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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

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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

goals of this analysis
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
breastfeeding and child mortality in west africa
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??
ebf versus other infant feeding methods
EBF versus Other Infant Feeding Methods
  • International consensus on superiority of EBF (WHO, UNICEF)
  • EBF definition
  • Extensive data on benefits
  • “Mixed feeding”
  • “Artificial feeding”
burkina faso ebf data
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)
ghana ebf data
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
burkina faso ghana child mortality and undernutrition
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
possible factors in differing rates of ebf in burkina faso ghana
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
possible factors in differing rates of ebf in burkina faso ghana9
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
possible factors in differing rates of ebf in burkina faso ghana10
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
summary recommendations for burkina faso to boost ebf rate
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?

references
References
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