Darillyn asked about causes of death in developing countries.  The Lancet
recently published an excellent article about these causes of death.  I
don't have the article in front of me, but I'm remembering quotes from
Miriam's talks at the UN Standing Committee on Nutrition Meeting and the
ILCA conference.  Malnutrition accounts for ~ 56% of the childhood deaths.
HIV is WAY down on the list.  Breastfeeding as an intervention can prevent
13% of all childhood deaths and is at the top of the list of interventions
for children.  The next one down on the list was Insecticide-treated
materials at 7% (this relates to preventin malarial deaths).

Weaning in many areas of Africa where I used to work is a time that is
fraught with increased risk of death.  In fact, the term Kwashiorkor, if I
remember correctly, is a Ghanaian term that literally refers to the
malnutrition that follows the abrupt weaning practice of sending the child
off to grandma.  It is a form of malnutrition that is far more deadly than
simple starvation - or marasmus.  Kwashiorkor is characterized by edema
(often the face is puffy), flaky paint skin, & brittle hair that loses its
color.

There are lots of theories about why some children develop marasmus and
some develop kwashiokor - such as the aflatoxin on peanuts & lack of
protein - but as far as I know no real definitive proof of one single
cause.  Sort of like the early development of secondary sexual
characteristics in girls or autism -- many factors are implicated.
Clearly, however, abrupt weaning in contaminated settings is a strong
precipitating factor.

Since I'm on a roll here, I know the topic of bottles versus cups came up
at ILCA and the Nigerian scientist that presented work on breastfeeding
handled the question beautifully.  One of the reasons that cup feeding is
so strongly recommended in developing areas of the world is that bottles
are hard to wash & easily contaminated.  In many areas of the world
firewood to boil water is scarce, water itself is scarce and sometimes
there is only enough water to drink, not enough for washing.  Time studies
have been done on the energy expenditure of collecting water and fuel and
in some areas of the world, this energy expenditure can have a significant
negative toll on women's nutritional status. Having spent a lot of time out
in those little dusty villages, I know that mothers have difficulty
breastfeeding.  I heard time and time again from these mother's that their
milk supply was low. At the time, I just passed it off as mother's
introducing supplements such as goat's or camel's milk as supplementary
feeding, but some of it may have been due to a problem that arose first and
led to a desparate attempt to correct it with the goat's or camel's milk.
I'm sure that there are infants that have sucking disorders & in those
settings they may just be the ones that whither away and get categorized
under the larger category of "malnutrition".  Some day, I would love to go
back and research this in such a setting.  I'm sure the numbers of problems
would be much lower than in the US setting where we see a lot of
iatrogenically induced low supply, but I'm sure it still exists.

Best, Susan Burger, MHS, PhD, IBCLC

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