Burden attributable to suboptimal breastfeeding: a cross-country analysis of country-specific trends and their relation to child health inequalities

Abstract

BackgroundIn 2010, more than 7·7 million children died before their fifth birthday. Over 98% of these deaths occurred in developing countries. Within these countries, child mortality is concentrated in the lowest wealth quintile. Breastfeeding is a proven child health intervention available to almost all mothers and it does not require additional health infrastructure. However, breastfeeding prevalence remains low in many developing countries. This paper seeks to examine how breastfeeding prevalence and associated disease burden vary across countries and how breastfeeding interventions may affect child health inequalities. MethodsUsing data from more than 400 health and nutrition surveys and spatial temporal regression models, the prevalence of suboptimal breastfeeding was estimated for 137 developing countries from 1990 to 2012. These estimates were compared against WHO infant feeding recommendations and combined with effect sizes from existing literature to estimate associated disease burden using a standard comparative risk assessment approach. These data were disaggregated by wealth quintile and compared with coverage rates for other child health interventions to assess how improved rates of breastfeeding may affect child health inequalities. FindingsIn 2010, the estimated prevalence of exclusive breastfeeding ranged from 3·5% in Djibouti to 77·3% in Rwanda. The estimated proportion of child disability-adjusted life-years attributable to breastfeeding is 7·6% at the global level and as high as 20·2% in Swaziland. Breastfeeding is a leading childhood risk factor in all developing countries and consistently ranks higher than water and sanitation. Within countries, breastfeeding practices vary considerably across wealth quintiles. InterpretationBreastfeeding is an effective child health intervention that does not require extensive health-system infrastructure. Improvements in rates of exclusive and continued breastfeeding can contribute to the reduction of child mortality inequalities in developing countries. Active promotion of breastfeeding can prevent a large proportion of child deaths and disease burden. FundingBill & Melinda Gates Foundation.