Nutritional Factors

Background

            Nutritional factor research has traditionally been focused around child and maternal health. Vitamin A and Zinc supplementation for children under five has been studied to explore its uses as a diarrhea prevention or treatment program. Exclusive breastfeeding has been studied to evaluate its preventive effects on infant diarrhea rates and protective effects for older children (Zwane, 2007, pg. 5).

Reccomendations

Studies about nutritional factors show that breastfeeding can significantly reduce diarrhea disease and mortality rates in infants and may even have protective effects for older children as well. This type of intervention is both effective and cost-effective with indications that it would be effective in the long-term. Vitamin A and Zinc supplementation should not be used in urban areas where sanitation and water practices are not as high risk, but can be used for rural areas where sanitation and water supplies are high-risk.

Evidence

Exclusive Breast Feeding

• Weaning foods are frequently contaminated with diarrhea causing pathogens and are thus associated with malnutrition and immunity deficiency for infants and small children.
• Until sanitary conditions can be established, using breastfeeding exclusively for as long as possible can help children’s developing immune systems avoid damaging pathogens thus enabling the development of a more robust immune system.
• This provides the argument for both the prevention of diarrhea in infants, helping to prevent malnutrition, and protection of older children by letting their immune systems fully develop before being exposed to diarrhea causing microorganisms.

Zwane, A.P. & Kremer, M. What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review. World Bank Reserve Obs,.2007 (0), lkm002v1-24.

• Exclusive breastfeeding means that no other food or drink, not even water, is permitted except for supplements of vitamins, minerals, and necessary medicines. 
• The best length of time for exclusive breastfeeding is six months (WHO 2001). 
• Complimentary feeding, breastfeeding and appropriate, safe foods, is then recommended for up to two years. Keusch et al  p. 376 (I couldn’t find this source in the list? Is it written somewhere else)
• Three breastfeeding promotion studies in Brazil, Honduras, and Mexico showed that breastfeeding strategies are a cost-effective way to reduce diarrhea incidence, reduce associated mortality, and adding disability-adjusted years of impact to the economy.
• The annual cost for this intervention was from 30 to 40 cents per birth, whereas formula programs currently in place in these countries was between 65 cents and $1.10. (Horton et al. 1996)

Vitamin A and Zinc Supplementation

• Therapeutic supplementation with Vitamin A and Zinc has been shown to have positive, but not statistically significant, effects of diarrheal disease and mortality (Zwane, 2007, pg. 5).
• A double-blind randomized control study in Mexico showed that, while actually harmful to children in urban areas, children in rural areas that had houses with dirt floors could have decreased diarrhea rates from regular supplementation of Vitamin and Zinc (Long, 2006, p.1).

References

Exclusive Breast Feeding

Horton, S., Sanghvi, T., Phillips, M., Fiedler, J., Perezescamilla, R., Lutter, C., Rivera, A., & Segall-Correa, A.M. (1996) Breastfeeding promotion and priority setting in health. Health Promotion and Planning, 11(2), 156-168. Free Full Text

Vitamin A and Zinc Supplementation

Long, K.Z., Montoya, Y., Hertzmark, Santon, J.I., & Rosado, J.L. (2006) A double-blind, randomized, clinical trial of the effect of vitamin A and zinc supplementation on diarrheal disease and respiratory tract infections in children in Mexico City, Mexico. The American Journal of Clinical Nutrition, 86, 693-700.

Zwane, A.P. & Kremer, M. What Works in Fighting Diarrheal Diseases in Developing Countries? A Critical Review. World Bank Reserve Obs,.2007 (0), lkm002v1-24.