Presentation on theme: " Timing of breastfeeding initiation has no impact on day 1 deaths. Early initiation can only reduce the risk of neonatal deaths that happen between."— Presentation transcript:
Timing of breastfeeding initiation has no impact on day 1 deaths. Early initiation can only reduce the risk of neonatal deaths that happen between days 2 & 28. We assume this is 65% of all neonatal deaths (mid-point of range given in Paper 1 of the Lancet neonatal series). The increased risks associated with delayed breastfeeding found in the Ghana study can be applied to all countries. These increased risks (ORs) reflect a causal relationship & all the excess is attributable to delayed breastfeeding. Babies who never breastfeed have the same risk as those who start after the first day; this is a conservative estimate. Meeting the child survival MDG: How many newborn lives could we save by improving coverage of early initiation of breastfeeding? Karen M Edmond, Ellie C Bard, Betty R Kirkwood (LSHTM) 274,000 livesAFRICA 25% deaths 26,000 livesAMERICAS 28% deaths 487,000 lives SE ASIA 34% deaths 147,000 lives W PACIFIC 31% deaths CONCLUSIONS AND RECOMMENDATIONS 36% of childhood deaths occur during the first month of life: reducing neonatal deaths is essential if the child survival MDG is to be met. 2005 Lancet Neonatal Series identified 16 interventions with proven efficacy for neonatal survival including exclusive breastfeeding. Early initiation of breastfeeding was not on this list. Recent results have become available from a large birth cohort study in Ghana demonstrating that delayed initiation of breastfeeding is associated with increased risk of neonatal mortality (Edmond et al, Pediatrics, in press). This increased risk is additional to those associated with predominant and partial as compared to exclusive breastfeeding. Background Early BF initiation: Current Coverage Coverage rates of early initiation of breastfeeding are low (see Figure); only about a third of babies are breastfed within the 1 st hour of birth, and for more than a fifth initiation is delayed until after the first day. The countries 60 UNICEF priority countries: these are countries with No. of under-five deaths ≥ 50,000 or U5MR ≥ 90/1000 live-births We used the numbers of neonatal deaths in each country as reported in the World Health Report 2005. These 60 countries account for 91% of the approx. 4 million newborns that die each year. DHS data on current coverage levels of early initiation were available for 38 of the 60 countries. Regional averages were used for the 22 countries with no coverage data. BF initiated Adjusted OR Attributable Risk (AR)* Day 1, 1st hour1- Day 1, later1.4431.0% After day 12.8865.3% Day 1 vs Later2.4058.3% * AR = (OR-1)/OR * 100% Ghana: Risk of Newborn Death after 1 st day MODEL A Newborn lives saved Deaths prevented NewbornU5 99% babies BF 1st hour 1,117,03231%11% 90% babies BF 1st hour 972,91727%10% MODEL B Newborn lives saved Deaths prevented NewbornU5 99% babies BF 1st day 866,85724%9% 90% babies BF 1st day 680,86419%7% The model Two intervention models: A: A: breastfeeding initiated within 1 st hour B: B: breastfeeding initiated within 1 st day (but not necessarily 1 st hour) Lives saved estimated for: Univeral coverage (defined as 99%) 90% coverage RESULTS The model is based on a single dataset; Similar data from other countries should be collated/collected as a priority. If risks from Ghana are confirmed EARLY BF initiation should be added to key child survival interventions & monitored. Potentially about 30% of newborn deaths (10% of U5 deaths) might be prevented with universal coverage of BF initiation within the 1 st hour 4,000 livesEUROPE 27% deaths 179,000 lives E MED 33% deaths
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