Læknablaðið - 15.10.1993, Page 45

LÆKNABLAÐIÐ 1993; 79: 333-4
333
NÝR DOKTOR í LÆKNISFRÆÐI
GEIR GUNNLAUGSSON
Þann 28. maí 1993 varði Geir Gunnlaugsson
læknir doktorsritgerð við barnadeild
Karolinska sjúkrahússins/St. Göran,
Karolinska Institutet Stokkhólmi. Ritgerðin
nefnist á frummáli: Transmission of qualities
through breast milk. Breastfeeding practices
and child health in Guinea-Bissau. Fer
ágrip hér á eftir.
The immediate qualities of colostrum, the
mother’s first milk, for the newborn baby
are widely recognized but information as to
its long-term impact on health is scarce. This
study aims to describe and understand cultural
ideas about colostrum and »bad milk« and to
quantify their impact on actual breastfeeding
practices of newly delivered mothers and
subsequent child health.
Interviews with rural elderly women in
Guinea-Bissau revealed that colostrum was
considered to be of good, bad or neutral
quality depending on ethnic background.
Balanta women had the most negative ideas
and recommended delayed breastfeeding start
for 3 to 5 days, discarding colostrum. All the
informants claimed that mature breast milk
could turn bad in certain situations, and knew
of ways for diagnosis and treatment.
In the capital Bissau, prospective cohorts of
singleton healthy children were identified
in the periurban area Bandim (n=734) and
the Central Hospital (n=414). Mothers were
questioned shortly after birth about their
breastfeeding start. A multivariate failure
time analysis (Cox’ regression) was applied.
In Bandim, Balanta ethnic background was
the most important determinant for delayed
initiation of breastfeeding. Other determinants
were mothers who did not attend antenatal
clinics and mothers who gave birth at other
Key words: colostrum, initiation of breastfeeding, milk
quality, growth, infant and child mortality, diarrhoeal
morbidity, rotavirus, child health, Guinea-Bissau.
hours than 06-12 PM. In the hospital, the
most important determinants for delayed
breastfeeding start were: year of birth, young
age of mother and ethnic group of Mancanha.
The cohort in Bandim was followed from
one month up to three years of age. To delay
breastfeeding start more than 24 hours after
birth had no discernible impact on later
growth or survival. Survival was rather
influenced by the mother’s attendance at
antenatal clinics and her education level. Out
of 1000 healthy children at one month of
age, who were to be exposed to the observed
mortality, 215 would die before 3 years of
age. Yet, there are indications, albeit not
significant, that delayed breastfeeding start
of more than 6 hours may increase morbidity
in acute infantile diarrhoea.