Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis

Aim: To synthesise the evidence for effects of optimal breastfeeding on all-cause and infection-related mortality in infants and children aged 0-23months. Methods: We conducted a systematic review to compare the effect of predominant, partial or nonbreastfeeding versus exclusive breastfeeding on mortality rates in the first sixmonths of life and effect of no versus any breastfeeding on mortality rates between 6 and 23months of age. A systematic literature search was conducted in PubMed, Cochrane CENTRAL and CABI. Results: The risk of all-cause mortality was higher in predominantly (RR 1.5), partially (RR 4.8) and nonbreastfed (RR14.4) infants compared to exclusively breastfed infants 0-5months of age. Children 6-11 and 12-23months of age who were not breastfed had 1.8- and 2.0-fold higher risk of mortality, respectively, when compared to those who were breastfed. Risk of infection-related mortality in 0-5months was higher in predominantly (RR 1.7), partially (RR 4.56) and nonbreastfed (RR 8.66) infants compared to exclusive breastfed infants. The risk was twofold higher in nonbreastfed children when compared to breastfed children aged 6-23months. Conclusion: The findings underscore the importance of optimal breastfeeding practices during infancy and early childhood.