Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines

Abstract

The effects of not breastfeeding on mortality due to diarrhea and acute lower respiratory infection (ALRI) in children under 2 years of age were examined using data from a 1988-1991 longitudinal study of 9,942 children in Metro Cebu, The Philippines. Cox regression methods were used to study the magnitude of the risks, possible interactions with birth weight and nutritional status, and the effect of additional confounding factors. Not breastfeeding had a greater effect on diarrheal mortality than on ALRI mortality. In the first 6 months of life, failing to initiate breastfeeding or ceasing to breastfeed resulted in an 8- to 10-fold increase in the rate of diarrheal mortality. The rate of mortality associated with both ALRI and diarrhea was increased nearly six times by not breastfeeding, but the rate of ALRI mortality alone was not increased. The data also suggested that the risk of mortality associated with not breastfeeding was greater for low birth weight infants and infants whose mothers had little formal education. After age 6 months, the protective effects of breastfeeding dropped dramatically. These findings underscore the importance of promoting breastfeeding, especially during the first 6 months of life, and of targeting high risk groups such as low birth weight babies and those of low socioeconomic status.

PIP: The effects of not breastfeeding upon mortality due to diarrhea and acute lower respiratory infection (ALRI) in children under age two years were examined using data from a 1988-91 longitudinal study of 9942 children in Metro Cebu, Philippines. Cox regression methods were used to study the magnitude of the risks, possible interactions with birth weight and nutritional status, and the effect of any additional confounding factors. Not breastfeeding was found to have a greater effect upon diarrheal mortality than upon ALRI mortality. Specifically, failing to initiate breastfeeding or ceasing to breastfeed during an infant's first six months of life resulted in an 8-10-fold increase in the rate of diarrheal mortality. The rate of mortality associated with both ALRI and diarrhea was increased almost six times by not breastfeeding, but the rate of ALRI mortality alone was not increased. The data also suggest that the risk of mortality associated with no breastfeeding was greater for low-birth-weight infants and infants whose mothers had little formal education. After age six months, the protective effects of breastfeeding dropped dramatically. The authors note how these findings highlight the importance of promoting breastfeeding, especially during the first six months of life, and of targeting high-risk groups such as low-birth-weight babies and those of low socioeconomic status.