BMJ 2001;323:303 ( 11 August )

Papers

Ecological study of effect of breast feeding on infant mortality in Latin America

Ana P Betrán, doctor, ^a Mercedes de Onís, medical officer, ^b Jeremy A Lauer, economist, ^c José Villar, medical officer. ^d

^a Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain, ^b Department of Nutrition for Health and Development, World Health Organization, CH-1211 Geneva, Switzerland, ^c Global Programme on Evidence for Health Policy, World Health Organization, ^d Reproductive Health and Research, World Health Organization

Correspondence to: A P Betrán, Reproductive Health and Research, World Health Organization, CH-1211 Geneva, Switzerland, betrana{at}who.int

Objective: To estimate the effect of exclusive breast feeding and partial breast feeding on infant mortality from diarrhoeal disease and acute respiratory infections in Latin America.
Design: Attributable fraction analysis of national data on infant mortality and breast feeding.
Setting: Latin America and the Caribbean.
Main outcome measures: Mortality from diarrhoeal disease and acute respiratory infections and nationally representative breastfeeding rates.
Results: 55% of infant deaths from diarrhoeal disease and acute respiratory infections in Latin America are preventable by exclusive breast feeding among infants aged 0-3 months and partial breast feeding throughout the remainder of infancy. Among infants aged 0-3 months, 66% of deaths from these causes are preventable by exclusive breast feeding; among infants aged 4-11 months, 32% of such deaths are preventable by partial breast feeding. 13.9% of infant deaths from all causes are preventable by these breastfeeding patterns. The annual number of preventable deaths is about 52 000 for the region.
Conclusions: Exclusive breast feeding of infants aged 0-3 months and partial breast feeding throughout the remainder of infancy could substantially reduce infant mortality in Latin America. Interventions to promote breast feeding should target younger infants.

What is already known on this topic Infant mortality is lower among breast fed than non-breast fed infants The reductions are greatest for deaths from diarrhoeal disease and acute respiratory infections What this study adds Exclusive breast feeding of infants aged 0-3 months and partial breast feeding for the remainder of the first year would prevent about 52 000 infant deaths a year in Latin America This corresponds to 13.9% of infant deaths from all causes Promotion of breast feeding has an important role in increasing survival of infants

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