Breastfeeding and Mortality in Emergencies

Summary of published paper¹

Well nourished breastfeeding child with mother

A recent study set out to assess the impact of prolonged breast-feeding on internally displaced children during the first three months of the war in Guinea-Bissau in 1998. Armed conflict had erupted between government and rebel soldiers in June of that year. The research was conceived in order to determine the extent to which breastfeeding status is a predictor of child mortality during war.

The study utilised routinely collected data from the Bandim health project in the capital, Bissau, during a three month period prior to the war. Started in 1978, the Bandim project covered 46,000 people in four sub-urban areas of Bissau. As a result of heavy shelling, most inhabitants covered by the health project took refuge just 5-15 km outside Bissau where they were living with friends and family. Virtually all returned after the war ended in May 1999. Data from the war cohort were compared with two control cohorts of children whose breastfeeding status had been similarly assessed by the surveillance system in the three months prior to June 1996 and June 1997. As very few children are weaned prior to 9 months of age (the median age of weaning is 22 months), the study assessed the risk of dying over a three month period for both breastfed and weaned children aged 9-20 months.

Malnourished infant with mother

Controlling for age, weaned children experienced a six-fold higher mortality during the first three months of the war compared with children still breastfeeding. In both control cohorts from 1996 and 1997, weaned children did not have higher mortality than the breastfed children over a similar three month period preceding the conflict. Mortality in weaned children was five times higher during the first three months of the conflict than in a similar group of weaned children from early June 1996 and June 1997, whereas there was no significant difference in mortality between breastfed children during the conflict and the preceding years. Controlling for other background factors, including living with mother, gender, ethnic group, mother's schooling, and district did not alter these differences.

The elevated mortality in the war cohort was most likely due to the higher infection pressure when people lived in overcrowded houses in the rural area, with less access to care. Breastfeeding is known to protect against diarrhoea and lower respiratory infections. The study concluded that the protective effect of breastfeeding against infections may be particularly important in emergencies and that continuing or recommencing breastfeeding should be emphasised in emergency settings.

¹Jacobsen. M et al (2003). Breastfeeding status as a predictor of mortality among refugee children in an emergency situation in Guinea-Bissau. Tropical Medicine and International Health, volume 8, no 11, pp 992-996