Abstract
BackgroundDespite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. This study examines the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants.MethodsThree waves of Bangladesh Demographic and Health Survey data were analysed using multivariate regression. The adverse health outcomes were: an episode of diarrhea, fever or acute respiratory infection (ARI) during the 2 weeks prior to the survey. Nutritional outcomes were assessed by stunting (height-for-age), wasting (weight-for-height) and underweight (weight-for-age). Population attributable fraction was calculated to estimate percentages of these six outcomes that could have been prevented by supplying EBF.ResultsFifty-six percent of infants were exclusively breastfed during the first 6 months. Lack of EBF increased the odds of diarrhea, fever and ARI. Among the babies aged 6 months or less 27.37% of diarrhea, 13.24% of fever and 8.94% of ARI could have been prevented if EBF was not discontinued. If EBF was terminated during 0–2 months, 2–4 months the odds of becoming underweight were 2.16 and 2.01 times higher, respectively, than babies for whom EBF was not terminated.ConclusionChildren who are not offered EBF up to 6 months of their birth may suffer from a range of infectious diseases and under-nutrition. Health promotion and other public health interventions should be enhanced to encourage EBF at least up to six-month of birth.Trail registrationData of this study were collected following the guidelines of ICF International and Bangladesh Medical Research Council. The registration number of data collection is 132,989.0.000 and the data-request was registered on September 11, 2016.
Highlights
Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues
Using nationally representative Bangladesh Demographic and Health Survey (BDHS) data, we examined the effect of termination of EBF during the first 2, 4 and 6 months of birth on a set of adverse health and nutritional outcomes of infants
If EBF was terminated during 0–2 months, 2–4 months and 4–6 months the odds for babies in getting diarrhea were 4.94 times, 3.07 times and 2.30 times higher, respectively, than babies for whom EBF was not terminated
Summary
Despite growing evidence in support of exclusive breastfeeding (EBF) among infants in the first 6 months of birth, the debate over the optimal duration of EBF continues. There is an increasing evidence that exclusive breastfeeding (EBF) up to six-month of age has profound biological effects and important consequences on health and nutritional outcomes of children [1, 2]. Khan and Islam BMC Public Health (2017) 17:889 of longer-term EBF against infectious diseases and adequacy of breast milk to meet infants’ nutritional requirements of beyond 4 months of age [6]. Sometimes the evidence has been questioned [7], and some experts have promoted a less stringent recommendation that is more akin to the pre-2001 WHO policy [8, 9] Part of this controversy is caused by findings of some individual studies [10]. The debate over the optimal duration of EBF is centered mainly on the choice between the known protective effect of EBF against infectious diseases and the insufficiency of breast milk alone to satisfy babies’ nutritional requirements (known as weanling’s dilemma)
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