Feeding modes and persistent diarrhea: A comparative case–control study in infants in Hodeida, Yemen

Abstract

Objectives: Diarrhea is a major cause of morbidity and mortality among infants globally. Infant feeding practices influence diarrhea risk, but its relationship requires further investigation, especially in Yemen. This study aims to identify associations between feeding modes (breastfeeding, mixed feeding, formula, and goat milk) and persistent diarrhea in Yemeni infants. Material and Methods: A hospital-based case–control study was conducted from January to June 2020 in Hodeidah, Yemen. The cases were 240 infants aged 2–24 months with persistent diarrhea. Controls were 120 age-matched healthy infants. Caregiver interviews collected data on feeding practices. Odds ratios (OR) estimate relationships between exposures and persistent diarrhea. Results: We observed a protective effect of breastfeeding against persistent diarrhea, with breastfed infants having a significantly lower risk of developing persistent diarrhea compared to non-breastfed infants (OR: 0.43, 95% confidence interval [CI]: 0.27–0.68, P = 0.037). In addition, we found a significant association between goat milk consumption and persistent diarrhea, with infants who consumed goat milk having a higher risk of persistent diarrhea (OR: 4.67, 95% CI: 1.15–19.01, P = 0.009). While mixed feeding showed a potential increased risk of persistent diarrhea compared to exclusive breastfeeding, the wide CI indicated that this association was not statistically significant and required further research (OR: 1.86, 95% CI: 1.09–3.18). In contrast, the association between formula feeding and persistent diarrhea was inconclusive and not statistically significant (P = 0.938; OR: 0.867, 95% CI: 0.353–2.128), suggesting no significant relationship. These results highlight the protective effect of breastfeeding and the potential risks of goat milk consumption, while relationships between mixed/formula feeding and persistent diarrhea require more evidence. Conclusion: Certain feeding practices increase the risk of persistent diarrhoea in Yemeni infants. Promoting exclusive breastfeeding and complementary feeding guidance alongside tailored behavior change strategies, especially in rural communities can help address these modifiable risk factors.