IS PROLONGED BREAST-FEEDING ASSOCIATED WITH MALNUTRITION - EVIDENCE FROM 19 DEMOGRAPHIC AND HEALTH SURVEYS

Background. A growing body of literature suggests that prolonged breas tfeeding (typically defined as beyond the first year of life) may be a risk factor for malnutrition. Methods. To examine the extent to which continued breastfeeding is a risk factor for malnutrition, we used mu ltiple regression techniques to relate current breastfeeding status to weight and stature in children <36 months old whose mothers participa ted in one of 19 Demographic and Health Surveys (DHS) conducted betwee n 1987 and 1989. Results. The data from 9 of 11 countries outside sub- Saharan Africa (SSA) indicated that among older children, those still breastfed are shorter and lighter than those no longer breastfed. Thes e differences, which reached statistical significance in five countrie s, become apparent at 12-18 months of age. In contrast, in five of eig ht SSA countries, younger still breastfed children are significantly s horter and lighter than those no longer breastfed, but, the difference s are largely diminished among older children. These basic patterns we re not altered by adjustment for family sociodemographic characteristi cs, health care utilization, and recent child illness. Conclusions. Im portant differences in nutritional status associated with continued br eastfeeding are observed throughout the developing world, and are not likely due to confounding by family sociodemographic characteristics, health care utilization or recent child illness. A unifying interpreta tion of the observed relationships is that child size is somehow relat ed to the decision to wean, and that whereas in SSA, the biggest child ren are weaned first, in non-SSA countries, the smallest children are weaned last.