Health and food safety concerns of early dietary introduction of unmodified cow milk to infants in developing countries

The timing of introduction of unmodified cow milk is critical in infant feeding. The objective of this review is to explore the underlying reasons for the early dietary introduction of unmodified cow milk to infant diets in the sub-Saharan African countries and also to assess the health and food safety concerns for its early introduction. Public health organisations including the American Academy of Paediatrics recommend that unmodified cow milk should not become part of infant diet before 12 months. Despite the recommendations and the evidence for an increased risk of multiple adverse health outcomes, the prevalence of early weaningand the early introduction of unmodified cow milk remain high in sub-Saharan African countries such as Uganda, Kenya and Ethiopia. Return to paid employment, inconsistent infant feeding advice from clinical professionals and maternal sickness are often the registered reasons by the mothers for the early introduction of breast milk substitutes. Therefore, parents should be educated on the health and food safety concerns of early introduction of unmodified cow milk. Unlike breast milk,unmodified cow milk does not provide a balanced diet for infants aged below 12 months. It contains excessive levels of protein, sodium, potassium, phosphorus, and calcium and insufficient levels of iron, vitamin C, and linoleic acid for human infant requirements. Consequently, the early introduction of unmodified cow milk is associated with risks of iron deficiency anaemia, protein-induced enterocolitis syndrome and increased renal solute load. Moreover, the introduction of unmodified cow milk into the infant diets should be delayed as long as possible to prevent thenutritional, health and food safety risks associated with its earlier introduction. It is also important that exclusive breastfeeding for 6 months in sub-Saharan African countries is promoted as it will extend breastfeeding benefits of prevention of iron deficiency anaemia and provide protection against infant nutritional childhood infections. Mothers should also be taught about proper infant feeding practices.Key words: Infant health, unmodified cow mil