The role of breastfeeding, antibiotics and antimalarial medicinal exposure in paediatric depression amongst children aged under 5: a population-based study

Abstract

Background: Although paediatric depression is a recognised problem worldwide, there is limited data on its prevalence in children aged under 5 years, and the role of breastfeeding and medicinal exposure. This study examined whether lack of breastfeeding, and exposure to antimalarial and antibiotic medicines, contribute to depression in Nigerian children aged under 5.

Methods: The study examined data from 31,103 children (mean age, 2.11 years (SD, 1.421)), collected during the 6th round of the MICS (Multiple Indicator Cluster Surveys), completed in 2021. A series of binary logistic regression models were used to analyse the data.

Results: Children exposed to antimalarial medicines, specifically ACT (AOR = 1.760, 95%CI [1.316-2.355]), and artesunate injections (AOR = 1.757, 95%CI [1.150-2.684]), and those who were not breastfed (AOR = 0.776, 95%CI [0.625-0.963]), had greater odds of depression, after adjusting for potential confounders. The association between ACT medication use and depression was salient in male children (AOR = 2.347, 95%CI [1.547-3.559]), whereas the relationship between breastfeeding and depression was primarily observed in female children (AOR = 0.689, 95%CI [0.498-0.951]). Robustness checks including variations in managing missing data, breastfeeding measurement, and analysis across subgroups for multiple covariates (e.g., geographical area, mothers' education, wealth index, medical symptoms), highlighted the importance of contextual factors.

Conclusions: This is the first population-based study to examine the role of breastfeeding and medicinal use in suspected depression amongst children aged under 5, from sub-Sharan Africa. Overall, exposure to antimalaria treatment, particularly ACT, and inadequate breastfeeding may help identify young children susceptible to paediatric depression.

Clinical trial number: Not applicable.