Comparison of Growth and Haemoglobin Concentration in Exclusively Breastfed Infants for Four Months Compared to Six Months, with and without Iron Supplementation in Khartoum State

Background Information: Exclusive breastfeeding for six months was recommended by the WHO in its declaration in the year 2002.The Sudan had been practicing exclusive breastfeeding for four months until the year 2004 when it has adopted the Geneva Declaration of exclusive breastfeeding for six months. Study Design: This study is a randomised and blinded clinical trial, following infants and mothers for six months. It is a facility and community based study. Study Settings: The study group was selected from Omdurman Maternity Hospital. The mothers were instructed to exclusively breastfeed their infants. At the age of four months, the infants were divided into two main groups; one group continued exclusive breastfeeding for six months while the other group introduced food. Half of the infants in the first group were given iron supplement, while the other half was given a placebo. At the age of six months the infants’ growth was assessed using parameters of weight and length. The Hb concentration was evaluated for the whole group. The Objectives: The objectives of this study were to assess growth, Haemoglobin concentration and iron supplementation in infants exclusively breastfed for six months and to study socio-economic factors affecting them in Khartoum State in 2005. The Results: At the age of six months the weights of infants who were exclusively breastfed for six months were found comparable to the weights of infants who were allowed to have food at the age of four months. The lengths of the two groups showed no significant difference although those infants who were exclusively breast fed for six months gained more length. There was no significant difference in the incidences of infants having weights less than -2 sd in the two V groups. Exclusive breastfeeding for six months did not expose infants to low weights when compared to those provided with food at the age of four months. Comparing the three groups (Group A which was allowed to have food at four months of age, Group BPb which continued exclusive breastfeeding to six months of age and were given placebo, and Group BFe which continued breastfeeding to six months of age and were given Iron supplements) showed no significant difference in haemoglobin concentration at the age of six months. Exclusive breastfeeding for six months did not compromise Hb concentration of the study infants. Food supplementation and iron supplementation did not improve the Hb concentration as well. The risk of having low Hb concentration was similar in all groups. The results cannot be isolated from the environment surrounding these infants. In comparing the education of the mothers using the weight as the dependent variable, it was found that the growth of infants exclusively breastfed for six months was not affected by the level of education of the mothers. While the growth of infants supplemented with food at the age of four months was influenced with the education. The growth improved with the increase in the level of education of the mothers. The economic status of the families had some impact on infants’ growth. The infants of low economic status showed lower weights than those of high economic status. The impact was more marked n those provided with food at the age of four months than the infants exclusively breastfed for six months. The family size had no effect on the growth of infants exclusively breastfed for six months. The Conclusion: Infants could be exclusively breastfed for six months with out faltering of growth or compromising the haemoglobin concentration and no need for food supplementation. The economic status of the families and the education of the mothers had impact on exclusive breastfeeding, thus families of low economic status need support, guidance and encouragement