Abstract
Abstract Objectives: to estimate the population attributable fraction of preventable infant mortality rates due to changes in breastfeeding (BF) indicators attributable to the Baby Friendly Hospital Initiative (BFHI). Methods: an estimate on the impact of BFHI in reducing infant mortality with an inferential level of plausibility, using secondary data from the II Breastfeeding Prevalence Survey of 2008. Initially, the effect of BFHI on breastfeeding in the first hour of life, exclusive breastfeeding, and any breastfeeding based on the prevalence of the outcomes among infants born in BFHI or non-BFHI was calculated. Second, the population attributable fraction of nonbreastfeeding was estimated for late neonatal mortality, mortality by all causes and infant mortality by infections, for BFHI and non-BFHI, and the number of potentially avoidable deaths if all children were born in BFH. Results: reduction of 4.2% of late neonatal deaths due to the increase in BF prevalence in the first hour, as provided by BFHI. BFHI potentially contributed with 3.5% of all-cause deaths and 4.2% of deaths from infection by BF promotion in infants below 6 months. Conclusions: the reduction of mortality in children between 7 and 180 days in 2008 potentially attributable to BFHI through the promotion of BF indicators reinforces the importance of strengthening and expanding this initiative in Brazil to ultimately enhance child survival.
Highlights
From 1990 to 2016, while infant mortality rate decreased by 52.3% worldwide, it decreased 73.6% in Brazil, reducing from 53 to 14 infant deaths per 1,000 live births
Breastfeeding rates among children who were born in a Baby-Friendly Hospital (BFH) (34.1% of 18,929 children under 6 months of age) were significantly higher in all indicators in the sample obtained from the II Breastfeeding Prevalence Survey (II BFPS) data
There was an increase of 11.7%, 7.9% and 2.1% for breastfeeding in the first hour of life (BFFHL), Exclusive breastfeeding (EBF) and any breastfeeding (ABF), respectively, for those who were born in a BFH
Summary
From 1990 to 2016, while infant mortality rate decreased by 52.3% worldwide, it decreased 73.6% in Brazil, reducing from 53 to 14 infant deaths per 1,000 live births. As it is a strong indicator of the living conditions and health inequities of a population, it remains to be regarded as a Public Health concern. Breastfeeding stands out as the single most effective practice among factors that help to reduce infant mortality, with the potential to prevent 823,000 deaths each year in children under five years of age worldwide, in addition to reducing the risk of acute and chronic diseases and promoting child growth and development; this effect is enhanced when breastfeeding starts within the first hour after birth and exclusively practiced in the first 6 months of life.[2,3,4,5,6] Data from studies conducted in São Paulo on breastfeeding impact on infant mortality estimated mortality rates that could be avoided by breastfeeding exceeded 60% for respiratory infection.[7]
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