Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2011 Apr 13;11 Suppl 3(Suppl 3):S15. doi: 10.1186/1471-2458-11-S3-S15.
Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness.
We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category.
We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52) and to any breastfeeding among children aged 6-23 months (RR: 2.18).
Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.
0-5 月龄婴儿纯母乳喂养不足和 6-23 月龄儿童母乳喂养不足与发展中国家腹泻发病率和死亡率升高有关。我们评估了不同程度的母乳喂养暴露对腹泻发病率、腹泻患病率、腹泻死亡率、全因死亡率和腹泻病住院率的保护作用。
我们系统地回顾了 1980 年至 2009 年发表的所有评估次优母乳喂养作为特定腹泻发病率和死亡率结局危险因素的文献。我们进行了随机效应荟萃分析，根据结局和年龄类别生成汇总相对风险。
我们发现了大量证据表明母乳喂养对腹泻发病率、患病率、住院、腹泻死亡率和全因死亡率具有保护作用。对 18 项纳入研究的随机效应荟萃分析结果表明，母乳喂养暴露程度存在不同程度的保护作用，0-5 月龄婴儿纯母乳喂养和 6-23 月龄婴儿和幼儿任何形式母乳喂养的保护作用最大。具体而言，与 0-5 月龄婴儿纯母乳喂养相比，不母乳喂养导致腹泻死亡率增加（RR：10.52），与 6-23 月龄儿童任何形式母乳喂养相比，不母乳喂养导致腹泻死亡率增加（RR：2.18）。
我们的发现支持目前世卫组织关于在生命最初 6 个月内进行纯母乳喂养的建议，这是一项关键的儿童生存干预措施。我们的发现还强调了母乳喂养在保护生命最初 2 年免受腹泻相关发病率和死亡率的重要性。
