Exploring the impact of breastfeeding practices in the first six months on childhood morbidity: global evidence and insights from Mongolia

<p dir="ltr">Childhood mortality remains a pressing global health issue, with diarrhoea and acute respiratory infections (ARI) accounting for a significant proportion of deaths among children under five, particularly in developing countries. These illnesses are largely preventable through cost-effective interventions, such as optimal breastfeeding practices, including exclusive breastfeeding (EBF) and early initiation of breastfeeding (EIBF). Despite global goals to improve breastfeeding practices, Mongolia continues to face a substantial burden from these preventable diseases. This thesis consists of two individual studies that explore the impact of breastfeeding practices on diarrhoea and ARI. The first study is a rapid review and meta-analysis assessing the impact of EBF on diarrhoeal disease in infants aged 0-6 months, focusing on studies from 2010 onwards that use the World Health Organization (WHO) definition of EBF. The second study examines the relationship between infant and young child feeding (IYCF) practices— including EBF, EIBF, bottle feeding, and prelacteal feeding— and diarrhoeal diseases and ARI among children aged 0-5 completed months in Mongolia, using data from the Multiple Indicator Cluster Surveys (MICS) conducted in 2010, 2013-14, and 2018. The rapid review and meta-analysis found that EBF significantly reduces the risk of diarrhoea in infants under six months, with 16 studies reporting decreased odds of diarrhoea among exclusively breastfed infants and a pooled adjusted odds ratio (AOR) of 0.57 (95% CI: 0.51, 0.61, I² = 57.66%). The MICS analysis showed that the prevalence of EBF among infants aged 0–5 completed months was 59.9% in 2010, 46.7% in 2013–14, and 51.1% in 2018. However, EBF rates at exactly 6 months, assessed using an additional analytical approach, were considerably lower at 16.2%, 17.6%, and 20%, respectively. Infants who were exclusively breastfed had a significantly reduced risk of ARI (AOR: 0.32, 95% CI 0.11, 0.98) and diarrhoea (AOR: 0.84, 95% CI 0.54, 1.30) among children under six months. Subgroup analysis showed a stronger protective effect of EBF against diarrhoea in infants in the first month of life (AOR: 0.19, 95% CI 0.06, 0.57). Those who initiated breastfeeding within the first hour after birth had lower odds of ARI (AOR: 0.41, 95% CI 0.15, 1.07), while prelacteal feeding showed increased association with both diarrhoea (AOR: 1.14, 95% CI 0.67, 1.95) and ARI (AOR: 1.64, 95% CI 0.69, 4.59). Bottle feeding was associated with lower odds of diarrhoea (AOR: 0.90, 95% CI 0.56, 1.46) and ARI (AOR: 0.80, 95% CI 0.27, 2.35). The findings of this research strongly support the need for continued and enhanced efforts to promote optimal breastfeeding practices as a critical component of public health strategies aimed at improving child health outcomes, especially during the vulnerable period of early infancy. Future research should incorporate recent data, like MICS7, to explore current trends and refine interventions, and investigate factors influencing early cessation of EBF in Mongolia.</p>