Only three African countries are expected to meet the global target for exclusive breastfeeding, "an unparalleled source of nutrition for newborns and infants, no matter where they are born," according to a global health expert.
The three nations, Guinea-Bissau, Rwanda, and São Tomé and Príncipe, are singled out in a new study from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington's School of Medicine. The study, published today in Nature Medicine in advance of World Breastfeeding Week Aug 1-7, finds areas of persistent low prevalence in countries that have made progress overall. Detailed maps accompanying the analysis reveal vulnerable populations, especially those living in rural areas and in extreme poverty.
However, researchers note that that several nations, including Burundi, Rwanda, and parts of Ethiopia, Uganda, and Zambia were among the highest rates of exclusive breastfeeding levels in 2000 and 2017. Sudan had some of the "highest and most consistent rates of increase" toward the exclusive breastfeeding goal of the World Health Organization (WHO) - prevalence by 2025 of at least 50% nationwide. The Global Burden of Disease, the annual comprehensive health study, attributed 169,000 child deaths to lack of breastfeeding in 2017, more than half of them in sub-Saharan Africa. Moreover, according to the WHO, increasing breastfeeding to near-universal levels could save more than 800,000 lives every year, the majority being children under 6 months.
The paper examines breastfeeding prevalence down to the level of individual districts and municipalities and compares progress among 49 African nations. The paper is accompanied by an interactive visualization tool that allows users to compare prevalence of exclusive breastfeeding within and across countries, look at the rate of change over time, and see the probability of meeting WHO's goal by 2025.
The value of exclusive breastfeeding of children cannot be over-emphasized.
Breastfeeding is an unparalleled source of nutrition for newborns and infants, no matter where they are born. If we are serious about ensuring that every infant is offered a healthy start in life, we need to know who isn't being reached with the support they need to breastfeed. By illustrating where exclusive breastfeeding rates are falling behind, these maps are a powerful tool to help policymakers and practitioners examine and act on disparities within their countries."
Dr. Ellen Piwoz, Bill & Melinda Gates Foundation
In 2017, at least a two-fold difference in exclusive breastfeeding prevalence existed across districts in 53% of countries, a three-fold difference in 14% of countries, and a more than six-fold difference in Niger and Nigeria.
Exclusive breastfeeding refers to mothers using only breast milk to feed their children for the first six months, with medications, oral rehydration salts, and vitamins as needed. The practice provides essential nutrition and can prevent infection and disease, particularly in areas without access to clean water.
The study's detailed maps reveal vulnerable populations left behind. Senegal, Angola, Ethiopia, and Tanzania had areas with a less than 5% probability of meeting the WHO target and, simultaneously, communities with a greater than 95% probability of meeting the target.
"Our maps allow us to see patterns and trends that aren't visible at the national level. They serve as an invaluable resource to ministries of health and others making decisions to advance child well-being," said lead author Dr. Natalia Bhattacharjee, Research Scientist at IHME.
The WHO and other organizations celebrate World Breastfeeding Week to encourage breastfeeding and improve the health of babies globally. They advocate for "family-friendly policies to enable breastfeeding and help parents nurture and bond with their children in early life, when it matters most," according to the WHO website. This includes enacting paid maternity and paternity leave.
The paper is part of the Local Burden of Disease project (LBD) at IHME, led by Dr. Simon I. Hay, Director of Geospatial Science at IHME and Professor of Health Metrics Sciences at the University of Washington's School of Medicine. It was funded by the Gates Foundation.
"Our collaboration with the Gates Foundation, as well as other researchers, academics, and clinicians throughout the world, enables us to develop the best tools possible for reaching populations where health care support can make the biggest difference," said Hay.
This study is the latest in a series of IHME papers as part of the institute's LBD project, which produces estimates of health outcomes and related measures covering entire continents at a fine resolution. Project leaders are seeking additional collaborators, including academics, researchers, and others, to contribute data and to evaluate draft papers.
Bhattacharjee, V N. et al. (2019) Mapping exclusive breastfeeding in Africa between 2000 and 2017. Nature Medicine. doi.org/10.1038/s41591-019-0525-0.