Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: a global ecological risk assessment.
OBJECTIVE
We estimate attributable fractions, deaths and years of life lost among infants and children < or = 2 years of age due to suboptimal breast-feeding in developing countries.


METHODS
We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants < or = 6 months of age and continued breast-feeding for older infants and children < or = 2 years of age. For infants, we consider deaths due to diarrhoeal disease and lower respiratory tract infections, and deaths due to all causes are considered in the second year of life. Outcome measures are attributable fractions, deaths, years of life lost and offsetting deaths potentially caused by mother-to-child transmission of HIV through breast-feeding.


METHODS
Developing countries.


METHODS
Infants and children < or = 2 years of age.


RESULTS
Attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life. Globally, as many as 1.45 million lives (117 million years of life) are lost due to suboptimal breast-feeding in developing countries. Offsetting deaths caused by mother-to-child transmission of HIV through breast-feeding could be as high as 242,000 (18.8 million years of life lost) if relevant World Health Organization recommendations are not followed.


CONCLUSIONS
The size of the gap between current practice and recommendations is striking when one considers breast-feeding involves no out-of-pocket costs, that there exists universal consensus on best practices, and that implementing current international recommendations could potentially save 1.45 million children's lives each year.
Lauer
Jeremy A
JA
Department of Making Pregnancy Safer, World Health Organization, Geneva, Switzerland. laueerj@who.int
Betrán
Ana Pilar
AP
Barros
Aluísio J D
AJ
de Onís
Mercedes
M
D001942:Breast Feeding / Q000453:epidemiology / Q000706:statistics & numerical data*; D002423:Cause of Death; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D014943:Global Health; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008297:Male; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors