Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums

Objectives. To describe breastfeeding practices and investigate the influen ce of exclusive breastfeeding in early infancy on the risk of infant deaths , especially those attributable to respiratory infections (ARI) and diarrhe a. Methods. A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and foll owed from birth to 12 months of age. After enrollment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported de aths. Proportional hazards regression models were used to estimate the effe ct of breastfeeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and di arrhea were measured. Results. The proportion of infants who were breastfed exclusively was only 6% at enrollment, increasing to 53% at 1 month and then gradually declining to 5% at 6 months of age. Predominant breastfeeding declined from 66% at e nrollment to 4% at 12 months of age. Very few infants were not breastfed, w hereas the proportion of partially breastfed infants increased with age. Br eastfeeding practices did not differ between low and normal birth weight in fants at any age. The overall infant mortality rate was 114 deaths per 1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold highe r risk of infant deaths resulting from all causes and 2.40- and 3.94-fold h igher risk of deaths attributable to ARI and diarrhea, respectively. Conclusion. The important role of appropriate breastfeeding practices in th e survival of infants is clear from this analysis. The reduction of ARI dea ths underscores the broad-based beneficial effect of exclusive breastfeedin g in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhea deaths.