Breast-feeding may help lower risk of death from Shigella infection in developing countries: Study

May 4 2010

Teaching parents about the importance of continued breast-feeding may help to lower the risk of death from brain disease (encephalopathy) related to Shigella infection in developing countries, reports a study in the May issue of The Pediatric Infectious Disease Journal. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Other risk factors for Shigella encephalopathy include dehydration and having an illiterate father, according to a study of Bangladeshi children with Shigella infection (shigellosis). The study was led by Dr. Mohammod Jobayer Chisti of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) in Dhaka, Bangladesh.

Stopping Breast-Feeding Early Is Key Risk Factor
Infections with Shigella bacteria are a major cause of death in poor countries, especially among children. Shigellosis most often causes diarrhea or dysentery. Some children also develop Shigella encephalopathy, which can lead to confusion, seizures, and coma and greatly increases the risk of death.

To identify the characteristics associated with this serious complication, Dr. Chisti and colleagues compared 29 children with Shigella encephalopathy to 87 children who had shigellosis without encephalopathy. Both groups were treated at the ICDDR,B's Dhaka Hospital, which specializes in the treatment of diarrhea and other infectious diseases.

Seven percent of the children with Shigella encephalopathy died, compared to none of those who had shigellosis without encephalopathy. With adjustment for other factors, the risk of death was four times higher for children with encephalopathy.

The strongest risk factor for Shigella encephalopathy was stopping breast-feeding early. Children whose mothers stopped breast-feeding during the newborn period were 40 times more likely to develop encephalopathy. Breast-feeding has been shown to reduce the risk of diarrhea and other serious infections in infants.

Dehydration and Illiteracy Also Affect Risk
Encephalopathy was more likely to develop in children who had dehydration caused by diarrhea, as well as those who had had diarrhea for less than one day. Risk was also increased for children with severely stunted growth, which results from malnutrition and causes reduced ability to fight infections.

Children who had an illiterate father were also at higher risk: five times higher than those whose fathers could read. "In Bangladeshi culture, the father is the dominant decision maker in the family," the researchers explain. "This influence in the family on proper child care might play a role for this association."

The study highlights the need to educate parents about the importance of breast-feeding to boost the infant's developing immune system, especially in poor countries like Bangladesh. Current World Health Organization recommendations state that "[I]nfants should be exclusively breast-fed for the first six months of life to achieve optimal growth, development and health."

Parents also need information on the importance of replacing fluids to prevent dehydration—particularly in children who are losing body fluids because of severe diarrhea. "Education of parents about the value of exclusive breast-feeding and of prompt hydration in children with Shigella is critical to minimize morbidity and deaths," Dr. Chisti and co-authors conclude.

SOURCE The Pediatric Infectious Disease Journal