Breast-feeding in a complex emergency: four linked cross-sectional studies during the Bosnian conflict

Abstract

Objective: To examine changes in breast-feeding and impacts on child health during the Bosnian conflict.

Design: Four linked representative cross-sectional household surveys, 1994 to 1997.

Setting: The countries of former Yugoslavia largely missed the international wave of enthusiasm for breast-feeding of the 1980s and early 1990s. The concern is that breast-feeding deteriorates during humanitarian emergencies, when children need it most.

Subjects: The four surveys visited a random sample of clusters from population registers in the Federation of Bosnia and Herzegovina (BiH) and the Republica Srpska (RS). Interviewers asked about breast-feeding and other factors related to child health, and measured mid upper-arm circumference in 1123 infants aged 1-12 months.

Results: One-fifth of infants were not breast-fed at all (220/1087). Muslim and displaced children were less likely to breast-feed; 59 % of Muslim displaced children never breast-fed. Among infants in sites visited by all four surveys, there was no change in the proportion ever breast-fed and a significant increase in duration of breast-feeding and exclusive breast-feeding between 1994 and 1997. Children were breast-fed for shorter durations in male absent households, in frontline communities, the RS, and households that did not receive remittances from abroad. Non-breast-fed children and those who breast-fed for less than 4 months were more likely to be malnourished, as were those with complementary foods added either before or after their sixth month of life.

Conclusions: If relief agencies had promoted and supported breast-feeding, this might have avoided some of the increased malnutrition that occurred during the conflict.