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Abstract
Background: Countries in the Eastern Mediterranean region (EMR) are facing many challenges that hinder progress in reduction of mortality rates (MRs) and nutritional status of children under-five years of age (CU5). Hence there is a need to identify breastfeeding practices that can influence malnutrition and MRs in the region. Aim: To analyze regional data of malnutrition, mortality and breastfeeding practices in mothers and CU5 in the EMR countries. Methods: Data from regional surveys of WHO and UNICEF for nutritional status and MRs in the EMR countries were analyzed in total and by income group and correlated to breastfeeding practices including timely first suckle (TFS), exclusive breastfeeding (EBF), breastfeeding rates at 12 (BR12) and 24 months (BR24) and percent designated Baby-friendly hospitals (DBFH). MRs included neonatal mortality rates (NMR), infant mortality rates (IMR), under-five mortality rates (U5MR), maternal mortality ratio (MMR). Selected indicators for development included illiteracy rates and total fertility rates (TFR). Results: Practices of early initiation (TFS), EBF, and continuity of breastfeeding are low in the region. MRs correlated with percent DBFH, TFS, EBF. Also BF12 and BF24 months correlated with stunting, wasting in the CU5, U5MR and overweight and obesity in adults. MRs correlated highly with stunting and wasting and poorly with overweight or obesity in CU5. Other variables as illiteracy, TFR, obesity and overweight in adults correlated significantly with MRs and with breastfeeding duration. At country level the low trends of shortened breastfeeding duration were associated with the high MRs and malnutrition rates. Conclusion: Suboptimal early feeding practices, low EBF and declines in breastfeeding duration impact child growth and survival and are associated with high stunting, wasting, overweight and mortality in CU5. Indices of development as improving literacy, birth spacing and can also help improve survival of children and mothers in the region.
Highlights
It is estimated that around 5.6 million children under-five years of age died in 2016
Our study demonstrated correlations between breastfeeding practices and mortality which were significant when analyzed by income group, being highest among Lowincome countries (LIC) between timely first suckle (TFS) and neonatal mortality rates (NMR) [r-0.6] and for exclusive breastfeeding (EBF) with NMR, infant mortality rates (IMR) and U5MR in High income countries (HIC) at P
In this study we found that TFS and EBF showed some degree of correlation with U5MR that was not statistically significant [P>0.05]
Summary
It is estimated that around 5.6 million children under-five years of age died in 2016. Malnutrition, which is a consequence of poor nutrition and repeated infections, is the underlying cause of death in around one third of all deaths among these children of which one half can be averted by optimal breastfeeding practices [1]. These include exclusive breastfeeding for six months and continued breastfeeding for two years. Promoting, protecting and supporting breastfeeding through the Baby-friendly Hospital Initiative (BFHI) is a global initiative lead by UNICEF and WHO in 1991 [3] and updated in 2009 [4] and again in 2017 [5] and aims at improving exclusive breastfeeding rates by implementing the Ten steps to successful initiation and continuation of breastfeeding. There is a need to identify breastfeeding practices that can influence malnutrition and MRs in the region
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