Exclusive Breastfeeding and Under-Five Mortality, 2006-2014: A Cross-National Analysis of 57 Low- and-Middle Income Countries.

Romuladus Azuine

doi:10.21106/ijma.52

Abstract

Few studies have examined the long-term, cross-national, and population-level impacts of exclusive breastfeeding on major global child health indicators. We investigated the overall and independent associations between exclusive breastfeeding and under-five mortality in 57 low- and-middle-income countries. Data were obtained from the latest World Health Organization, United Nations, and United Nations Children's Fund databases for 57 low- and middle-income countries covering the periods 2006-2014. Multivariate linear regression was used to estimate the effects of exclusive breastfeeding on under-five mortality after adjusting for differences in socioeconomic, demographic, and health-related factors. In multivariate models, exclusive breastfeeding was independently associated with under-five mortality after adjusting for sociodemographic and health systems-related factors. A 10 percentage-points increase in exclusive breastfeeding was associated with a reduction of 5 child deaths per 1,000 live births. A one-unit increase in Human Development Index was associated with a decrease of 231 under-five child deaths per 1,000 live births. A $100 increase in per capita health care expenditure was associated with a decrease of 2 child deaths per 1,000 live births. One unit increase in physician density was associated with 2.8 units decrease in the under-five mortality rate. Population-level health system and socioeconomic factors exert considerable effect on the association between exclusive breastfeeding and under-five mortality. Given that the health policy and socioeconomic indicators shown to influence exclusive breastfeeding and under-five mortality are modifiable, policy makers could potentially target specific policies and programs to address national-level deficiencies in these sectors to reduce under-five mortality in their countries.

Highlights

Exclusive breastfeeding is the practice of feeding infants only on breast milk without any additional food or drink, even water, for the first six months of life.[1,2] Exclusive breastfeeding enhances the overall benefits of breast milk, which is widely recognized as the ideal form of nutrition for infants
We investigate the association between exclusive breastfeeding and under-five mortality, a leading child health indicator, using data from 57 low- and middle-income countries.The aims of our study were two-fold
This study found that in the presence of enabling health systems and sociodemographic indicators such as Human Development Index (HDI), physician density, and healthcare expenditure, the association between exclusive breastfeeding and the under-five mortality rate in the 57 countries investigated becomes substantial and statistically significant. These findings suggest that the ability of exclusive breastfeeding to impact the under-five mortality rate is determined, in part, upon other sociodemographic and health factors and, in the presence of these other factors, the effect that exclusive breastfeeding has on the under-five mortality rate is increased

Summary

Introduction

Exclusive breastfeeding is the practice of feeding infants only on breast milk without any additional food or drink, even water, for the first six months of life.[1,2] Exclusive breastfeeding enhances the overall benefits of breast milk, which is widely recognized as the ideal form of nutrition for infants. The short and long-term health benefits of exclusive breastfeeding for infants and mothers have been well-reported These benefits include protection from infectious diseases, reduction in the risks of chronic diseases, diabetes, asthma, lymphoma, leukemia, Hodgkin’s disease, gastrointestinal tract infection, atopic eczema, and improvement in cognitive functioning.[4,5,6] Breast milk contains and provides all the nutrients an infant needs for healthy development; it is safe and rich in antibodies that protect infants from the two leading causes of child mortality namely pneumonia and diarrhea worldwide; and breast milk is readily available and affordable.[6,7] Optimal breastfeeding of all children aged 0-23 months could lead to an annual savings of about 800,000 under-five children’s lives around the world.[8] Exclusive breastfeeding has been associated with natural birth control for the first six months after birth, reduction in the risks of breast and ovarian cancers among mothers later in life, reduction in obesity rates, and faster return to their pre-pregnancy weights.[6]. Few studies have examined the long-term, cross-national, and population-level impacts of exclusive breastfeeding on major global child health indicators.We investigated the overall and independent associations between exclusive breastfeeding and under-five mortality in 57 low- and-middle-income countries

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Discussion

Conclusion