Prolonged breastfeeding in Bangladesh: indicators of inadequate feeding practices or mothers' response to children's poor health?

Abstract

The association between breastfeeding and diarrhoeal morbidity was examined in a prevalence study of 5502 children aged 6-71 months from rural and urban Bangladesh. Breastfeeding was found to be associated with reduced prevalence of diarrhoea. This association was most pronounced at the age of six months and declined linearly to zero at approximately 30 months of age; thereafter, breastfeeding was increasingly associated with diarrhoeal illness. The linear association was found only among those children who have no access to modern health services and information, when controlling for urban and rural differences. The literature provides two opposing explanations for the positive association of prolonged breastfeeding with diarrhoeal illness. The first explanation suggests that breastfeeding can be seen as mothers' response to children's poor health. The second explanation incriminates sub-optimal child feeding practices, characterised by prolonged breastfeeding and inadequate quality and quantity of complementary foods, as the cause of malnutrition and diarrhoea. Further studies are needed to identify which explanation is correct, given the public health implications in terms of children's survival, growth and development.

PIP: The importance of breast-feeding in preventing and treating diarrheal diseases during infancy is well documented. The association between breast-feeding and diarrheal morbidity was investigated in a study of 5502 children aged 6-71 months from rural and urban Bangladesh. 88.2% of the 740 infants aged 6-11 months were breast-fed, as well as 82.6% of the 946 aged 12-23 months, 44.6% of the 980 aged 24-35 months, 13.9% of the 999 aged 36-47 months, 6.2% of the 788 aged 48-59 months, and 3.5% of the 806 aged 60-71 months. Breast-feeding was found to be associated with reduced prevalence of diarrhea, with the association most pronounced at age 6 months and declining linearly to zero at approximately age 30 months. Thereafter, breast-feeding was increasingly associated with diarrheal illness in the child. The linear association was found only among children who had no access to modern health services and information, when controlling for urban and rural differences. One explanation proposed in the literature for the positive association of prolonged breast-feeding with diarrheal illness is that breast-feeding can be seen as mothers' response to children's poor health. A second possible explanation cites sub-optimal child feeding practices, characterized by prolonged breast-feeding and inadequate quality and quantity of complementary foods, as the cause of malnutrition and diarrhea. Further study is needed to identify which explanation is correct.