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Review
. 2011 Apr 13;11 Suppl 3(Suppl 3):S15.
doi: 10.1186/1471-2458-11-S3-S15.

Breastfeeding and the risk for diarrhea morbidity and mortality

Laura M Lamberti  1 , Christa L Fischer Walker, Adi Noiman, Cesar Victora, Robert E Black
Affiliations
Review

Breastfeeding and the risk for diarrhea morbidity and mortality

Laura M Lamberti et al. BMC Public Health. .

Abstract

Background: Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness.

Methods: We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category.

Results: We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52) and to any breastfeeding among children aged 6-23 months (RR: 2.18).

Conclusions: Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.

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Figures

Figure 1
Figure 1
Synthesis of study identification in review process of the effects of suboptimal breastfeeding exposure on diarrhea incidence, prevalence, mortality, hospitalizations, and all-cause mortality
Figure 2
Figure 2
Forest plot for the effect of partial breastfeeding as compared to exclusive breastfeeding on diarrhea incidence among infants 0-5 months of age
Figure 3
Figure 3
Forest plot for the effect of not breastfeeding as compared to exclusive breastfeeding on diarrhea incidence among infants 0-5 months of age
Figure 4
Figure 4
Forest plot for the effect of not breastfeeding as compared to any breastfeeding on diarrhea incidence among infants 6-11 months of age
Figure 5
Figure 5
Forest plot for the effect of predominant breastfeeding as compared to exclusive breastfeeding on diarrhea mortality among infants 0-5 months of age
Figure 6
Figure 6
Forest plot for the effect of partial breastfeeding as compared to exclusive breastfeeding on diarrhea mortality among infants 0-5 months of age
Figure 7
Figure 7
Forest plot for the effect of not breastfeeding as compared to exclusive breastfeeding on diarrhea mortality among infants 0-5 months of age
Figure 8
Figure 8
Forest plot for the effect of not breastfeeding as compared to any breastfeeding on diarrhea mortality among infants 6-23 months of age
See this image and copyright information in PMC

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