Hostname: page-component-6766d58669-r8qmj Total loading time: 0 Render date: 2026-05-19T14:00:31.556Z Has data issue: false hasContentIssue false
  • English
  • Français

Infant Feeding Practices in Complex Emergencies: A Case Study Approach

Published online by Cambridge University Press:  28 June 2012

Mary E. O'Connor ,
Frederick M. Burkle Jr.  and
Karen Olness
Mary E. O'Connor*
Affiliation:
Associate Professor of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado, USA
Frederick M. Burkle Jr.
Affiliation:
Senior Scholar, Scientist and Visiting Professor, The Center for International Emergency, Disaster and Refugee Studies, Schools of Medicine and Public Health, Departments of Emergency Medicine and International Health,The Johns Hopkins University Medical Institutions, Baltimore, Maryland, USA
Karen Olness
Affiliation:
Professor of Pediatrics, Family Medicine and International Health, Case Western University, Cleveland, Ohio, USA
*
Westside Family Health Center, 1100 Federal Blvd., Denver, CO 80204, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

The majority of deaths associated with complex emergencies are attributed to infants and children under the age of five years. Most of these deaths are related to preventable diseases such as malnutrition, diarrhea, and malaria. Infant feeding emergencies have emerged as a major factor in complex emergencies. This paper reviews the current information relative to infant feeding, and uses four case studies as educational tools for the management of infant feeding emergencies.

Child mortality rates in refugee population have been linked directly to protein-energy malnutrition (PEM). Breast feeding has many advantages over all other forms of feeding for children up to the age of two years of age. These advantages are discussed in detail in this paper. In addition, the appropriate and inappropriate uses of breast-milk substitutes (BMS) are discussed. Breast feeding also may play a role in the spread of HIV infections from the mother to the infant. However, in the setting of complex emergencies in the developing world, the risk of an infant dying of malnutrition and infection when not breastfed is likely to be greater than is the risk of death due to HIV acquisition through breastfeeding.

The physiology of lactation is reviewed with particular reference to the roles of prolactin, oxytocin, and the feedback inhibitor of lactation (FIL) hormone. No medications have been demonstrated to augment milk production that can be used in a practical sense in complex emergencies. Lastly, the principles promulgated by the WHO and UNHCR for the feeding of infants and children in emergencies and for milk powder distribution are summarized.

Keywords

breast feedingbreast-milk substituteschildrencomplex emergenciesinfantsinfectionlactationmalnutritionmortalityphysiologyprotein-energy malnutrition

Information

Type
Part 1. Complex Emergencies: Lessons Learned
Information
Prehospital and Disaster Medicine , Volume 16 , Special Issue 4: Complex Emergencies , December 2001 , pp. 231 - 238
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Burkholder, BT, Toole, MJ: Evolution of complex emergencies. Lancet 1995;346:1012–1015.Google Scholar
2.Roberts, L: Executive summary: Mortality study, Eastern Democratic Republic of Congo (February-April 2001) at www.theirc.org/mortality.cfm. Accessed 07 September 2001.Google Scholar
3.Burkle, FM: Lessons learnt and future expectations of complex emergencies. BMJ 1999;319:422–426.Google Scholar
4.Stephenson, LS, Latham, MC, Ottesen, EA: Global malnutrition. Parasitology 2000;121:5–22.Google Scholar
5.Toole, MJ, Waldman, RJ: Refugees and displaced persons: War, hunger and public health. JAMA 1993;270(5):600–605.CrossRefGoogle ScholarPubMed
6.O'Keefe, F: Infant feeding in Emergencies: Experience from Rwanda. Emergency Nutrition Network, Field Exchange 1997 May:4.Google Scholar
7.Puoane, T, Sanders, D, Chopra, M et al. : Evaluating the clinical management of severely malnourished children: A study of two rural district hospitals. The South Africian Medical Journal 2001;91(2):137–141.Google ScholarPubMed
8.Rikimaru, T, Yartley, JE, Taniguchi, K et al. : Risk factors for the prevalence of malnutrition among urban children in Ghana. Journal of Nutritional Science and Vitaminology 1998;44(3):391–407.Google Scholar
9.Infant feeding practices: Observations from Macedonia and Kosovo. www.ennonline.net/fex/08/fa27.html. accessed 08 August, 2001.Google Scholar
10.Walsh, A: Infant feeding emergencies: Experience from the former Yugoslavia. Emergency Nutrition Network, Field Exchange 1997; May:3-4.Google Scholar
11.Borrel, A, Taylor, A, McGrath, M et al. : From policy to practice: Challenges in infant feeding in emergencies during the Balkan crisis. Disasters 2001;25(2):149–163.Google Scholar
12.World Health Organization: Expert Consultation on the Optimal Duration of Exclusive Breastfeeding. 2001. www.who.int/inf-pr-2001/en/note2001-07.htmlGoogle Scholar
13.Labbok, MH, Perez, A, Valdes, V et al. : The Lactational Amenorrhea Method (LAM): A postpartum introductory family planning method with policy and program implications. Adv in Contraception 1994;10:93–109.Google Scholar
14.UNICEF, UNAIDS, WHO: HIV and infant feeding: A guide for healthcare managers and supervisiors.1998. http://www.unaids.org/publications/documents/mtct/infantguide.pdf.Google Scholar
15.Dewey, KG, Heinig, MJ, Nommsen, LA, Lonnerdal, B: Adequacy of energy intake among breastfed infants in the DARLING study: Relationships to growth velocity, morbidity, and activity levels. J Pediatr 1991;119:538–547.Google Scholar
16.Cohen, RJ, Brown, KH, Canahuati, J, Rivera, LL, Dewey, KG: Determinants of growth from birth to 12 months among breastfed Honduran infants in relation to age of introduction of complementary foods. Pediatrics 1995;96(3):504–510.Google Scholar
17.Mandalakas, A, Torjeson, K, Olness, K: Helping the Children. Johnson & Johnson Pediatric Institute and Health Frontiers: 1999. pp 69–77.Google Scholar
18.WHO Working Group on Infant Growth: An Evaluation of Infant Growth. Nutrition Unit, WHO: Geneva. 1994.Google Scholar
19.Simondon, KB, Simondon, F, Costas, R et al. : Breastfeeding is associated with improved growth in length, but not weight, in rural Senegalese toddlers. American Journal of Clinical Nutrition 2001;73:959–967.CrossRefGoogle Scholar
20.Regional Office for the Eastern Mediterranean WHO: Field Guide on Rapid Nutritional Assessment in Emergencies. World Health Organization: Geneva. 1995.Google Scholar
21.WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality: Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: A pooled analysis. Lancet 2000;355:451–455.Google Scholar
22.Duncan, B, Ey, J, Holbert, CJ et al. : Exclusive breastfeeding for at least 4 months protects against otitis media. Pediatrics 1993;91(5):867–872.Google Scholar
23.Paradise, JL, Elster, BA, Tan, L: Evidence in infants with cleft palate that breast milk protects against otitis media. Pediatrics 1994;94(6):853–860.CrossRefGoogle ScholarPubMed
24.Duffy, LC, Faden, H, Wasielewski, R et al. : Exclusive breastfeeding protects against bacterial colonization and day care exposure to otitis media. Pediatrics 1997;100(4):e7.CrossRefGoogle ScholarPubMed
25.Wright, AL, Holberg, CJ, Taussig, LM, Martinez, FD: Relationship of infant feeding to recurrent wheezing at age 6 years. Arch Pediatr Adolesc Med 1995;149:758–763.CrossRefGoogle ScholarPubMed
26.Oddy, WH, Holt, PG, Sly, PD et al. : Association between breastfeeding and asthma in 6 year old children: Findings of a prospective birth cohort study. BMJ 1999;319:815–819.CrossRefGoogle ScholarPubMed
27.Datta, P, Embree, JE, Kreiss, JK et al. : Mother-to-child transmission of human immunodeficiency virus type 1: Report from the Nairobi study. Journal of Infectious Diseases 1994;170:1134–1140.Google Scholar
28.VanRensburg, EJ, Lemmer, HR, Joubert, JJ: Prevalence of viral infections in Mozambican refugees in Swaziland. African Medical Journal 1995;72(9): 588–590.Google Scholar
29.Meyers, TM, Pettifor, JM, Gray, GE et al. : Pediatric admissions with human immunodeficiency virus infection at a regional hospital in Soweto, South Africa. Journal of Tropical Pediatrics 2000;46(4):224–230.Google Scholar
30.UNICEF, UNAIDS, WHO: HIV and infant feeding: A policy statement. 1997. http://www.unaids.org/publications/documents/mtct/infantpole.html.Google Scholar
31.Van De Perre, P, Simonon, A, Msellati, P et al. : Postnatal transmission of Immunodeficiency Virus Type 1 from mother to infant. N Engl J Med 1991;325(9):596–598.CrossRefGoogle ScholarPubMed
32.DeCock, KM, Fowler, MG, Mercier, E et al. : Prevention of mother-to-child HIV transmission in resource-poor countries. JAMA 2000;283(9): 1175–1182.CrossRefGoogle Scholar
33.Guay, LA, Musoke, P, Fleming, T et al. : Intrapartum and neonatal single dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda. Lancet 1999;354:795–802.CrossRefGoogle ScholarPubMed
34.Coutsoudis, A, Pillay, K, Kuhn, L et al. : Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: Prospective cohort study from Durban, South Africa. AIDS 2001;15(3):379–387.Google Scholar
35.Miotti, P, Taho, TET, Kumwenda, NI et al. : HIV transmission through breast-feeding: a study in Malawi. JAMA 1999;282(8):744–749.CrossRefGoogle ScholarPubMed
36.Dabis, F, Msellati, P, Meda, N et al. : 15 month efficacy of maternal oral zidovudine to decrease vertical transmission of HIV-1 in breastfed African children. Lancet 1999;354:2050–2051.Google Scholar
37.Lederman, SA: Estimating infant mortality from Human Immunodeficiency Virus and other causes in breastfeeding and botde feeding populations. Pediatrics 1992:89(2):290–295.CrossRefGoogle ScholarPubMed
38.Boss, L et al. : Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. JAMA 1994;272:371–376.Google Scholar
39.Lawrence, RA, Lawrence, RM: Breastfeeding, A Guide for the Medical Profession 5th ed. Mosby: St Louis. 1999. pp 67–71.Google Scholar
40.Peaker, M, Wilde, CJ, Knight, CH: Local control of the mammary gland. Biochem Soc Symp 1998:63:71–79.Google ScholarPubMed
41.Report of the Ad Hoc Group on Infant Feeding in Emergencies: Infant Feeding Emergencies: Policy, Strategy & Practice. Emergency Nutrition Network. May 1999. http://www.ennonline.net/ife/index.html.Google Scholar
42.World Health Organization: Guiding principles for feeding infants and young children in emergencies. The Management of Nutrition in Major Emergencies 2000. Annex 5, 202–203, Annex 6, pp 207-212.Google Scholar