title: Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.
abstract: BACKGROUND
  The impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children's Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.
  
  
  METHODS
  The study used the most recent Demographic and Health Survey datasets collected in nine sub-Saharan African countries with high diarrhoea mortality, namely: Burkina Faso (2010, N = 9,733); Demographic Republic of Congo (2013; N = 10,458); Ethiopia (2013, N = 7,251); Kenya (2014, N = 14,034); Mali (2013, N = 6,365); Niger (2013, N = 7,235); Nigeria (2013, N = 18,539); Tanzania (2010, N = 5,013); and Uganda (2010, N = 4,472). Multilevel logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between infant feeding practices and diarrhoea in these nine African countries.
  
  
  RESULTS
  Diarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding. Early initiation of breastfeeding and exclusive breastfeeding were significantly associated with lower risk of diarrhoea (OR = 0.81; 95% confidence interval (CI): 0.77-0.85, P<0.001 and OR = 0.50; 95%CI: 0.43-0.57, respectively). In contrast, introduction of complementary foods (OR = 1.31; 95%CI: 1.14-1.50) and continued breastfeeding at one year (OR = 1.27; 95%CI: 1.05-1.55) were significantly associated with a higher risk of diarrhoea.
  
  
  CONCLUSIONS
  Early initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality. To reduce diarrhoea mortality and also achieve the health-related sustainable development goals in sub-Saharan African, an integrated, multi-agency strategic partnership within each country is needed to improve optimal infant feeding practices.
authors.affiliation: Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, New South Wales, Australia.|Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
authors.forename: Felix A
authors.initials: FA
authors.lastname: Ogbo
authors.affiliation: School of Science and Health, Western Sydney University, Campbelltown Campus, New South Wales, Australia.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Agho
authors.affiliation: Department of Public Health, College of Science, School of Public Health, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia.
authors.forename: Pascal
authors.initials: P
authors.lastname: Ogeleka
authors.affiliation: Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.|Department of Community Child Health/Integrated Care, Sydney Children's Hospital Network, Randwick, New South Wales, Australia.|School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, New South Wales, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Woolfenden
authors.affiliation: Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, New South Wales, Australia.|Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Page
authors.affiliation: Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.|School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, New South Wales, Australia.|Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, New South Wales, Australia.|School of Public Health, Griffith University, Gold Coast, Queensland, Australia.|Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, Croydon, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Eastwood
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001903:Bottle Feeding / Q000706:statistics & numerical data*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D003967:Diarrhea / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007225:Infant Food; D007226:Infant Mortality; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D055361:Multilevel Analysis; D015995:Prevalence; D055815:Young Adult