Breast-feeding and Infectious Diarrhea

To the Editor.—  Gordon¹ raises the question of why breast-feeding is lifesaving in developing countries, and he terms it an "unanswered major issue." He implies that supine feeding is the problem, but neglects to mention the difficulties of maintaining a sanitary food supply in developing countries.Where sanitation is poor, non—breastfed infants are more frequently exposed to sources of infection than are breastfed infants. For example, a study in Gambia² showed that supplementary foods provided to infants, whether traditional gruels or commercial infant formulas, "were heavily contaminated with potentially pathogenic microorganisms," because the foods were not freshly prepared. In Chile,³ 80% of feeding bottles were found to harbor dangerously large numbers of bacteria. In a study in Uganda,⁴ bacterial counts were elevated in infant foods and on the surface of utensils used in preparation and feeding. In that study, 49% of infants whose mothers had attempted