Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.

Felix A Ogbo,John Eastwood,Andrew Page,Kingsley Agho,Pascal Ogeleka,Sue Woolfenden,Umberto Simeoni

doi:10.1371/journal.pone.0171792

Abstract

BackgroundThe impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children’s Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.MethodThe study used the most recent Demographic and Health Survey datasets collected in nine sub-Saharan African countries with high diarrhoea mortality, namely: Burkina Faso (2010, N = 9,733); Demographic Republic of Congo (2013; N = 10,458); Ethiopia (2013, N = 7,251); Kenya (2014, N = 14,034); Mali (2013, N = 6,365); Niger (2013, N = 7,235); Nigeria (2013, N = 18,539); Tanzania (2010, N = 5,013); and Uganda (2010, N = 4,472). Multilevel logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between infant feeding practices and diarrhoea in these nine African countries.ResultsDiarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding. Early initiation of breastfeeding and exclusive breastfeeding were significantly associated with lower risk of diarrhoea (OR = 0.81; 95% confidence interval (CI): 0.77–0.85, P<0.001 and OR = 0.50; 95%CI: 0.43–0.57, respectively). In contrast, introduction of complementary foods (OR = 1.31; 95%CI: 1.14–1.50) and continued breastfeeding at one year (OR = 1.27; 95%CI: 1.05–1.55) were significantly associated with a higher risk of diarrhoea.ConclusionEarly initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality. To reduce diarrhoea mortality and also achieve the health-related sustainable development goals in sub-Saharan African, an integrated, multi-agency strategic partnership within each country is needed to improve optimal infant feeding practices.

Highlights

In the past three decades, the world has made significant improvements in child survival; these gains have been disproportionate between and within countries [1]
Diarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding
Initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality

Summary

Introduction

In the past three decades, the world has made significant improvements in child survival; these gains have been disproportionate between and within countries [1]. Despite significant investments in the prevention of diarrhoeal-related morbidity and mortality, diarrhoea remains one of the leading sources of under-5 mortality (U5M) worldwide, leading to more than 2,100 under-5 deaths daily [2] Of these deaths, more than three-quarters occur in the mostly poor and less developed countries of the world [3], 42% in sub-Saharan Africa [4]. An increasing number of studies have reported on the benefits of the breast milk and optimal breastfeeding practices for the mother-infant pair [6,7,8,9]. The impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children’s Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality

Objectives

Methods

Conclusion