Abstract
Introduction: Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death. Objective: To study the effect of breast-feeding duration on the survival of infants along with other demographic, socioeconomic and service related factors and to compare the decadal changes in the association. Methods: A total of 36,754 and 26,782 births less than 3 years of age from two rounds of the National Family Health Survey (NFHS) carried out in India during 1992-1993 (NFHS-1), and 2005-2006 (NFHS-3) respectively comprised the sample. Infant mortality was examined against a set of variables and breastfeeding as a time dependent covariate using multivariate extended Cox regression model. Results: Hazard of infant death observed in NFHS-3 (2005-2006) was 18 percent less [HR = 0.82; 95% CI = 0.759 - 0.879] as compared to that observed in NFHS-1 (1992-1993). After adjustment of other factors, the risk of infant death was 97% less amongst children who were breastfed [HR = 0.03; 95% CI = 0.029 - 0.033] as compared to those who were not breastfed. In contrast to rural area, babies belonging to urban area had an 18 percent less hazard of death during the infancy period [HR = 0.82]. Hazard of infant death was less among births to mothers with higher maternal education levels [HR = 0.93] and in those who were in gainful occupation [HR = 0.91]. The risk of infant death was higher in babies perceived to be small at birth [HR = 1.40] and belonging to states with medium post neonatal mortality rate (PNMR) [HR = 1.23; 95% CI = 1.112 - 1.371] and high PNMR [HR = 1.46; 95% CI = 1.327 - 1.609] in contrast to those born to women belonging to states with low post neonatal mortality. Conclusion: Promotion and implementation of evidenced based strategies are needed in India to combat the high rates of child under-nutrition and infant and child mortality.
Highlights
Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death
Babies born to mothers who were in gainful occupation had a 6 percent less hazard of infant death than babies born to mothers who were not gainfully occupied
Children’ mothers who received antenatal/natal care, the hazard of infant mortality was estimated at 0.49 [95% CI = 0.461 - 0.528] which were substantially lower than that seen in women who did not receive it
Summary
Sub-optimal infant and early childhood feeding practices in India contribute to the high burden of child under-nutrition and infant death. The risk of infant death was higher in babies perceived to be small at birth [HR = 1.40] and belonging to states with medium post neonatal mortality rate (PNMR) [HR = 1.23; 95% CI = 1.112 - 1.371] and high PNMR [HR = 1.46; 95% CI = 1.327 - 1.609] in contrast to those born to women belonging to states with low post neonatal mortality. Among 23 interventions considered by the Bellagio Child Survival Study Group, scale-up of exclusive breast-feeding of infants for 6 months and continued feeding until 1 year could prevent an estimated 1.3 million child deaths per year [2]
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