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Mohammed S, Calvert C, O Mugisha J, Ronald M, Asiki G, R Glynn J, Oakley LL, Marston M. Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study. Glob Health Action 2024; 17:2338023. [PMID: 38652548 PMCID: PMC11041517 DOI: 10.1080/16549716.2024.2338023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. OBJECTIVE This study investigated the association between breastfeeding duration and children's educational attainment in rural Southwest Uganda. METHODS We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. RESULTS Most mothers breastfed for more than a year. Just over one-third breastfed for 18-23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7-12, 13-17, 18-23, and > 23 months compared to those breastfed for 0-6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. CONCLUSION Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children's health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Makanga Ronald
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Gershim Asiki
- African Population and Health Research Center (APHRC), Nairobi, Uganda
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Grevet LT, Teixeira DS, Pan PM, Jackowski AP, Zugman A, Miguel EC, Rohde LA, Salum GA. The association between duration of breastfeeding and the trajectory of brain development from childhood to young adulthood: an 8-year longitudinal study. Eur Child Adolesc Psychiatry 2024; 33:1863-1873. [PMID: 37650992 DOI: 10.1007/s00787-023-02283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
Breastfeeding has been associated with several short- and long-term health benefits, including positive cognitive and behavioral outcomes. However, the impact of breastfeeding on structural brain development over time remains unclear. We aimed to assess the association between breastfeeding duration in childhood and the developmental trajectory of overall cortical thickness, cortical area, and total intracranial volume during the transition from childhood to early adulthood. Participants included 670 children and adolescents with 1326 MRI scans acquired over 8 years from the Brazilian High-Risk Cohort for Mental Conditions (BHRCS). Breastfeeding was assessed using a questionnaire answered by the parents. Brain measures were estimated using MRI T1-weighted images at three time points, with 3-year intervals. Data were evaluated using generalized additive models adjusted for multiple confounders. We found that a longer breastfeeding duration was directly associated with higher global cortical thickness in the left (edf = 1.0, F = 6.07, p = 0.01) and right (edf = 1.0, F = 4.70, p = 0.03) hemispheres. For the total intracranial volume, we found an interaction between duration of breastfeeding and developmental stage (edf = 1.0, F = 6.81, p = 0.009). No association was found between breastfeeding duration and brain area. Our study suggests that the duration of breastfeeding impacts overall cortical thickness and the development of total brain volume, but not area. This study adds to the evidence on the potential impact of breastfeeding on brain development and provides relevant insights into the mechanisms by which breastfeeding might confer cognitive and mental health benefits.
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Affiliation(s)
- Laura Tietzmann Grevet
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), School of Medicine, Avenida Ipiranga, 6681-Partenon, Porto Alegre, Rio Grande do Sul, 90619-900, Brazil.
| | - Danielle Soares Teixeira
- Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Pedro Mario Pan
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), Iterdisciplinary Lab for Clinical Neurosciences (LiNC), São Paulo, SP, Brazil
| | - Andrea Parolin Jackowski
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), Iterdisciplinary Lab for Clinical Neurosciences (LiNC), São Paulo, SP, Brazil
| | - André Zugman
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Universidade Federal de São Paulo (UNIFESP), Iterdisciplinary Lab for Clinical Neurosciences (LiNC), São Paulo, SP, Brazil
| | - Euripedes Constantino Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Department and Institute of Psychiatry, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Luis Augusto Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- ADHD Outpatient Program and Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Giovanni Abrahão Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INCT-CNPq), São Paulo, SP, Brazil
- Child Mind Institute, New York, NY, USA
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Pereyra-Elías R, Carson C, Quigley MA. Association between breastfeeding duration and educational achievement in England: results from the Millennium Cohort Study. Arch Dis Child 2023; 108:665-672. [PMID: 37277226 PMCID: PMC10423478 DOI: 10.1136/archdischild-2022-325148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/29/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the association between breastfeeding duration and educational outcomes at the end of secondary education among children from the Millennium Cohort Study. DESIGN Cohort study comparing school results at age 16 according to breastfeeding duration. SETTING England. PARTICIPANTS Children born in 2000-2002 (nationally representative sample). EXPOSURE Self-reported breastfeeding duration (categorised). MAIN OUTCOME MEASURES Standardised school assessments taken at the end of secondary education (General Certificate of Secondary Education (GCSEs), marked 9-1) in English and Mathematics, categorised as: 'fail, marks <4', 'low pass, marks 4-6' and 'high pass, marks ≥7 (equivalent to A-A*)'. Additionally, overall achievement was measured using the 'attainment 8' score (adding the marks of eight GCSEs, English and Mathematics double weighted; 0-90). RESULTS Approximately 5000 children were included. Longer breastfeeding was associated with better educational outcomes. For example, after full adjustment for socioeconomic markers and maternal cognitive ability, in comparison with children who were never breastfed, those who were breastfed for longer were more likely to have a high pass in their English and Mathematics GCSEs, and less likely to fail the English GCSE (but not the Mathematics GCSE). Additionally, compared with those never breastfed, those breastfed for at least 4 months had, on average, a 2-3 point higher attainment 8 score (coefficients: 2.10, 95% CI 0.06 to 4.14 at 4-6 months; 2.56, 95% CI 0.65 to 4.47 at 6-12 months and 3.09, 95% CI 0.84 to 5.35 at ≥12 months). CONCLUSIONS A longer breastfeeding duration was associated with modest improvements in educational outcomes at age 16, after controlling for important confounders.
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Affiliation(s)
- Reneé Pereyra-Elías
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Mohammed S, Webb EL, Calvert C, Glynn JR, Sunny BS, Crampin AC, McLean E, Munthali-Mkandawire S, Lazarous Nkhata Dube A, Kalobekamo F, Marston M, Oakley LL. Effects of exclusive breastfeeding on educational attainment and longitudinal trajectories of grade progression among children in a 13-year follow-up study in Malawi. Sci Rep 2023; 13:11413. [PMID: 37452129 PMCID: PMC10349128 DOI: 10.1038/s41598-023-38455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023] Open
Abstract
The benefits of exclusive breastfeeding (EBF) for infant health and survival are well documented. However, its impact on educational outcomes has been contested and poorly researched in Africa. It has been hypothesised that positive associations reported in high-income countries can be attributed to residual confounding by socioeconomic status (SES). Our study investigated whether EBF duration in infancy is associated with educational attainment and age-for-grade attainment trajectories at school-age in rural Malawi. Longitudinal data on 1021 children at the Karonga demographic surveillance site in Malawi were analysed. Breastfeeding data were collected 3 months after birth and again at age one. The school grade of each child was recorded each year from age 6 until age 13. We calculated age-for-grade based on whether a child was at, over, or under the official expected age for a grade. Generalised estimating equations estimated the average effect of breastfeeding on age-for-grade. Latent class growth analysis identified age-for-grade trajectories, and multinomial logistic regression examined their associations with EBF. Maternal-child characteristics, SES, and HIV status were controlled. Overall, 35.9% of the children were exclusively breastfed for 6 months. Over-age for grade steadily increased from 9.6% at age 8 to 41.9% at age 13. There was some evidence that EBF for 6 months was associated with lower odds of being over-age for grade than EBF for less than 3 months (aOR = 0.82, 95%CI = 0.64-1.06). In subgroup analyses, children exclusively breastfed for 6 months in infancy were less likely to be over-age for grades between ages 6-9 (aOR = 0.64, 95%CI = 0.43-0.94). Latent class growth analysis also provided some evidence that EBF reduced the odds of falling behind in the early school grades (aOR = 0.66, 95%CI = 0.41-1.08) but not later. Our study adds to the growing evidence that EBF for 6 months has benefits beyond infant health and survival, supporting the WHO's recommendation on EBF.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Bindu S Sunny
- United Nations Educational, Scientific and Cultural Organization, Paris, France
| | - Amelia C Crampin
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Estelle McLean
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | | | | | | | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Mohammed S, Oakley LL, Marston M, Glynn JR, Calvert C. The association of breastfeeding with cognitive development and educational achievement in sub-Saharan Africa: A systematic review. J Glob Health 2022; 12:04071. [PMID: 36057881 PMCID: PMC9441109 DOI: 10.7189/jogh.12.04071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Systematic reviews and meta-analyses of studies mainly from high-income countries suggest that breastfeeding improves cognitive function and educational achievement. However, these associations may be a manifestation of who breastfeeds in these settings rather than an actual effect of breastfeeding. We investigated the association of breastfeeding with cognitive development and educational achievements in sub-Saharan Africa, where breastfeeding is the norm, and socioeconomic status is not strongly correlated with ever breastfeeding. Methods We searched Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), and Africa-Wide Information in January 2021 for studies that assessed the cognitive and educational benefits of breastfeeding in children and adolescents in sub-Saharan Africa. Two reviewers independently screened, extracted, and critically appraised the included studies. Results After reviewing 5552 abstracts and 151 full-text articles, seventeen studies on cognitive development and two on educational achievements met our predefined inclusion criteria. The included studies were from ten sub-Saharan African countries and published between 2013 and 2021, with sample sizes ranging from 54 to 6573. Most of the studies (n = 14) were prospective cohort studies, but only nine collected data on breastfeeding prospectively. The studies differed in analytic approaches and cognitive and educational achievements measurements. Of the 17 studies on cognitive development, only four adjusted sufficiently for key confounders. None of these four studies found an overall association between breastfeeding and cognitive development in children or adolescents in sub-Saharan Africa. The two studies on education measured achievements based on the highest grade of school attained, 12 or more years of education, or grade repetition at age 7-11 years. Both studies adjusted for a range of sociodemographic factors and found no evidence that children exclusively breastfed or breastfed for a longer duration have a better educational outcome than sub-optimally breastfed children. Conclusions The current evidence from sub-Saharan Africa is limited but does not corroborate previous findings that breastfeeding is associated with improved cognitive development and educational achievement. Registration This study is registered with PROSPERO, CRD42021236009.
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Affiliation(s)
- Shamsudeen Mohammed
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura L Oakley
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Milly Marston
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith R Glynn
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Calvert
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Baldwin S, Bick D, Spiro A. Translating fathers' support for breastfeeding into practice. Prim Health Care Res Dev 2021; 22:e60. [PMID: 34728005 PMCID: PMC8569909 DOI: 10.1017/s1463423621000682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/24/2021] [Accepted: 10/04/2021] [Indexed: 11/07/2022] Open
Abstract
Breastfeeding has numerous health benefits for the mother and child. For breastfeeding to be successful and continue for longer, women need adequate support. Fathers/partners play an important role in providing this support to women, but research suggests that fathers/partners often feel inadequately informed and supported by health professionals. Midwives and health visitors are in ideal positions to offer women and their partner's timely and relevant breastfeeding information and support throughout the perinatal period. This article discusses the benefits of breastfeeding, presents research evidence of the crucial role fathers/partners play in promoting and supporting breastfeeding, and recommends ways in which health professionals can provide breastfeeding information and support to fathers/partners.
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Affiliation(s)
- Sharin Baldwin
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
- Learning and Organisational Development, London North West University Healthcare Trust, London, UK
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
- University Hospitals Coventry and Warwickshire, Warwick, UK
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Nguyen TT, Weissman A, Cashin J, Ha TT, Zambrano P, Mathisen R. Assessing the Effectiveness of Policies Relating to Breastfeeding Promotion, Protection, and Support in Southeast Asia: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e21286. [PMID: 32955449 PMCID: PMC7536596 DOI: 10.2196/21286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite its well-known benefits, breastfeeding practices remain suboptimal worldwide, including in Southeast Asia. Many countries in the region have thus enacted policies, such as maternity protection and the World Health Assembly International Code of Marketing of Breast-milk Substitutes (the Code), that protect, promote, and support breastfeeding. Yet the impact of such national legislation on breastfeeding practices is not well understood. OBJECTIVE This study aims to review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Vietnam. METHODS This mixed methods study includes a desk review, trend and secondary data analyses, and quantitative and qualitative data collection. Desk reviews will examine and compare the contents, implementation strategies, coverage, monitoring, and enforcement of national policies focusing on maternity protection and the Code in each country with global standards. Trend and secondary data analyses will examine the potential impact of these policies on relevant variables such as breast milk substitute (BMS) sales and women's workforce participation. Quantitative data collection and analysis will be conducted to examine relevant stakeholders' and beneficiaries' perceptions about these policies. In each country, we will conduct up to 24 in-depth interviews (IDI) with stakeholders at national and provincial levels and 12 employers or 12 health workers. Per country, we will survey approximately 930 women who are pregnant or have a child aged 0-11 months, of whom approximately 36 will be invited for an IDI; 12 partners of the interviewed mothers or fathers of children from 0-11 months will also be interviewed. RESULTS This study, funded in June 2018, was approved by the Institutional Review Boards of the relevant organizations (FHI 360: April 16, 2019 and May 18, 2020; and Hanoi University of Public Health: December 6, 2019). The dates of data collection are as follows: Vietnam: November and December 2019, May and June 2020; the Philippines: projected August 2020; Myanmar and Thailand: pending based on permissions and funding. Results are expected to be published in January 2021. As of July 2020, we had enrolled 1150 participants. We will present a comparison of key contents of the policies across countries and against international standards and recommendations and a comparison of implementation strategies, coverage, monitoring, and enforcement across countries. We will also present findings from secondary data and trend data analyses to propose the potential impact of a new or amended policy. For the surveys with women, we will present associations between exposure to maternity protection or BMS promotion on infant and young child feeding practices and their determinants. Findings from IDIs will highlight relevant stakeholders' and beneficiaries' perceptions. CONCLUSIONS This study will increase the understanding of the effectiveness of policy interventions to improve breastfeeding, which will be used to advocate for stronger policy adoption and enforcement in study countries and beyond. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21286.
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Affiliation(s)
| | - Amy Weissman
- Alive & Thrive, FHI 360, Hanoi, Vietnam
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
| | | | - Tran T Ha
- Research and Training Center for Community Development (RTCCD), Hanoi, Vietnam
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Lutter R, Ruhm C, Lin D, Liu S. Breastfeeding, schooling, and income: Insights from the Indonesian Family Life Survey. MATERNAL & CHILD NUTRITION 2019; 15:e12651. [PMID: 30182457 PMCID: PMC7199039 DOI: 10.1111/mcn.12651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/25/2018] [Accepted: 04/20/2018] [Indexed: 11/29/2022]
Abstract
Recent research has highlighted associations of breastfeeding with IQ, schooling, and income, but uncertainty about such links remains. The Indonesian Family Life Survey, representative of 83% of the Indonesian population, provides data on breastfeeding, parents' years of schooling, wealth, and other family characteristics in 1993-1994, as well as schooling and income in 2014-2015 for 5,421 children of those families. Using linear regressions and controlling for village or neighbourhood, as well as propensity score matching, we analysed breastfeeding associations for boys and girls separately, when regularly fed foods/beverages other than breast milk is significantly associated with years of schooling in 2014-2015 for girls, but not for boys, after controlling for the village or neighbourhood of residence in 1993-1994. For girls, ages 1 to 1.9, 2 to 2.9, 3 to 3.9, and >4 months, relative to ages <1 month, are associated with an additional 0.41 to 0.46 years of schooling, with p values of 0.086, 0.071, 0.043, and 0.026, respectively. No comparable estimate for boys attains statistical significance. Using propensity score matching yields similar results. Associations with annual income in 2014-2015 are not statistically significant, either for all children, or for either sex. Our finding suggests that delaying regular feeding of foods/beverages other than breast milk beyond 1 month may help girls' schooling but has no observable association with annual income, perhaps because of lower labour force participation by women. Also, the inclusion of controls for village or neighbourhood of residence reduces confounding.
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Affiliation(s)
| | - Christopher Ruhm
- Frank Batten School of Leadership and Public PolicyUniversity of VirginiaCharlottesvilleVirginia
| | - Dajun Lin
- Department of EconomicsUniversity of VirginiaCharlottesvilleVirginia
| | - Siying Liu
- Department of EconomicsUniversity of VirginiaCharlottesvilleVirginia
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Exclusive breastfeeding promotion and neuropsychological outcomes in 5-8 year old children from Uganda and Burkina Faso: Results from the PROMISE EBF cluster randomized trial. PLoS One 2018; 13:e0191001. [PMID: 29474479 PMCID: PMC5824999 DOI: 10.1371/journal.pone.0191001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 12/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The beneficial effects from exclusive breastfeeding (EBF) have been widely acknowledged. We assessed the effect of exclusive breastfeeding promotion by peer counsellors in Uganda and Burkina Faso, on cognitive abilities, social emotional development, school performance and linear growth among 5-8 years old children. METHODS Children in the PROMISE EBF trial (2006-2008) were re-enrolled in the follow-up PROMISE Saving Brains (SB) study (2013-2015). Caretaker interviews captured sociodemographic characteristics and social emotional development using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Overall cognition and working memory were assessed using the Kaufman Assessment Battery for Children, second edition (KABC2), cognitive flexibility was measured with the Child Category Test (CCT), and attention with the Test of Variables of Attention (T.O.V.A), while school performance was measured by a standardized test on arithmetic and reading. Country-pooled, age adjusted z-scores from each of the above outcomes were entered into a linear regression model controlling for confounders. RESULTS The number of children re-enrolled in the intervention and control arms were: 274/396 (69.2%) and 256/369 (69.4%) in Uganda and 265/392 (67.6%) and 288/402 (71.6%) in Burkina Faso. Assessment of cognitive ability showed small and no significant differences, of which general cognition (z-scores, 95% CI) showed the largest mean difference: -0.17 (-0.40; 0.05). Social emotional symptoms were similar across arms. There were no differences in school performance or linear growth for age detected. CONCLUSION Peer promotion for exclusive breastfeeding in Burkina Faso and Uganda was not associated with differences at 5-8 years of age in a range of measures of child development: cognitive abilities, emotion-behaviour-social symptoms or linear growth. This study from sub Saharan Africa did not reconfirm findings elsewhere that have shown an association between exclusive breastfeeding and cognitive performance. This might be due to a number of methodological limitations inherent in the current study. For example since the majority of the children were breastfed, the benefits of the intervention could have been diluted. Other factors such as the mental and HIV status of the mothers (which were not assessed in the current study) could have affected our results. Hence regarding the effect of exclusive breastfeeding on measures of child neurocognitive development in sub Saharan Africa, the jury is still out. TRIAL REGISTRATION ClinicalTrials.gov NCT01882335.
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Nandi A, Lutter R, Laxminarayan R. Breastfeeding Duration and Adolescent Educational Outcomes: Longitudinal Evidence From India. Food Nutr Bull 2017; 38:528-541. [PMID: 28978231 PMCID: PMC7705127 DOI: 10.1177/0379572117733100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is a significant evidence gap on the long-term educational benefits of longer breastfeeding in low- and middle-income countries. We estimated the association between duration of (any) breastfeeding and educational outcomes of Indian children. METHODS We used regression analysis to examine the association between the length of breastfeeding (in months) and future education outcomes on the basis of 2 data sets: (1) data from a follow-up survey known as the Andhra Pradesh Children and Parents Study (APCAPS, 2003-2005) of 1165 children aged 13 to 18 years from a controlled nutrition trial originally conducted in South India during the period of 1987 to 1990; and (2) nationally representative data from the India Human Development Survey (IHDS-2, 2011-2012) of 6121 children aged 6 to 12 years. RESULTS In APCAPS, children with >36 months of breastfeeding scored 0.28 (95% confidence interval [95% CI]: 0.00-0.56; P < .05) higher on tests than those with up to 12 months of breastfeeding. In the nationally representative IHDS-2 data, above-median breastfeeding duration was associated with 0.1 year (95% CI: 0.04-0.16; P < .01) higher educational attainment. In IHDS-2, >12 to 24 months and >24 months of breastfeeding were associated with 0.12 (95% CI: 0.01-0.23; P < .05) and 0.19 years of (95% CI: 0.05-0.34; P < .05) higher educational attainment, respectively, than for those with up to 6 months of breastfeeding. In additional analyses by sex, we found that the benefits of breastfeeding accrued primarily to boys. CONCLUSION Breastfeeding duration was associated with small gains in educational outcomes for boys but not for girls in India.
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Affiliation(s)
- Arindam Nandi
- Tata Centre for Development, University of Chicago, Chicago, IL, USA
- Center for Disease Dynamics, Economics & Policy, Washington, DC, USA
| | - Randall Lutter
- Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, VA, USA
- Resources for the Future, Washington, DC, USA
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India
- Princeton Environmental Institute, Princeton University, Princeton, NJ, USA
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Cebolla-Boado H, Jiménez-Buedo M, Salazar L. Avoiding selection bias without random assignment? The effect of breastfeeding on cognitive outcomes in China. Soc Sci Med 2017; 194:151-159. [PMID: 29100140 DOI: 10.1016/j.socscimed.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Recent studies suggest that some of the health benefits traditionally attributed to breastfeeding may be overstated due to selection bias problems, since typically breastfeeding is more prevalent in more resourceful households. In this paper we argue that an important antidote against selection bias consists in analyzing data from contexts in which breastfeeding is not normativised, or where it is not systematically associated to socioeconomic advantage and best parenting practices. We estimate the effect of breastfeeding on the cognitive outcomes of Chinese children. METHODS We use observational data from a representative sample of children aged 10-15 from the China Family Panel Study. We estimate province fixed effect linear regression models to predict the impact of breastfeeding on test scores. RESULTS Our paper shows that there are no advantages in the results obtained by breastfed children when compared with those who were not breastfed, regardless of the duration of breastfeeding. CONCLUSIONS Some of the cognitive benefits associated to breastfeeding can be attributed to flaws inherent to the research designs usually adopted.
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Affiliation(s)
| | - María Jiménez-Buedo
- Department of Logic, History and Philosophy of Science, UNED, Senda del Rey 7, 28040, Madrid, Spain.
| | - Leire Salazar
- Department of Sociology II, UNED, Calle Obispo Trejo 2, 28040, Madrid, Spain
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12
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Girard LC, Côté SM, de Lauzon-Guillain B, Dubois L, Falissard B, Forhan A, Doyle O, Bernard JY, Heude B, Saurel-Cubizolles MJ, Kaminski M, Boivin M, Tremblay RE. Factors Associated with Breastfeeding Initiation: A Comparison between France and French-Speaking Canada. PLoS One 2016; 11:e0166946. [PMID: 27902741 PMCID: PMC5130209 DOI: 10.1371/journal.pone.0166946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 11/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background Breastfeeding is associated with multiple domains of health for both mothers and children. Nevertheless, breastfeeding initiation is low within certain developed countries. Furthermore, comparative studies of initiation rates using harmonised data across multiple regions is scarce. Objective The aim of the present study was to investigate and compare individual-level determinants of breastfeeding initiation using two French-speaking cohorts. Methods Participants included ~ 3,900 mothers enrolled in two cohort studies in Canada and France. Interviews, questionnaires, and medical records were utilised to collect information on maternal, family, and medical factors associated with breastfeeding initiation. Results Rates of breastfeeding initiation were similar across cohorts, slightly above 70%. Women in both Canada and France who had higher levels of maternal education, were born outside of their respective countries and who did not smoke during pregnancy were more likely to initiate breastfeeding with the cohort infant. Notably, cohort effects of maternal education at the university level were found, whereby having ‘some university’ was not statistically significant for mothers in France. Further, younger mothers in Canada, who delivered by caesarean section and who had previous children, had reduced odds of breastfeeding initiation. These results were not found for mothers in France. Conclusions and Implications for Practice While some similar determinants were observed, programming efforts to increase breastfeeding initiation should be tailored to the characteristics of specific geographical regions which may be heavily impacted by the social, cultural and political climate of the region, in addition to individual and family level factors.
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Affiliation(s)
- Lisa-Christine Girard
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Sylvana M. Côté
- Department of Social and Preventive Medicine, Université de Montreal, Montreal, Canada
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation, Russia
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
| | - Blandine de Lauzon-Guillain
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Lise Dubois
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Bruno Falissard
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Paris, France
| | - Anne Forhan
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Orla Doyle
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- School of Economics, University College Dublin, Dublin, Ireland
| | - Jonathan Y. Bernard
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Barbara Heude
- INSERM, UMR 1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Early ORigin of the Child’s Health and Development Team (ORCHAD), Villejuif, France
- Paris Descartes University, Paris, France
| | - Marie-Josephe Saurel-Cubizolles
- Paris Descartes University, Paris, France
- INSERM UMR 1153- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris, France
| | - Monique Kaminski
- Paris Descartes University, Paris, France
- INSERM UMR 1153- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris, France
| | - Michel Boivin
- Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation, Russia
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
- School of Psychology, Université Laval, Quebec, Canada
| | - Richard E. Tremblay
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
- Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
- Research Unit on Children’s Psychosocial Maladjustment (GRIP), Université de Montreal, Montréal, Canada
- Departments of Pediatrics and Psychology, Université de Montreal, Montréal, Canada
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Victora CG, Horta BL, Loret de Mola C, Quevedo L, Pinheiro RT, Gigante DP, Gonçalves H, Barros FC. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. LANCET GLOBAL HEALTH 2016; 3:e199-205. [PMID: 25794674 PMCID: PMC4365917 DOI: 10.1016/s2214-109x(15)70002-1] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Breastfeeding has clear short-term benefits, but its long-term consequences on human capital are yet to be established. We aimed to assess whether breastfeeding duration was associated with intelligence quotient (IQ), years of schooling, and income at the age of 30 years, in a setting where no strong social patterning of breastfeeding exists. Methods A prospective, population-based birth cohort study of neonates was launched in 1982 in Pelotas, Brazil. Information about breastfeeding was recorded in early childhood. At 30 years of age, we studied the IQ (Wechsler Adult Intelligence Scale, 3rd version), educational attainment, and income of the participants. For the analyses, we used multiple linear regression with adjustment for ten confounding variables and the G-formula. Findings From June 4, 2012, to Feb 28, 2013, of the 5914 neonates enrolled, information about IQ and breastfeeding duration was available for 3493 participants. In the crude and adjusted analyses, the durations of total breastfeeding and predominant breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with IQ, educational attainment, and income. We identified dose-response associations with breastfeeding duration for IQ and educational attainment. In the confounder-adjusted analysis, participants who were breastfed for 12 months or more had higher IQ scores (difference of 3·76 points, 95% CI 2·20–5·33), more years of education (0·91 years, 0·42–1·40), and higher monthly incomes (341·0 Brazilian reals, 93·8–588·3) than did those who were breastfed for less than 1 month. The results of our mediation analysis suggested that IQ was responsible for 72% of the effect on income. Interpretation Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood. Funding Wellcome Trust, International Development Research Center (Canada), CNPq, FAPERGS, and the Brazilian Ministry of Health.
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Affiliation(s)
- Cesar G Victora
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil, Pelotas, Rio Grande do Sul, Brazil
| | - Bernardo Lessa Horta
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil, Pelotas, Rio Grande do Sul, Brazil.
| | - Christian Loret de Mola
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil, Pelotas, Rio Grande do Sul, Brazil
| | - Luciana Quevedo
- Postgraduate Programme in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Ricardo Tavares Pinheiro
- Postgraduate Programme in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Denise P Gigante
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil, Pelotas, Rio Grande do Sul, Brazil
| | - Helen Gonçalves
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Brazil, Pelotas, Rio Grande do Sul, Brazil
| | - Fernando C Barros
- Postgraduate Programme in Health and Behavior, Universidade Católica de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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14
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Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387:475-90. [PMID: 26869575 DOI: 10.1016/s0140-6736(15)01024-7] [Citation(s) in RCA: 3660] [Impact Index Per Article: 457.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.
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Affiliation(s)
- Cesar G Victora
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
| | - Aluísio J D Barros
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Giovanny V A França
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Susan Horton
- Department of Economics, University of Waterloo, ON, Canada
| | - Julia Krasevec
- Data and Analytics Section, Division of Data, Research, and Policy, UNICEF, New York, NY, USA
| | - Simon Murch
- University Hospital Coventry and Warwickshire, Coventry, UK
| | - Mari Jeeva Sankar
- WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Neff Walker
- Institute for International Programs, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nigel C Rollins
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland
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15
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Jonas W, Woodside B. Physiological mechanisms, behavioral and psychological factors influencing the transfer of milk from mothers to their young. Horm Behav 2016; 77:167-81. [PMID: 26232032 DOI: 10.1016/j.yhbeh.2015.07.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 07/12/2015] [Accepted: 07/23/2015] [Indexed: 12/13/2022]
Abstract
This article is part of a Special Issue "Parental Care".Producing milk to support the growth of their young is a central element of maternal care in mammals. In spite of the facts that ecological constraints influence nursing frequency, length of time until weaning and the composition of milk, there is considerable similarity in the anatomy and physiology of milk production and delivery across mammalian species. Here we provide an overview of cross species variation in nursing patterns and milk composition as well as the mechanisms underlying mammary gland development, milk production and letdown. Not all women breastfeed their infants, thus in later sections we review studies of factors that facilitate or impede the initiation and duration of breastfeeding. The results of these investigations suggest that the decisions to initiate and maintain breastfeeding are influenced by an array of personal, social and biological factors. Finally, studies comparing the development of breastfed and formula fed infants as well as those investigating associations between breastfeeding, maternal health and mother/infant interaction are reviewed. Leading health agencies including the World Health Organization and CDC advocate breastfeeding for at least the first 6months postpartum. To achieve these rates will require not only institutional support but also a focus on individual mother/infant dyads and their experience.
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Affiliation(s)
- Wibke Jonas
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Fraser Mustard Institute of Human Development, University of Toronto, Toronto, Canada
| | - Barbara Woodside
- Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada.
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