, 1977 to 1978a Duration of Breastfeeding, mo RR of Survival (rather than mortality) >12 1.0 9-12 0.99 6-9 0.87b 3-6 0.85b 1-3 0.71b 0-1 0.71b a From Janowitz et al. (1981). b p &le; .05. COMMENTS: It is unclear to what age results refer or whether ages of all groups were equivalent. Results were adjusted for maternal education, parity, age, and past infant death (results therefore are probably overcontrolled). ABSTRACT B-10 Case-Fatality Rates and Relative Risk (RR) Among 2,339 Young Breastfeeding and Weaned Children Hospitalized with Measles, Diarrhea, or Acute Lower Respiratory Disease, by Breastfeeding Status in Kigali, Rwandaa   Case Fatality Rate, % Age, mo Breastfed Infants Weaned Infants RRb 0-5 11.2 20.7 1.85 6-11 13.5 26.8 1.99c 12-17 17.3 31.5 1.82 18-23 15.1 23.7 1.57d a Based on data from Lepage et al. (1981). b Relative risk for breastfed infants = 1.0. c p < .001 for entire first year. d p< .001 for entire second year.

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Nutrition During Lactation ABSTRACT B-11 Mortality Rates and Relative Risk (RR) of Death Among Very Low and Low Birth Weight Infants in the Special Care Nursery, Bombay, India, by Feeding Method and Birth Weighta,b   Mortality, % Birth Weight, kg Breastfed Infants Bottle-Fed Infantsc RRd 1.00-1.30 35.0 59.1 1.69 1.31-1.50 30.0e 50.0 1.67 1.51-1.80 20.0e 40.0 2.02 Total 23.0e 47.0 2.04 a From Patel et al. (1981). b Age of the infants was not provided. There were 100 infants in each feeding group. c The number of ''breastfed" infants who were fed human milk by tube or bottle was not stated. d Relative risk for breastfed infants in each weight group = 1.0. e p < .01. ABSTRACT B-12 Infant Deaths Resulting from Diarrhea in 12 Villages in Egypt, by Age and Feeding Method, 1979 to 1980a   Percentage of All Deaths Due to Diarrhea Age, mo Breastfed Infants (N [deaths] = 150) Exclusively Bottle-Fed Infants (N [deaths] = 19) Mixed-Fed Infants (N [deaths] = 33 0-5 28 60 63 6-11 76 86 71 a Based on data from Tekçe (1982).

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Nutrition During Lactation ABSTRACT B-13 Reduction of Infant Death Rate in Malaysia Attributed to Breastfeeding (Compared with Never Breastfeeding), by Age, 1976 and 1977a   Adjusted Impact of Breastfeeding Throughout the Preceding Period, Reduction in Deaths/1,000 Ageb Exclusive Breastfeeding Mixed Feeding 8–28 days 16.0 5.1 1–5 mo 23.2 10.5 6–12 mo 20.6 10.0 a From Butz et al. (1984), DaVanzo et al. (1983), DaVanzo and Habicht (1986), and Habicht et al. (1986, 1988). Data from the Malaysian Family Life Survey, which included 1,262 households, 5,573 singleton live births, and 270 infant deaths. b Age period to which the feeding method applies. COMMENTS: Neither death rates of nonbreastfed infants nor numbers of breastfed infants were presented. Effects were much smaller in households with a toilet and piped water. The authors' conclusion of a declining association of breastfeeding and mortality with age is not obviously supported by the data presented. The same data set was used by Holland (1987) and Millman and Cooksey (1987). The data do not allow estimation of relative risks. ABSTRACT B-14 Death Rates and Relative Risk (RR) Among Breastfed, Bottle-Fed, and Mixed-Fed Infants Delivered to More Than 15,000 Women in One Hospital in Tehran, Iran, by Feeding Method, 1977 and 1978 a Feeding Method Sample Size Number of Deaths Death Rate/1,000 RR Breast or mixed 12,004 307 25.6 1.0 Bottle 2,379 868 364.8 14.3 a From Janowitz and Nichols (1983). ABSTRACT B-15 Schmidt (1983) reported on a collaborative study among urban poor in eight Latin American countries and Portugal involving 7,659 children in 1981 and 1982. The infant mortality rate for formula-fed infants was 18.6/1,000 live births, but the results were not presented in a form that allows calculation of mortality rates for those infants who were breastfed or mixed fed or for those whose feeding method was unknown. Furthermore, results were not stratified by site or age of child. The group that was breastfed only was probably much younger (and more susceptible to higher death rates) than the weaned group.

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Nutrition During Lactation ABSTRACT B-16 Adjusted Relative Risk (RR) of Mortality Among 1to 12-Month-Old Breastfed and Never Breastfed Infants Living in Urban and Rural Areas of Brazil, 1980a   RR   Characteristic of Residence Breastfed Never Breastfed (CI)b Urban 1.0 1.53 (0.97–2.41)c Rural 1.0 2.31 (1.41–3.78)d a From Goldberg et al. (1984). Data obtained from a survey in four states in northeastern Brazil, including 7,852 women and 3,457 children. b CI = 95% confidence interval. c p = .07. d p < .01. COMMENTS: Results were adjusted for mother's education, employment, age at the time of delivery, parity, time since birth, and use of health services. Adjusting for use of health services may not be appropriate in that it might make real differences between the groups less apparent. ABSTRACT B-17 Adjusted Relative Risk (RR) of Mortality Associated with Bottle Feeding of Infants in the Near Easta       RR of Mortality of Bottle-Fed Infants, by Ageb Country Year of Survey Total Sample Size 1–5 mo 1–11 mo Jordan 1976 8,458 3.35 2.95 Tunisia 1978 7,060 3.35 2.95 Yemen 1979 3,889 NSc NRd Egypt 1980 11,961 8.39 6.38 a From Adlakha and Suchindran (1985). Data were obtained in world fertility surveys. b Relative risk for infants breastfed during the ages specified = 1.0 for each country. c NS = Not significantly different. d NR = Not reported. COMMENTS: Infants had been breastfed at least until the end of month 1 after delivery. There were very few nonbreastfed infants (4 to 8%) during the first month, suggesting that these infants were aberrant.

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Nutrition During Lactation ABSTRACT B-18 Percent Mortality and Relative Risk (RR) of Mortality Associated with Replacement of Formula by Human Milk for Low-Birth-Weight Infants in a Special Care Nursery in Bombay, India, 1978 to 1980a   Mortality,b % (sample size) Birth Weight, g Human Milk Formula RRc ≤;1,250 77.0 (74) 84.3 (102) 1.09 1,251–1,499 40.2 (102) 59.6 (104) 1.48 ≥;1,500 18.5 (157) 34.4 (186) 1.86 Total sample 38.1 (333) 54.1 (392) 1.42 a From Daga and Daga (1985). b Mortality differences were observed primarily after 72 h of age; diarrhea and sepsis were the principal causes of death. c Relative risk of death for breastfed infants = 1.0. ABSTRACT B-19 Barros and colleagues (1982) conducted a study involving all 5,914 births in the hospital in Pelotas, Brazil, in 1982. The children were followed up at age 2 years. Of the infants born weighing less than 2,000 g, 42% were never breastfed (compared with less than 10% of all others). The children who were small at birth were also more likely to be weaned. The authors reported that even if breastfeeding (either partial or exclusive) had no protective effect, nonbreastfed babies appeared to be at 30% increased risk of death. The duration of breastfeeding was unrelated to birth weight in the highest two (of five) socioeconomic groups. ABSTRACT B-20 Relative Risk (RR) of Mortality Among Breastfed Infants in Peru, 1977 and 1978, Based on the First and Next-to-Last Births of 5,640 Women Aged 15 to 49 Yearsa Age, mob RRc of Mortality, Breastfed Compared with Other Infants p Value 1–2 0.37 <.01 3–5 0.57 <.01 6–11 0.44 <.01 12–23 0.88 NRd 24–59 0.67 NR a From Palloni and Tienda (1986). Based on data from the World Fertility Survey. b Period of breastfeeding was up to the lower age bound in each category. c Relative risk was based on a risk of 1.0 for infants not breastfed, using multivariate analysis. d NR = Not reported. COMMENTS: The total number of births included was not reported. Results were controlled for previous birth interval; birth order; gender; mother's age, education, and region; and father's occupation.

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Nutrition During Lactation ABSTRACT B-21 Infant Deaths from Diarrhea or Measles by Feeding Method Among Infants Attending a Clinic in Benin, Nigeria, 1981a Feeding Method Number of Deaths Sample Size Infant Deaths/1,000 Breast 0 65 0 Mixed 20 282 70.9 Bottle 9 67 134.3 Total 29 414 70.0 a From Scott-Emuakpor and Okafor (1986). Relative risks not calculable, given that there were no deaths in the breastfed group. ABSTRACT B-22 Relative Risk (RR) of Infant Death in Malaysia by Duration of Breastfeeding and Infant Age, 1976a   RRb by Age of Infant, mo Duration of Breastfeeding, mo 0–1 2–3 4–6 7–12 Never 1.00 1.00 1.00 1.00 Ever 0.82 NAc NA NA <1 NA 0.89 0.61 NA 1 NA 0.41 0.64   2–3 NA NA 0.14 0.87 4–6 NA NA NA 0.54 a From Holland (1987). b Relative risk was derived from the author's log-linear models based on data from the Malaysian Family Life Survey, which included 1,262 households and 5,593 births. This is the same data set as that used by Butz et al. (1984) and Millman and Cooksey (1987). c NA = Not applicable. ABSTRACT B-23 Logit Coefficient and Relative Risk (RR) of Increased Mortality Among Infants in Malaysia, by Feeding Method, 1976a Period of Measuring Mortality Feeding Method Logit Coefficient RRb Through 1 mo All others versus ever breastfed 1.82c–2.06c,d 6.11–7.85 Through 1 yr Bottle only 1.10c–1.47c,d 3.00–4.35 1–12 mo Breastfed <1 mo versus longer breastfeeding 0.69–0.85c,d 1.99–2.34 a From Millman and Cooksey (1987). Based on data from the Malaysian Family Life Survey. b Range of relative risks associated with range of logit coefficients. c p < .01. d Range depends on logistic model used.

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Nutrition During Lactation ABSTRACT B-24 Relative Risk (RR) of Mortality Among Guatemalan Children by Duration of Breastfeeding and Age, 1974 to 1976a   RRb by Duration of Breastfeeding Age, mo 0 1–5 mo 6–11 11–23 1–5 6.1c NAd NA NA 6–11 3.7c 2.3e NA NA 12–23 0.8 1.3 1.3 NA 24–59 0.4 0.4 0.5 0.6 a From Pebley and Stupp (1987), who obtained data on approximately 2,880 children in four villages that had health and nutrition intervention and from two urban communities. b Relative risk for exclusively breastfed infants = 1.0. c p < 0.05. d NA = Not applicable. e p < 0.01. ABSTRACT B-25 Adjusted Relative Risk (RR) of Infant Mortality, by Disease and Method of Feeding, Among Infants in Urban Southern Brazil, 1985a   RR of Death, by Disease Method of Feeding Diarrhea Respiratory Infections Other Infections Breast only 1.0 1.0 1.0 Breast plus formula 4.5b 2.1 0.1b Breast plus cow's milk 3.4b 1.2 1.4 Formula only 16.3b 3.9b 2.3 Cow's milk only 11.6b 3.3b 2.6 a From Victora et al. (1987, 1989). b Significantly different from the risk for those breastfeeding only.

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Nutrition During Lactation ABSTRACT B-26 Infant and Child Mortality/1,000 in Rural Sierra Leone and Beta Coefficients from Regression Analysis, by Duration of Breastfeeding, 1979a,b Duration of Breastfeeding, mo Infant and Child Mortality/1,000c Beta Coefficients from Regression Analysis <6 356 Reference group 6–12 253 -0.094d 13–24 194 -0.162d ≥25 286 -0.080d a From Bailey (1988). Based on data obtained from a probability survey of 2,000 women aged 15 to 49. b In regression analysis "Dependent variable is . . . ratio of infant and child deaths to live births corresponding to each mother in the sample" (Bailey, 1988, p. 165). c No statistical test presented. d p < .001. COMMENTS: Results are open to circularity: death could cause a shorter period of breastfeeding. It is unclear to what age death rates refer and how infants less than age 3 years at the time of the survey were handled in the analysis. ABSTRACT B-27 Mortality and Relative Risk (RR) of Mortality Within 1 Month of Interview Among Children in Bangladesh, by Breastfeeding Status and Age, 1985 and 1986a   Breastfed Infantsb Weaned Infants Age, mo Number of Deaths Period, Child-Monthsc Number of Deaths Period, Child-Months RRd 12–17 11 6,622 0 176 e 18–23 8 5,108 3 753 3.39 24–29 7 5,267 12 2,611 3.45 30–36 3 3,035 7 4,103 1.73 Total 29 20,032 22 7,643 2.83 a From Briend et al. (1988). b Includes infants partially or exclusively breastfed. c Child-months refers to the number of months of observation summed across all children. d Relative risk for breastfed infants = 1.0. e Cannot be estimated. COMMENTS: An effect was observed only among those with the smallest arm circumferences. Incidence of diarrhea was not affected, but the case fatality rate was higher among weaned children. The possibility of a spurious association of diarrhea causing weaning was ruled out.

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Nutrition During Lactation REFERENCES Aaby, P., J. Bukh, I.M. Lisse, A.J. Smits, L. Smedman, O. Jeppsson, and A. Lindeberg. 1981. Breastfeeding and measles mortality in Guinea-Bissau. Lancet 2:12-31. Adlakha, A.L., and C.M. Suchindran. 1985. Factors affecting infant and child mortality. J. Biosoc. Sci. 17:481-496. Bailey, M. 1988. Factors affecting infant and child mortality in rural Sierra Leone. J. Trop. Pediatr. 34:165-168. Barros, F.C., C.G. Victora, J.P. Vaughan, P.G. Smith. 1986. Birth weight and duration of breastfeeding: Are the beneficial effects of human milk being overestimated? Pediatrics 78:656-661. Briend, A., B. Wojtyniak, and M.G. Rowland. 1988. Breastfeeding, nutritional state, and child survival in rural Bangladesh. Br. Med. J. 296:879-882. Butz, W.P., J.-P. Habicht, and J. DaVanzo. 1984. Environmental factors in the relationship between and infant mortality: the role of sanitation and water in Malaysia. Am. J. Epidemiol. 119:516-525. Cantrelle, P., and H. Leridon. 1971. Breastfeeding, mortality in childhood and fertility in a rural zone of Senegal. Popul. Stud. 25:505-533. Daga, S.R., and A.S. Daga. 1985. Impact of breast milk on the cost-effectiveness of the special care unit for the newborn. J. Trop. Pediatr. 31:121-123. DaVanzo, J., and J.-P. Habicht. 1986. Infant-mortality decline in Malaysia, 1946-1975: the roles of changes in variables and changes in the structure of relationships. Demography 23:143-160. DaVanzo, J., W.P. Butz, and J.-P. Habicht. 1983. How biological and behavioural influences on mortality in Malaysia vary during the first year of life. Popul. Stud. 37:381-402. del Pinal, J.H. 1981. Breastfeeding and Infant Mortality: Retrospective Evidence from Six Communities in Guatemala. Paper Presented at the Annual Meeting of the Population Association of America, March 25-27, 1981. Population Association of America, Washington, D.C. 25 pp. Dugdale, A.E. 1980. Infant feeding, growth and mortality: a 20-year study of an Australian Aboriginal community. Med. J. Aust. 2:380-385. Goldberg, H.I., W. Rodrigues, A.M.T. Thome, B. Janowitz, and L. Morris. 1984. Infant mortality and breastfeeding in North-Eastern Brazil. Popul. Stud. 38:105-115. Gordon, J.E., I.D. Chitkara, and J.B. Wyon. 1963. Weanling diarrhea. Am. J. Med. Sci. 245:345-377. Grantham-McGregor, S.M., and E.H. Back. 1970. Breastfeeding in Kingston, Jamaica. Arch. Dis. Child. 45:404-409. Habicht, J.-P., J. DaVanzo, and W.P. Butz. 1986. Does breastfeeding really save lives, or are apparent benefits due to biases? Am. J. Epidemiol. 123:279-290. Habicht, J.-P., J. DaVanzo, and W.P. Butz. 1988. Mother's milk and sewage: their interactive effects on infant mortality. Pediatrics 81:456-461. Holland, B. 1987. Breastfeeding, social variables, and infant mortality: a hazards model analysis of the case of Malaysia. Soc. Biol. 34:78-93. Iunes, M., D. Sigulem, and A.C. Campino. 1975. Estado Nutricional de Criances de 6 a 60 Meses no Municipio de Sao Paolo. 11. Analise de Dados, Sao Paolo: Escola Poaulista de Medicina. Janowitz, B., and D.J. Nichols. 1983. Child survivorship and pregnancy spacing in Iran. J. Biosoc. Sci. 15:35-46. Janowitz, B., J.H. Lewis, A. Parnell, F. Hefnawi, M.N. Younis, and G.A. Serour. 1981. Breastfeeding and child survival in Egypt. J. Biosoc. Sci. 13:287-297.

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Nutrition During Lactation Lepage, P., C. Munyakazi, and P. Hennart. 1981. Breastfeeding and hospital mortality in children in Rwanda. Lancet 2:409-411. McKenzie, H.I., H.G. Lovell, K.L. Standard, and W.E. Miall. 1967. Child mortality in Jamaica. Milbank Mem. Fund Q. 45:303-321. Menchu, M.A., M. Flores, M.Y. Lara, and M. Behar. 1972. Lactancia y destete en el area rural de Centro America y Panama. Arch. Latinoam. Nutr. 22:83-99. Millman, S.R., and E.C. Cooksey. 1987. Birth weight and the effects of birth spacing and breastfeeding on infant mortality. Stud. Fam. Plann. 18:202-212. Oberndorfer, L., and W. Mejia. 1968. Statistical analysis of the duration of breastfeeding. A study of 200 mothers of Antioquia Province, Colombia. J. Trop. Pediatr. 14:27-42. Palloni, A., and M. Tienda. 1986. The effects of breastfeeding and pace of childbearing on mortality at early ages. Demography 23:31-52. Patel, R.B., S.A. Khanna, K. Lahiri, and G.V. Kulkarni. 1981. Breast milk in low birth weight babies. Indian J. Pediatr. 48:195-196. Pebley, A.R., and P.W. Stupp. 1987. Reproductive patterns and child-mortality in Guatemala. Demography 24:43-60. Plank, S.J., and M.L. Milanesi. 1973. Infant feeding and infant mortality in rural Chile. Bull. W.H.O. 48:203-210. Puffer, R.R., and C.V. Serrano. 1973. Patterns of Mortality in Childhood. Report of the Interamerican Investigation of Mortality in Childhood. Scientific Publ. No. 262. Pan American Health Organization, Washington, D.C. 470 pp. Schmidt, B.J. 1983. Breastfeeding and infant morbidity and mortality in developing countries. J. Pediatr. Nutr. 2:S127-S130. Scott-Emuakpor, M.M., and U.A. Okafor. 1986. Comparative study of morbidity and mortality of breastfed and bottle-fed Nigerian infants. East Afr. Med. J. 63:452-457. Tekçe, B. 1982. Oral rehydration therapy: an assessment of mortality effects in rural Egypt. Stud. Fam. Plann. 13:315-327. Victora, C.G., P.G. Smith, J.P. Vaughan, L.C. Nobre, C. Lombardi, A.M. Teixeira, S.M. Fuchs, L.B. Moreira, L.P. Gigante, and F.C. Barros. 1987. Evidence for protection by breastfeeding against infant deaths from infectious diseases in Brazil. Lancet 2:319-322. Victora, C.G., P.G. Smith, J.P. Vaughan, L.C. Nobre, C. Lombardi, A.M. Teixeira, S.C. Fuchs, L.B. Moreira, L.B. Gigante, and F.C. Barros. 1989. Infant feeding and deaths due to diarrhea: a case-control study. Am. J. Epidemiol. 129:1032-1041. Wray, J.D. 1978. Maternal nutrition, breastfeeding and infant survival. Pp. 197-229 in W.H. Mosley, ed. Nutrition and Human Reproduction. Plenum Press, New York.