Intended for healthcare professionals


Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of consumers and paediatricians in Laos

BMJ 2008; 337 doi: (Published 09 September 2008) Cite this as: BMJ 2008;337:a1379
  1. Hubert Barennes, training and research coordinator1,
  2. Todisoa Andriatahina, paediatrician, IFMT student1,
  3. Vattanaphone Latthaphasavang, teaching assistant1,
  4. Margot Anderson, paediatric residency coordinator2,
  5. Leila M Srour, paediatric continuing medical education coordinator2
  1. 1Institut de la Francophonie pour la Médecine Tropicale, BP 9519, Vientiane, Lao Popular Democratic Republic
  2. 2Health Frontiers, University of Health Sciences, Vientiane
  1. Correspondence to: H Barennes hubert.barennes{at}
  • Accepted 15 July 2008


Objective To investigate the use of Bear Brand coffee creamer as a food for infants and the impact on consumers of the logo of a cartoon baby bear held by its mother in the breastfeeding position.

Design Interviews with paediatricians throughout the country and a national survey of potential consumers regarding their perceptions and use of the Bear Brand coffee creamer.

Setting 84 randomised villages in south, central, and northern Laos.

Participants 26 Lao paediatricians and 1098 adults in households in a cluster sampling.

Results Of the 26 paediatricians, 24 said that parents “often” or “sometimes” fed this product to infants as a substitute for breast milk. In the capital city, paediatricians said that mothers used the product when they returned to work. In the countryside, they reported that poor families used it when the mother was ill or died. Of 1098 adults surveyed, 96% believed that the can contains milk; 46% believed the Bear Brand logo indicates that the product is formulated for feeding to infants or to replace breast milk; 80% had not read the written warning on the can; and over 18% reported giving the product to their infant at a mean age of 4.7 months (95% confidence interval 4.1 to 5.3).

Conclusion The Bear Brand coffee creamer is used as a breast milk substitute in Laos. The cartoon logo influences people’s perception of the product that belies the written warning “This product is not to be used as a breast milk substitute.” Use of this logo on coffee creamer is misleading to the local population and places the health of infants at risk.


  • We thank the P8 Masters’ students of the Institut de la Francophonie pour la Médecine Tropicale (Agence Universitaire de la Francophonie), J P René, and Bryan Watt; the Lao paediatricians and the staff of Health Frontier, Vientiane; and the families and health authorities of Vientiane Municipality, Savannakhet, Hinheup, Atapeu, and Luang Nam Tha.

  • Contributors: HB was responsible for the overall coordination of the study and contributed to the study design, enrolment, field supervision, and data analysis; he is also guarantor. TA and VL enrolled and followed up the children and collected and analysed the data. MA and LMS were responsible for the first survey and contributed to the interpretation of the data. All authors contributed to the writing of the paper.

  • Funding: Agence Universitaire de la Francophonie (AUF).

  • Competing interests: None declared.

  • Ethical approval: National ethical review board of Laos.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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