Because it is easily misinterpreted, the Bear Brand logo should not be permitted on products that are not infant formula, say the authors.
Bear Brand is a popular creamer intended for use in coffee and is nutritionally inadequate for infants.
The creamer has an illustration of an infant feeding bottle with a cross through it and a warning on the can which states "This product is not to be used as breast milk substitute" in English, Thai, and Lao. However, many people in Laos do not speak any of these languages—more than 45 languages are spoken in the country—and there are high rates of illiteracy in the region, particularly in rural areas.
The company also uses the same Bear Brand logo on infant formula products for infants from 6 months and on its sterilised cow's milk product.
Hubert Barennes and colleagues from the Institut de la Francophonie pour la Médecine Tropicale in Laos encountered first hand a number of children and infants admitted to hospital with malnutrition who had been fed the Bear Brand creamer exclusively.
In light of these findings they conducted two surveys to determine how widespread the practice of feeding this coffee creamer to infants was in Laos and to understand people's perception of the cartoon logo.
In 2006 they interviewed 26 paediatricians working in eight of the 17 provinces in Laos to collect information on parents' use of the Bear Brand coffee creamer as a substitute for breast milk. In 2007 they conducted a sample survey in five representative provinces randomly selecting villages and households to answer questions about their knowledge and use of the Bear Brand coffee creamer.
The authors found that the Bear Brand coffee creamer is a well recognised and widely distributed product. Nearly half of the adults surveyed believed that the product is "good for infants" or a "replacement for breast milk", and nearly a fifth of parents had given the product to their young infants, often when mothers returned to work or when the mother was ill or died.
Nearly half of respondents did not notice the written warning on the label or the picture of the baby's bottle with a cross through it. 12% did not understand the meaning of the cross through the bottle.
The authors warn that the cartoon bear and cub logo may mislead parents into believing that the coffee creamer is a suitable breast milk substitute despite the warnings on the label to the contrary.
They conclude: "The sale of coffee creamer with this logo places the health of infants and children at risk in a developing nation that already has extreme levels of malnutrition."