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The benefits of exclusive breastfeeding for health in infants have been widely described. The goal of this study was to determine whether partial breastfeeding has protective effects against enteric infection and associated morbidity in population where early addition of supplementation is common. In this prospective study 238 Bedouin infants were followed from birth to age 18 months. Exclusive breastfeeding was protective against infection and morbidity at ages 0 to 3 months. In the age range of 4 to 6 months, partial versus non breastfeeding was associated with lower rates of infection with Cryptosporidium spp (Odds Ratio OR 0.34, 95% confidence interval CI 0.18; 0.65), and Campylobacter spp (OR 0.58, CI 0.35; 0.98), lower rates of ear infections (OR 0.47, CI 0.24; 0.90) and of asthma (OR 0.33, CI 0.13; 0.81). In older children (10-12 month age range) partial breastfeeding as compared to none, protected against infections with Cryptosporidium spp (OR 0.57, CI 0.36; 0.91) and Giardia lamblia (OR 0.92, CI 0.85; 0.99). In Bedouins, and possibly in other populations, even partial breastfeeding, especially at ages 4 to 6 months offers protection against infection. Thus, encouraging mothers to continue to at least partially breastfeed past age 3 months may help reduce infections and morbidity in infants.

Background: Giardia lamblia (G. lamblia) is a prevalent enteric pathogen causing both asymptomatic carriage and diarrheal illness among children worldwide. In this study we examined the hypothesis that G. lamblia may modulate the effect of other enteric pathogens during concurrent infection., Methods: Bedouin (n = 238) infants were followed from birth to ages 18-23 months. Morbidity was ascertained by weekly home interviews and infant's stools were collected fortnightly. The risk for and severity of diarrheal disease were compared between episodes caused by enteric pathogens other than G. lamblia alone and G. lamblia-mixed episodes., Results: In 59 of 293(20.1%) diarrhea episodes two or more pathogens were detected. In two thirds of the mixed episodes G. lamblia was involved. Neither the incidence of diarrhea nor the mean diarrheal episode duration differed between follow up months in which G. lamblia was or was not detected, when age specific or age adjusted values were compared. There were no differences in severity of episodes for single or G. lamblia-mixed infections except for rotavirus. Episodes with rotavirus alone were more severe as compared to episodes where co-infection with G. lamblia was found., Conclusions: The results of this study do not confirm the hypothesis that G. lamblia modulates the clinical effect of infection with other enteric agents. However, the findings of the change in severity of infection with rotavirus suggest that this question warrants further investigation.

Giardiasis is a common protozoan infection, with varying clinical manifestations. We investigated the associations between Giardia lamblia carriage and environmental, family, illness, and growth characteristics. Bedouin infants (n=234) were followed from birth to age 18-23 months. At monthly home visits, stool samples were obtained, history of illness was determined, and an environmental assessment was done. The comparisons presented are between 4 groups defined by length of carriage of G. lamblia. Study children had a mean+/-SD of 4.1+/-2.9 diarrhea episodes. No illness, environmental, or family characteristics were associated with length of carriage. Significant differences were found in weight-for-age and weight-for-height z scores between the never-positive-for-G. lamblia group and all other carriage groups combined. Faltering growth was shown to be subsequent to G. lamblia infection rather than preceding it. Our findings confirm that G. lamblia carriage is not associated with diarrhea. However, the effect on growth deserves further investigation.