To determine risk factors for diarrhea, the authors followed an open cohort of 1,314 children from Guinea-Bissau by weekly diarrhea recall interviews between April 1987 and March 1990. Data on feeding practices and measles infection were available for all children and, for 531 children, comprehensive data on explanatory variables were recorded. Of 57 variables, seven were independently associated with an increased incidence of diarrhea. These were a recent (in the past 14 days) diarrheal episode, male sex, being weaned from breast milk, not being looked after by the mother, head of the household being < 30 years old, eating cold leftovers, and drinking water from an unprotected public water supply. In breastfed children, only three variables were associated with diarrhea, including prior diarrhea, male sex, and not being looked after by the mother. Among weaned children, six variables delineated increased rates of diarrhea, including unprotected public water supply, eating of cold leftovers, and lack of maternal education. Major determinants of persistent diarrhea included weaning, lack of maternal education, and having pigs in the home. It is concluded that, in addition to the promotion of breastfeeding, important interventions against diarrhea include improvements in water supply, hygiene, and food handling. However, because of effect modification by breastfeeding, the largest effects of these interventions will probably be among weaned children.

No abstract

ment would need to be examined. It is important that women without cervical intraepithelial neoplasia and perhaps those with cervical intraepithelial neoplasia grade I, are not overtreated; a randomised trial is needed to address this issue.In conclusion, this study shows that cytological surveillance is not an efficient strategy for managing women with mildly abnormal smears and that women with any grade of dyskaryosis should be referred for colposcopy. We 8 Richart RM, Barron BA. A follow-up study of patients with cervical dyskaryosis. AmJ Obstet Gynecol 1969;105:386-93. 9 Nasiell K, Roger V, Nasiell M. Behaviour of mild cervical dysplasia during long term follow up. AmJ Obstet Gynecol 1986;67:665-9. 10 Fletcher A, Mehaxes N, Grubb G, Chamberlain J. Four and a half years' follow up ofwomen with dyskaryotic cervical smears. BMJ 1990;301:641-4 Subjects-849 children aged less than 3 years. Main outcome measures-Incidence and duration ofdiarrhoea, weight for age, and death ofa child.Results-The incidence of diarrhoea was higher in weaned children than in partially breast fed children, both in 1 year olds (relative risk 1*41; 95% confidence interval 123 to 1.62) and in 2 year olds (1.67; 1-29 to 2.15). The mean duration of an episode of diarrhoea was 5'3 days in breast fed children compared with 6-3 days in weaned children (P= 0.001). Independent of the age of weaning, a similar increase was found in an analysis comparing, for each child, the rate and duration of diarrhoea one month before and one month after weaning. Children with low weight for age were breast fed longer than the better nourished children (P=0.02). Children aged 12-35 months who were not breast fed had a 3'5 times higher mortality (1.4 to 8.3) than breast fed children.Conclusions-The beneficial effects of breast feeding are not restricted to infancy. Though children who are partially breast fed after infancy may have a lower state of nutrition than the weaned ones, the benefit in terms of lower morbidity may be more important for child survival in places with a high morbidity from diarrhoea and with high mortality.

No abstract

No abstract