Association of breast feeding and birth interval with child mortality in Pakistan: a cross-sectional study using
Rafi Amir-Ud-Din1, Hafiz Zahid Mahmood1, Faisal Abbas2
1Department of Economics, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan.
Insights
Breastfeeding (BF) and optimal birth intervals (BI) significantly reduce neonatal mortality (NM), infant mortality (IM), and under-5 mortality (U5M). These cost-effective interventions are crucial for child survival in Pakistan.
Area of Science:
- Public Health
- Pediatrics
- Demography
Background:
- Child mortality remains a significant global health challenge.
- Breastfeeding (BF) and birth intervals (BI) are recognized as key determinants of child survival.
Purpose of the Study:
- To analyze the association between breastfeeding (BF) and birth interval (BI) with neonatal mortality (NM), infant mortality (IM), and under-5 mortality (U5M) in Pakistan.
Main Methods:
- Cross-sectional study utilizing data from the Pakistan Demographic and Health Survey (2017-2018).
- Multivariate logistic regression analysis was employed.
- Inclusion of 12,769 children born to multiparous women aged 30-49 years.
Main Results:
- Breastfeeding (BF) was associated with a significant reduction in NM (98%), IM (96%), and U5M (94%).
- Short preceding birth intervals (PBI <18 months) were linked to increased risks of NM (6x), IM (5x), and U5M (5x) compared to optimal intervals (36+ months).
- Protective effects of BF and risks associated with short PBI were observed across various child gender, residence, and maternal occupation subgroups.
Conclusions:
- Breastfeeding (BF) and optimal birth intervals (BI) are consistent protective factors against neonatal, infant, and under-5 mortality.
- Optimal BF and BI represent the most cost-effective interventions to reduce child mortality in resource-constrained settings like Pakistan.
Objectives:
This study analysed the association between breast feeding (BF) and birth interval (BI) (both succeeding and preceding) with neonatal mortality (NM), infant mortality (IM) and under-5 mortality (U5M).
Design:
This cross-sectional study used data from the Pakistan Demographic and Health Survey 2017-2018.
Settings:
All provinces, Islamabad and Federally Administered Tribal Areas were included in the analysis.
Participants:
A total of 12 769 children born to ever-married multiparous women aged 30-49 years who gave live birth within 5 years preceding the interview. Multiple births are not included.
Data Analysis:
Multivariate logistic regression analysis was used.
Results:
We found that BF was associated with nearly 98% lower risk of NM (OR 0.015; 95% CI: 0.01 to 0.03; p<0.001), 96% lower risk of IM (OR 0.038; 95% CI: 0.02 to 0.06; p<0.001) and 94% lower risk of U5M (OR 0.050; 95% CI: 0.03 to 0.08; p<0.001). Compared with optimal preceding birth interval (PBI) (36+ months), short PBI (<18 months) was associated with around six times higher risk of NM (OR 5.661; 95% CI: 2.78 to 11.53; p<0.001), over five times risk of IM (OR 4.704; 95% CI: 2.70 to 8.19; p<0.001) and over five times risk of U5M (OR 4.745; 95% CI: 2.79 to 8.07; p<0.001). Disaggregating the data by child's gender, place of residence and mother's occupational status showed that being ever breast fed was associated with a smaller risk of NM, IM and U5M in all three disaggregations. However, the risk of smaller PBI <18 months was generally more pronounced in female children (NM and U5M) or when the children lived in rural areas (NM, IM and U5M). PBI <18 months was associated with greater risk of NM and IM, and smaller risk of U5M when mothers did a paid job.
Conclusion:
This study's significance lies in the fact that it has found BF and BI to be consistent protective factors against NM, IM and U5M. Given Pakistan's economic constraints, optimal BF and BI are the most cost-effective interventions to reduce child mortality.
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