Skip to main content Accessibility help
×
Home

Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment

  • Jeremy A Lauer (a1), Ana Pilar Betrán (a2), Aluísio JD Barros (a3) and Mercedes de Onís (a4)

Abstract

Objective

We estimate attributable fractions, deaths and years of life lost among infants and children ≤2 years of age due to suboptimal breast-feeding in developing countries.

Design

We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants ≤6 months of age and continued breast-feeding for older infants and children ≤2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding.

Setting

Developing countries.

Subjects

Infants and children ≤2 years of age.

Results

Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242 000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed.

Conclusions

The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author: Email lauerj@who.int

References

Hide All
1World Health Organization (WHO). The World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva: WHO, 2002.
2Black, RE, Morris, SS, Bryce, J. Where and why are 10 million children dying every year? Lancet 2003; 361: 2226–34.
3Jones, G, Steketee, RW, Black, RE, Bhutta, ZA, Morris, SS. How many child deaths can we prevent this year? Lancet 2003; 362: 6571.
4Ezzati, M, Lopez, AD, Rodgers, A, Vander Hoorn, S, Murray, CJ. Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347–60.
5Ezzati, M, Vander Hoorn, S, Rodgers, A, Lopez, AD, Mathers, CD, Murray, CJ. Estimates of global and regional potential health gains from reducing multiple major risk factors. Lancet 2003; 361: 271–80.
6Lauer, JA, Betrán, AP, Victora, CG, de Onis, M, Barros, AJ. Breastfeeding patterns and exposure to suboptimal breastfeeding among children in developing countries: review and analysis of nationally representative surveys. BMC Medicine 2004; 2: 26.
7WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 2000; 355: 451–5.
8Brown, KH, Black, RELopez de Romaña, G, Creed de Kanashiro, H. Infant feeding practices and their relationship with diarrhoeal and other diseases in Huascar (Lima), Peru. Pediatrics 1989; 83: 3140.
9Victora, CG, Vaughan, JP, Lombardi, C, Fuchs, SMC, Gigante, LP, Smith, PG, et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet 1987; 2: 319–22.
10Hanson, LA. Breast-feeding as a protection against gastroenteritis and other infections. Acta Paediatrica Scandinavica 1985; 74: 641–2.
11Arifeen, SE, Black, RE, Antelman, G, Baqui, AH, Caulfield, LE, Becker, S. Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums. Pediatrics 2001; 108: E67.
12Kramer, MS, Kakuma, R. The Optimal Duration of Exclusive Breastfeeding. A Systematic Review. WHO/NHD/01.08 Geneva: World Health Organization, 2002.
13World Health Organization (WHO). Infant and young child nutrition. Resolution WHA54.2, Fifty-fourth World Health Assembly. Geneva: WHO, 2001. Also available at http://www.who.int/gb/ebwha/pdf_files/WHA54/ea54r2.pdf. Accessed 4 December 2003.
14World Health Organization (WHO). The Optimal Duration of Exclusive Breastfeeding. Report of an Expert Consultation. WHO/NHD/01.09. Geneva: WHO, 2002, Geneva, 28–30 03 2001.
15World Health Organization (WHO). Global Strategy for Infant and Young Child Feeding. Geneva: WHO, 2003.
16Newell, ML. Prevention of mother-to-child transmission of HIV: challenges for the current decade. Bulletin of the World Health Organization 2001; 79: 1138–44.
17Murray, CJ, Ezzati, M, Lopez, AD, Rodgers, A, Vander Hoorn, S. Comparative quantification of health risks: conceptual framework and methodological issues. Population Health Metrics 2003; 1: 1.
18Rothman, KJ, Greenland, S. Modern Epidemiology. Philadelphia, PA: Lippincott Williams and Wilkins, 1998.
19Bradburn, MJ, Deeks, JJ, Altman, DG. Stata technical bulletin 44 (sbe24) [online], 8 01 2002. Available at http://www.stata.com/products/stb/journals/stb44.html. Accessed 4 December 2003.
20Yoon, PW, Black, RE, Moulton, LH, Becker, S. Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines. American Journal of Epidemiology 1996; 143: 1142–8.
21Hanson, LA, Ashraf, R, Karlber, J, Lindbland, BS, Jalil, F. Breast feeding is a natural contraceptive and prevents disease and death in infants, linking infant mortality and birth rates. Acta Paediatrica 1994; 83: 36.
22United Nations (UN). World Population Prospects. The 2000 Revision. New York: UN Department of Economic and Social Affairs, Population Division, 2001.
23Murray, CJ, Lopez, AD, Mathers, CD, Stein, S. The Global Burden of Disease 2000 Project: Aims, Methods and Data Sources. GPE Discussion Paper No. 36. Geneva: World Health Organization, 2001.
24Mathers, CD, Stein, S, Ma Fat, D, Rao, C, Inoue, M, Tomijima, N, et al. Global Burden of Disease 2000 : Version 2 Methods and Results. GPE Discussion Paper No. 50. Geneva: World Health Organization, 2002.
25World Health Organization (WHO). The World Health Report 2003. Shaping the Future. Geneva: WHO, 2003.
26Lopez, AD, Ahmad, OB, Guillot, M, Inoue, M, Ferguson, BD, Salomon, JA. Life Tables for 191 Countries for 2000: Data, Methods, Results. GPE Discussion Paper No. 40. Geneva: World Health Organization, 2001.
27Kirkwood, BR, Gove, S, Rogers, S, Lob-Levyt, J, Arthur, P, Campbell, H. Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review. Bulletin of the World Health Organization 1995; 73: 793–8.
28 United Nations Children's Fund. Information by country [online], 2003. Available at http://www.unicef.org/infobycountry/. Accessed 4 December 2003.
29Collaborative Group on AIDS Incubation and HIV Survival including the CASCADE EU Concerted Action. Time from HIV-1 seroconversion to AIDS and death before widespread use of highly-active antiretroviral therapy: a collaborative re-analysis. Lancet 2000; 355: 1131–7.
30Betrán, AP, de Onis, M, Lauer, JA, Villar, J. Ecological study of effects of breast feeding on infant mortality in Latin America. British Medical Journal 2001; 323: 303–6.
31Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L, Coovadia, HM. Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 1999; 354: 471–6.
32World Health Organization (WHO). Infant and Young Child Nutrition (Progress and Evaluation Report; and Status of Implementation of the International Code of Marketing of Breast-milk Substitutes): Report by the Director-General. Document EB/9317. Geneva: WHO, 2001.
33Walker, ARP, Adam, FI. Breast-feeding in sub-Saharan Africa: outlook for 2000. Public Health Nutrition 2000; 3: 285–92.
34Silfverdal, SA. Protective effect of breastfeeding on invasive Haemophilus influenzae infection: a case–control study in Swedish preschool children. International Journal of Epidemiology 1997; 26: 443–50.
35Levine, OS, Farley, M, Harrison, LH, Lefkowitz, L, McGeer, A, Schwartz, B. Risk factors for invasive pneumococcal disease in children: a population-based case–control study in North America. Pediatrics 1999; 103: E28.
36Nafstad, P. Breastfeeding, maternal smoking and lower respiratory tract infections. European Respiratory Journal 1996; 9: 2623–9.
37Morrow, AL, Guerrero, ML, Shults, J, Calva, JJ, Lutter, C, Bravo, J, et al. Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 1999; 353: 1226–31.
38Haider, R, Ashworth, A, Kabir, I, Huttly, SR. Effect of community-based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000; 356: 1643–7.
39Lutter, CK, Perez Escamilla, R, Segall, A, Sanghvi, T, Teruya, K, Wickham, C. The effectiveness of a hospital based program to promote exclusive breastfeeding among low income women in Brazil. American Journal of Public Health 1997; 87: 659–63.
40Sikorski, J, Renfrew, MJ, Pindoria, S, Wade, A. Support for breastfeeding mothers. Cochrane Database Syst Rev 2002; (1): CD001141.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed