Exclusive Breastfeeding (EBF) and Child Mortality in West Africa: An Examination of the Difference in Rates in Burkina Faso and Ghana - PowerPoint PPT Presentation

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Exclusive Breastfeeding (EBF) and Child Mortality in West Africa: An Examination of the Difference in Rates in Burkina Faso and Ghana. Emily A. Ramshur, BA, RN/BSN, MPH Candidate Johns Hopkins University Bloomberg School of Public Health Capstone Project, Fall 2009

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Exclusive Breastfeeding (EBF) and Child Mortality in West Africa: An Examination of the Difference in Rates in Burkina Faso and Ghana

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Exclusive Breastfeeding (EBF) and Child Mortality in West Africa:An Examination of the Difference in Rates in Burkina Faso and Ghana

Emily A. Ramshur,

BA, RN/BSN, MPH Candidate

Johns Hopkins University

Bloomberg School of Public Health

Capstone Project, Fall 2009

Dr. William Brieger, Advisor


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Goals of this Analysis

  • To understand EBF as compared to other IF methods

  • To illuminate EBF’s relationship to child undernutrition and mortality in West Africa

  • To compare lack of success in boosting EBF rate in Burkina Faso with success in Ghana

  • To recommend approaches and initiatives for raising EBF rate in Burkina


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Breastfeeding and Child Mortalityin West Africa

  • 4th UN Millennium Development Goal (MDG)

  • Child mortality in SSA

  • EBF in West & Central Africa

  • Relationship between child mortality and suboptimal BF

  • Single most critical strategy to achieve MDG #4??


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EBF versus Other Infant Feeding Methods

  • International consensus on superiority of EBF (WHO, UNICEF)

  • EBF definition

  • Extensive data on benefits

  • “Mixed feeding”

  • “Artificial feeding”


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Burkina Faso: EBF Data

  • UNICEF 1993: 1-6% EBF

    UNICEF 2003: 3-8% EBF

  • DHS 2003: <2 month olds = 18% 2-3 month olds = 22% 4-5 month olds = 16% 6-7 month olds = 16%

  • 3-19% between 1990-2004 (24% Cameroon, 25% Mali, 34% Senegal, 53% Ghana)


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Ghana: EBF Data

  • UNICEF 1988: 1-4% EBF

    UNICEF 2006: 75%  40% (4 mos)  10% (6 mos)

  • DHS 2003: <2 month olds = 62%, 2-3 month olds = 65%, 4-5 month olds = 39%, 6-7 month olds = 14%

  • DHS 2008: <2 month olds = 84%, 4-5 month olds = 49%, overall = 63%

  • Grew 4-53% from 1990-2004


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Burkina Faso & Ghana:Child Mortality and Undernutrition

*deaths per 1,000 live births

  • In Burkina, suboptimal BF responsible for 6,200 infant deaths, or 11% all-cause infant mortality

  • Many possible factors; low EBF may be one


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Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana

  • Sociocultural factors

    • Obstacle in both countries

  • Maternal formal education

    • Directly linked to EBF

    • Very low levels in Burkina

  • Practical education

    • Positive impact on EBF

    • Requires training of HCWs

    • Must boost out-of-hospital promotion by HCWs, particularly in Burkina Faso


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Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana

  • Community-level interventions?

    • Dearth of evidence in Burkina Faso

    • Broad-reaching, highly successful programs in Ghana

  • Level of poverty and availability of funding?

    • Fewer funds in Burkina

    • Ghana $34; Madagascar only $10/new acceptor

    • Can be affordable & sustainable

    • Reprioritization of goals & fund reallocation


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Possible Factors in Differing Rates of EBF in Burkina Faso & Ghana

  • Baby-Friendly Hospital Initiative (BFHI)?

    • 19 Baby-Friendly facilities in Burkina; 192 in Ghana

    • Hospitals not requirements, but helpful

  • International policy?

    • Int’l Code of Marketing of Breastmilk Substitutes

    • Signature only in Burkina; concrete action in Ghana

  • National commitment?

    • Need reprioritization & true/demonstrated will


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Summary: Recommendationsfor Burkina Faso to Boost EBF Rate

  • Practical education of mothers/families

  • Education of HCWs, in/outside hospitals

  • Expansion of BFHI

  • Monitoring, enforcement, and penalization for violations of current codes/laws/regulations

  • Shifting of national goals with fund reallocation

  • Enhanced large-scale, community-level programming

  • Coordination of stakeholders and collaboration with local and international agencies


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THANK YOU!

ANY QUESTIONS?


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References

  • Aidam, B.A., Perez-Escamilla, R., and Lartey, A.1 (2005). Lactation counseling increases exclusive breast-feeding rates in Ghana. The journal of nutrition, 135, 1691-1695.

  • Aidam, B.A., Perez-Escamilla, R., Lartey, A., and Aidam, J.2 (2005). Factors associated with exclusive breastfeeding in Accra, Ghana. European journal of clinical nutrition, 59, 789-796.

  • Aguayo, V., Ross, J., Kanon, S., and Ouedraogo, A. (2003). Monitoring compliance with the International Code of Marketing of Breastmilk Substitutes in West Africa: Multi-site cross sectional survey in Togo and Burkina Faso. British Medical Journal, 326, 127-130.

  • Appoh, L.Y. and Krekling S. (2005). Maternal nutritional knowledge and child nutritional status in the Volta Region of Ghana. Maternal and child nutrition, 1, 100-110.

  • Baby-Friendly Hospital Initiative (BFHI) (2006). About the BFHI. Retrieved from http://www.babyfriendlyusa.org/eng/01.html on September 21, 2009.

  • Baya, B., Sangli, G., and Maiga, A. (2004). Measuring the effects of behavior change interventions in Burkina Faso with population-based survey results. Retrieved from http://www.jhpiego.org/resources/pubs/mnh/mnhSurveyRpt_BrkFaso.pdf on October 1, 2009.

  • Bicego, G.T. and Boerma, J.T. (1993). Maternal education and child survival: A comparative study of survey data from 17 countries. Social science and medicine, 36(9), 1207-1227.

  • Burkina Faso Ministry of Health (2005). Les projets et chantiers – Assistance aux groupes vulnerable (BKF 6129). Retrieved from http://www.sante.gov.bf/SiteSante/projets/bkfpam.html on September 27, 2009.

  • Central Intelligence Agency (CIA) (2009). The world factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/ on September 27, 2009.

  • Cleland, J.G. and van Ginneken, J.K. (1988). Maternal education and child survival in developing countries: The search for pathways of influence. Social science and medicine, 27(12), 1357-1368.

  • Edmond, K.M., Kirkwood, B.R., Amenga-Etego, S., Owusu-Agyei, S. and Hurt, L.S. (2007). Effect of early infant feeding practices on infection-specific neonatal mortality: An investigation of the causal links with observational data from rural Ghana. American journal of clinical nutrition, 86, 1126-1131.

  • Edmond, K.M., Kirkwood, B.R., Tawiah, C.A., and Owusu-Agyei, S. (2008). Impact of early infant feeding practices on mortality in low birth weight infants from rural Ghana. Journal of perinatology, 28, 438-444.

  • Edmond, K.M., Zandoh, C., Quigley, M.A., Amenga-Etego, S., Owusu-Agyei, S., and Kirkwood, B.R. (2005). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics,117, 380-386.

  • Ghana Statistical Service (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), and ORC Macro (2004). Ghana Demographic and Health Survey 2003. Calverton, Maryland: GSS, NMIMR and ORC Macro.

  • Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF Macro (2009). Ghana Demographic and Health Survey 2008. Accra, Ghana: GSS, GHS, and ICF Macro.

  • Hobcraft, J. (1993). Women’s education, child welfare and child survival: A review of the evidence. Health transition review, 3(2), 159-173.

  • Hofmann, J., DeAllegri, M., Sarker, M., Sanon, M., and Bohler, T. (2009). Breastmilk as the ‘water that supports and preserves life’-- Sociocultural constructions of breastfeeding and their implications for the prevention of mother to child transmission of HIV in sub-Saharan Africa. Health policy, 89, 322-328.

  • Hong, R. (2007). Effect of economic inequality on chronic child undernutrition in Ghana. Public health nutrition, 10(4), 371-378.

  • Institut National de la Statistique et de la Démographie and ORC Macro (2004). Enquête Démographique et de Santé du Burkina Faso 2003. Calverton, Maryland: INSD and ORC Macro.

  • Integrated Regional Information Networks (IRIN)¹ (2009). Analysis: Breast not always seen as best in Burkina Faso. Retrieved from http://www.irinnews.org/report.aspx?ReportID=85562 on September 10, 2009.

  • Integrated Regional Information Networks (IRIN)² (2009). Burkina Faso: The path to mother’s milk is paved with kola nuts. Retrieved from http://www.irinnews.org/report.aspx?ReportID=85570 on September 10, 2009.

  • Integrated Regional Information Networks (IRIN)³ (2009). Niger: Passing along hunger but little milk. Retrieved from http://www.irinnews.org/Report.aspx?ReportId=85597 on September 10, 2009.

  • Integrated Regional Information Networks (IRIN)4 (2009). West Africa: The hour window to find the breast. Retrieved from http://www.irinnews.org/Report.aspx?ReportId=85611 on September 10, 2009. 


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  • Integrated Regional Information Networks (IRIN)5 (2009). West Africa: Babies force-fed to free time for fields. Retrieved from http://www.irinnews.org/Report.aspx?ReportId=85625 on September 10, 2009.

  • Joint United Nations Program on HIV/AIDS (UNAIDS) (2006). Fact sheet 2006: Sub-Saharan Africa. Retrieved from http://www.who.int/hiv/mediacentre/200605-FS_SubSaharanAfrica_en.pdf on September 20, 2009.

  • Joint United Nations Program on HIV/AIDS (UNAIDS) (2008). Ghana 2008: Country situation. Retrieved from http://data.unaids.org/pub/FactSheet/2008/sa08_gha_en.pdf on September 20, 2009.

  • Lauer, J.A., Betran, A.P., Barros, A.J.D., and de Onis, M. (2005). Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world: A global ecological risk assessment. Public Health Nutrition, 9(6), 673-685.

  • Nakiyingi, J.S., Bracher, M., Whitworth, J.A.G., Ruberantwari, A., Busingye, J., Mbulaiteye, S.M., and Zaba, B. (2003). Child survival in relation to mother’s HIV infection and survival: Evidence from a Ugandan cohort study. AIDS, 17, 1827-1834.

  • Nwankwo, B.O. and Brieger, W.R. (2002). Exclusive breastfeeding is undermined by use of other liquids in rural Southwestern Nigeria. Journal of tropical pediatrics, vol. 48, 109-112.

  • ORC Macro (2005). Nutrition of young children and mothers in Ghana: Findings from the 2003 Ghana Demographic and Health Survey. Retrieved from http://www.measuredhs.com/pubs/pdf/ANC16/ANC16-GH03CB.pdf on September 22, 2009.

  • Otoo, G.E., Lartey, A.A. and Perez-Escamilla, R. (2009). Perceived incentives and barriers to exclusive breastfeeding among periurban Ghanaian women. Journal of human lactation, 25(1), 34-41.

  • Perez-Escamilla, R. (2007). Evidence based breast-feeding promotion: The Baby-Friendly Hospital Initiative. The journal of nutrition, 137(2), 484-487.

  • Sokol, E., Aguayo, V., and Clark, D. (2007). Protecting breastfeeding in West and Central Africa: 25 years implementing the International Code of Marketing of Breastmilk Substitutes. Retrieved from http://www.unicef.org/wcaro/WCARO_Pub_Breastfeeding.pdf on September 12, 2009.

  • Tawiah-Agyemang, C., Kirkwood, B.R., Edmond, K., Bazzano, A., and Hill, Z. (2008). Early initiation of breast-feeding in Ghana: Barriers and facilitators. Journal of perinatology, 28, S46-S52.

  • United Nations (2008). The United Nations Millennium Development Goals Report 2008. Retrieved from http://mdgs.un.org/unsd/mdg/Resources/Static/Products/Progress2008/MDG_Report_2008_En.pdf#page=22 on September 20, 2009.

  • United Nations Children’s Fund (UNICEF) (2002). Current status of Baby-Friendly Hospital Initiative: March 2002. Retrieved from http://www.unicef.org/nutrition/files/nutrition_statusbfhi.pdf on September 27, 2009.

  • United Nations Children’s Fund (UNICEF) (2005). WHO/UNAIDS/UNICEF infant feeding guidelines. Retrieved from http://www.unicef.org/nutrition/index_24811.html on September 20, 2009.

  • United Nations Children’s Fund (UNICEF) (2006). UNICEF records: Baby-Friendly Hospital Initiative 2006 records update. Retrieved from www.waba.org.my/docs/BFHIjan07.xls on September 25, 2009.

  • United Nations Children’s Fund (UNICEF) (2008). Breastfeeding: Key infant and young child feeding definitions. Retrieved from http://www.unicef.org/nutrition/index_24824.html on September 16, 2009.

  • United Nations Children’s Fund (UNICEF) (2009). The Baby-Friendly Hospital Initiative. Retrieved from http://www.unicef.org/programme/breastfeeding/baby.htm on September 21, 2009.

  • United Nations Children’s Fund (UNICEF) (2009). Statistics by area: Child Nutrition: Burkina Faso. Retrieved from http://www.childinfo.org/breastfeeding_burkina_faso.html on September 12, 2009.

  • United Nations Children’s Fund (UNICEF) (2009). Statistics by area: Child Nutrition: Ghana. Retrieved from http://www.childinfo.org/breastfeeding_ghana.html on September 12, 2009.

  • United Nations Development Project (UNDP) (2008). Human development project 2007/2008. Retrieved from http://hdr.undp.org/en/reports/global/hdr2007-2008/ on October 1, 2009.

  • World Health Organization (WHO) (1998). Evidence for the ten steps to successful breastfeeding. Retrieved from http://www.who.int/nutrition/publications/evidence_ten_step_eng.pdf on September 22, 2009.

  • World Health Organization (WHO)1 (2006). Burkina Faso: Core health indicators. Retrieved from http://apps.who.int/whosis/database/core/core_select_process.cfm?countries=bfa&indicators=StuntedChild&indicators=UnderweightChild&indicators=OverweightChild on September 22, 2009.

  • World Health Organization (WHO)2 (2006). Ghana: Core health indicators. Retrieved from http://www.who.int/countries/gha/gha/en/ on September 22, 2009.

  • World Health Organization (WHO, 2008). Learning from large-scale community-based programmes to improve breastfeeding practices. Retrieved from http://whqlibdoc.who.int/publications/2008/9789241597371_eng.pdf on September 19, 2009.

  • World Health Organization (WHO)1 (2009). Burkina Faso: Country statistics. Retrieved from http://www.who.int/countries/bfa/en/ on September 22, 2009.

  • World Health Organization (WHO)2 (2009). Exclusive breastfeeding. Retrieved from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html on September 16, 2009.

  • World Health Organization (WHO)3 (2009). Ghana: Country statistics. Retrieved from http://www.who.int/countries/gha/en/ on September 22, 2009.


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