EFFECT OF BREASTFEEDING PRACTICES ON INFANT AND CHILD MORTALITY IN AFRICA: SYSTEMATIC REVIEW AND META ANALYSIS

Objective: Lack of exclusive breastfeeding for infants withi the age of 0 and 6 months and no breastfeeding for children aged 6 to 24 months is linked to increased odds of death before the second birthday. Infant mortality in these age groups is due to bot infectious and non-infectious causes. We examine the existing evidence for impact of proper breast- feeding on all-cause mortality in children aged 0 to 24 months in Africa.

Methods: We carried out a systematic search of the literature to examine the influence of other breastfeeding practices versus EBF on mortality rates in the initial 180 days post birth and the effect of no breastfeeding versus any breastfeeding type on mortal- ity rates between 6 and 24 months post birth. We Performed our search in the PubMed and Cochrane Library databases. Data obtained was analyzed used the Generic Inverse Variance Method using the R Software, and heterogeneity was assessed using forest plots.

Results: The pooled effect size (Odds Ratios) for the difference in mortality between infants who were predominantly breastfed vs those that were fed on breast-milk alone was found to be 1.15, 95% CI [1.05; 1.27]. This implies that predominantly breastfed children were 15% more likely to die between the months of 0-6 compared to children who were fed on breast-milk alone. Compared to infants who were fed solely on breast-milk, infants that were not breastfed were 9.64 times more likely to die (OR = 9.64 95% CI [8.01; 11.62], Three studies). Compared to infants between the ages of 6-23 months who got any form of breastfeeding, infants who never received any breast-milk were 3.19 times more likely to die (OR = 3.19 95% CI [1.42; 7.15] Five studies).

Conclusion: The findings from our study are consistent with previous research on the protective ability of proper breastfeeding habits on infant and child mortality. They sup- port the WHO recommended practices of EBF for the half an year and continued/partial breastfeeding up to the second birthday as key interventions in reducing infant and child deaths in these age groups.

  

 

 

 

 

Infant mortality remains a critical area of concern as far as children health and survival is concerned in Africa. The death of babies before their second birthday continues to be a challenge not only in Kenya but in other developing and under developed nations in Africa. According to UNICEF’s latest child mortality report published in September 2020, an estimated 2.6 million children whose age is below 5 years died in 2019 in the African region. Additionally, it is important to note infant deaths account for approximately 70% of the total under-5-mortality (UNICEF, 2021). The Sub-Saharan Region, made up of 44 nations located south of the Sahara Desert, accounted for over 90% of all the total deaths in Africa in 2019 (UNICEF, 2021). Statistics released by the World Bank further revealed that the mortality rate in Africa was 76 deaths per 1000 live births and the highest as compared to other regions in the world (World Bank, 2021). Other regions had much lower rates with Europe and Central Asia at 8 and North America at 6 while North Africa and Middle East was at 22 per 1000 births.

Under-2-Mortality in Africa is fueled by various causes among them transmiNable and non-transmiNable diseases. According to WHO, the major causes of infant and child mortality in Africa are Pneumonia, Malaria, Diarrhea and Pre-term birth complications. Data obtained from the WHO website shows that Pneumonia accounted for 16% of the total deaths in 2016 while Diarrhea and Malaria accounted for 20% of total deaths in children whose age is below two years of age. It is important to note that 45% of all U2M in Africa is aNributed to malnutrition as an underlying factor as revealed in a study conducted in South Africa (Itaka & Omole, 2020). The neonatal period which is a critical phase that determines survival rate has also in the past had a high mortality rate of 28 deaths per 1000 live births and main cause been Neonatal Sepsis and birth complications. These facts point to the conclusion that majority of deaths in children under the age of 2 are caused by Infectious diseases which are preventable.

 

The WHO has in the past and continually put great emphasis on the need for all nations in the WHO African region to cooperate in lowering the high ICMR in Africa. The health watchdog recommends many interventions that if properly practiced can significantly reduce U2M. One of such interventions is optimal infant feeding practices as well as adherence to laid out vaccination schedules. WHO continually gives and updates guide- lines on the optimal breastfeeding habits for babies under the age of 2 years. The different breastfeeding categories are defined as below:

Additionally, the WHO recommends optimal breastfeeding practices that can boost im- munity among infants and children under 2. These practices are initiation to breastfeed- ing before the lapse of the initial 60 minutes post birth and feeding on breast milk alone until the baby turns 6 months old (WHO, 2009). Further, mothers are advised to prac- tice complementary feeding and continued breastfeeding up to the age of 2 years for maximum immunity against childhood diseases (WHO, 2009).

The recommendations on optimal infant feeding habits by WHO are based on scien- tific research conducted in Africa and other continents linking proper breastfeeding and reduced infant mortality rates. Numerous studies have pointed to the importance of breastfeeding in boosting infant’s immunity and thus bringing down the ICMR .Timely initiation to breastfeeding has been found to increase the odds of survival for babies un- der the age of 2 according to findings from a study by Neovita Group (Group et al., 2016). Further findings have revealed that optimal breastfeeding has a protective ability against Diarrhea which is among the top causes of U2M in Africa (Ogbo et al., 2017).

 

Three more studies based in Africa have determined that the WHO breastfeeding prac- tices have protective effects against ARIs including pneumonia and Bronchiolitis (Shi et al., 2015; Ahmed et al., 2020; Troeger et al., 2017). These, amongst many other studies, highlight the significance of breastfeeding in reducing infant deaths among many other key factors.

The present study will pool results from all eligible studies and come up with more robust effect estimates that can be confidently relied upon in implementing the WHO recom- mended infant feeding practices.

To assess the evidence for the effect of breastfeeding practices on infant mortality from all causes

The link between breastfeeding and child mortality has been widely researched in Africa. This fact implies that there are many individual researches that have investigated and reported the impact of optimal breastfeeding practices and the risk of death under infants and children aged 2 years and below. Each of these studies employs a unique study design to generate results, unique sample size and different age groups are assessed for each study. For instance, Zhao et al. (2020) uses secondary data from DHS and a sample size of 215,000 participants in assessing the impact breastfeeding has on IMR within the within the initial 180 days of life (Zhao et al., 2020). A different research carried out in Ethiopia in 2020 used a prosperity matching concept and a sample size of 4,000 participants to assess the impact of breastfeeding practices on ICMR from ARIs and Di- arrhea Ahmed et al. (2020). Several other reviews and analyses investigated the effect of best breast-feeding practices on mortality from Malaria, obesity and malnutrition related complications across Africa.

The already existing research on this subject is wide yet diverse with regards to methods, cause of mortality, sample sizes and breastfeeding categories assessed. In order to be able to draw more robust conclusions on the subject, our present study pools results from the different studies that meet our eligibility criteria. Some of the main advantages of a SRMA is increased precision as the pooled result is obtained from more studies and provide more convincing evidence (Deeks et al., 2019). Further, our SRMA will provide a solid base upon which recommendations based on the results can be relied upon. According to Wao et al in their detailed book chapter on the rationale and methods of conducting SRMA, the health sector requires recommendations based on precision and high level reliability which is achieved through SRMA (Wao et al., 2017). The other reason why this study is important is because despite having many SRMAs on the subject, none has focused solely on studies performed within the African Continent.