Breastfeeding, the health of children and infant mortality in northeast Brazil

Santos, Taís de Freitas (1996) Breastfeeding, the health of children and infant mortality in northeast Brazil. University of Southampton, Doctoral Thesis.

Abstract

The thesis comprises three main parts: breastfeeding behaviour, the association between breastfeeding and the health of children and the association between breastfeeding and infant mortality. To investigate the subject different statistical methods are used. Breastfeeding behaviour is investigated through a discrete-time competing risk event history model. Logistic models are used to examine the association between breastfeeding and morbidity, specifically diarrhoea and respiratory infection. The relationship between breastfeeding and infant morality is examined using a piecewise constant proportional hazards model. Graphical models are also used to investigate the indirect association between breastfeeding and infant mortality.

The findings indicate that although the spectacular multifaceted programme to promote breastfeeding launched in the beginning of the 1980s, breastfeeding behaviour did not change considerably in the last decade. The proportion of babies initiating breastfeeding increased only slightly and duration remained fairly constant. The study did not reveal any association between breastfeeding and infectious diseases, but it should be borne in mind that problems such as poor data quality may have affected the results, as discussed in the thesis. The pattern of results supports the suggestion of a strong association between breastfeeding and postneonatal mortality, even when the effect of other confounding and the bias introduced by reverse causality are controlled to some extent. Breastfeeding was found to affect directly postneonatal mortality and also to be a path through which other socio-economic determinants influence mortality. Finally, the Brazilian National Breastfeeding Promotion Programme and some policy implications are discussed in the light of the results brought about by the study.

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